Rehab Final Flashcards
1
Q
UE Assessment- Biomechanical
A
- Understand the underlying injury - mechanism & timeframe
- Anatomy
- Soft-tissue mobility
- Edema
- ROM
- Strength
- Coordination
2
Q
Upper Quadrant consists of?
A
Scapula, shoulder, elbow, hand
3
Q
UQ UE injuries are?
A
very common; specifically work related, also from disease and congenital abnormalities
4
Q
What percentage of severe stroke patients recover hand function?
A
15%
5
Q
What is the hand vital for?
A
human function, complex movements
6
Q
What can loss of hand function impact?
A
livelihood and occupational performance
7
Q
What is a specialty area in OT?
A
Hand therapy
8
Q
Common shoulder conditions
A
Rotator Cuff Tear (SITS) Adhesive capsulitis Shoulder impingement Bicep tendonitis Shoulder bursitis Thoracic Outlet Syndrome Frozen shoulder
9
Q
Elbow and hand conditions
A
Lateral epicondylitis Cubital tunnel syndrome Thumb UCL instability (skiers or gamekeepers thumb) CMC arthritis Carpal Tunnel Syndrome Nerve lacerations Tendon lacerations Forearm and hand fractures
10
Q
Observation of UE, inspection of skin (color of hand)
A
pallor, cyanosis, erythema
11
Q
Observation of UE, inspection of skin - trophic changes
A
change in the appearance of nails, increased dryness or moistness of skin, open wounds, necrotic tissue
12
Q
Certified Hand Therapist
A
specialization required advanced study & clinical experience
- American Society of Hand Therapists
- CHT certification- advanced certification with exam
13
Q
Psychosocial UE
A
Decreased function; depression/anxiety; body image; PTSD- traumatic accidents; emotional support
14
Q
Neuropraxia
A
contusion of the nerve (recovers few days-weeks)
15
Q
Axonotmesis
A
nerve fibers distal to the injury degenerate but the nerve remains intact (6 months or more)
16
Q
Neurotmesis
A
complete laceration of nerve & fibrous tissues, needs surgical repair; may need nerve grafting. (6-9 months) regeneration is one inch per month.
17
Q
Nerve Injuries
A
can occur at any point from nerve roots (brachial plexus) to fingers
-Understanding of PNS
18
Q
Nerve Injuries Observations
A
weakness, atrophy, paralysis, sensory loss, contractures
19
Q
Immobilization
A
use of splints, casts or fixators to keep the structures from moving
20
Q
early mobilization
A
partial immobilization with specific movement prescribed
21
Q
what is the purpose of immobilization?
A
- rest of injured structures
2. support the injured joint (promoting motion, optimum position)
22
Q
what is the purpose of early mobilization?
A
prevents stiffness; pain tolerance; optimum positioning; often with specifications (ROM angles) to maintain integrity of surgical intervention; phased mobilization (after pain control)- stretching
23
Q
Tendon Glides
A
- Incorporates thumb ROM
- The exercises allow the flexor tendons to glide to their maximum potential and can greatly facilitate therapeutic activities
- Incorporate in a comprehensive intervention program
24
Q
Anesthesia
A
complete loss of sensation
25
Paresthesia
abnormal sensation- tingling or crawling sensation
26
Hypoesthesia
decreased sensation
27
Hyeresthesia (hypersensitivity)
increased tactile sensitivity
28
Analgesia
complete loss of pain sensation
29
Hypoalgesia
diminished pain sensation
30
Hyperalgesia
increased pain
31
Dyesthesia
unpleasant sensation that may be spontaneous or as a result of stimulation
32
allodynia
pain caused by a stimulus that would normally not cause pain
33
What often occurs in conjunction with sensory impairment?
Sympathetic issues; change in vasomotor function, sudomotor, pilomotor, trophic changes, slow healing
34
vasomotor function
skin temp, skin color
35
sudomotor function
sweating - too much, too little
36
pilomotor changes
no goose bumps
37
trophic changes
atrophy of nails and/or finger pulps, change in hair
38
what do physical agents do?
may be used to reduce or modulate pain, reduce inflammation, increase tissue extensibility and range of motion, promote circulation, decrease edema, facilitate healing, stimulate muscle activity, and facilitate occupational performance
39
State Regulations are State Specific
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Continuing Education
Institution Specific requirements
Demonstrating competence
PAMs coverage and billing
Evidence based practice
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40
Role of OTA in use of PAMs
The OTA may use PAMs as a therapeutic modality if she has been trained; OT supervising must be competent in the use of PAMs; rules dependent on specific state licensure, Maine has no restrictions on use of PAMs by OT practitioners
41
Use of PAMs in OT
- Preparatory to functional activity
- Concurrent to functional/purposeful activity
- Necessary component to a person's routine
42
PAMs documentation
Provide an accurate description of the intervention as well as patient's response to treatment; include description of the type of agent used, method of application, the name/number of the machine (if applicable area treated), position of the patient, treatment parameters/time
43
Billing PAMs Unattended vs. Attended (Not reimbursed - but documented)
Supervised- the application of a modality that does not require direct one-to-one patient contact; application of a modality to one or more areas; hot or cold packs, traction, mechanical, electrical stimulation, vasopneumatic devices, paraffin bath, whirlpool, dialthemy, infrared
44
Billing PAMs Attended- reimbursed and documented
The application of a modality that requires direct patient contact; application of a modality to one or more areas; electrical stimulation (manual); each 15 mins; iontophoresis, contrast baths, ultrasound, Hubbard tank, unlisted modality
45
Superficial thermal
hydrotherapy/whirlpool, cryotherapy, fluidotherapy, hot packs, paraffin, water, infrared
46
Deep thermal
therapeutic ultrasound, phonophoresis, shortwave diathermy
47
Electrotherapeutic
transcutaneous electrical nerve (TENS), neuromuscular electrical stim (NMES), iontophoresis
48
Superficial heat (heat pack, fluidotherapy)
Reduce pain (analgesia); decrease muscle spasm; increase tissue extensibility (connective tissue, scars, superficial joint capsules and tendons); increase blood flow- increased O2 and nutrients, antibodies, leukocytes, enzymes which can assist in tissue healing; increases metabolic rate - release of histamines and prostaglandins into blood stream
49
Contraindications & Precautions with heat
Client skin should be observed throughout treatment; Do NOT use with edema; proper positioning; client complains - remove heat source; do not use with clients who have: impaired sensation / circulation, tumors/cancer, acute inflammation/edema, DVT, pregnancy, tendency to bleed, impaired cognition, advanced cardiac disease
50
Paraffin - superficial heat
Dip & wrap; 5-8 times; wrap in plastic then bath towel; paraffin glove stays on 15-20 mins; wash hands before using and throw out after use on client; paraffin 47-54 degree celsius / 117-129 F
51
Cold (cryotherapy)- superficial
Cooling of tissue decreases the amount of oxygenation; decrease edema and inflammation in acute injury - most effective when combined with compression; edema reduction; pain reduction; reduction of muscle spasm & spasticity
52
Precautions & Contraindications for Cryotherapy
Continually monitor client skin
Never apply gel pack directly to skin
Apply cold pack no more than 20 mins
Tissue damage occurs at 59 F
Frostbite occurs below 14-39 F
Don't use with clients who have cold sensitivity
Do not use in areas of impaired circulation
Do not apply over deep open wound
Be careful with impaired sensation or cognition
53
Therapeutic Ultrasound: Conversion
sound waves are converted in to heat, and/or tissue vibration
54
What does therapeutic ultrasound do?
heats tissue; decrease pain; decrease inflammation; tissue healing; phonophoresis (anti-inflammatory medicine)
55
Two types of ultrasound
Thermal & non-thermal
56
Thermal ultrasound
heats tissues (100% duty cycle)
57
Nonthermal ultrasound
wound healing vibration of tissues, but no heat (less than 100% duty cycle)
58
Frequency
the number of completed wave cycles that pass a fixed point in one second
59
Frequency MHz
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1MHz = low, slow, deep (up to 5 cm)
3MHz = high, fast, shallow (up to 3 cm)
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Higher frequency - more cycles per second
Lower frequency = fewer cycles per second
60
Ultrasound terminology - continuous ultrasound
Continuous ultrasound- uninterrupted flow of sound waves, causes heating of tissue
61
pulsed ultrasound
interrupted sound wave, does not cause heating
62
Duty Cycle
amount of time US is on the client (continuous or pulsed); continuous = 100%, pulsed = 50 -75 %, lower duty cycle = less than 50%
63
Precautions and Contraindications- Ultrasound
Never use over eye, heart, pregnant uterus, or reproductive organs
Do not use over malignant tumors
Decreased circulation
Avoid growth plates in children
Always keep transducer moving to avoid- "hot" spots
If client complains of pain, decrease intensity or move head more
Metal can cause a standing wave - be cautious
64
Electrical Stim
flow or movement of electrons or charged particles from one point to the other; restores the balance between positive and negatively charged particles
electricity may cause magnetic, chemical, mechanic and thermal effects on human tissue
65
TENS
pain control; healing of injured muscle or bone; chronic pain; use with ADL
66
NMES
muscle contraction; neuro-diagnoses (stroke, TBI); improve function, use with ADL
67
Iontophoresis
Deliver anti-inflammatory medication; decrease pain, inflammation, assist with scar breakdown; non-functional based modality
68
electrodes
may be self-adhesive or require additional adhesive; skin should be clear prior to application; electrodes come in many different sizes; larger electrodes are more comfortable than smaller electrodes
69
bipolar placement
one electrode placed over motor point, the other electrode placed elsewhere on muscle belly, used in TENS and NMES
70
monopolar placement
active electrode is placed over treatment area, other electrode is placed at a distance from the first electrode; higher current density. used for stimulation of trigger points and in wound healing.
71
Frequency (pulse rate)
Acute pain: higher pps (hz)
| Chronic pain: lower pps (hz)
72
Intensity (amplitude)
Average tolerates is 35-80amps, OT finds the amps for pain control (TENS) or muscle contraction (NMES)
73
rise and fall (ramp)
gradual increase to desired level; typically 2-5 seconds
74
TENS
pain control- low frequency - electroanalgesia effect brain releases endorphins; high frequency - blocks peripheral nerves through A and C fibers, nociceptors; post surgical; chronic or acute; impacts the pain cycle; inconclusive evidence, most respond favorably; constant electrical stimulation with modulated current to peripheral nerves; OT controls the frequency, amplitude
75
Neuromuscular Electrical Stim
purpose: cause selective muscle contraction; only works on muscles that are partially or fully innervated; may be useful for clients with CNS injuries; may be used to strengthen muscles, prevent muscle atrophy, increase ROM, facilitate voluntary motor control, decrease edema, decrease spasticity & muscle spasm, and act as a substitute for orthotic devices
76
Iontophoresis
method of delivering medication to a specific localized area; use direct electrical current to ionically force the medication through the skin; generally used in OT to treat inflammatory conditions, modify scar tissue, and to assist in the healing process
77
Precautions for Estim
absent or diminished sensation; peripheral neuropathies; bony prominences; erythema - skin irritation; previous reaction to electricity or skin gels
78
Contraindications for E-Stim
Pregnancy; pacemaker; cardiac disease; cancer; DVT (blood clot); infections; carotid sinus/artery; seizure hx; infections; rapid fatigue syndrome
79
Dry Needling
specialty course with certification; increases blood flow; helps with pain; releases tightness
80
Epidermis
environmental protection; temp regulation
81
Dermis
keratinocytes (help control infection); fatty tissue/subcutaneous
82
Types of burns
heat burns; chemical burns; electrical burns; frostbite; disease: Stevens-Johnson syndrome, toxic epidermal necrolysis; incidence has declined since the 60s; increased hospitalizations due to improved medical interventions
83
Superficial partial thickness (also donor sites- skin grafting)
first degree burn
84
Partial thickness
second degree burn
85
Full thickness
third degree burn
86
Percentage of body involved
Rule of 9's
Greater than 15% leads to hospitalization
Impact of PMH, chronic conditions
87
Phases of healing - inflammatory
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vascular and cellular responses, painful phase.
Wound debridement (cleaning of bacteria and dead skin)
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88
Phases of healing - proliferation
re-growing of skin; vascularization; deposit of collagen
89
Phases of healing- maturation
fibroblasts leave and collagen takes over; scar softens, they are never as strong as original skin (80%)
90
Hypertrophic scars
raised, thick rigid, leads to skin tightness. Loss of ROM
91
Keloid scars
thick and raised, extend outside the area of injury. Take longer to develop, quite unsightly.
92
What does scarring cause?
increased self-conscious behaviors, often people avoid public.
93
Complications
Respiratory - smoke inhalation, facial burns- damage to internal structures (heat); infection control (sepsis); pain management; cardiovascular (shock)
94
Medical Management for Burns
Fluids & edema; hydrotherapy (whirlpool, loosens dead tissue for debrieding); surgical interventions (skin grafting); vacuum assisted (wound-vac)-negative pressure; nutrition- metabolic rate changes
95
Rehab Phases Team
MD, RN, PT and OT, respiratory therapy, nutritionists, SW, psychologist, SLP, orthoptist, rec therapy, pastoral/clergy, cultural needs.
96
Overall goal for rehab phase:
providing support, promoting healing, preparing for self-care, reinforcing importance of AROM, pt. education
-acute care phase, surgical/post-op phase, rehab phase, reconstructive phase
97
acute care & post surgical phase - OT
eval within the first 24-48 hours if possible; functional status; ROM & strength; activity and mobility tolerance; psychological status; supports; anticipated discharge; *child Developmental Level
98
Acute Care Post Surgical Phase - OT Interventions (Burns)
1. Positioning to prevent contractures; dependent on injury location, assure position was optimal for function, resources
2. Splinting - pre and post operative, anti deformity position (intrinsic plus for hands)
3. ADLs
4. Therapeutic Ex & Activity
5. Education
99
Functional Interventions (Burns and Wounds)
Build up utensils, writing tools, and toothbrushes with cylindrical tubing; pad walker handles with wash cloth and tape to enhance gross grip ability; Coban or compression gloves to keep hand wounds/dressings clean; train grasp and manipulation of urinal, toilet paper, toothpaste, toothbrush, writing/drawling tools, etc; Enhance grip/pinch with light resistance thera putty placed in medical glove
100
Other Intervention Focus (Burns & Wounds)
Posture and movement: speed of movement, slow and guarded>"normalize" speed; quality of movement; posture; compensatory movements/substitutions; pain with task; anxiety; fear; distraction/calming techniques
101
Rehab Phase: Sub-acute & outpatient (Burns and Wounds)
Eval upon admission; functional status; ROM & strength; splints applied at hospital/protocol; activity and mobility tolerance; psychological status; supports; anticipated discharge
102
OT interventions (sub-acute & outpatient- burns/wounds)
splint management - re-molding or remarking as necessary; ADLs; therapeutic exercise and activity; education; scar massage; re-assessment of goals; compression therapy; edema mgmt
103
Home Exercise Program (Burns and Wounds)
Wound care & positioning; skin and scar care; self-care: optimizing activity and function; splints/orthotics- monitor and clean, schedule of wearing; pressure garments- schedule; exercises
104
Splint Management Burns & Wounds: Continuous use (Acute phase & early rehab phase)
protection of joints of tendons at risk; full thickness dorsal hand burns; uncooperative or unconscious patient; following skin grafting; edema reduction; reduction of contractures
105
Splint Management Burns & Wounds: Intermittent use (Rehab & beyond)
To maintain gains in ROM; alternate splints (burns on both sides of the hand); use at night only; maintenance of normal joint range
106
Scar Management
Compression garments- Custom OTs measure for these- order through a manufacturer
Fitted 3 weeks after wound healing, should be worn 22-23 hours of the day for optimum results, only come off for 30 min MAX, typically wear for 12-18 months; topical agents
107
Burn Complications
Heterotrophic Ossification- formation of bone. Impacts joint function, hard to manage surgically.
Neuromuscular complications - peripheral neuropathy, caused by metabolic insufficiencies, infections, etc.
Disfigurement
108
Psychological Impairments- Burns & Wounds
Move through the stages of grief- OT support throughout (acute phase-discharge); inability to reach acceptance significantly impacts therapy and complicates recovery
109
Denial
I'm going to be fine once these heal. Do not take into consideration the life long changes.
110
Anger
Express anger to medical staff "leave me alone"
111
Bargaining
Putting things off, especially therapy
112
Depression
Sadness associated with the loss of normal life
113
Acceptance
Acclimation to new living, move forward
114
OT role wound care prevention
Activity analysis, positioning, appropriate equipment usage, environmental modifications, and lifestyle/risk reduction- we can help keep skin intact.
Activities and roles- but ensuring it in a safe and skin-protecting manner is an area that many OTs can identify with.
115
OT role wound care- managing wounds
Vital skill for a clinician
monitor and observe their skin.
Accurately assess, know the correct terminology to use, positioning,
High risk areas and teach a person how to monitor and assess their own skin.
116
OT role wound care - lifestyle modification
Many clients will have wounds when they come to us, which may take some time to heal. This issue is a perfect intersection between functional engagement and skin/wound care
117
OT role wound care - After wound healing
Discuss risk factors, ongoing skin management (both self-administered or directing a caregiver). OTs can work with clients to make sure that their life supports them not getting a wound again.
118
Orthotic
a force system designed to control, correct, or compensate for a bone deformity, deforming forces, or forces absent from the body
119
Splint
an orthopedic device for immobilization, restraint, or support of any part of the body
120
OT Role - splints
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activity analysis
assessment of function and anatomical structures
fabrication
adaptation
progression and monitoring
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121
What is the purpose of splinting?
Increase comfort, prevent or decrease deformity, protect structures, maintain tendon length, position joints, stretch & elongate tissues, increase function / movement, limit movement / immobilize
122
Articular splint
most common; stabilize one or more joint/structure
123
Non articular splint
stabilize one structure
124
immobilization orthosis
prevent movement for the protection of joint/structure, rest
125
mobilization orthosis
allow for minimal supported movement
126
static
no movement, protect reduce pain and prevent muscle shortening
127
dynamic
includes one or more components to produce motion (supported)
128
Serial Static orthosis
slow progressive increase in ROM by repeated remolding
129
Considerations when splinting
Bones & bony prominences; arches of the hands; nerves of the hand; blood vessels of the hand; muscles of the hand; skin of the hand; pain, wounds, ability to tolerate heat of plastic, patient's ability to don/doff, compliance, wearing schedule, skin sensitivity
130
Maintain as much function as possible when splinting
Understand the biomechanics of the joints included; grasp and pinch patterns; opposition; hand dominance; specific tasks
