overview Flashcards
Osteoarthritis (OA)
- define
- characteristics
- onset
- 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
OA: joints affected
- individual joints
- neck, spine, hips, knees, MTPs, DIPs, PIPs, thumb CMCs, weight bearing joints
OA: symptoms/clinical features
- joint pain
- stiffness
- tenderness
- limited movement
- variable degrees of local inflammation
- crepitus
- morning stiffness <30 mins
Rheumatoid arthritis (RA)
- define
- characteristics
- onset
- 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
Two categories of RA
- reversible signs and symptoms due to acute inflammatory synovitis
- irreversible cumulative structural damage (from recurrent synovitis)
RA: joints affected
- polyarticular, symmetric
- neck, jaw, hips, knees, ankles, MTPs, shoulders, elbows, wrists, PIPs, MCPs, thumb joints
RA: symptoms/clinical features
- 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
Four stages of RA inflammatory process
- acute
- subacute
- chronic active
- chronic inactive
*stages may overlap
symptoms of acute RA
- limited mvmt
- pain and tenderness at rest that increase with movement
- overall stiffness
- weakness
- tingling
- numbness
- hot/red joints
symptoms of subacute RA
- limited mvmt
- tingling
- decrease in pain and tenderness
- stiffness limited to AM
- joints appear pink and warm
symptoms of chronic active RA
- less tingling, pain, and tenderness
- increased tolerance of activity
- endurance remains low
symptoms of chronic inactive RA
- no signs of inflammation
- low endurance, pain, and stiffness due to disuse
Most common joint changes usually seen in RA
- wrist radial deviation
- MP ulnar deviation
- swan neck
- boutonniere
OT eval for arthritis
- ct hx
- occupational profile
- occupational performance status
- cognitive, psychologic, social status
- clinical status
Clinical status: eval components
- inflammation
- ROM
- strength
- hand function
- stiffness
- pain
- sensation
- joint instability and deformity (instability can lead to deformity)
- physical endurance
- functional mobility
Signs of inflammation and synovitis indicate________
active disease process
Types of swelling: effusion
- excess fluid in the joint capsule
- seen as fusiform swelling that is spindle shaped and conforms to the shape of the joint
Types of swelling: boggy
- thin and full of fluid
- puffy, spongy, soft to the touch
- seen in early active stages of synovitis
What is it called when a ct.’s AROM is significantly less than their PROM? What causes this?
- lag
- caused by pain, weakness, mechanical inefficiencies due to joint damage
How is strength testing in clients with arthritis different from normal testing procedures?
Resistance is applied at the end range of pain-free motion rather than at the true end of the ROM.
Muscle atrophy indicates_________ and __________
- severe weakness
- possible nerve compression
Signs of intrinsic hand atrophy
- flattening of thenar and hypothenar eminences
- hallowing between metacarpals on dorsal aspect of hand
standardized & non-standardized tests of hand function
- 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.
Intervention: overarching goals
- decrease pain
- protect joints
- increase function
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
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)
Assisted devices for arthritis: dressing
- dressing stick
- shoe horn
- sock aid
- button hook
- zipper pull
- elastic shoelaces
Assisted devices for arthritis: bathing
- hand-held shower hose
- bath bench
- grab bars
- long-handles sponge
Assisted devices for arthritis: toileting
- raised toilet seat
- grab bars
- extended perineal hygiene aid
Assisted devices for arthritis: feeding
- built-up or extended-handle utensils
- lightweight T-handled mug
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
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
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
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
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
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
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)
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
