Hand and Upper Extremity Flashcards
(85 cards)
1
Q
What are the bones of the forearm and upper arm?
A
Radius, Ulna, Humerus
2
Q
What are the muscles of the forearm and upper arm?
A
Deltoid, Triceps, anconeus, biceps, brachii, brachioradialus, brachialis
3
Q
What arteries provide blood supplies to the forearm and upper arm
A
Brachial artery and brachiocephalic artery
4
Q
What are the bones of the hand and wrist?
(Some Lovers Try Positions That They Can’t Handle”
A
Scaphoid, Lunate, Triquetrum, pisiform (proximal)
Trapezium, Trapezoid, Capitate, Hamate (distal)
5
Q
What are the muscles that originate from the lateral epicondyle?
A
Anconeus, Brachioradialis, Supinator, Extensor carpi radialis longus (ECRL), Extensor carpi radialis brevis (ECRB), Extensor carpi ulnaris (ECU), Extensor digitorum (ED), and Extensor digiti minimi (EDM)
6
Q
What are the muscles that originate from the medial epicondyle?
A
Pronator teres, Flexor carpi radialis (FCR), Flexor carpi ulnaris (FCU), Palmaris longus (PL), and Flexor digitorum superficialis (FDS)
7
Q
What are the main arteries that supply blood to the hand and wrist?
A
Radial and Ulnar arteries
8
Q
What are the sensory receptors of the hand?
A
Pacinian corpuscles - responsible for vibration
Ruffini end organs - responsible for tension
Merkel cells - responsible for pressure
9
Q
-Establish rapport and review medical history and history of current condition. Identify occupational profile
-Observe posture, spontaneous use of upper extremity and hand, guarding, scar, wounds, and skin
-Use gentle approach to palpation to check for pain, adhesions, and edema, and use provocative nerve tests to elicit symptoms and clarify the injury
-Specific testing
=Pain scales
=Wound and scar assessment: Size, Depth, and Color
=Vascular: Observation of color, trophic changes, pulses, skin temperature, capillary refill, peripheral pulse, modified Allen’s Test
=ROM: active and passive goniometric measurements
=Edema: Volumeter or centimeter tape
=Sensation: Semmes-Weinstein monofilament and two-point duscrimination. Monofilament is used for nerve compression, and two-point discrimination is typically used for nerve laceration and recovery
=Strength: Manual Muscle Testing, dynamometer, and pinch gauge meter
=Coordination: O’conner Dexterity Test, Nine-Hold Peg Test, Jebsen-Taylor Hand function Test, Minnesota Rate of Manipulation Test, Crawford Small Parts Dexterity Test, and Purdue Pegboard test
-Interview the client about pain, splint, and functional use; use an ADL checklist to uncover ADL dysfunction and set goals
-Measure outcomes using the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick DASH) before and after therapy
=Quick Dash - asks about your symptoms as well as your ability to perform certain activities.
A
EVALUATION of Hand
10
Q
Base shaft, neck, head, such as a boxer’s (4th and 5th finger) fracture
A
Finger Metacarpal fracture
11
Q
Type of Thumb Fracture
A
Thumb base fracture - Bennett Fracture
Shaft and neck fracture
Torn ligament - Skier’s thumb
12
Q
Occur when the tendon separates from the bone and insertion and removes bone material with the tendon
A
Avulsion Injuries:
Mallet Finger, Boutonniere Deformity, Swan Neck Deformity
13
Q
What is a Mallet Finger? How do you splint this injury?
A
Mallet Finger is avulsion of the terminal tendon and is splinted in full extension for 6 weeks
14
Q
What is a Boutonniere Deformity? How do you splint this injury?
A
Boutonniere deformity is disruption of the central slip of the extensor tendon characterized by proximal interphalangeal (PIP) flexion and distal interphalangeal (DIP) hypertension;
the PIP is splinted in extension, and isolated DIP flexion exercises are performed.
15
Q
What is a Swan Neck Deformity? How do you splint this injury?
A
Swan neck deformity is injury to the metacarpophalangeal (MCP), PIP, or DIP joints characterized by PIP hyperextension and DIP flexion
the PIP is splinted in slight flexion
16
Q
What are the 3 common phases of fracture healing?
A
Inflammation - provides the cellular activity needed for healing
Repair - forms callus for stabilization
Remodeling = deposits bone
17
Q
Medical intervention for fractures
A
Closed reduction (CR) or open reduction, internal fixation (ORIF)
18
Q
What is heat, ultrasound, cryotherapy, paraffin, and transcutaneous electrical nerve stimulation (TENS)
used for?
A
these are modalities for pain relief and tissue healing
19
Q
What is early controlled mobilization? And when does it begin?
A
Therapeutic exercises provide motion to further enhance performance and function to ultimately improve ADL performance.
Controlled AROM begins 3-6 weeks after fracture IF FIXATION IS STABLE.
20
Q
What is the most severe complication of hand fracture?
A
Complex regional pain syndrome (CRPS)
21
Q
What is a Colles Fracture?
A
Collest fracture is a type of wrist fracture that is a complete fracture of the distal radius with dorsal displacement. It is the most common type of fracture.
Occurs as a result of a fall on an outstretched hand
22
Q
What is a Smith’s Fracture
A
SMith’s fracture is a type of wrist fracture that is a complete fracture of the distal radius with palmar displacement (opposite of Colles fracture)
23
Q
What is the most common fracture seen and missed in injuries to the wrist?
A
Fractures of the scaphoid carpal bone
24
Q
What is Lunate fracture associated with?
A
Keinbock’s disease - avascular necrosis of the Lunate (lunate loses blood supply leading to death of the bone)
25
What are nerve injuries associated with wrist fracture?
Median nerve injury & Ulnar Nerve injury
26
What is Median Nerve Injury?
Median nerve injury produces carpal tunnel - like symptoms, such as palmar numbness and numbness of the first digit to the half of the fourth digit, with generalized weakness and pain
27
What is Ulnar Nerve Injury?
Ulnar nerve injury results in ulnar claw deformity and numbness of the ulnar side of the hand and the fifth and half of the fourth digits, with generalized weakness of the ulnar side of the hand and pain
28
ROM is allowed in the early phases of healing and repair
Orthotics are used to protect the extremity from motion or allow for protected motion; later, dynamic or static-progressive orthotics can be used after the fracture is healed to increase ROM
Edema and [ain reduction techniques, scar management, and desentization techniques
A home program is provided to increase progression of function and outcomes
Exercises are used to facilitate movement and improve performance of the UE; ex: include AROM with wrist extended and fingers flexed; blocking exercises; tendon and nerve gliding exercises; stretching exercises and later strengthening exercises (e.g., use of therapy putty, hand exercises)
Modalities (e.g., heat, ultrasound, cryotherapy, paraffin, TENS) are used to prepare tissues for work and assist with pain relief and tissue healing
INTERVENTION for wrist fracture
29
What is the primary and most severe complication of distal radius fracture is
Complex regional pain syndrome (CRHS
30
What is the most common elbow fracture?
Radial head fracture. these fractures are usually caused by a fall on an outstretched hand (FOOSH)
31
What is Type I forearm fracture?
Type I forearm fracture is a nondisplaced fracture that can be treated with a long arm sling
32
What is Type II forearm fracture?
Type II forearm fracture is displaced with a single fragment treated non operatively with immobilization for 2-3 weeks and early motion with medical clearance
33
What is Type III forearm fracture?
Type III forearm fracture is comminuted and is treated operatively with immobilization and early motion within the first postoperative week as medically prescribed
34
What is the most common fracture if the upper arm?
Proximal humeral fractures
35
-Orthotics (e.g., humeral fracture brace) can be worn for support of the fracture ends
-ROM may begin as early as 2 weeks after a nonoperative fracture as medically prescribed
-A sling is used to immobilize the fracture in nonoperative treatments
-A ROM protocol consists of aggressive stretching and can begin 4-6 weeks after the fracture as prescribed by the physician
-Management at home
=A home exercise program is crucial for the return of motion and function and for ADL performance
=The home program can include a sling for comfort and sleeping for the first 6 weeks as needed
INTERVENTIONs for Fractures of the upper arm
36
Allodynia (sensation misinterpreted as pain)
Hyperalgia (increased response to painful stimuli)
Hyperpathia (Pain that continues after stimuli removed)
Edema
Contractures
Bluish or red, shiny skin
Abnormal sweating and hair growth
Muscle spasms
Decreased strength
Low tolerance for activity
These are symptoms of CRPS
37
- Stellate or sympathetic block = an injection of local anesthetic into the front of the neck or lumbar region of the back to block pain
- Intrathecal analgesia = injection of pain medication into spinal canal
- Removal of neuroma = Surgery to remove a thickened nerve
- Installation of spinal cord stimulator = a small electrical pulse generator implanted in the back to control pain
- Installation of peripheral nerve stimulator = electrodes placed on the peripheral nerves to send electrical impulses to control pain
These are medical treatment for CRPS
38
- Gentle, pain-free AROM for short periods; no passive range of motion (PROM) or painful treatment
- Stress loading: for example, scrubbing the floor, carrying a weighted handbag
- Pain control techniques: Transcutaneous electrical nerve stimulation, splinting (static, then dynamic as tolerated), continuous passive motion
- Edema control techniques: Elevation, massage, AROM, contrast baths, compression
- Desensitization techniques, fluidotherapy
- Blocked exercises, tendon gliding
- Joint protection, energy conservation
OT INTERVENTION for CRPS
39
What is Cumulative Trauma Disorder (CTD)?
CTD is trauma to soft tissue caused by repeated force AKA overuse syndrome and repetitive straining injury
40
What are some diagnosis of cumulative trauma disorder (CTD)?
Tendinitis; Nerve compression syndrome, Myofascial pain; Cervical/thoracic/lumbar osteoarthritis or nerve root impingement; Thoracic outlet syndrome; Rotator cuff tear; Bursitis; Epicondylitis; Cubital tunnel syndrome; Carpal tunnel syndrome; De Quervain syndrome
41
What are symptoms of cumulative trauma disorder?
muscle fatigue, chronic inflammation, pain, sensory impairment, and decreased ability to work
42
What are the five grades of severity of CTD?
Grade I = pain after activity, resolves quickly
Grade II = Pain during activity, resolves when activity stop
Grade III = Pain persists after activity and affects work productivity; objective weakness and sensory loss
Grade IV = use of extremity results in pain up to 75% of time, work is limited
Grade V = Unrelenting pain, unable to work
43
-Acute phase
=Reduction of inflammation and pain through static splinting, ice, contrast baths, ultrasound phonophoresis, iontophoresis, and high-voltage electric and interferential stimulation
-Subacute phase:
=Slow stretching, myofascial release, progressive resistive exercise as tolerated, proper body mechanics, education on identifying triggers and returning to acute phase treatment with flare ups; static splint during activities that cause pain
-Return to work
=Assessment of job site, tools used and body positioning
=Therapy using a work simulator, weight well, elastic bands, putty, functional activities, and strengthening activities
-Functional capacity evaluation
-Work hardening
OT INTERVENTION for Cumulative trauma disorder (CTD)
44
What are the 5 zones of extensor tendon of THUMB
Zone I = Falls over the interphalangeal (IP) joint
Zone II = Falls over the proximal phalanx
Zone III = Falls over the MCP joint
Zone IV = Falls over the first metacarpal
Zone V = Falls over the wrist
45
What are the 7 zones of extensor tendon of digits II-V?
Zone I = Distal interphalangeal joint
Zone II = Middle phalanx
Zone III = Proximal interphalangeal joint
Zone IV = Proximal phalanx
Zone V = Metacarpal phalangeal joint (MCP joint)
Zone VI = Metacarpophalangeal bone
Zone VII = Carpal bones and wrist
46
- Exercises promote tendon excursion and prevent adhesions
- Modalities include heat, to gradually prepare the tissue for motion, and neuromuscular electrical stimulation (NMES), to promote tendon excursion and activation. Use of modalities begins once cleared by the prescribing physicians
- A clearly identified and planned home exercise program is important to ensure the client’s safety and progress toward goals
- Tendon glides are used to promote excursion and prevent adhesions
- ROM
- Strengthening usually is not initiated until the late phase of the repair, around 8-12 weeks after surgery
OT INTERVENTION for extensor tendon after surgical repair
47
What are the 5 zones of flexor tendons?
Zone I = extends from the fingertips to the center portion of the middle phalanx
Zone II = extends from the center portion of the middle phalanx to the distal palmar crease
Zone III = extends from the distal palmar crease to the transverse carpal ligament
Zone IV = overlies the transverse carpal ligament
Zone V = extends beyond the level of the wrist
48
What is the DURAN protocol?
The Duran protocol is a early passive ROM program
49
What is the Kleinert protocol?
the Kleinert protocol involves active extension of digits with passive flexion via traction, typically via rubber band
50
What is the Early active motion protocol?
The Early active motion protocol begins within days of surgery to prevent adhesions and promote tendon gliding and excursion
51
What is an immobilization protocol?
An immobilization protocol is advisable only for patients who are unable to care for themselves or sometimes used with children to prevent rupture of the repair
52
What is Splinting?
Splinting is used to prevent rupture because the repaired tendon is at its weakness 10 to 12 days post surgery
53
-Exercises promote tendon excursion and prevent adhesions
-Modalities include heat, to gradually prepare the tissue for motion, and NMES, to promote tendon excursion and activation. Use of modalities begins once cleared by the prescribing physician
-A clearly identified and planned home exercise program is important to ensure the client’s safety and progress towards goals
-Tendon glides are a sequence of movements used to promote full tendon excursion and full AROM and prevent adhesions (the sequence of movements is fingers straight, MCP flexion, hook fist, then flat fist)
ROM
-Strengthening usually is not initiated until the late phase of the repair, around 8-12 weeks after surgery
-If the client cannot cognitively follow a protocol, the extremity is cast in a protected position for 6 weeks
OT INTERVENTION for flexor tendon injuries
54
What are symptoms, nonoperative treatments, and operative treatments for Radial Nerve Injury?
- Symptoms: Posture of hand is wrist drop w/ possible lack of finger and thumb extension
- Nonoperative treatment: Wrist cock-up splint with or without dynamic finger and thumb extension assist, passive and active ROM, and isotonic strengthening exercises upon muscle reinnervation
- Operative treatment: Static wrist extension splint 30°, after 4 weeks, adjust splint to 10° to 20° extension
55
What are symptoms, nonoperative treatments, and operative treatments for Radial Tunnel Syndrome?
Radial Tunnel Syndrome: Entrapment of the radial nerve in an area extending from the radial head to the supinator muscle
- Symptoms: Burning pain in lateral forearm
- Nonoperative treatment: Long arm splint, elbow flexed, forearm supinated, wrist neutral, massage or TENS for pain management; pain-free ROM; nerve glides; and activity modification; avoid forceful wrist extension and supination
- Operative treatment: Long arm splint, elbow flexed, forearm supinated, wrist neutral for 2 weeks, then wrist cock up for 2 more weeks; passive and active pronation and supination; hand-strengthening exercise at 3 weeks, and resistive exercise at 6 weeks
56
What is Anterior Interosseous Syndrome? And what does it result in?
- Compression to the anterior interosseous nerve
- Results in a motor loss involving the flexor pollicis longus to the thumb, flexor digitorum profundus to the index finger, and pronator quadratus
- (Patients with anterior interosseous syndrome can NOT do the OK sign)
57
What are symptoms, nonoperative treatments, and operative treatments for Pronator Syndrome?
Pronator Syndrome: Entrapment of the proximal median nerve between the heads of the pronator muscles
- Symptoms: Deep pain proximal forearm with activity
- Nonoperative treatment: Splint elbow 90°-100° flexion, forearm neutral, TENS for pain, gentle prolonged stretching supination and elbow, wrist, and finger extension, activity modification; avoid repetitive forearm rotation with resistance and prolonged elbow flexion
- Operative treatment: half cast, AROM all UE joints while wearing cast, muscle strengthening in 1 week, full AROM gained by 8 weeks
58
What are symptoms, nonoperative treatments, and operative treatments for Median Nerve Injury?
- Causes ape hand deformity
- Symptoms: Ape hand deformity; sensory loss in index, middle, and radial side of ringer finger; loss of pinch, thumb opposition, index finger MCP and PIP flexion; and decreased pronation
- Nonoperative treatment: Static thenar web spacer splint
- Operative treatment: Dorsal wrist blocking splint worn for 4-6 weeks, AROM and PROM in splint for digits and thumb, tendon gliding exercises, scar massage; discontinue splint at 6 weeks and begin strengthening exercises
59
What are symptoms, nonoperative treatments, and operative treatments for Carpal Tunnel Syndrome?
- Carpal tunnel syndrome is caused by entrapment of the medial nerve as it courses through the carpal tunnel. It is the most common nerve compression of the UE
- Causes include tenosynovitis, cumulative trauma disorder, fluid retention (e.g., from pregnancy, endocrine malfunctions), gangions, tumors, diabetes rheumatoid arthritis, and trauma such as wrist fracture of lunate dislocation
- Sensory impairment general involves numbness and tingling in the thumb, and index and middle fingers, especially at night
- Motor impairment presents as diminished fine motor coordination; in advanced cases, the abductor pollicis brevis and opponens pollicis muscles may be atrophied
60
What are some evaluations for Carpal Tunnel Syndrome?
- Tinel’s sign is a tap on the median nerve at the wrist to elicit symptoms
- Phalen’s test is holding the wrist in full flexion for 1 minute to elicit changes in sensation
- Moberg Pickup test is a timed test involving picking up, holding, manipulating, and identifying small objects. It is used with children and cognitively impaired adults to test median nerve function
- Semmes-Weinstein monofilament testing is used to test for loss of sensation
61
What are nonoperative treatments for Carpal Tunnel Syndrome?
- A carpal tunnel syndrome splint or wrist cock-up splint at 0°-10° wrist extension is used to relieve pressure on the medial nerve in the carpal tunnel and control edema; a prefabricated wrist cock-up splint can be used if wrist position is adjustable
- Nerve and tendon gliding exercises are used
- Activity modification includes ergonomic handles, gel pads, or padding on handles
- Client education recommends avoidance of postures and activities that aggravate the condition (e.g., those that involve wrist flexion). Training is provided in the use of an ergonomic keyboard modification, if applicable
- Postural retraining and proximal conditioning exercise are provided
62
What are operative treatments for Carpal Tunnel Syndrome?
- Surgical treatment includes traditional open carpal tunnel release surgery or endoscopic release
- After surgery, some clients may not need therapy
- For more complicated cases, wound care and scar mobilization are provided
- Pain management may include use of gel pads on the scar. Pain on either side of the surgical release is called Pillar Pain
- Splinting is provided only to clients who sleep with the wrist flexed or who will engage in too much activity too soon (e.g., immediate return to work)
- AROM of wrist, thumb, and fingers begins 1-2 days post surgery
- Nerve and tendon gliding exercises are provided
- Strengthening activities begin in 3-6 weeks
63
What is Cubital Tunnel Syndrome and what are its symptoms?
- Cubital tunnel syndrome is caused by proximal ulnar nerve compression at the elbow between the medial epicondyle and the olecranon process. It is the second most common nerve compression of the UE after carpal tunnel syndrome
- Causes include fracture of dislocation of the elbow, osteoarthritis, rheumatoid arthritis, diabetes, alcohol abuse, tourniquets, and assembly line work
- Sensation is decreased in the little finger and ulnar half of the ring finger
- Motor problems may include decreased grip and pinch strength because of the weak interosseous adductor pollicis, and flexor carpi ulnaris muscles
64
What are some evaluations for Cubital Tunnel Syndrome?
-Tinel’s sign is a tap over the cubital tunnel to elicit symptoms
-Froment’s sign is flexion to the interphalangeal (IP) of the thumb when a lateral pinch is attempted
=Wartenberg’s sign is the fifth finger held abducted from the fourth finger
-The elbow flexion test involves holding the elbow in flexion for 5 minutes with the wrist neutral to elicit symptoms
65
What are nonoperative treatments for Cubital Tunnel Syndrome?
Edema control, pain management, Elbow splint or positioning at 30°-60° flexion for 3 weeks, Ulnar nerve gliding, Proximal conditioning activities, Posture and ergonomic training
66
What are postoperative treatments for Cubital Tunnel Syndrome?
- During the protection phase (1 day to 3 weeks), splint the elbow at 70°-90°; provide wound care, edema control, pain management, and AROM of uninvolved joints; and teach one handed ADL techniques
- During the active phase (beginning at 3 weeks), discontinue the elbow splint and anti-claw splint if used before surgery, then add elbow AROM (in pronation first, then supination; add wrist motion with elbow flexed, then extended), ulnar nerve gliding, and desensitization techniques
67
What is Claw Defmority? and what are the symptoms?
- Claw Deformity is distal ulnar nerve compression of lesion at the wrist
- Causes include ganglion, neuritis, arthritis, or carpal fractures at Guyon’s canal
- Sensory loss occurs in the little finger and ulnar side of ring finger plus the palmer ulnar hand; if sensory loss is on the dorsal side of hand, the injury is proximal to Guyon's canal
- Loss of intrinsic ulnar innervated muscles (interossei and adductor pollicis, flexor and abductor digiti mini) and resulting motor loss result in deformity in which the MCPs hyperextend and the IPs flex, hand arches are flattened, and pinch strength is loss
68
What are some evaluations for Claw hand Deformity?
- Froment’s sign is flexion of the IP of the thumb when a lateral pinch is attempted
- Wartenber’s sign is the fifth finger held abducted form the fourth finger
- Jeanne’s sign is hyperextension of the thumb MCP
- Semmes-Weinstein monofilament testing is used to test for loss of sensation
69
What are nonoperative treatments for Claw Hand Deformity?
- An ulnar nerve palsy or anti-claw splint is used, and dynamic PIP extension assist may be added if PIP flexion contractures are present
- A padded anti-vibration glove can be used during activity to protect from further nerve irritation
- Activity modification includes ergonomic handles, gel pads, or padding on handles of vibratory equipment (e.g., lawn mower)
- Client education recommends avoidance of postures and activities that aggravate the condition. Such as ulnar deviation combined with wrist flexion
70
What are postoperative treatments for Claw Hand Deformity?
-Bulky dressing is applied for 3-10 days
-A dorsal blocking splint is used to maintain the wrist at 20-30° flexion and an MCP lock to 45° FLEXION to protect nerve repair. The splint is adjusted at 3-6 weeks to increase wrist position to neutral. Discontinue splint at 6 weeks.
-Use of the preoperative splint continues until muscle function return
-Wound care and scar mobilization are performed
Sensory desensitization begins when at 6 weeks; clients may resume ADLs and begin muscle strengthening and work conditioning, if needed
-Sensory reeducation begins at 10-12 weeks post surgery, once protective sensation has returned
-Tendon transfer is done if the nerve has not regenerated within 1 year. After surgery, the practitioner may provide electromyography biofeedback, NMES, and instruction in avoiding substitution of movement patterns
71
What is Double Crush Syndrome and what are its symptoms and treatments?
- Occurs when a peripheral nerve is entrapped in more than one location
- Symptoms: Intermittent diffuse arm pain and paresthesia with specific postures
- Nonoperative treatment: treat according to each nerve injury or syndrome. Avoid movements or positions that aggravate the symptoms. Nerve gliding exercises and exercises for scapular stability, posture, and core trunk strengthening are recommended
72
What is De Quervain Syndrome?
-De Quervain syndrome is caused by cumulative microtrauma resulting in tenosynovitis of the thumb muscle tendon unit, the abductor pollicis longus and extensor pollicis brevis, and the tendons in the first dorsal compartment of the wrist
-Causes include forceful, repetitive thumb abduction with wrist ulnar deviation, carpometacarpal (CMC) osteoarthritis, scaphoid fracture, intersection syndrome, or radial nerve neuritis
At highest risk are women ages 35-55, women inlate pregnancy, mothers of young children, and people who engage extensively in keyboarding, piano playing, knitting, needlepoint, and racket sports
73
What are the nonoperative treatments for De Quervain Syndrome?
-Medical treatment includes corticosteroids injections
-OT treatment consists of a forearm-based thumb spica splint with wrist in neutral and thumb radially abducted for 3 weeks
-Activity modification and avoidance of pinch are recommended
-After 3 weeks, the client progresses to a soft splint and isometric exercises
-Computer ergonomics education is provided
Strengthening activities are provided
74
What are the operative treatments for De Quervain Syndrome?
- Surgical release of the first dorsal compartment
- OT treatment postsurgery consists of a forearm-based thumb spica splint with wrist 20 degrees extension and thumb radially abducted for 3 weeks
- Gentle ROM and tendon gliding exercises are performed
- Grip and pinch strengthening begins at 2 weeks
- Scar management and desensitization techniques are used
75
What is Digital Stenosing Tenosynovitis?
- Protective reeducation educates clients to visually compensate for sensory loss and to avoid working with machinery and temperatures below 60 degrees
- Discriminative reeducation uses motivation and repetition in a vision tactile matching process in which clients identify objects with and without vision
- Sensory recovery begins with pain perception and progresses to vibration of 30 cycles per second, moving touch, adn constant touch
- Desensitization is a process of applying different textures and tactile stimulation to education the nervous system so clients can tolerate sensation during functional use of the UE
76
What are types of cryotherapy and what does it do?
- Cryotherapy cools tissues
- Methods include ice massage, ice, towels, cold packs, cold water immersion baths, cool whirlpools, cold compression units, and vapocoolant spray
- Effects on the client include pain relief, decrease edema, decreased muscle spasms, decreased inflammation, decreased metabolic activity of tissue, and reduced nerve conduction velocity
77
What are the Indications, contraindications, and precautions for cryotherapy?
Indications, contraindications, and precautions: Avoid use with clients with impaired circulation, peripheral vascular disease, hypersensitivity to cold impaired sensation, open wounds, or infections
78
What are types of Thermotherapy and what does it do?
- Thermotherapy heats tissues t0 1-2 cm depth
- Methods include warm whirlpools, fluidotherapy, hot packs, contrast baths, and paraffin baths
- Effects on the client include increased blood flow, increased rate of cell metabolism, increased inflammation, increased muscle contraction velocity, increased capillary permeability, increased oxygen consumption, decreased fluid viscosity, decreased muscle spasms, and decreased pain
79
What are the Indications, contraindications, and precautions for Thermotherapy?
Indications, contraindications, and precautions: avoid use with clients with acute inflammation, edema, sensory impairment, cancer, blood clot, infection, cardaic problems, adn impaired cognition
80
What are types of ultrasound and what does it do?
-Ultrasound heats tissues to 1-5 cm depth
-Ultrasound has thermal and nonthermal effects and also is used in phonophoresis
-Effects on the client
=Thermal effects increase tissue extensibility and blood flow and decrease pain, joint stiffness, muscle spasm, and chronic inflammation
=Nonthermal effects increase protein synthesis and boen healing and decrease inflammation
=Phonophoresis is the use of ultrasound to promote absorption of topically applied medication to accelerate tissue repair and decrease inflammation
81
What are the Indications, contraindications, and precautions for ultrasound?
Indications, contraindications, and precautions: Avoid use with clients who have cancer; are pregnant, or have a pacemaker, bleeding, or an infection. Avoid use over the eyes, blood clots and growth plates of bones in children. Be cautious when using with inflammation, fractures and breast implants and with clients who have cognitive, language, or sensory impairment
82
What are types of Electrical Stimulation and what does it do?
-Methods include NMES, TENS, and iontophoresis
-Effects on the client
=NMES promotes wound healing, maintained muscles mass, increase ROM, decreased edema, facilitates voluntary motor control, and decreased spasm and spasticity and can be used as an orthotic substitute
=TEMS primarily controls pain through three possible mechanisms: gate control, endorphins release, and acupuncture
=Iontophoresis decreased inflammation and controls pain
83
What are the Indications, contraindications, and precautions for electrical stimulation?
Indications, contraindications, and precautions: Do not use over pacemakers, carotid sinus, pregnancy uterus, and eyes or with clients with epilepsy, cancer, infection, decreased sensation, cardiac disease, and stroke. With Iontophoresis used, be aware of possible drug allergies
84
What is Low-level laser and light therapy and what does it do?
- Methods include light-emitting diodes, superluminescent diodes, and lower-level laser diodes
- Effects on the client include decreased pain, edema, and inflammation; increased wound healing; and decreased scar tissue
85
What are the Indications, contraindications, and precautions for Low-level laser and light therapy?
Indications, contraindications, and precautions: Wear protective eyewear when using laser; do not use over vagus nerve, carotid sinus, pregnant uterus, eyes, or endocrine glands or with clients with cancer or infection
