overview Flashcards
1
Q
Osteoarthritis (OA)
- define
- characteristics
- onset
A
- degenerative joint disease, attacks hyaline cartilage of synovial-lined joints
- characterized by breakdown of articular cartilage and reactive new bone formation
- cartilage softens–>large sections wear away–>dec. joint space–>new bone formation–>bone on bone contact
- non-inflammatory (secondary inflammation may occur)
- onset: slowly over period of years
2
Q
OA: joints affected
A
- individual joints
- neck, spine, hips, knees, MTPs, DIPs, PIPs, thumb CMCs, weight bearing joints
3
Q
OA: symptoms/clinical features
A
- joint pain
- stiffness
- tenderness
- limited movement
- variable degrees of local inflammation
- crepitus
- morning stiffness <30 mins
4
Q
Rheumatoid arthritis (RA)
- define
- characteristics
- onset
A
- chronic, systemic inflammatory condition. possibly autoimmune inflammatory response in joint lining
- synovitis: inflammation of synovial membrane that lines joint capsules
- joint swelling from excess synovial fluid, thickening joint capsule-weakens capsule, distends ligaments
- synovial membrane activity destroys cartilage, bone, tendons, ligaments, scar tissue forms causing rigidity
- may have exacerbations and flare-ups & remissions
- onset: often suddenly, within weeks or months
5
Q
Two categories of RA
A
- reversible signs and symptoms due to acute inflammatory synovitis
- irreversible cumulative structural damage (from recurrent synovitis)
6
Q
RA: joints affected
A
- polyarticular, symmetric
- neck, jaw, hips, knees, ankles, MTPs, shoulders, elbows, wrists, PIPs, MCPs, thumb joints
7
Q
RA: symptoms/clinical features
A
- low-grade fever
- fatigue
- malaise
- extra-articular manifestations
- symmetric polyarticular pain and swelling
- morning stiffness >/1 hr, often >2 hrs
- synovial inflammation: warm, spongy, erythematous joints
8
Q
Four stages of RA inflammatory process
A
- acute
- subacute
- chronic active
- chronic inactive
*stages may overlap
9
Q
symptoms of acute RA
A
- limited mvmt
- pain and tenderness at rest that increase with movement
- overall stiffness
- weakness
- tingling
- numbness
- hot/red joints
10
Q
symptoms of subacute RA
A
- limited mvmt
- tingling
- decrease in pain and tenderness
- stiffness limited to AM
- joints appear pink and warm
11
Q
symptoms of chronic active RA
A
- less tingling, pain, and tenderness
- increased tolerance of activity
- endurance remains low
12
Q
symptoms of chronic inactive RA
A
- no signs of inflammation
- low endurance, pain, and stiffness due to disuse
13
Q
Most common joint changes usually seen in RA
A
- wrist radial deviation
- MP ulnar deviation
- swan neck
- boutonniere
14
Q
OT eval for arthritis
A
- ct hx
- occupational profile
- occupational performance status
- cognitive, psychologic, social status
- clinical status
15
Q
Clinical status: eval components
A
- inflammation
- ROM
- strength
- hand function
- stiffness
- pain
- sensation
- joint instability and deformity (instability can lead to deformity)
- physical endurance
- functional mobility
16
Q
Signs of inflammation and synovitis indicate________
A
active disease process
17
Q
Types of swelling: effusion
A
- excess fluid in the joint capsule
- seen as fusiform swelling that is spindle shaped and conforms to the shape of the joint
18
Q
Types of swelling: boggy
A
- thin and full of fluid
- puffy, spongy, soft to the touch
- seen in early active stages of synovitis
19
Q
What is it called when a ct.’s AROM is significantly less than their PROM? What causes this?
A
- lag
- caused by pain, weakness, mechanical inefficiencies due to joint damage
20
Q
How is strength testing in clients with arthritis different from normal testing procedures?
A
Resistance is applied at the end range of pain-free motion rather than at the true end of the ROM.
21
Q
Muscle atrophy indicates_________ and __________
A
- severe weakness
- possible nerve compression
22
Q
Signs of intrinsic hand atrophy
A
- flattening of thenar and hypothenar eminences
- hallowing between metacarpals on dorsal aspect of hand
23
Q
standardized & non-standardized tests of hand function
A
- Jebson-Taylor Hand Function Test (use for ct.s over 5yrs old; ok for ct’s with disabilities that impact hand function)
- observation of ct performing common functional tasks requiring various grasp and prehensile patterns.
24
Q
Intervention: overarching goals
A
- decrease pain
- protect joints
- increase function
25
intervention: general objectives of OT
- maintain/increase ability to engage in occupations
- maintain/increase joint mobility and strength
- maximize physical endurance
- protect against or minimize effects of deformities
- increase understanding of the disease and methods for dealing with physical, functional, psychosocial effects
- assist with adjustment to disability
26
OT intervention: tx methods
- sleep and rest
- PAMs
- therapeutic exercise
- therapeutic activities
- splinting
- assistive devices
- ct and family education (disease process, symptom mgmt, joint protection and fatigue mgmt)
27
Assisted devices for arthritis: dressing
- dressing stick
- shoe horn
- sock aid
- button hook
- zipper pull
- elastic shoelaces
28
Assisted devices for arthritis: bathing
- hand-held shower hose
- bath bench
- grab bars
- long-handles sponge
29
Assisted devices for arthritis: toileting
- raised toilet seat
- grab bars
- extended perineal hygiene aid
30
Assisted devices for arthritis: feeding
- built-up or extended-handle utensils
| - lightweight T-handled mug
31
Assisted devices for arthritis: meal prep
- electric can and jar openers
- adapted cutting board
- utensils with built-up handles
- ergonomic right-angled knives
- rolling utility cart
- knob turner for stove
- reacher
32
Assisted devices for arthritis: miscellaneous
- doorknob levers
- built-up or extended key holder
- extended-handle dust pan
- built-up pens
- loop or spring-loaded scissors
- speaker phone
33
Components of Ct and family education
- disease process
- symptom mgmt (monitoring signs for inflammation, when to modify/cease activity, rationale/integration of PAMS into daily routine)
- joint protection and fatigue mgmt
34
Tx precautions related to arthritis
- respect pain
- avoid fatigue
- avoid placing stress on inflamed or unstable joints
- use resistive exercise or activity w/caution
- be aware of sensory impairments
- be cautious with fragile skin
35
What is a sign that therapeutic exercise or activity should be modified or decreased?
Pain lasting 1 or 2 hours after completion of exercise/activity
36
Which kind of exercise is usually lease painful for cts with RA? Why?
- isometric exercises
| - they eliminate joint motion and can be effective in improving muscle strength and endurance
37
Contraindications for exercise with arthritis
- NEVER stretch during acute phase
- NEVER use resistive exercise during acute phase
- grip-strengthening exercise, even using light putty, can put large forces on unstable hand joints (should be avoided in rheumatoid hand involvement)
38
general principles of fatigue mgmt/joint protection
- respect pain
- maintain muscle strength and joint ROM
- use each joint in its most stable anatomic and functional plane
- avoid positions of deformity
- use strongest joints available
- ensure correct patterns of mvmt
- avoid staying in one position for long periods
- avoid starting an activity that cannot be stopped immediately if it becomes too stressful
- balance rest and activity
- reduce force and effort
