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enabling occupational performance > hand therapy and burns > Flashcards

hand therapy and burns Flashcards

(85 cards)

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1
Q

what is the role of the hand therapist?

A
  • active engagement
  • knowledge in upper limb anatomy
  • skilled implementation of intervention
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2
Q

what is initial assessment in hand therapy?

A
  • history of condition
  • comorbidities
  • social history
  • ADLs
  • interests
  • goals
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3
Q

what should be assessed in physical testing in hand therapy?

A
  • pain
  • skin condition
  • wound
  • scar
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4
Q

what should be looked at in relation to pain in physical assessment?

A

visual analogue and verbal rating scale

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5
Q

what should be looked at in relation to skin condition in physical assessment?

A
  • sweating/hair
  • nail growth/texture
  • dry/flaking
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6
Q

what should be looked at in relation to wound in physical assessment?

A
  • open
  • infection
  • hyper granulating
  • epithelising
  • granulating
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7
Q

what should be looked at in relation to scar in physical assessment?

A
  • colour
  • height
  • size
  • pliability
  • blanching or puckering on motion
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8
Q

how is ROM assessed?

A

passive/active ROM using goniometry

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9
Q

how is strength assessed in hand therapy?

A

manual muscle testing and dynamometer

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10
Q

how is sensibility assessed?

A

tactile sensation and hot/cold 2 point discrimination

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11
Q

what are functional assessments undertaken during hand therapy?

A
  • subjective report
  • self-report functional outcome scale
  • test battery
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12
Q

what are provocative tests for hand therapy?

A
  • Phalen’s for carpal tunnel

- grind test for OA

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13
Q

what are some principles of hand management?

A
  • use clinical judgement
  • each injury treated according to anticipated rate of healing
  • acute different to chronic
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14
Q

what does acute treatment for the hand involve?

A
  • rest
  • ice
  • compression
  • elevation
  • protection
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15
Q

what does chronic treatment for the hand involve?

A

-rest, heat, stretch, pain control, and education

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16
Q

how long does the inflammatory phase following injury last?

A

up to 72hrs

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17
Q

what occurs in the inflammatory phase following injury?

A
  • vasoconstriction followed by dilation
  • platelets produce fibrin clot
  • increased permeability
  • WBC
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18
Q

what does increased permeability in the inflammatory give rise to?

A

tissue oedema

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19
Q

what are treatments that promote wound and oedema control?

A
  • wound management
  • rest and orthotics
  • elevation
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20
Q

when does the proliferative/fibroblastic phase commence and last?

A

commences at day 3 and lasts approx 3-4 weeks

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21
Q

what does the proliferative/fibroblastic phase involve?

A
  • infiltration of fibroblasts
  • collagen production
  • form new blood vessels
  • epithelialisation
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22
Q

what are some treatment options for scars?

A
  • massage
  • compression
  • silicone based products
  • sensory re-education
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23
Q

when does the maturation/remodelling phase following injury begin and last?

A

begins around 3-4 weeks and lasts months (up to two years)

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24
Q

what does the maturation/remodelling phase following injury include?

A
  • extracellular matrix reorganised
  • collagen synthesis and degradation
  • wound tensile strength increases
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25
what treatment options are utilised during the maturation/remodelling phase?
- exercise - strengthening (isometric, resistance with bands/putty) - sensory motor rehab (proprioception training)
26
what are some treatment focuses of acute hand therapy?
- education - psychological support - activity mod - wound management - orthotics - oedema control
27
what are treatments for ongoing therapy?
- education - psych - activity mod - sensory motor function - sensory retraining - motion
28
what are some focuses of chronic and therapy treatment?
- education - psych - motion and gentle strengthening - activity assessment - orthotics
29
what are some mechanisms and causes of OA?
- changes in cartilage and underlying bone - weight - joint damage - infection
30
what are some assessments of OA?
- xray - pain/swelling - nodules - poor active range - decreased function
31
what are conservative treatment options for OA?
- orthoses - steroid injection - oedema control - gentle heat - strengthening stabilising muscles - protetction techniques
32
what is carpal tunnel syndrome?
compression of median nerve at wrist
33
what are some signs and symptoms of carpal tunnel?
- pain - worse at night - worse with repetitive forceful motion - weakness/clumsiness
34
what are some anatomical causes of carpal tunnel?
- fractures - carpal dislocation - osteophytes - lesion tumour - cysts
35
what are some neuropathic or inflammatory disorders causes of carpal tunnel?
- diabetes - alcoholism - changes in fluidbalance eg.pregnancy
36
what are some mechanical forces causes of carpal tunnel?
changes in joint position caused by tendon load, external forces, vibration
37
how does obesity cause carpal tunnel?
correlations between BMI and CTS
38
how should the wrist be positioned in orthosis for carpal tunnel syndrome?
neutral
39
what is involved in the clinical assessment of De Quervain's Tenosynovitis syndrome?
- CMC arthritis - trigger thumb EPB funger - wrist or digital tendonitis - intersection syndrome
40
what is De Quervain's?
an inflammatory condition
41
how can inflammation be treated in management of De Quervain's?
- NSAIDS - oedema control - orthosis - controlled loading of tendon
42
is De Quervain's likely to go away completely?
no
43
what can a paddle orthosis pattern by used for?
- resting splint | - POSI splint
44
what is a resting orthosis suitable for?
intermittent splinting
45
what is the aim of a resting orthosis?
rest in comfortable position
46
what position is the hand and wrist in in a resting orthosis?
- wrist: 20-30 degrees extension - MCP: 45 flexion - PIP: 30 flexion - DIP: 10 flexion - thumb in palmar abduction
47
what is a POSI orthosis suitable for?
acute stage of trauma, burns, post-operative, acute infection/inflammation
48
what is the aim of a POSI orthosis?
prevent contractures
49
what is the position of the wrist and hand in a POSI orthosis?
- wrist: 30 degrees extension - MCP: 70-90 flexion - IP: full extension - thumb in abduction but lying lateral to index
50
what is the position of the short opponens orthosis?
splint thumb in opposition to allow function and maintain sign of O
51
what are some goals of orthoses?
- relieve pain - stabilise - protect - promote healing - prevent/correct deformity - increase occupational performance
52
what are some effective mechanical principles in orthoses constriction?
optimise. .. - surface area - lever arm - straps - arches -conform to contour
52
what are some effective mechanical principles in orthoses constriction?
optimise. .. - surface area - lever arm - straps - arches -conform to contour
53
what are five principles of fit of an orthosis?
- mechanical and technical considerations - anatomic considerations - practical considerations - physical appearance - client education
54
what are some functions of the skin?
- protective - immunological - fluid balance - thermoregulation - neuro-sensory - social-interactive - metabolism
55
what happens to the skin when there is a superficial dermal burn?
- surface is dry - red (sunburn) - painful
56
what happens to the skin when there is a superficial partial-thickness burn?
- blistered surface, soft/wet texture - swollen - red/bright pink - intact sensation, painful
57
how long does healing take to occur for a superficial dermal burn?
3-7 days with peeling
58
how log does a superficial partial-thickness burn take to heal?
spontaneous re-epithelialisation will occur in 1 day or less
59
what happens to the skin when there is a deep partial-thickness burn?
- mottled red or waxy white - soft and wet looking, blanching - sensation is varied
60
how does healing occur in a deep partial-thickness burn?
re-epithelialisation is possible but takes up to 3-6 weeks usually requires skin graft/substitute
61
what happens to the skin when there is a full thickness burn?
- surface is white, tan or waxy - looks dry and leathery, is rigid and non-elastic - initially painless
62
how does healing occur in full thickness burns?
skin grafts required, hypertrophic scarring
63
what layers of the skin are damaged in full thickness burns?
complete epidermis and dermis
64
what layers of the skin are damaged in deep partial thickness burns?
epidermis and a greater portion of dermis
65
what layers of the skin are damaged in superficial partial thickness burns?
epidermis and upper layer of dermis
66
what layers of the skin are damaged in superficial burns?
epidermal layer only
67
what does the severity of a chemical burn injury depend on?
- concentration - quantity - duration of skin contact - surface area - mechanism
68
how do burns effect the skin?
- loss of protective epidermis - loss of thermo regulators - risks in function
69
how do burns effect the CVS?
- inflammatory response results in increased vascular permeability - hypovolemic shock - increased HR
70
what is hypovolemic shock?
drop in blood volume and pressure
71
how do burns effect the renal system?
- acute renal failure can occur from reduced CO, mainly by fluid loss - reduced urine output - period of hlemodialysis
72
how do burns effect the GI system?
reduced blood supply to intestine can result in... - gastric ulcers - paralysis of ileum or bowel obstruction
73
how do burns effect the pulmonary system?
-burn to upper oropharynx and upper airway results in swelling and can block airway
74
how do burns effect the metabolism?
- increased rate of tissue breakdown - metabolic rate increases - weight loss
75
what are the aims of treatment following burns?
- prevent additional injury/infection - rapid wound closure - preservation of motion - early functional rehab
76
what are some treatment principles with burns?
- determine dimensions/depth - decompression - wound dressings - conservative or surgical treatment
77
what is the OTs role with burns?
- anti-deformity positioning/splinting - scar management - facilitating ADLs and functional use - increasing ROM, strength and endurance
78
how are fluids replaced following burn?
- maintain adequate material and venous pressures - adequate urine output - restore intravascular electrolytes - prevent hypovolemic
79
what is intubation?
tube inserted to maintain airway
80
what is tracheostomy?
surgically insert tube into trachea
81
how can body temp be maintained by modifying the hospital enviro?
- heated rooms | - ward set up to accomodate thermo regulators
82
how are wounds managed with burns?
- dressings absorb and prevent bacteria entering - wounds are clean - silver products - antibacterial cream, gauze and crepe bandages
83
how does early excision and grafting allow early wound closure with burns?
- decreases risk of infection - decreases metabolism and energy requirements - cosmetic outcome - decrease contracture risk
84
what types of surgery can be undertaken for burns?
- amputation - debridement - splint skin grafts - cadaverty/biobrane

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