Week 5 Flashcards
Orthoses for arthritis are used to do what?
Reduce inflammation
Support and stabilize joints during function to reduce pain
Protect joints from increased stress/demand
Prevent joint contractures
Immobilize unstable joints
Increase ROM
Increase Function
Position joints for occupational performance
What is the presentation for Rheumatoid arthritis?
Boutonniere deformity of thumb
Ulnar deviation of metacarpophalangeal joints
Swan neck deformity of fingers
What is the presentation for Osteoarthritis?
Fusiform swelling of joints
Heberden’s nodes
White in joint spaces in X-ray demonstrating bone overgrowth
What is Wolff’s law?
If you don’t use it, you lose it.
What joints does OA often affect?
DIP, PIP and CMC joints
What are the common symptoms of OA?
Joint tenderness
Crepitus pain-creaking joints
What often occurs to the wrist joint for RA patients?
95% develop bilateral wrist joint involvement
What are the four types of orthoses used for RA?
Resting orthosis
Static orthosis
Static progressive orthosis
Dynamic splints
What are the aspects of the resting orthosis?
Provides passive immobilization during acute stage of inflammation
Alleviate pain
Facilitate the use of uninvolved joints
What are the aspects of the static orthosis?
Provides support, stabilization, protection, and immobilization
No moving components
What do finger orthoses do?
Prevent swan neck deformity
What does a thumb post do?
Prevent swan neck deformity of thumb
What does a HO do?
Stabilizes CMC joint and MP joint
What should be used with more wrist involvement?
A WHO
What are the aspects of the static progressive orthosis?
Used to regain joint motion
Joint motion is achieved by the hook and loop closures, hinges, screw, and turnbuckles
Reduces ulnar deviation
What are the aspects of the Dynamic orthosis?
Used to apply force to lengthen tissue in order to restore motion
Counteract the deforming forces of RA with constant gentle traction
Essential for post-op rehabilitation to maintain the surgically achieved mobility
How many people in the US suffer from traumatic brain injury each year/
1.5 million
How many people die from TBI each year?
50,000
How many people suffer long term disabilities?
85,000
How many people in the US live with disabilities cause by TBI?
5.3 million
What are the top three causes of TBI injury?
MVA
Firearms
Falls
Who are involved in the highest incident rates?
Males, 15-24
Geriatrics, 75+
What are the two classifications of TBI?
Open head injury
Closed head injury
What is open head injury?
Involved acceleration/deceleration with penetration
What is closed head injury?
Rapid acceleration/deceleration without apparent visible damage.
How do open head injuries occur?
Bullet wounds
Penetration of the skull
Largely focal damage
How do closed head injuries occur?
Slip and fall, MVA
Focal damage and diffuse damage to axons
Effects tend to be broad
NO penetration of skull
What are the immediate damages of closed head injuries?
scalp laceration skull fracture cerebral contusions cerebral lacerations intracranial hemorrhage diffuse axonial injury
What are the secondary damages of closed head injuries?
Ischemia
hypoxia
cerebral swelling
infection
What is another name for deceleration injuries?
Diffuse axonal injuries
What is diffuse axonal shearing?
When the brain is slammed back and forth inside the skull it is alternately compressed and stretched because of the gelatinous consistency till they are torn
What are deceleration injuries?
The long, fragile axons of the neurons are also compressed and stretched
What occurs when axonal shearing happens?
The neuron dies
What is Coup Contra-coup injury?
Instance where the brain bounces back and forth inside of the head, causing damage to the brain where it hit the skull
What determines how a patient will present?
The extent of brain injury
What are the different types of TBI presentations?
Hemiplegia
Diplegia
Quadraplegia
What should be checked on TBI patients?
Each affected limb for flexor or extensor synergy patterns
What is synergy?
Synergy occurs when muscles are firmly linked together and the patient is unable to master individual joint movements
What can the static tests show?
The affected limb may manifest as dystonic with dominant synergy pattern slowly taking precidence
What are the different limb synergies?
Reflexive
Voluntary
A combination of reflexive and voluntary
What is a reflexive synergy pattern?
Involuntary evoked response to a physical agent (touch, stretching, vibration)
What is a voluntary synergy pattern?
Produced through volitional movement, such as active knee or elbow extension
Why are orthotic subscribed to TBI patients?
Prevent contractures Maintain mobility (for hygiene)
What orthosis can be used for TBI patients?
A WHO to maintain wrist alignment and prevent finger flexor deformities
Finger separators are preferred to prevent friction between fingers
What device should be used if spasticity occurs in the finger flexors and full extension can’t be reached?
A sphere-shaped palmer device
What can be used if the patient has hypersensitivity to palmar contact?
A dorsal splint because palmar contact can elicit a grasp response
What additional resources might benefit OA, RA and TBI populations?
Assistive devices
Knowledge-pamphlets, support groups, 360 care
