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OCTH 742 exam 1
| Question | Answer |
|---|---|
| based on OTPF... practitioner sets methods and tasks to prep client for occupational performance, used as part of treatment or provided as HEP, interventions that are often done to client without their active participation | interventions that support occupations |
| ex. you client's goal is to be able to don her shirt and bra independently after a wrist fracture: interventions - heat, AROM/PROM, strengthening, FMC/dexterity exercises | interventions that support occupation |
| ex. you client's goal is to be able to don her shirt and bra independently after a wrist fracture: interventions - ADLs, graded tasks, part of task/chaining, AE training | occupation - based interventions |
| doing this creates a good foundation with client when you first meet them | building rapport |
| find out what client wants, ask about client, ask about preferences in therapy, summarize what will happen next, understand there may be trauma or pain with this population | how to gain client buy - in |
| why they were referred, review their medical chart, look at their history of therapies | medical history |
| consists of their primary roles; meaningful occupations and activities; important people and support system; factors of client's self-id; impact of condition on client, family, economics, function, etc. | occupational profile |
| occupation-based assessment, goal setting and outcome measurement, identifies problems in occupational performance, client (with input from OT) can decide which problem areas should be addressed in treatment plan | Canadian Occupational Performance Measure |
| position and posture -> skin integrity -> skin color -> temp -> sweat -> hair -> fingernails -> atrophy -> contractive/deformity -> joint deviation or rotation | visual examination |
| part of visual examination: this can tell us a lot about what is going on | positioning and posture |
| part of visual examination: feeling for muscles, joints, tendons, scars | palpation |
| type of end feel: hard (normal) | bone to bone |
| type of end feel: soft (normal) | soft tissue approximation |
| type of end feel: firm with movement (normal) | capsular |
| type of end feel: harsh movement in opposite direction (abnormal) | spasm |
| type of end feel: hard rebound (abnormal) | springy |
| type of end feel: no true end feel or stop due to pain (abnormal) | empty |
| increase in fluid volumes, can be normal healing or concerning dependent on timing and extent; measurements - circumferential, figure 8, volumetric | edema |
| type of edema with indentation or "pit" at site of pressure; test by pressing on area for 5 seconds with enough force to create an indent; 4 stages | pitting edema |
| stages: 1 - slight (2 mm), no visible distortion, disappears rapidly; 2 - somewhat deeper (2-4 mm), disappears within 10-25 seconds; 3 - grossly swollen, noticeible deep (~6 mm), may last 1+ min; 4 - very deep (6-8 mm), grossly distorted, lasts 2-5 mins | pitting edema |
| sensation test: tested with cotton ball/swab, pencil eraser, or finger | touch awareness |
| sensation test: tested with Semmes-Weinstein monofilaments | touch threshold |
| sensation test: tested with pencil eraser | touch localization |
| sensation test: tested with deep sensation perceived in muscles, tendons, ligaments, and joint structures | proprioception |
| sensation test: to test position the affected UE and ask them to match it with the unaffected UE | joint position |
| sensation test: to test move the affected UE and ask them to report the direction of the movement | movement / kinesthesia |
| what scale do we use to measure pain | Short Form McGill Pain Questionnaire |
| what test do we use to test vascular status | Modified Allen's Test |
| type of muscle contraction: muscle contracts but does not shorten | isometric contraction |
| type of muscle contraction: muscle shortens when contracted | concentric contraction |
| type of muscle contraction: muscle elongates | eccentric contraction |
| impacted by muscle growth and effectiveness of neural connections; neural change; low reps, more weight | muscle strength |
| ability of muscle to sustain or perform repeated contractions over time; repetitive; more reps, low weight | muscle endurance |
| goals: 1. maintenance of ROM, 2. increase ROM, 3. increase strength, 4. increase endurance | The Biomechanical Approach |
| goal of Biomechanical Approach: principle - immobilization and inactivity affects ROM; interventions - decrease edema, minimize contractures, movement through full ROM | maintenance of ROM |
| goal of Biomechanical Approach: principle - some limitations in ROM can be improved or corrected by stretching; intervention - stretching; effectiveness influenced by duration, intensity, speed, and frequency | increase ROM |
| amount of time tissues are held by an external force; longer tissue is held at end range under tension, greater gains of ROM; 40-60 second holds | duration |
| amount of force put on tissues during stretch; best results may be achieved by moving to point of max strength and holding that position; static progressive training | intensity |
| goal of Biomechanical Approach: should be slow to allow tissues to gradually adjust forces applied to it; this will provide protective mechanisms in which connective tissues resists quick vigorous stretching | speed |
| number of sessions during day or week that stretching is complete; no optimal amount defined, but a regular schedule is important; adequate time between stretching needs to be allowed to enable tissues to heal and prevent inflammation | frequency |
| type of stretching: provides a slow stretch; patient is involved in activity; activity involves alternating motions using contracted muscles and muscles opposing contraction; other type may follow | active stretching |
| type of stretching: preparatory method to increase ROM; manual stretching; hold for 45-60 seconds | passive stretching |
| for what kind of injury should active stretching be done before passive, patient should be in control of force applied, less risk of re-injury, contract/relax force of muscle compress and decompresses the injury to promote healing | fracture |
| for what type of injury should passive stretching be done before active, the OT is in control of force, allows for movement and decreases risk of contracture, and AROM should be avoided to avoid risk of re-injury | tendon repair |
| sudden movement or thrust, of small amplitude, performed at a speed that renders patient powerless to prevent it; OTs do not perform this since it is not in our scope of practice | joint manipulation |
| purpose is to restore structures within a joint to their normal and/or pain-free positions to facilitate recovery of motion, to relieve pain, to restore ROM, and allows client to control movements | joint mobilization |
| goal of Biomechanical Approach: purpose - a muscle is strengthened if it works against resistance to allow max working force of muscle; interventions - functional tasks that challenge strength, therapeutic exercise, strengthening program | increase strength |
| type of strengthening exercise: weak muscle is isometrically contracted to maximize force for 10 reps with rest between each contraction, no supplies needed | isometric |
| type of strengthening exercise: weak muscle is contracted through as much ROM as patient can achieve, then therapist and/or external device provides manual assistance to complete the motion | active assistive ROM |
| type of strengthening exercise: patient contracts muscle to move through partial or full ROM | active ROM |
| type of strengthening exercise: patient contracts muscle to move through full available ROM against resistance | passive ROM |
| type of strengthening: therapist may gradually increase resistance with resistance putty, resistance bands, or hand weights | progressive resistance |
| theory is that muscles can perform more efficiently if given a warmup period; protocol - 3 sets of 10; set 1=reps at 50% of 10 RM, set 2=reps at 75% of 10 RM, set 3=reps at 100% of 10 RM | DeLorme's Method : 10 Rep Max |
| protocol - 4 sets of 10; untrained = 4 sets of 10 reps at 60% of RM, trained = 4 sets of 10 reps at 80% of RM | 1 RM |
| how to calculate RM: 1 RM = (wr/30) + 5 r = repetition w = weight used | Epley Formula |
| goal of Biomechanical Approach: principle - involves submaximal resistance over a period of time, low weight and high reps; intervention - graded functional tasks, therapeutic exercise | increase endurance |
| intervention for increasing endurance: activities are graded by time and repetitions (ex. carrying 1/2 load of laundry instead of full) | graded functional tasks |
| intervention for increasing endurance: reps can be increased, time and isometric contraction being held is increased (ex. 40-60% of 1 RM) | therapeutic exercise |
| goal of Biomechanical Approach: contraindications/precautions - pain after stretching, isometric exercise causing increased BP and heart rate, osteoporosis and rheumatoid arthritis, post-op and post-fracture patients always have precautions | increase endurance |
| withhold resistance training for those with a fracture until they are out of what phase of healing; it could cause increased blood flow to area which can lead to swelling; it poses a risk to a pathological fracture due to torque and pressure | inflammatory phase |
| PROM does not change with repositioning of joints proximal and/or distal to it | joint tightness |
| PROM of joint varies with repositioning of joints crossed by that musculotendinous structure (ex. if you extend elbow, the wrist becomes less tight) | musculotendinous tightness |
| when a joint has greater PROM than AROM | lag |
| when a joint has a PROM limitation, strucrural changes have occurred | contracture |
| intervention for endurance: tendon gliding exercises which maximize total gliding and differential gliding of digit flexor tendons at wrist; very common for HEPs in hand therapy | digital tendon gliding exercises |
| intervention for endurance: effective for increasing ROM when PROM exceeds AROM | place - and - hold exercises |
| intervention for endurance: proximal support is provided to promote isolated motion at a particular site, these exercises exert more force than non-blocking exercises | blocking exercises |
| intervention for endurance: use of a mirror may address pain, sensory, and motor problems | mirror training |
| MP extension = less PIP/DIP flexion; MP flexion = more PIP/DIP flexion; treatment = complete PIP/DIP flexion with MPs hyperextended; ex. hold marker with tips of fingers and flex/extend MPs | intrinsic tightness |
| MP extension = more PIP/DIP flexion; MP flexion = less PIP/DIP flexion; treatment = perform combined flexion or extension movements of multiple joints, also passively flex MPs then flex and extend PIP/DIP | extrinsic tightness |
| hands-on technique provided to decrease pain and restore motion, gentle sustained pressure into myofascial connective tissue restrictions, has been used to address a variety of conditions and concerns, requires continuing education | myofascial release |
| what 4 things should you address when writing goals | person, biomechanical component, objective measurement, occupation |
| patient completes isometric contraction for 3-10 seconds and at same time the therapist is resisting the motion; patient then relaxes and therapist moves limb in direction opposite of contraction and holds position; repeated | contract relax |
| patient completes isometric contraction for 5-10 seconds and at same time therapist is resisting this motion; relax and move to "new" end range | MET / RI |
| 1. place joint in resting position; 2. patient and body part well-supported; 3. patient is relaxed; 4. mobilizing force should be close to therapist's COG; 5/ stabilize 1 bone and mobilize other, usually proximal; 6. contact should not be painful | joint mobilization |
| aspect of joint mobilization: decrease in space between 2 joint surfaces, adds stability to joint, normal reaction of joint to muscle contraction | compression |
| aspect of joint mobilization: 1 joint surface is glided over the other, need to know normal glide that occurs at joint surface during movement, used to improve motion at joint | glide |
| aspect of joint mobilization: 2 surfaces are pulled apart, used to increase stretch of capsule | distraction |
| aspect of joint mobilization: 1 joint surface spins over the other, consider movement in joint with normal ROM | rotation |
| grade of joint mobilization: first 25%, quick oscillations | grade I |
| grade of joint mobilization: first 50%, to middle and back | grade II |
| grade of joint mobilization: full 100%, to end and back | grade III |
| grade of joint mobilization: last 25%, quick oscillations, quick thrust through end range; not in OT's scope of practice | grade IV |
| inflammatory arthritis, malignancy, tuberculosis, osteoporosis, ligamentous rupture, bone disease, neurological involvement, bone fracture, herniated discs with nerve compression, congenital bone deformities, vascular diseases | contraindications for mobilizaiton |
| osteoarthritis, pregnancy, total joint replacement, severe scoliosis, poor general health, patient's inability to relax | precautions for mobilization |
| phase of tissue healing: days 1-10; immediate protective response, characterized by heat, redness, swelling, and pain; increased blood in area; depending on diagnosis, rest/immobilization is usually recommended | inflammatory phase |
| phase of tissue healing: days 3-20; re-epithelialization until compromised area is covered; fibroblasts synthesize scar tissue; AROM and splints may be most appropriate at this stage; increased collagen fibers | proliferative / fibroplasia phase |
| phase of tissue healing: day 9 up to 1-2 years; tissue more responsive early in phase; increased tensile strength of collagen fibers; gentle resistive exercise is indicated but may create inflammatory response | remodeling / maturation phase |
| techniques used to remodel collagen fibers of tissue to promote tissue excursion and to improve cosmetic appearance | scar management |
| goals: restore normal function of UE, improve appearance of scar, promote tissue gliding to allow ROM, decrease hypersensitivity and pain, prevent/treat joint contractures | scar management |
| precautions: delayed wound closure, edema/swelling, skin maceration, infection, pain, lack of sensation, sun exposure, early aggressive massage/therapy, wound tension, hypersensitivity | scar management |
| methods: compression, desensitization, silicone gel/sheets, padding, elastomer pads, scar massage, scar extraction, AROM/PROM, PAMs | scar management |
| main causes: nerve compressions, repetitive use syndromes, nerve repairs or grafts, underlying neuropathic diseases, hypersensitivity after injury | sensory impairment |
| method for addressing sensory impairment: a method of learning to re-interpret altered neural impulses; theory is that cortical maps can be altered by directing sensory experiences; re-education and localization | sensory re - education |
| phase 1: passive sensory training - can be used by pt. with or without sensation, intended to maintain cortical hand maps; phase 2: active sensory training - most at least have perception of touch, involves techniques of learning, repetition, other senses | sensory re - education after peripheral nerve injury |
| passive: electrical or manual stimulation; active: use of meaningful sensory motor experiences, use of involved hand in bimanual tasks, early incorporation of hand, prevent compensation, textured handles, mirror therapy | sensory re - education after CVA |
| ordinary stimulus produces exaggerated or unpleasant sensations | hypersensitivity |
| method for addressing sensory impairment: a method of reducing hypersensitivity | desensitization |
| method for addressing sensory impairment: techniques - mirror visual feedback, dowel and immersion textures, vibration, continuous pressure, weight bearing, scar massage, PAMs, use of involved hand in ADLs | desensitization |
| methods of adapting to loss of protective sensation (pain and temp extremes that signal threat of tissue damage); without that feedback there is a high frequency of burns, cuts, and bruises; goal is to prevent injury; caregiver/pt education to prevent | compensatory strategies |
| reduction techniques: bulky hand dressings, high-voltage pulse current, elevation, compression, cold packs, light retrograde massage, limited active motion of uninvolved areas, balance of activity and rest for all structures to prevent inflammation | acute edema |
| reduction techniques: trunk stretches/exercises, manual edema mobilization (MEM), kinesio taping, continuous passive motion machines, fluidotherapy, compression, contrast baths, active and passive exercise, pneumatic pump, chip bags | subacute edema |
| cotton stockinette filled with small foam pieces of various densities, as you wear them they knead and massage hardened areas to soften tissue | chip bags |
| reduction techniques: all for subacute edema as well as methods for softening hard tissue such as chip bags, foam-lined splints, low-stretch bandaging, silicone gel sheets, and elastomer pads | chronic edema |
| precautions: when using compression for edema control, be sure to monitor skin color to ensure adequate circulation | edema reduction |
| considerations: CHF, acute infections, renal failure, DVT | edema reduction |
| originates from science of kinesiology; was used by chiropractors, orthopedists, and acupuncturists; now used by medical practitioners and athletes around the world | kinesiology taping |
| uses: removal of ecchymosis, facilitate muscle function, edema reduction, inhibit muscle function, improve joint ROM, decrease pain, scar tissue mobilization | kinesiology taping |
| methods: influences proprioception, impacts physiology through cutaneous receptors, elastic quality of tape mimics that of human muscle | kinesiology taping |
| clean skin - no oils or lotions, wash skin with soap and water, clip hair; skin protectors - skin prep, Milk of Magnesia | kinesiology taping |
| removal: 1. moisten tape with water, oil, or lotion; 2. remove tape in direction of hair growth; 3. pull skin off tape, work skin off as you pull tape; 4. moisturize skin as needed; 5. avoid re-application of tape for at least 24 hours | kinesiology taping |
| scaline triangle, axilla, popliteal fossa, antecubital fossa | where to avoid taping |
| contraindications: infections, open swounds, unhealed scars, active cancer, over radiation burns/skin grafts, congestive heart failure, renal insufficiency, DVT, extremely thin skin | kinesiology taping |
| application for edema: place joint in its available pain-free ROM, apply tape proximal to distal, apply base toward lymph nodes, entire length has no tension, tap as you lay tape, tails applied on involved areas | kinesiology taping |
| muscle application: indicated for increased or decreased muscle tone; no stretch during application; can improve muscle tone, decrease pain, and increase healing | kinesiology taping |
| apply tape along muscle fibers from muscle origin to insertion, or proximal to distal | muscle facilitation |
| apply tape along muscle fibers from muscle insertion to origin, or distal to proximal | muscle inhibition |
| ligament application: tendon or ligamentous injury, "I" cut, ends have no stretch | kinesiology taping |
| subluxation: 1 strip over supraspinatus muscle, can stabilize AC joint, can help to correct, can correct glenohumeral joint | kinesiology taping |
| type of kinesiology taping: bracing technique; used to improve position; 2 parts - underwrap and rigid/adhesive | McConnell tape |
| type of kinesiology taping: indications - instability, pain, dysfunction, poor posture, hypertonicity, hypermobility | McConnell tape |
| type of kinesiology taping: precautions/indications - allergies, sensitive skin, open wounds, irritated/red skin, rashes | McConnell tape |
| type of kinesiology taping: rules for application - tape in position of stability, allow to contour skin, prep skin, ok to shower/bathe | McConnell tape |
| type of kinesiology taping: rules for removal - remove if increased pain, itching, redness, or swelling; use oil and peel off in direction of hair | McConnell tape |
| type of kinesiology taping: postural feedback - ask patient to stand up tall and make an "X" with tape, pull tape caudally to facilitate scapular retraction and depression | McConnell tape |
| how does taping relate to occupations and function | provides stability, pain relief, postural re - education |
Created by:
emma.scarmon-coyotes
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