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UL Ox > Overview of Ox Management of the Upper Limb > Flashcards

Overview of Ox Management of the Upper Limb Flashcards

1
Q

Major Challenge of UL Ox

A

Fine Motor Function - may require multiple ox to achieve goals

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2
Q

Duration of Use

Percentages

A

Interim Ox = 85-90%
Definitive = 10-15%

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3
Q

Activities of Daily Living

DEATH

A
  • Dressing
  • Eating
  • Ambulation
  • Transferring
  • Toileting
  • Hygiene
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4
Q

Instramental Activities of Daily Living

SHAFT

A
  • Shopping
  • Housework
  • Accounting
  • Food Preparation
  • Telephone/Transportation
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5
Q

Common Terminal Points

Anatomy of the UL

A

Palmar creases or distal to distal finger pads

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6
Q

Prehension Patterns

Anatomy of the UL

A
  • Cylindrical - tube
  • Tip - All fingers to thumb
  • Hook - carrying a purse
  • 3 Jaw Chuck - pencil (functional)
  • Spherical - grapping a ball
  • Lateral - holding a credit card

Look at the Picture :)

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7
Q

Intrinsic Plus

Pathological Hand Positions

A
  • Cause - weak extrinsics; spastic intrinsics
  • “safe position”
  • Position: 30 degrees wrist ext., 70-90 degrees MCP flexion, PIP/DIP ext.
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8
Q

Intrinsic Minus

Pathological Hand Positions

A
  • Cause - strong extrinsics; weak intrinsics
  • Positions: MCP hyperext.; PIP/DIP flexion
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9
Q

Functional

Hand Positions

A
  • Wrist: 30 degrees ext.
  • MCP 2-5: 35-40 degrees flex.
  • PIP 2-5: 30 degrees flex.
  • DIP 2-5: 5-10 degrees flex.

Thumb is extended at IP, opposed to digits 2/3, and web space is maintained

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10
Q

Static Ox

Describing Orthoses

A
  • Components are in a single fixed position during use
  • Joints can be adjusted at fitting/eval.
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11
Q

Static-Progressive Ox

Describing Orthoses

A

Anatomical joint positions can be changed, but ox is fixed in each subsequent postion during use
* Used to increase ROM

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12
Q

Dynamic Ox

Describing Orthoses

A

Components of the ox change position during use
* Options - Free, Stop, Assist, Resist

can facilitate AROM or PROM

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13
Q

Therapeutic

Describing Orthoses

A
  • Primary use: therapeutic
  • may be worn during activity
  • not intended to enable ADLs
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14
Q

Static Functional

Describing Orthoses

A
  • Primary use: enables ADLs
  • may also have therapeutic effects
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15
Q

Dynamic Therapeutic

Describing Orthoses

A
  • Not intended to enable ADLs
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16
Q

Dynamic Functional

Describing Orthoses

A
  • Intended to enable ADLs
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17
Q

Low Temp. Thermoplastic (LTT)

Common Materials

A
  • 135-180 degrees
  • directly moldable to pt
  • AKA Orthoplast
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18
Q

High Temp. Thermoplastic (HTT)

Common Materials

A
  • above 250 degrees
  • PE, CP, PP

we know enough about this by now…

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19
Q

Time

Clinical Decision Making

A

OTS is quicker

20
Q

Cost

Clinical Decision Making

A

OTS is cheaper

21
Q

Fit

Clinical Decision Making

A

Custom for triplanar control

22
Q

Edema

Clinical Decision Making

A

Custom Dorsal style can accommodate for fluctuation

23
Q

Sports

Clinical Decision Making

A

Soft prefeb (protect other players)

24
Q

Rancho Los Amigos (CA)

Three Traditional Systems

A
  • Aluminum w/ Plastazote
  • Easy to Contour
  • Continuous Dorsal/Palmar Bars
  • Components easily attached
25
Texas Institute For Rehab. and Research (TIRR) | Three Traditional Systems
* Prefebricated from thermoset * Difficult to adjust * Palmar piece is main component * Difficult to don (tight webspace) * Improved cosmesis
26
Institute for Rehab and Medicine (IRM) | Three Traditional Systems
* Custom from thermoplastic * Lowest profile of three * Self suspending (AP dimension) * No straps
27
Goals | Hand Orthoses
* Maintain palmar arch * Maintain thumb position * Maintain Webspace * Serve as attachment site for components | All HO designs can be used on Ox for more proximal levels
28
Palmar and Dorsal Bars | Hand Orthoses Components
* Maintain palmar arch * can be continuous (still titled separately)
29
Opponens Bar | Hand Orthoses Components
* Encapsulates shaft of first MC * Maintains thumb in opposition
30
C Bar (thumb adduction stop) | Hand Orthoses Components
* Maintains webspace * helps identify proper alignment when donning
31
Thumb Control General Principle
Provide the minimum level of control needed to achieve treatment goals
32
Thumb Post | Thumb Control
Used for: Flail Thumb (SCI, intrinsic minus hand, nerve injuries) * Distal trimline - mid nail bed * no padding (friction)
33
Thumb Adduction Stop | Thumb Control
Used for: Median or Radial Nerve injuries * usually high tone/spasticity * adjustable if webspace is tight * distal trimline - proximal to IP crease of thumb
34
Thumb Abduction Assist | Thumb Control
Used for: Radial nerve injury * dynamic spring component * balances adductors and abductors of thumb * attaches to prox. phalynx of the thumb * distal end - prox. to IP crease of thumb
35
Thumb Extension Assist
Used for: Radial Nerve Injury * weak entensors/strong flexors * restores muscle balance * attaches to opponens bar * Perpendicular pull angle is optimal
36
MP Stop / IP Ext. Assist | MCP Control
Used for: Median or Ulnar nerve injuries * weak lumbricals * MCPs - extended; IPs - flexed * Designed to maintain MCP flexion (35 degrees) * Does not interfere with IP flexion
37
MCP Flexion Assist | MCP Control
Used for: Median and Ulnar nerve injuries * Can address extension contractures
38
First Dorsal Interosseus Assist | Finger Control
Used for: Ulnar nerve injury * Attaches to middle phalanx of 2nd digit * Angle of pull perpendicular to the middle phalanx is optimal * Finger loop does not impede PIP or DIP
39
Finger Driven WHO | Finger Control
Used for: weakened MP ext. * Must have active flexion of at least one finger * Provides 3 point prehension * Maintain PIP flexion (30) and DIP flexion (5-10) * Terminate at mid nail bed
40
WH(F)O - Common Diagnoses | Wrist Control
* Carpal Tunnel Syndrome * Radial Nerve Palsy * Flexor or Extensor Tendonitis
41
WH(F)Os - Common distal trimline | Wrist Control
* At palmer crease = allows normal MCP / IP movement * Distal to the finger tips = greatest control
42
Wrist Stability | Wrist Control
Orthosis should cross an unstable joint
43
Dynamic Designs Indications | Wrist Control
* R.O.M. * weakness * spasticity with spring
44
Static Design Indications | Wrist Control
Need for positioning and stabilization
45
Grasp and Release | Wrist Control
* Wrist driven (C6,7) - Harnesses tenodesis grasp * Ratchet driven (C5) * External power | AKA Prehension

UL Ox (11 decks)

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