AOTA Musculoskeletal Impairments

Question 1

what are the different levels of amputation

Answer 1

ATK: transfermoral
BTK: transtibial
BTA: transmetatarsal
ATE: transhumeral
BTE: transradial
BTW: transmetacarpal
disarticulation - across a joint

Question 2

describe the pre-prostethic training goals

Answer 2

assist client in coping with psychological aspects of limb loss
optimize wound healingmaximize residual limb shrinkage
denensitize residual limb
maintain or increase ROM/strength
facilitate indepednence in basic ADLs
explore prosthetic options

Question 3

describe prosthetic training goals

Answer 3

teach client to independently don and doff prosthesis
train client in care of prosthesis
increase client’s wearing timne to fully day
encourage client in independent use

Question 4

how do you evaluate for amputations

Answer 4

limitated may be seen in all areas of occupation
self care should be evaled with and without prosthesis
watch for client factors that are limited
performance skills realted to motor skills of uninvolved hand in prep for training in one-handed techniques
functional mobility andbalance inLE amputation
vocationl and recreational interested
driving eval
environmental analsys of commnuity, home and school

Question 5

describe pre-prosthetic interventions

Answer 5

training in limb hygiene
wound healing
limb shrinkage and shaping - used to reduce edema dndevelop tapered shape.
desensization of residual limb
maintenance of or increasing flxexbility and strength of residual limb to prevent contractures
maintenance of or increasing strength and flexibilty of remaining limbs

Question 6

describe prosthetic considerations

Answer 6

legnth, strength, flexibilty adns kin integrity
patient reference for cosmesis and fucntion
hand dominance
typical activities to be performed
motivation and attidue
financial coverage
coignition

Question 7

describe post-prosthetic interventions

Answer 7

client education
training to don/doff prosthesis
wearing schedule - start at 15 mins and increase by 15 with no visual redness
limb hygiene
care
training in use - control, prepositioning, prehension, functional

Question 8

define contractures

Answer 8

fixed position because of shortening of skin, ligaments, joint capsule, tendons and muscles resulting from conditions

Question 9

how do you eval contractures

Answer 9

arom/prom

Question 10

what are the interventions used with contractures

Answer 10

superficial and deep heat to increase tissue extensibility
slow stretch
static splinting

Question 11

describe fibromyalgia with symptoms

Answer 11

syndrome consisting of widespread pain affecting entire musculoskeletal system

symptoms - soft tissue pain, nonrestorative sleep, fatigue, inability to think clearl,y paresthesias, joint swelling, depression and anxieyt.

Question 12

how do you eval fibromyaglia

Answer 12

daily activity log, COPM and pain assessment

Question 13

what are some interventions used with fibromyalgia

Answer 13

client education to avoid pain triggers
gentle regular aerobic exercise, stretching/strengthening activities
sleep hygiene
myofasicla release and trigger point tratment
fatigue management
memory aids
activity/environmental modifications

Question 14

describe the different types of hip fractures

Answer 14

femoral neck fx - caused by slight rauma or rotational force
intertrochanteric fx - direct blow to the area between greater and lesser trochanter
subtrochanteric fx - direct blow to lesser trochanter

Question 15

what is the medical management for hip fractures

Answer 15

goals are to relieve pain, maintain good bone position, allow fx healing, and restore optimal function of client

Question 16

name the weight bearing restrictions

Answer 16

nonweightbearing - no weight
toe touch - 10% of bodyweight on leg
partial - 50% BW
weight bearing as toerated  -  as much as can be toerated
full - 100% bw

Question 17

what are the two approaches to hip replacements and their precautions

Answer 17

posteriolateral approach - no hip flexion, no adduction and no internal rotation

anterolateral approach - no adduction, no external rotation, no extension

Question 18

what is the medical management of hip replacements

Answer 18

joint replacements are no considered if client will not comply wiht rhab or if client will not experience sifgnificant fucntional improvement
dependent on type of surgery
get patients up and walking 1-3 days after surgery

Question 19

what is the role of the OT in hip replacements?

Answer 19

 Complete occupational profile
 Provide home safety recommendations
 Offer education and reeducation regarding hip precautions, including transfers, home mods, ROM restrictions, and positioning.
 Emphasize maintaining or increasing joint motion
 Increase strength of surrounding musculature
 Emphasize increasing independence in ADLs/IADLs using precautions, safety techniques and compensatory strategies.
 Prescribe and instruct client in useful adaptive equipment.
 Use PAMs as appropriate.

Question 20

what are the different types of structural changes for LBP

Answer 20

sciatic pain, spinal stenosis, facet joint pain
spondylosis - stress fx of forsal transverse process
spondylolisthesi - slippage of a vertebra out of position
herniated nucleus pulposus - stress tearing of fibers of a disc, causing outward bulge pressing on spinal nerves.

Question 21

what are the interventions for LBP

Answer 21

education
neutral spine positioning
body mechanic education
adaptive equipment
task analysis and ergonomic designs
training in energy conservation
pain management

Question 22

what should rehab aim when dealing with injuries

Answer 22

reduction of pain
stabilization techniques
use of adaptive euqipment
incoropation of body mechanics and ergoniomic techniques
adbility to adapt learnig to future applications.

Question 23

what are some interventions uesd with oncology

Answer 23

training in energy conservation, fatigue management, adn activity adn exercise  tolerance to manage the side effects  of medical tratments
independence and safety in ADLs/IADLs
adaptive equipment and assitive tech
psychosocial support,
caregiver training and support
sensory education and denensitization
scar management
wheelchair seating and positioniong
fall prevention
lymphedema treatment
PAMs
end of life care

Question 24

what are signs and symptoms of osteoarthrisis

Answer 24

most affected jointsa re DIPs, PIPs and first CMC, firs MTP, cervical and lumbar apophyseal joints and knee and hips.
symptoms - joint pain, stiffness, limted ROM, local inflammation and creputis of joints.
bouchard nodes on PIP, heberdens on DIP

Question 25

what do you eval for osteoarthritis

Answer 25

ADLs, rest and sleep, work, swallowing evals, fall risk, pain

Question 26

what are some OT interventions for osteoarthritis

Answer 26

occupation based retraining, low impact weight bearing activities
good positioning and posture
enviuronmental modifications
education in body mechanics, energy conservation and joint protection

Question 27

what are the signs and symptoms of RA

Answer 27

symmetric polyarticular presentation - PIP, MCP joints, all thumb joints, wrist, elbowm, ankle, metatarsophalangeal joints, TMJ, hips, knees, shoulder and cervical spine.

symptoms - pain, redness, warmth, tenderness, morning stiffness, ROM lmiitations, muscle weakness, weight loss, malaise, fatigue, and depression

Question 28

what are some common deformities seen with RA

Answer 28

boutonniere deformity, swanneck, mallet finger, ulnar drfit, subluxation of wrist, MCP joints, anklyosis of joint fusion, extensor tendon rupture, trigger finger
mutilans deformity - floppy joints with shortned bones and redundant skin
subcutaneous nodules
claw toe
hammer toe
cock up toe
bunions

Question 29

how can you diagnose RA

Answer 29

need four of the following:
morning stiffness
three or more swollen joints in 14 possible areas
swollen joints of hands
symmetric swoollen joints
RA
serum rheumatoid factor
radiogrpahic changes on posterioanterior hand and wrist radiographs

Question 30

what are the stages of RA

Answer 30

acute
subacute
chronic-active
chronic-inactive

Question 31

what are the classifications for the progression of RA

Answer 31

stage 1 - no changes on xray
stage 2 - evidence of osteoporsis; no joint deformity
stage 3 - joint deformity, muscle atrophy
stage 4 - terminal + all of stage 3

Question 32

what are some ot evaluations used for RA

Answer 32

biomechanical factors
cognitive function factors
psycholigcal factors
loss of social relationships
performance affected by time of day and medkication use
fatigue

Question 33

what are some OT interventions used for RA

Answer 33

lmite activities during acute flare ups
assistve devices
PAMs
therapeutic exercise
splinting during acute flair ups
education on disease process, sypmtoms management, joint protetion, and fatigue managment