Flashcards in Joint Replacements Deck (21)
Posterior hip precautions
no hip flexion greater than 90°; no internal rotation; no adduction of affected hip joint
Anterior hip precautions
No external rotation; no extension; no adduction of affected hip joint
Joint replacements are generally not considered if the client ________
will not comply with rehabilitation or if
the client will not experience significant functional improvement (e.g., is immobile or bedridden).
Out-of-bed activity should occur early with both anterior and posterior hip replacement approaches, traditionally ___ days postoperation.
Role of the OT in hip replacement surgery
1. Complete an occupational profile with the client and family or caregiver.
2. Provide home safety recommendations.
3. Offer education and reeducation regarding hip precautions, including proper transfer techniques,
home modification recommendations, ROM restrictions, and positioning to perform ADLs.
4. Emphasize maintaining or increasing joint motion.
5. Increase strength of surrounding musculature.
6. Emphasize increasing independence in ADLs and IADLs using prescribed precautions, safety tech-
niques, and compensatory strategies.
7. Prescribe and instruct the client (and family or caregiver, as necessary) in use of adaptive equipment
8. Use physical agent modalities (PAMs) as appropriate to the practitioner’s level of training and in
compliance with specific state regulations (e.g., some states require occupational therapists to ob-
tain a PAM certification).
Facts about low back pain
A. LBP generally resolves within 6 weeks for 90% of clients and 12 weeks for 5% of clients.
B. LBP is rarely the result of serious spinal diseases, and less than 5% is true nerve root
1. Sciatic pain is cause when ________
when the nerve is trapped by a herniated disc
Spinal stenosis is the narrowing of the
Facet joint pain: inflammation or changes of the
Spondylosis is a stress fracture of the
dorsal to transverse process
Spondylolisthesis: slippage of
a vertebra out of position
Herniated nucleus pulposus: stress tearing of
the fibers of a disc, causing an outward bulge pressing
on spinal nerves
OT guidelines for LBP
A. An occupational profile should always be completed in the initial evaluation.
B. Questionnaires are sometimes used to identify performance areas currently affected by
C. Determining occupational performance is best done by observing actual performance
on tasks in the clinic or elsewhere simulating ADLs, IADLs, and skills highlighted in the
client’s occupational profile.
OT interventions for LBP
Education regarding back anatomy and movements related to the client’s occupational performance
2. Use of neutral spine back stabilization techniques to promote decreased pain
3. Body mechanics education
4. Training in adaptive equipment and modified tasks
5. Task analysis and introduction of ergonomic design
6. Training in energy conservation
7. Use of occupation to increase strength and endurance
8. Education for pain management, stress reduction, and coping
What type of lift is the safest for the back; ideal for heavy loads (e.g., clients)
The stoop lift should be used only for
light loads (<20 lb)
What lift is an alternative to the semisquat when space is limited?
Guidelines for LBP with Bathing
a. A shower is generally better than a bath because neutral spine can be maintained.
b. All items should be kept within reach using a shower caddy or alternative device.
c. A handheld shower reduces unnecessary movements and twisting.
d. A bath mat should be used to decrease chance of slipping.
Guidelines for LBP with dressing
a. Emphasis is placed on minimizing bending.
b. The client should sit while dressing.
c. The client should lie flat on the bed when pulling clothing up.
d. Socks are applied and removed by bringing foot to the knee.
e. Slip-on shoes are encouraged if possible.
f. Belts are threaded through the loops before donning pants to decrease twisting.
Guidelines for LBP with functional mobility
a. Logrolling, a technique for rolling the body as a whole unit without twisting, is recommended
for bed mobility.
b. To sit up, the client bends the knees and pushes up with the arms.
c. To lie down, the client brings the legs up and uses the arms to lower the body to the bedside.
d. For toilet mobility, the client lowers the body while maintaining a straight back and neutral
e. Firm-armed chairs are encouraged to ensure that the client is not too low, which increases vul-
nerability to back stress.
f. The client is advised not to sit for longer than 15 to 20 minutes.