Occupational Therapy for Adult Intervention
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| What is the prevalence of developmental disabilities? | 1-3% of the population
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| What is the definition of Mental Retardation? | significant limitations in intellectual functioning and adaptive behavior as expressed in conceptual, social and practical adaptive skills before age of 18
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| What are specific diagnostic characteristics occurring with individual’s with Down’s syndrome? | Round face, small head, low set ears, flattened nose bridge, short limbs, protruding tongue, dysphagia, hypotonia, MR
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| What is the prognosis of MR? | life long and typically non progressive
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| Name 7 types of developmental disability | MR
Down Syndrome
Fragile X
Autism
Epilepsy
Spina Bifida
CP
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| What was the previous diagnostic classification for intellectual functioning? | IQ (70-75 and below for MR)
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| What is the current diagnostic classification for intellectual functioning? | 2 or more standard deviations from the mean
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| How are IQ's used with children vs adults? | Children - identifies educational level
adults - moving away from IQ's and looking at function and adaptive skills
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| What are the levels of MR and their incidence? | Mild - 85%
Moderate - 10%
Severe 3.5%
Profound 1.5%
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| What are the three types of adaptive behavior? | conceptual skills, social skills and practical skills
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| What are conceptual skills? | receptive/expressive language, reading, wirting, money, self directions
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| What are social skills | interperosnal skills, responsibility, self-esteem, rules and laws
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| What are Practical Skills | ADL's, IADL's, safety
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| Describe MMT Grade 5 | Normal - Full ROM against gravity w maximal resistance
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| Describe MMT Grade 4 | Good - Full ROM against gravity with moderate resistance
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| Describe MMT Grade 4 - | Good minus - Full ROM against gravity with less than moderate resistance
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| Describe MMT Grade 3+ | Fair Plus - Full ROM against gravity with minmial resistance before it breaks
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| Describe MMT Grade 3 - | Fair minus - less than full ROM against gravity
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| Describe MMT Grade 3 | Fair - Full ROM against gravity with no added resistance
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| Describe MMT Grade 2+ | Poor Plus - Full ROM in a gravity eliminated plane with minimal resistance, then breaks
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| Describe MMT Grade 2 | Poor - Full ROM in a gravity eliminated plane with no added resistance
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| Describe MMT Grade 2 - | Less than full ROM in a gravity eliminated plane
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| Describe MMT Grade 1 | Trace - Tension is palpated in the muscle or tendon but no motion occurs at the joint
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| Describe MMT Grade 0 | Zero - no tension is palpated in muscle or tendon
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| What muscle grade is the first to use gravity eliminated plane? | 2+
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| How do you measure obesity? | BMI
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| What BMI is classified as morbid obesity? | 40+
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| What BMI is classified as obese? | 30-40
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| What BMI is classified as overweight? | 25-30
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| What BMI is classified as healthy weight? | 18.5-25
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| What BMI is classified as underweight | 18.5 and below
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| what are some characterizations of obesity? | imbalance between energy intake and expenditure
significant compromises in health
increased health/medical consumption
decreased function in areas of occ. perf.
premature death
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| What are three surgical and treatment options? | bariatric surgery
anti obesity drugs
life style changes
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| In therapy, what should we remember about obese clients? | sensitivity, no life environment after surgery, apple shaped clients cant do supine positions because it puts more weight on thoracic cavity
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| Where can you find a peripheral IV line? | forearm vein or femoral vein
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| What is a PCA Patient controlled Analgesia? | patient pushes button to release pain meds thru peripheral IV or epidural catheter in spinal canal above level or surgery or pain
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| Where can you find the Central Venous Catheter? | subclavian or jugular vein
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| What is the Sorenson? Where is it found? | hemodialysis, found in subclavian, jugular, or femoral veins (2 lumen)
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| What is an A Life? Where is it found? What does it do? | Arterial line, found in radial vein, measures BP
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| What is a CVP - central venous pressure line? Where is it found? what does it do? | found in subclavian or interal jugular vein, measures pressure in superior vena cava
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| What is a Swan-Ganz? What does it do, where is it found? | catheter in jugular or subclavian, threads through the heart and monitors heart function
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| What is an EVD external ventricular drain? Where does it go? What does it do? | catheter drilled thru skull into brain. Threaded into lateral ventricles, measures intracranial pressure
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| What is a Licox? What does it do? Where is it found? | measures oxygen partial pressure of brain tissue, inserted into white matter of brain
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| What is a Hemovac? | suctions wounds
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| What is a Jackson Pratt? | drain that looks like an egg. squeeze and it drains.
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| What is a Duvall? | Drain that connects to a wall suction or colection bag
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| What is a Penrose? | looks like a straw
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| What does an Ortho-pat-system do? | reinfuses blood
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| What is a lumbar drain? | catheter placed in subdural space in lumbar area that drains CSF
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| What is a chest tube? | catheter inserted into thorax and removes air and fluid and helps re-expand lungs
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| What is an NG tube? | inserted into nose or sometimes mouth
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| What is a Peg, G Tube, Peg-J, J Tube? | feeding tube that goes directly into stomach or jejunum
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| What is a nasoenteric tube? | Dobbhoff - silk tube threaded to the stomach into the intestine
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| What is a orotracheal tube? | inserted into the trachea via mouth
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| What is a foley? | catheter that goes in urethra into bladder and held in by balloon
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| What is a suprapubic catheter | inserted into abdominal wall above pubic bone into bladder
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| What is a Flexi Seal? | rectal tube that collects feces
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| What is a Colostomy? | surgical creation of an artificial anus on the abdominal wall
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| What is Telemetry? | 5 leads on chest that monitor heart and respiratory rate and rhythm
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| What is a pulse oximeter? | attached to finger and measures oxygen saturation
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| What are sequential Compression Devices (SCD) | pumps blood continuously through legs to avoid DVT
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| What are Ted Stockings? | knee high stockings that supply continuous pressure to legs
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| What is the first heart beat sound? | mitral and tricuspid valves closing
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| What is the second heart beat sound? | aortic and pulmonary valves closing
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| What is normal BP? | 120/80
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| What HBP? | 140+/90+
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| What is orthostatic hypotension? | BP drops, when u get up too fast after being laying down for a while. Dizziness, fainting, etc.
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| What is congestive heart failure? | heart pump is weak and blood flow is reduced and sometimes pools
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| What is Atria Fibrillation? | heart flutter - atria contract rapidly and may cause heart failure or stroke
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| What is Tachycardia? | fast heart rate
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| What is angina? | chest pain
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| What is ischemic heart disease? | heart isnt getting enough oxygen
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| What is Atherosclerosis and CAD? | clogged arteries, blood cant flow well
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| What is a Heart Attack (myocardial infarction) | blood supply cut off. heart muscle starts to die because it has no oxygen
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| What is an aneurysm? | bulge in artery. wall tears. bleed
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| What is a DVT? | blood clot in deep veins
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| What is syncope? | loss of consciousness because of decreased blood flow to brain
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| What are cardiovascular disorder symptoms? | pain, sob, fatigue, palpitations, light headedness, fainting, swelling, numbness, skin color changes
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| What are Heart Attach Symptoms? | tight chest, dull aching, numbness, tingling of arms, SOB, sweating
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| What are symptoms of cardiac distresss? | chest pain, labored breaking? orthopnea (sob), nausea, diaphoresis (sweating) , fatigue, cerebral signs,
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| What are cardiac problem risk factors? | smoking, high cholesterol, HTN, Diabetes, obesity, lack of exercise
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| What are some psychosocial considerations of cardiopulmonary diseases? | fear, anxiety, depression, denial, hopelessness
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| What is COPD? | obstruction of airway from smoking or heredity
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| What is atelectasis? | lung becomes airless and contracts
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| What is Pneumothorax? | pocket of air in lung that results in collapsing
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| what is ARDS? Acute Respiratory Distress Syndrome? | lung failure due to fluid in lungs
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| What is a MET? Basal Betabolic Equivalent | amount of oxygen needed to provide energy for a certain task
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| what is 1 MET equivalent to? | resting in bed quietly
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| What are some pulmonary rehab techniques? | ADL eval and training
breathing techniques
UE strength
energy conservation
work simplification
adaptive equipment
stress management
relaxation techniques
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| What are some energy conservation ideas? | re arrange your environment
eliminate unnecessary effort
plan ahead
prioritize
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| What are some sternal precautions? | avoid pulling or pushing with arms
avoid lifting more than 10 lbs
avoid reaching over head, behind body and stretching forward
avoid arm exercises and machines
avoid sexual activity
avoid driving
avoid wheelchair propulsion
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| What are some safety considerations for using oxygen? | no smoking, keep away form open flame, keep away from electrical devices
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| What is the systole measurement of BP? | pressure in arteries as heart contracts
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| What is the diastole measurement of BP? | pressure that is still in the arteries when the heart is between contractions
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| What is normal heart rate? | 60-100 bpm
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| What is angle in space? | angle of the seat back in rleation to the true vertical when the seat and back are rotated counterclockwise as a unit (tilt in space)
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| What is camber? | the amount of angle on the wheels creating flare out at the bottom?
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| what is the recommendation for camber? | 4-6 degrees
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| What is Pelvic rotation? | asymmetrical position of the pelvis with forward position of one side, due to low back rotation, muscle asymmetry or spinal deformity
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| What is Pelvic Obliquity? | uneven level of ASIS's and IT's associated with spinal scoliosis, hip abnormality and pelvic deformity
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| What is the seat-back angle? | angle of the seat surface relative to back surface
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| What is the typical seat to back angle? | 90-10 degrees
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| What is RESNA? | rehab engineering and AT society of north america
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| What are personal profile factors when selecting a wheel chair? | age, stature, developmental status, environment, education and work status or future plans, recreation, needs for AT
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| What are medical profile factors when selecting a wheelchair? | history, physical assessment, diagnosis, skin integrity, blood supply, tone, reflexes, etc
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| What are goals of seating and positioning in a wheelchair? | decrease tone/reflexes
dlay or provide corrective forces for defomrity
improve function and ADLs
accomodate for loss of sensation
improve comfort
improve self image
promote posture
tissue protection
solid base of support
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| What are three types of wheelchairs? | attendant propelled, manual, power mobility
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| What does camber to do the measurement of a wheelchair? | makes it wider
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| Why are medical tests performed? | to confirm a diagnosis
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| What are types of tests of structure? | x ray
ct s can
mri
ultra sound
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| What are types of tests of function for the electrical system? | EKG - heart
EMG - muscle
EEG - brain
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| What are three broad categories of tests of function? | electrical, body fluids, physical exam
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| What is a type of imaging test? | PET scan - looks at glucose in cells, tumors, brain function, etc
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| What is the best way to find out information on patients? | taking a good history is the main way of diagnosing along with a good physical exam
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| What is sensitivity? | test picts up the disease from a population of poeple that have it
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| What is specificity? | the test doesnt pick up the disease from a population of people that dont have it
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| What test would be used to diagnose CVA? | EKG, imaging tests, clotting tests
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| What test would be used to diagnose CAD? | EKG, Enzymes, lipids
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| What test would be used to diagnose CNS Trauma? | imaging, CSF, CBC
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| What test would be used to diagnose burns | fluids, electrolyes, culture, sensitivity
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| What test would be used to diagnose MS? | MRI, CSF
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| What test would be used to diagnose parkinsons | dopamine levels
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| What test would be used to diagnose RA? | x rays, esr, ana
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| What test would be used to diagnose OA? | esr, x ray
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| What test would be used to diagnose diabetes? | glucose, urine, hemoglobin
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| What are 5 types of hip injuries? | subcapital, basilar, intertrochanteric, subtrochanteric, transcervical
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| What are ANTERIOR hip precautions? | no external rotation, no extension, no adduction
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| what are POSTERIOR hip precautions? | no internal rotation, no flexion, no adduction
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| what are some types of adaptive equipment used for hip fractures? | sock aid
reacher
dressing stick
leg lifter
long handled sponge
walker bag
elastic shoe laces
shoe horn
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| What does NWB mean? | non weight bearing - no weight on leg
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| What does TTWB mean? | toe touch weight bearing- only toe can be placed on ground for balance
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| What does PWB mean? | partial weight bearing - 50% body weight can be placed on leg
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| What does WBAT mean? | weight bearing as tolerated - patient judges based on pain
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| What does FWB mean? | full weight bearing - no limitations
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| Define SCI | Any injury of the neural elements within the spinal canal from either trauma or disease.
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| What causes most SCIs? | car accidents and falls
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| Define: tetraplegia | any degree of paralysis involving the 4 limbs and trunk musculature
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| Define: paraplegia | paralysis of lower extremities and trunk but not involving UE’s
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| Define: Autonomic Dysreflexia | irritation below level of injury that triggers a “panic” response
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| What are symptoms of Autonomic Dysreflexia? | Headache, stuffy nose, sweating, increased BP
Most frequently caused by full bladder/bowel
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| What is Spasiticty? | involuntary muscle contraction below level of injury that results from lack of inhibition in the brain
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| What is heterotrophic ossification? | bone the develops in abnormal anatomical locations. (usually hip and knee, sometimes elbow and shoulder)
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| What are three physical exam aspects that are predictors of recovery? | Sensory and Rectal sensation
Motor and Rectal Voluntary contraction
ASIA Impairment classification
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| Elbow Flexion occurs at what SC Level? | C5
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| Wrist Extension occurs at what SC Level? | C6
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| Elbow Extension occurs at what SC Level? | C7
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| Finger Flexion occurs at what SC Level? | C8
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| Finger Adduction occurs at what SC Level? | T1
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| Hip Flexion occurs at what SC Level? | L2
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| Knee Extension occurs at what SC Level? | L3
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| Ankle Dorsiflexion occurs at what SC Level? | L4
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| Long Toe extension occurs at what SC Level? | L5
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| Ankle Plantar Flexion occurs at what SC Level? | S1
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| What SC levels are seen in the arm dermatome? | C5, C6, T1
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| What SC levels are seen in the hand dermatome? | C8, C7, C6
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| Describe ASIA A? | COMPLETE – no motor, no sensory, no function in S4, S5
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| Describe ASIA B? | INCOMPLETE – no motor, yes sensory, no function in S4, S5
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| Describe ASIA C? | INCOMPLETE – yes motor, more than half muscles have a grade less than 3
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| Describe ASIA D? | INCOMPLETE – yes motor, more than half muscle have a grade 3 or more
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| Describe ASIA E? | NORMAL – motor and sensory function are normal
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| Define Sensory Level | the most caudal dermatome to have normal sensation on both sides of the body
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| Define Motor Level | the most caudal level where strength is at least 3/5 on body sides of the body and the next level is 5/5.
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| What is Central Cord Syndrome? | damage to the center of the spinal cord
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| Describe effects of Central Cord Syndrome? | UE's more effected, in older populations with stenosis or hyperextension
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| What is Brown-Sequard? | only one side of the SC is damaged
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| Describe effects of Brown-Sequard? | due to stabbing or gun shot wounds
decreased motor function and proprioception on same side
decreased pain, temp and touch on opposite side
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| What is Anterior Cord Syndrome? | damage to the anterior spinal artery
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| Describe the effects of Anterior Cord Syndrome? | loss of pain temp and touch
proprioception is in tact
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| Describe Conus Medullaris Injury | UMN injury
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| Describe effects of Conus Medullaris Injury | cuases hypertonicity, bowel bladder dont release
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| Describe Cauda Equina Injury | LMN injury
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| Describe effects of Cauda Equina injury | hypotonicity, problems with controling bowel and bladder because of low tone
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| The greatest UE recovery in SCI happens when? | within the first 6 months
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| what percent of SCI's regain a level of function? | 40-90%
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| Which regain more function? Incomplete or complete SCIs? | incomplete
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| What are two types of cervical braces? | cervical collar
Halo Vest
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| What are three types of throcaci, Lumbar, Sacral braces? | TLSO, LSO and corset
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| What are acute stage therapeutic considerations? | ROM, splinting, education discharge planning
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| What are rehabilitation phase therapeutic aspects and objectives? | assessment, maintain ROM, increase strength and endurance, maximize independence, ADLs, training patient and caretakers, adaptive equipment
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| What are some complications of SCI? | skin integrity
osteoporosis
orthostatic hypotension
autonomic dysreflexia
heterotrophic ossicification
sexuality
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