Final Exam Wk 5 to 13 Flashcards
(91 cards)
1
Q
Topic Functional Mobility:
What part of the OTPF is included in the evaluation?
A
Evaluation includes client factors and performance skills
2
Q
Define the following weight bearing status
- NWB
- TTWB
- PWB
- FWB
A
NWB-Non weight bearing-Affected foot not touching floor
TTWB-Toe touch weight bearing-May lightly touch the floor for balance, not to weight bear through the leg (10%)
PWB-Partial weight bearing-30-50% of body weight on affected side
FWB-Full weight bearing-Full body weight allowed
3
Q
What are the transfer levels?
- IND
- MOD I
- Contact Guard
- Min Assist
- Mod Assist
- Max Assist
- Dependent
A
Independent-Pt completes transfer I, safely with no assistance
Mod (I)-Pt completes transfer I with use of AE
Contact Guard-Pt requires close supervision
Min Assist-Pt performs 75% or greater of the transfer
Mod Assist-Pt performs between 50% -74 % of the transfer
Max Assist-Pt performs between 25-49% of the transfer
Dependent-Pt assists less than 25 %, performed entirely by 1 or two other people or mechanical lift
4
Q
Public Transportation:
What’s fixed route?
A
Fixed route-defined routes with predetermined stops
OT interventions include: Inform, educate and encourage to use the system. Identifying barriers and providing remediation of compensation for skills.
5
Q
Public Transportation:
What’s paratransit?
A
Paratransit-demand/response with geographic area for qualified riders
OT interventions include: Orientation to system, training in making reservation and education of service limitations
6
Q
Ramps:
For every 1 inch of rise you need _____ foot of run
A
1 foot of run
1 in to 12 in
7
Q
Pain is….
A
Pain is subjective
Pain is multifaceted
Pain is affected by mood, attention, prior pain experiences, familial factors, cultural factors
8
Q
What’s the causation of acute pain?
A
Caused by tissue irritation or damage due to injury, disease or disability
Has a defined onset
Serves a biological purpose
Predictable
Responds to medication or treatment
9
Q
What’s chronic pain?
A
Does not serve biologic purpose
Unpredictable
Does not respond to routine interventions
Often causes changes in personality, lifestyle and functional ability
Associated with depression and anxiety
Lasting longer than 6 months
10
Q
Define the following:
- Allodynia
- Analgesia
A
Allodynia- Pain associated with a stimulus that is not normally painful (light touch)
Analgesia- Absence of pain response to a stimulus that should be painful (burn)
11
Q
Define the following:
- Hyperalgesia
- Hyperesthesia
- Hyperpathia
A
Hyperalgesia- Increased sensitivity to stimuli (includes allodynia and hyperesthesia)
Hyperesthesia- Increased sensitivity to noxious stimuli
Hyperpathia-Abnormal painful reaction to stimuli (especially repetitive) often includes extended duration of pain, frequently with a delay
12
Q
Define the following:
-Hyopesthesia
A
Hyopesthesia- decreased sensitivity to stimuli
13
Q
Define the following:
- Nociception
- Sympathetic pain
- Neuropathic pain
A
-Nociception- Response to a noxious stimuli that produces pain under normal circumstances
Sympathetic pain- Pain associated with an over-action of sympathetic pain fibers (CRPS)
Neuropathic pain- Pain from nerves
14
Q
What’s Bipsychosocial model of pain?
A
Focuses on the interaction between body, mind, and environment
Conceptualizes the multilayered nature of pain
Pain behaviors can exist in the absence of nociception
15
Q
What’s the 4 distinct domains of the Bipsychosocial model of pain?
A
Four distinct domains:
Nociception- detection of tissue damage transmitted to A-delta and C fibers in the peripheral nerves. Tells the body to react to pain (pull hand away from hot stove)
Pain- Perceived noxious input to the nervous system
Suffering- The negative affective response to pain
Pain Behavior- What an individual says/does or does not say or do leading others to believe they are in pain. Pain behaviors are influenced by culture, family, experiences and environment
16
Q
What are common pain syndromes?
A
Headache Pain Low Back Pain Arthritis Complex Regional Pain Syndrome Myofascial Pain Syndrome Fibromyalgia Cancer Pain Disability-Related Pain
17
Q
CRPS…what is is and what are the 2 types?
A
Complex Regional Pain Syndrome Previously known as Reflex Sympathetic Dystrophy (RSD) No clear cause No precise way to diagnose No gold standard treatment
Two Types
CRPS I- No known cause
CRPS II- Same s/s of I but directly related to a nerve injury
18
Q
What are the signs and symptoms of crps?
A
Severe pain- Out of proportion (often refuse to be touched) Swelling Stiffness Discoloration Decreased function
Vasomotor changes- Changes in color and temperature
Sudomotor changes- Changes in sweat
Trophic changes- Changes in nails, finger pad and skin appearance, bone health
Pilomotor changes- Changes in goosebump response
19
Q
What are medical management for CRPS?
A
-Medications: Corticosteroids, NSAIDs Antidepressants Anticonvulsants Topical agents Opiates
- Nerve Blocks
- Neuromodulation (i.e. spinal cord stim)
20
Q
What are signs and symptoms present in Myofascial Pain Syndrome?
A
Muscle pain Presence of trigger points Pressure on trigger points causes pain to well-defined distal area (predictable pain referral pattern) Usually constant dull ache Commonly found in the UT
21
Q
What are interventions for myofascial pain?
A
Needling
Manual therapy
Modalities
22
Q
What are the 5 different pain assessments
A
Numeric analog scales- Line with markings from 0-5, 10 or 20 is used to indicate
pain level
Visual analog scale- Patient uses a 10 cm line to indicate pain level
Verbal rating scale- Patient describes pain in 4/5 words
Graphic representations- marking pain on a body chart
Pain Questionnaire-Written standardized Questionnaire (McGill’s)
23
Q
What are the mechanism of nerve injury?
A
Compression or Entrapment ¡ Internal sources ¡ External sources Traction Avulsion Laceration Burn (Thermal/Electrical) Chemical Ischemic Radiation Injection injuries
24
Q
Symptoms of nerve injury for motor/sensory/autonomic
A
Motor ¡ Weakness ¡ Venous/lymphatic issues ¡ Atrophy ¡ Muscle/joint fibrosis
Sensory ¡ Paresthesia ¡ Altered vibratory perception ¡ Abnormal discrimination ¡ Decreased functional use ¡ Increased risk of burn
Autonomic ¡ Vasomotor ÷ Skin temp, edema, color ¡ Sudomotor ÷ Sweat patterns ¡ Pilomotor ÷ Absence of goosebumps ¡ Trophic ÷ Nail and hair changes, slowed skin healing and slow bone growth in kids
25
Where is motor screen at C5, C6, C7, C8, T1?
```
C5- Shoulder abd
C6- Elbow flexion, wrist ext
C7- Elbow ext, wrist flexion
C8- Digital flexion
T1- Digital abd/add
```
26
Where is sensory screen at C5, C6, C7, C8, T1?
```
C5- Skin over deltoid
C6- Tip of thumb, radial wrist
C7- Tip of middle finger
C8- Tip of SF, Ulnar wrist
T1- Medial elbow
```
27
# Define incomplete injury
What are the different types of incomplete injuries (7)
Incomplete- External tissue remains to some degree
attached. Prognosis varies by damage
1. Mononeuropathy- damage to single nerve
2. Multiple mononeuropathy- muti-focal, asymmetrical
involvement of multiple nerves (ie. MN and UN)
3. Double crush syndrome- One nerve, multiple sites of
pathology
4. Polyneuropathy- B/l extremity damage to two or
more PN due to metabolic changes
5. Peripheral polyneuropathy- Often hands and feet, in
smokers, alcoholism, autoimmune diseases.
6. Neuropraxia- Compression and loss of blood flow to
a nerve = sensory and motor loss. Recovery weeks to
months (Saturday night palsy) (Sutterlands type 1)
```
7. Axonotmesis-Severe compression, axons distal to
compression degenerate. Endoneurial tubes remain,
good recovery (Sunderland type 2)
```
28
# Define complete injury
What are the different types of complete injuries (5)
Complete- Poorest prognosis, need surgical
intervention
1. Sunderland type 3- Destruction of endoneurial tubes
2. Sunderland type 4- Destruction of perineurium
(significant internal scarring which impairs functional
recovery) Nerve graft probably required
3. Sunderland type 5 and 6- Physiologic disruption of entire
nerve or section of nerve. Requires surgery.
4. With complete severed PN will see loss of sensation, motor control,
reflexes.
5. Wallerian degeneration- Breakdown of the axon distal to
site of injury. Starts 48-96 hrs after injury and concludes
3 wks after injury. During this process there is
deterioration of myelin and distal axons become
disorganized. (Surgery best performed before this starts)
29
What are different medical management techniques for Peripheral nerve damage ?
Primary nerve repair- within first wk of injury
Secondary nerve repair- week or more after injury
Nerve grafting- when primary repair on the cut ends
can not occur due to tension on the nerve
¡ Autograft-harvested from sensory nerves
¡ Allograft- cadavers
¡ Conduits- commercially available tubes to bridge gap
Neurolysis- free nerve from surrounding tissue
Nerve decompression- remove nerve from
impingement by moving nerve or cutting tissue
Tendon transfers
30
Define Neuropraxia
Neuropraxia- A conduction block, no anatomical
| disruption- all components attached
31
Define Axonotmesis
Axonotmesis- Disruption of axons and myelin
| sheaths, but endoneurial tubes are intact
32
Define Neurotmesis
Neurotmesis- Complete severance or serious
| disorganization- No spontaneous recovery
33
What factors influence regeneration?
| How long does it take?
```
Factors that influence regeneration
¡ Age
¡ Amount of scar tissue
¡ How high the injury (proximal worse prognosis)
¡ Delayed reconstruction
¡ Severity of injury
¡ Inaccurate alignment of fascicles during surgery
¡ Neuroma development
```
-Regeneration: 1-4mm per day (after 3 wks of
Wallerian degeneration) (about 1 in per month)
34
What's the pattern of sensory recovery?
```
Pain perception
Vibration of 30 cps
Moving touch
Constant touch
Vibration 256 cps
```
35
How does high radial nerve injury looks like?
Presentation
¡ Tricep spared (can ext elbow)
¡ Weakness- wrist ext, supination, thumb ext, MP ext
¡ Paresthesia- dorsum of the hand
High Radial Nerve Injury
¡ Crutch palsy- compression at axilla, motor and sensory
involvement
¡ Saturday night palsy (High RN injury)- compression of the RN
at midhumerus, motor and sensory involvement (tricep
spared)
¡ Humeral shaft fx
36
What 3 syndromes is caused by compression of the median nerve?
Pronator syndrome:
Anterior interosseous syndrome:
Carpal tunnel syndrome:
37
Sensory Re-education is divided into 2 stages, what are they?
Divided into two stages
1. Protective sensory reeducation
2. Discriminative sensory reeducation
38
What are the 2 phases of Discriminative sensory reeducation?
Two phases
1. Early phase- Starts when protective sensation,
÷ Use of visual/auditory cues
÷ Imagining a movement and the feel of touch
÷ Mirror therapy
2. Late phase-When moving/constant touch of 256 cps is
perceived at fingertips with good localization
÷ Functional tasks
÷ Desensitization
÷ Sensory localization
39
What's the ASIA impairment Scale?
§ A= Complete. No sensory or motor function is preserved below the level of injury.
Includes sacral segments S4-5
§ B = Sensory Incomplete. Some sensation is preserved, but no motor function is
preserved below the level of injury. Includes sacral segments S4-5
§ C = Motor Incomplete. Motor function is preserved below the neurological level of
injury and the muscles have a muscle grade less than 3.
§ D = Motor Incomplete. Motor function is preserved below the level of injury and at
least half of the key muscle functions below the level of injury have a muscle grade
greater than or equal to 3.
§ E = Normal. Motor and sensory function are normal in all segments.
40
Define clinical syndromes
§ After SCI spinal shock occurs from 24 hrs to 6 wks. Reflex activity ceases below the
level of injury.
§ Bowel/Bladder – above T12 (Upper motor neuron)spastic, L1 and below (lower motor
neuron) bowel/bladder flaccid
§ Deep tendon reflexes are decreased, sympathetic functions disturbed due to low BP,
constriction of blood vessels, slower HR, no perspiration below level of injury
§ Muscles below the level of SCI usually develop spasticity
§ Sympathetic functions become hyperactive
41
What does a median nerve orthosis do?
Prevent thumb add contracture (web space
| contracture)
42
What are the compression Sites of the UN ?
Cubital tunnel
| Guyon’s canal (ulnar tunnel)
43
Guyons Canal
```
Pain, sensory symptoms and/or motor weakness
(depends on area of compression)
AKA -handle bar palsy
Test- Compression to canal
TX- padded glove, injection, surgery
```
44
Ulnar Nerve Orthosis
Prevents...?
And puts MPS in... (flexion or extension) ?
Prevent RF/SF from clawing
| Put MPs in flexion
45
What are the 4 functions of skin
1. Protection: Environmental barrier, moisture barrier
2. Thermoregulation- temp regulation, prevents heat loss, allow for rapid
cooling
3. Neurosensory- processing environmental stimuli (pressure, pain, temp)
4. Cosmesis- Body image
46
Name the 3 parts of the skin anatomy
1. Epidermis-
§ Non-vascular
§ Rapid regeneration
§ Protects from sun
2. Dermis-
§ Vascular
§ Fiberous connective tissue made up of collagen and elastin,
§ lymph spaces, sweat glands, hair follicles
3. Subcutaneous tissue
§ Fatty tissue
§ Fibrous CT
47
Burn Depth
§ Burn wounds are now classified by depth:
§ Superficial (1st degree)
§ Superficial partial thickness (superficial 2nd degree)
§ Deep partial thickness (deep 2nd degree)
§ Full thickness (3rd degree)
§ Subdermal (4th degree)
48
What are the phases of wound healing?
Stages are overlapping
§ Inflammatory Phase
3-10 days after injury
§ Proliferation Phase
Day 3 till wound heals
Maturation Phase
§ Week 3- 2 years
49
1. Describe a Hypertropic scar. How long for wound closure?
2. How long does hypertrophic scars mature?
3. Does it lead to loss of motion/joint contracture?
4. Can scar formation be influenced by proper positioning, exercise, splinting, and
compression?
1. Scar development varies by: amount of time for wound closure, age, race,
burn depth, infections
Hypertrophic scars: are thick, rigid, red scars (6-8 wks after wound closure)
Deeper wounds that take over 2 wks to heal have an increased wrist of
hypertrophic scaring
2. Hypertrophic scars mature btwn 12-24 months (keloids take up to 3 yrs)
3. Can lead to loss of motion and joint contracture
4. Can influence scar formation by proper positioning, exercise, splinting, and
compression
50
Medical Management:
Fluid resuscitation:
Fluid resuscitation:
§ With IV fluids such as Ringer solution. Monitor vitals, hematocrit and urinary output
51
Medical Management:
Edema
Edema:
§ Can cause compartment syndrome- interstitial pressure get high enough to
compress blood vessels, tendons and nerves which can lead to tissue death
§ Escharotomy or Fasciotomy are performed
52
Medical Management:
§ Respiratory management
Smoke inhalation, burns to face
§ Tracheostomy, ventilator (over oral intubation)
53
Medical Management:
Wound care and Infection control
-Surgical – graft
| § Non surgical- dressings
54
What are the 8 methods to wound care?
1. Topical agents
- Used to control microbial colonization and prevent infection
2. Biologic Dressings
- Temporary coverings to close wound (prevent infection, reduce fluid loss, decrease pain)
- Allograft (cadaver skin), Xenografts (pig skin)
3. Biosynthetic Products
- Used to close wounds, may lead to less pain, faster skin regrowth and less scarring
4. Hydrotherapy
-Removes debris and left of topical antibiotic. Use of shower trolley (nonsubmersive). Pain
medications.
-Therapist usually performs ROM at this time
5. Sepsis
-Can result due to infection (s/s ischemia, tachycardia, hypotension, hypothermia, disorientation,
decrease urinary output, coma)
6. Surgical Intervention
- When wound will take more than 2 wks to heal (Debridement, skin grafts)
7. Vacuum-Assisted Closure
- A sealed dressing and controlled negative pressure
8. Nutrition
55
Skin Grafts
-Split thickness skin graft- Upper layers of skin (epidermis, part of dermis)
§ Can cover large areas
-Full thickness skin graft- Epidermis and dermis
§ Need for deep burns where bone, tendon are at risk
-Microvascular skin flap
§ Provides vascularization
§ Can include skin, fat, muscle, bone
56
What are the 3 Complications of Burns
-Stress
§ Reliving the event, avoidance, hypervigilance
§ PTSD
-Pain
§ Pharmacologic tx (opiates, anti-inflammatory drugs, antidepressants,
anticonvulsants, benzodiazepine, ketamine)
§ Nonpharmacological tx (CBT, hypnosis, relaxation techniques, breathing
exercises, guided imagery, music therapy, aromatherapy etc)
-Psychosocial Factors
§ Depression
§ Severe grief
§ Denial/isolation, Anger, Bargaining, Depression, Acceptance
57
Burn rehab STG/LTG?
§ Multidisciplinary team
```
§ Goals
-STG
§ Providing support
§ Preparing for self-care tasks
§ AROM
§ Education
```
- LTG
§ Established with patient, family and rehab team
58
What are the 3 phases of recovery for burn pts?
1. Acute care phase
§ Psychosocial support, edema, prevent contractures and loss of ROM, strength and
activity tolerance, Promote occupational performance and I with self-care,
education
2. Postop phase
§ Protect/preserve graft and donor sites (splints, positioning), Prevent atrophy and
DVT (exercises as appropriate), I with self-care, AE, Educate
3. Rehab phase
§ Begins when wound closes
§ All above goals including:
§ Scar mgt program, compression therapy, improve jt mobility and prevent contractures
§ Restore ROM, MMT, coordination and endurance
§ ADL, IADL retraining, post dc planning (school, work)
59
When is OT eval done for pts? What does it include?
§ Eval done btwn 24-48 hrs after admission
```
§ Gather PMH, secondary dx, burn etiology
§ Assess wounds
§ Occupational profile (both pt and family)
§ Joint mobility
§ Strength
§ Sensation
§ Functional use
§ Education
```
60
OT interventions for burns
```
§ Preventive positioning
§ Splinting
§ ADLs
§ Therapeutic exercise
§ Scar management
§ Compression therapy
§ Edema management
```
61
Preventive positioning for burn pts
§ Goals
§ Reduce Edema
§ Maintain antideformity position***
§ Pedretti pg 1128
§ Position of comfort is usually position of contracture
§ Position of contracture includes
§ UE- shoulder add and flexion
§ LE-flexion of the hip, knees with plantar flexion of the ankles, toes pulled dorsally
§ Hand- MP ext, IP flexion, Thumb add (claw hand)
62
Splinting for burn pts
```
§ Splint in antideformity position
§ Acute phase- static splint
§ Volar hand splint-
§ Wrist ext 15-30*, MP flex 50-70*, IP ext, Th abd/ext
§ Elbows and knees
§ 5* of flexion
§ Ear protection splint
§ Check for pressure
§ Assessment daily
§ Secure with figure of 8 wrap
```
63
Immobilization after surgery
§ Split thickness skin grafts (STSG) 3-5 days
§ Epithelial grafts 7-10 days
§ Avoid shearing after graft placement
§ Assess surrounding tissue for graft integrity
§ Donor sites are treated similar to burn sites
64
ADLS acute phase for burn pts
§ Can be very limited during acute phase
§ Self suctioning of oral cavity if not facial burns have occurred
§ After extubation oral care is attempted
§ Self feeding when cleared by MD
§ AE for ADLs
§ Select tasks with high probability of success
65
What does scar massage/skin conditioning do for burn pts?
§ Help improve scar integrity and durability
§ Used on any burned area taking over 2 wks to heal
§ Lubrication and massage with water based cream performed 3-4 x per day
§ Help desensitize, soften scar bands
§ Massage in circular motion (pressure increases gradually over time)
§ Scar maturation takes 12-18 mo after injury
66
Compression therapy for burn pts
```
§ Initiated early usually 5-7 days after removal of dressings
§ Decrease hypersensitivity, edema control and scar compression
§ Considerations
§ Shearing force
§ Pressure gradient
§ Ease of application
§ Consistency of pressure
§ Skin tolerance
```
67
Edema management for burn pts
§ Chronic edema can lead to fibrosis
§ Elevation, progressive compression and activity are recommended
§ Coban used for digits, hands and feet (tips of finger left open to monitor
color)
§ Elastic wrap for remainder of limb
§ Elevate above heart
§ LE’s double wrapped when ambulating, elevation when resting
§ Compression pump therapy used for distal extremities
§ Custom made compression garments (OT measures, orders and fits)
§ Worn 23 hrs/day
§ Must apply equal pressure over entire burned area
68
Burn complications
```
§ Heterotopic ossification
§ Neuromuscular complications (burn of PNS)
§ Electrical burns
§ Infection
§ Metabolic abnormalities
§ Neurotoxicity
§ Facial disfigurement
§ Rigid facial orthosis for scar mgt
```
69
PSYCHOSOCIAL ADJUSTMENT TO AMPUTATION:
| Grieving process?
•Grieving process (denial, anger, depression, coping and acceptance)
Note*
•Hostility and anger are common. It is important to react with positive reinforcement with use of the rehab process and provide interactions with other amputees
70
AMPUTATION:
| •Skin-most common postsurgical problem and treatments
* Delayed healing, extensive grafting, wounds, infection, allergic reaction
* Can occur during any stage of rehab process
```
Treatments include
•Daily massage
•Compression wrapping
•Skin checks
•Gradual wearing schedule
```
71
AMPUTATION: Define hyperesthesia
| How can you desensitize the limb?
* Hyperesthesia-Overly sensitive limb
| * Desensitization of residual limb includes texture stimulation, tapping and massage
72
AMPUTATION: Whats Neuroma? What does treatment include?
Neuroma-
•Small ball of nerve tissue caused by axons attempting to re-grow toward the distal limb. Can cause pain with pressure. Most occur 1-2 in from end of the residual limb.
Treatment includes injection, US, massage, stretching.
•Surgical interventions.
•Adjustment to socket
73
AMPUTATION:Phantom limb
* Sensation of the limb that has been amputated
* Normal sensation, may reduce over time or may remain
* TX: Education and counseling and use of residual limb
74
AMPUTATION: •
| Phantom Sensation
* Phantom Sensation
* Cramping, pain, squeezing, numb/tingling, stuck, cold, moving, hot, achy
* Constant or intermittent
* TX: Isometric exercises, AROM of residual limb, mirror therapy, biofeedback, TENS, US, relaxation exercises, controlled breathing
* Tapping, massage, pressure
75
AMPUTATION: Bone spurs-
```
Excess bone usually at the end of the residual limb
•DX by X-ray
•Pain, continued drainage
•TX-surgery
•
Can grow back
```
76
AMPUTATION: Factors that affect wound healing include:
Smoking, DM, renal disease, cardiac disease and infection
* Infection from contaminated wounds including foot ulcers or traumatic open injuries
* Wound must be closed for prosthetic wearing
* Monitor for wounds, blisters, redness during prosthetic training/wearing
77
AMPUTATION: CONSIDERATIONS FOR PROSTHESIS includes?
* Age
* Health status
* Amputation level
* Skin condition
* Cognitive status
* Pt’s preference
78
AMPUTATION: PREPROSTHETIC TRAININGPREPARING RESIDUAL LIMB
* Desensitization-tapping, massage, vibration, pressure, textures
* Scar management/skin grafts-massage
* Shaping the limb-wrapping, figure of 8 method (video)
* Circumference measurements
* ROM
* Endurance
* Education-Hygiene, wrapping, desensitization program, insensate skin, SKIN INSPECTION
79
AMPUTATION: PROSTHETIC PROGRAM
* Begins after final fitting with prosthetist
* Team program-prosthetist, client and therapist work closely. Numerous adjustments are usually required
* Functional training using meaningful activities
* Prosthetic is used as ”helper” will not mimic lost limb
* If the ptwas R handed and had a R UE amp, they are now L handed
* Training-hygiene, donning/doffing (coat and sweater methods)
* Wearing schedule (15-30 min, 3 x per day, increasing 30 min daily) SKIN INSPECTION!
80
AMPUTATION: WHAT ARE 5 BODY POWERED DEVICE COMPONENTS
1. Prosthetic sock-absorbs perspiration and protects skin from irritation. Used for volume change in socket
2. Socket-Cast molding of residual limb is used to make socket. All other components are attached. Fits over the residual limb.
3. Harness and Control System
•Figure of 8 harness commonly used
•Action of the UB creates tension when operates the prosthesis
4. Terminal Device-to grasp and maintain an object
•Hook-functional
•Voluntary opening (VO)-opens when wearer exerts tension on cable
•Voluntary closing-(VC)-closes when wearer exerts tension on cable
5. Hand
•Cosmetic-min function
81
AMPUTATION: ELECTRIC POWERED PROSTHESIS
Myoelectric prosthesis-“Uses muscle surface electricity to control the prosthetic hand function”
82
AMPUTATION: PREPROSTHETIC THERAPY
* Can be a frustrating process
* Id potential muscle sites
* Improve muscle control and strength
* Use of a myotesterto help train muscles with both auditory and visual feedback
* Preparatory socket and prosthetic fitting-used to find optimal mm sites and fit
* Financial consideration
83
AMPUTATION: PROSTHETIC PROGRAM FOR MYOELECTRIC LIMB
* Orientation of prosthesis
* Education-don/doffing, skin checks, charging procedure, residual limb care
* Wearing schedule-15-30 min to start, with increases of 30 min increments 2-3x per day. Check for redness *if redness does not subside within 20 min after removal of prosthesis, prosthesis should be returned to prosthetist for adjustments
84
```
AMPUTATION:
Terminology
AKA
BKA
Ankle disarticulation
```
•95% of all LL amps in US due to PVD with 25-50% due to DM complications
* Terminology
* AKA (Above-knee amputation/transfemoral)
* BKA (Below-knee amputation/transtibial)
* Ankle disarticulation/Syme’samputation)
85
AMPUTATION: POSTSURGICAL CARE
```
Skin care
•Positioning
•Wrapping
•Shrinking and shaping can take up to 3 moor longer
•Scar mgt
•Psychosocial issues
```
86
AMPUTATION: OT INTERVENTION
* Education
* ADLs
* Adaptive equipment for ADLs, repositioning
* Wheelchair fitting-
* IADLs
* Sleep-phantom symptoms
87
CONDITIONS AFFECTING SEXUAL FUNCTIONING
* Amputations
* Arthritis
* Burns
* Cardiac disease
* Cerebral palsy
* CVA
* Diabetes
* Hand injury
* Head Injury
* Musculoskeletal injuries
* Spinal cord injury
88
OCCUPATIONAL THERAPY ROLE in intimacy
* Goals that facilitate an increased self-esteem
* Foster feelings of self-worth and positive body image
* Encourage trust and communication
* Be prepared with information and resources
* Approaches to intervention can include individual, partner or group sessions
* Role may depend on your practice setting
89
OCCUPATIONAL THERAPY INTERVENTIONS MACRAE (2016)
* Health promotion:
* Remediation:
* Modification:
* Health promotion: This approach consists of support groups, educational programs, and stress-relieving activities.
* Remediation: This approach consists of restoring skills, such as range of motion, strength, endurance, effective communication, and social engagement, as part of meeting sexual needs.
* Modification: This approach consists of changing the environment or routine to allow for sexual activity.
90
What's PLISSIT
* Approach to guide the therapist in helping the client deal with sexual information
* Permission-Allowing the client to to feel new feelings and experiment with new thoughts or ideas regarding sexual functioning
* Limited information-Explaining what effect the disability can have on sexuality. Facts are shared, myths dispelled
* Specific suggestions-for specific problems that relate to disability such as positioning. (Highest level of input the average OT should attempt without advanced training)
* Intensive Therapy-Advanced training
91
Intimacy resources
```
•Healthcare Providers
–Primary Care Physicians
–Urologists, Gynecologists,
–Behavioral Health (Psychologists/Psychiatrists)
–OT/PT
–Nurses
–Social Workers
–Fertility specialists
–Certified Sex Counselors or Therapists
```
* Peer connections or support groups
* Internet
