Systems Based Categories of Disability: Exam 1

Question 1

Mobility considers differ based on what?

Answer 1

Pts underlying patho

Question 2

pts in acute/rehab categorized into

Answer 2

tracks

*NOTE: complex pts fall into mult. groupings

Question 3

Most common tracks

Answer 3

1. MSK
2. NMSK/medically complex
3. cardiac

Question 4

MSK track common dx:

Answer 4

• TJA
  
  • hip/knee–“Jiffy Knee”
• Fx mgmt
  
  • ORIF
  • Closed red.
  • Ext fixators
• Spinal sx
  
  • pain 2* disc/jt patho
  • curve corrects
• amputations
• tendon/lig injuries/repairs
• inflamm/degen jt diseases

Question 5

Pts w/ MSK cond’s/patho present w/ following clinical impairments:

Answer 5

• impaired strength
• restricted/limtd ROM
• Pain
• dec endurance
• dec UE usage
• sensory deficits
  
  • swelling w/ post op
• dec functional mobility indep.

Question 6

Considerations for MSK track:

Answer 6

• Jt motion contraindications
  
  • ​THA
  • Spinal
• Wt. Bearing status
• resist training limits
  
  • NO MMT IMMED POST OP
• high infection risk
• pot. for blood status and DVT
• anemia 2* blood loss during sx
• high re-injury risk

Question 7

Considerations for MSK track:

Wt. Bearing Status

Answer 7

Amt wt indiv can place on limb that has sustained injury or sx procedure

Question 8

Wt Bearing Status

FWB

Answer 8

NO restrictions

Question 9

Wt bearing status:

WBAT

Answer 9

indiv can place as much wt as is tolerated on the limb

*this can = FWB if TOLERATED

Question 10

Wt Bearing Status:

PWB

Answer 10

UP to but NOT exceeding 50% of bw

*NOTE: use 2 scales!!!

Question 11

Wt bearing status:

TTWB

Answer 11

Only indiv’s TOE can bear wt

Question 12

Wt bearing status:

NWB

Answer 12

NO wt. permitted on limb

*often crutches

*NOTE: PT can be helpful in progressing WB status

Question 13

TKA and THA classic impairments

Answer 13

strength

ROM about joint and t/o limb

*set wt bearing status by surgeon

Question 14

Specific contraindications for TJA

Answer 14

Total hip precautions

*HIGHLY variable on length of time req’d to maintain

60 days-6mos

*req’d to dec risk of disloation*

vary based on surgical approach

Question 15

THA precautions:

Posterolateral

MOST COMMON

*go in thru glute max/med

KNOW THESE!!!

Answer 15

• Avoid hip flex more than 80-90deg, ADD., IR beyond neutral
• Transfer to the GOOD SIDE from bed to chair, chair to bed
• DO NOT CROSS LEGS, ROLLING PRECAUTIONS
  
  • remember, have them push up a LITTLE bit, no rolling, turn them and bring them out….YOU MUST TO STAND PIVOT TRANSFER W/ THA!!!
• keep knees below hips w/ sitting
• no low chairs—no bending trunk over legs
• raised toilet
• shower chair
• PIVOT ON GOOD SIDE
• sleep supine w/ ABD pillow

Question 16

THA precautions:

Anterolateral and Lateral Sx approach

LESS common

Answer 16

• AVOID:
  
  • hip EXT
  • ADD
  • ER past neutral
• AVOID combo motion: sitting w/ legs crossed (Tailor)
  
  • hip flex
  • ABD
  • ER
• avoid Indian style sitting
• avoid hip hypERext. w/ walking
  
  • step-to gait

Question 17

Fx/Bony reconstruct Considerations

Answer 17

• monitor WB status
• PREVENT bed rest
• watch for DVT
  
  • passive DF
  • squeeze test w/ calf
    
    • if pain==DVT
• mindful of intervention
  
  • ORIF
  • closed red
  • ext fixator

Question 18

Spinal Precautions

KNOW THIS!!!

Generally include….

Answer 18

• NO bending
  
  • @ hips forward, side to side
• NO twisting
  
  • NO trunk rot.
    
    • *USE log roll and STAND PIVOT w/ feet
• NO lifting
  
  • >5-10lbs
    
    • gallon of milk @ most

Question 19

Low limb amp.

AKA

Answer 19

Above Knee

transfemoral amp.

Question 20

Low limb amp

BKA

Answer 20

Below knee amp

Transtibial amp

Question 21

Lower limb amp considerations

Answer 21

AVOID pos’s of comfort to prevent contractures

typically FLEX pos’s

*NOTE: encourage Prone pos’ing

Question 22

Protect what w/ Low limb amps

Answer 22

• During mobility–> protect incision site
  
  • ​CLOSE GUARD
    
    • amp alters COM===INC fall risks
      
      • need to re-learn to move***

Question 23

NMSK track common dx

Answer 23

CVA

traumatic/non-traumatic BI

SCI

neuro dis’s (MS, PD)

Question 24

NMSK track impairments:

Answer 24

• Impaired or Abnormal:
  
  • coord
  • motor control/strength
  • mm tone
  • sensation/functional neglect
    
    • loss sensation dramatic and forget limb is there
  • exec. functioning/safety/cog/memory
  • problem-solving skills
  • inconsist. performance
  • systemic comps
    
    • seizure/unstable vitals
  • dec funct indep

Question 25

CVA

Answer 25

• UNILATERAL phys impairs on CONTRALAT side of body
  
  • Rt CVA==L side deficits
    
    • Hemiplegia/paresis
      
      • ​WEAKNESS ONLY!!!
• Degree impair==brain damage/location

Question 26

Tetraplegia injury occurs where in SC?

results in what?

Answer 26

Cervical spine TO T1

BILATERAL

partial or complete paralysis of UEs, trunk, LEs

assist w/ ALL ADLs

Question 27

Paraplegia occurs where in SC?

results in what?

Answer 27

injury BELOW T1

BILATERAL

partial or complete paralysis of LEs and trunk mm

indep for SOME basic skills but may req bracing/AD for locomotion

Question 28

CP track common dx:

Answer 28

CHF

s/p MI

Sx pts post cardiac cath, valve replace, bypass

COPD

s/p lung resection

chronic PNA

Question 29

CP track deficits

Answer 29

• strength
• mm endurance/fitness
• unstable/fluct. vitals
• systemic comps

Question 30

CP track considerations:

Answer 30

• VITALS!!!
  
  • close/consist monitoring
• Chest incision site protection***
  
  • pillow against chest for pain control
  • REDUCE strain UEs pull/push to prevent dehiscence
• ​IVs/lines/O2
  
  • ​mng accordingly
• ​USE RPE SCALES TO GRADE EFFORT!!!!!!