Midterm Flashcards
(174 cards)
1
Q
The biomechanical frame of reference is commonly used in __________________, ____________________, and ___________________ practice areas .
A
The biomechanical frame of reference is commonly used in musculoskeletal, neurology/neurodegenerative, rehabilitation/general medicine practice areas.
2
Q
The biomechanical frame of reference focuses on…
A
The biomechanical frame of reference focuses on the physical components such as movement, sensation and strength, required to perform an occupation.
3
Q
Give some examples of how the biomechanical frame of reference may be used in assessment and intervention.
A
the biomechanical frame of reference may be used in assessment and intervention through mobility assessment/treatment, and grip and pinch strength assessment/treatment
4
Q
The biomechanical frame of reference is based on principles of…
A
The biomechanical frame of reference is based on principles of physics: forces, center of gravity, (bio)mechanical advantage, need to consider joint, muscle/tendon properties.
5
Q
Screening may be more appropriate than testing individual muscles, particularly in what type of settings?
A
Screening may be more appropriate than testing individual measures, particularly in acute inpatient and rehabilitation settings where patients may be experiencing dibilitation, or, fluctuate from day to day, or time day, or , in very early stages of a disease process.
6
Q
Formal measures may be more appropriate over screening when?
A
Formal measures may be more appropriate when specific changes are anticipated and you are using these as outcome measures.
7
Q
Screening is a process for…
A
Screening is a process for evaluating the possible presence of a particular problem. The outcome is normally a simple yes or no.
8
Q
Evaluation of lower extremity function is typically done with client demonstration of…
A
Evaluation of lower extremity function is typically done with the demonstration of ADL/IADL tasks and functional transfers. The OT should screen motion and strength to ensure safety when engaging in functional tasks.
9
Q
What is a difference between upper extremity functional screen and lower extremity functional screen in OT?
A
The evaluation of upper extremity function is usually completed through a general movement screen, whereas, the evaluation of lower extremity function is typically done with the client demonstrating ADL/IADL tasks and functional transfers.
10
Q
Name some precautions/ contraindications associated with upper and lower extremity ROM screens.
A
Joint dislocation/inflammation/infection/subluxation; arthritis, osteoporosis, or other bony conditions; weight-bearing status (post total hip replacement; prolonged immobilization); unhealed fractures; post-surgery (precautions, dressings, edema, open areas, goal of surgery).
11
Q
What is active range of motion?
A
Active range of motion is motion at a joint(s) caused by the muscle(s) acting on that joint(s).
12
Q
What is passive range of motion?
A
Passive range of motion is motion at a joint(s) caused by an external force.
13
Q
What is active assisted range of motion?
A
Active assisted range of motion is a combination of active range of motion and passive range of motion (motion is caused simultaneously by the muscles and the external force).
14
Q
What is resisted range of motion?
A
Resisted range of motion is applied force against a muscle’s action (important in manual muscle testing).
15
Q
Name the general steps of the process to evaluate range of motion.
A
- Functional active range of motion screen
(assess relevant joints by “screening” their active range of motion to help you determine the joint(s) needing further assessment) - Specific recordings using a goniometer
- Record (in degrees) the range of motion of the joint
16
Q
What size goniometer should be used for the shoulder, hip and knee?
A
Large
17
Q
What size goniometer should be used for the elbow, wrist, and ankle?
A
Medium
18
Q
What size goniometer should be used for the fingers?
A
Small (metal type is the best)
19
Q
When using the Neutral Zero Method of measuring joint range of motion, ______________ is considered as “0” OR if different than _______________ the starting point is noted as “0”.
A
Anatomical position is noted as “0”.
20
Q
When performing a range of motion measurement using a goniometer the axis is placed where?
A
The axis is placed at the joint axis of motion (may be at a bony landmark or over soft tissue at the end of the range)
21
Q
When performing a range of motion measurement using a goniometer the stationary arm is placed where?
A
The stationary arm is placed parallel to the longitudinal axis of the body part/lever PROXIMAL to the joint being measured.
22
Q
When performing a range of motion measurement using a goniometer the movable arm is placed where?
A
The movable arm is placed parallel to the longitudinal axis of the body part/lever DISTAL to the joint being measured.
23
Q
You are completing the process to measure range of motion at a client’s joint what is your first step?
A
Instruct the client to move joint through its active range of motion if they are able.
24
Q
You are completing the process to measure range of motion at a client’s joint, you have already instructed the client to move their joint through its active range of motion and they do, during this task, however, the client experiences difficulty and cannot move joint through full AROM (joint stiffness/muscle weakness/tendon integrity). What is your next step?
A
The next step would be to perform passive range of motion of the joint.
25
You are completing the process to measure range of motion at a client's joint, you have already instructed the client to move their joint through its active range of motion and they do, during this task, however, the client experiences difficulty and cannot move joint through full AROM. After this realization, you perform a passive range of motion of the joint, the client has full passive range. What are you thinking at this point? What is your next step?
At this point I am thinking the client may be experiencing active excursion or muscle weakness issue. My next step would be to perform active range of motion measures with the goniometer and manual muscle testing.
26
You are completing the process to measure range of motion at a client's joint, you have already instructed the client to move their joint through its active range of motion and they do, during this task, however, the client experiences difficulty and cannot move joint through full AROM. After this realization, you perform a passive range of motion of the joint, the client has passive range deficits. What are you thinking about at this point? What is your next step?
At this point I am thinking the client may be experiencing joint stiffness. My next step would be to do active and passive range of motion measures with the goniometer and to check succeeding joints.
27
You are completing the process to measure range of motion at a client's joint, you have already instructed the client to move their joint through its active range of motion and they do without difficulty. What is your next step?
I would record the client's AROM as within functional limits (WFL).
28
Any movement of the thumb is a ______________ movement.
Composite movement.
29
What is soft-end feel (when performing PROM)?
Occurs when two soft tissue masses meet one another, limiting further movement e.g. when the hamstrings and calf complex meet during knee flexion, it feels soft and cushioned.
30
What is hard-end feel (when performing PROM)?
A firm end feel gives the sensation of a firm, elastic response with a slight give. Carpal flexion in the normal patient will have a firm end feel.
31
Describe eccentric motion.
Active muscle is lengthening, thus is acting as the resistance force.
32
Describe concentric motion.
Active muscle is shortening, thus it is acting as the effort force.
33
Describe isometric motion.
No shortening or lengthening of the active muscle(s).
34
Describe muscle tone.
A continuous sub maximal contraction that maintains a small degree of tension in a muscle: keeps the muscle in a state of readiness for active contraction.
35
Describe elastic maximum in terms of physiology.
A muscle/tendon unit only has a certain amount of elasticity and can only respond to a certain amount of stretch (stress) at one time before it begins to break down.
36
Deficits in strength may be due to...
Deconditioning, innervation issues, structural damage to muscles.
37
Name a very important consideration when performing manual muscle testing to ensure client safety.
When applying force or resistance DO NOT cross the joint that you are testing.
38
Name the general steps of manual muscle testing.
1. Set the stage
(What is the full AROM of the joint? what is (are) the plane(s) of motion? Are you testing one specific muscle or a group of muscles?)
2. Position the muscle(s) at the greatest mechanical advantage
(approximately 1/2 the available range of motion of the joint on which the muscle(s) act)
3. Stabilize proximally
(tester places one hand at the proximal aspect of the proximal lever)
4. Resist distally
(the patient is asked to hold the position as the tester applies resistance at the distal aspect of the distal lever)
39
When placing the muscle(s) in the position of greatest mechanical advantage, where does this usually occur?
Approximately 1/2 the available range of motion of the joint on which the muscle(s) act.
40
When performing Manual Muscle Testing, if the client is able to achieve full AROM against gravity they score at least a __________.
3
41
A score of 3 on the Manual Muscle Test indicates the client is able to perform...
Full AROM against gravity; unable to resist any applied resistance
42
A score of 4 on the Manual Muscle Test indicates the client is able to perform...
Full AROM against gravity; able to resist moderate applied resistance
43
A score of 5 on the Manual Muscle Test indicates the client is able to perform...
Full AROM against gravity; able to resist maximum applied resistance
44
Before performing a Pinch/Grip Test, which precaution related to healing post-op/trauma should you be aware of?
The client must be cleared by physician to perform a Maximum Voluntary Contraction (MVC).
45
Should bilateral testing be performed when completing Grip/pinch strength tests?
Yes, normative data available-bilateral testing should be performed.
46
What are the three types of pinch testing?
- Two point pinch
- Three point pinch (tripod)
- Lateral/key pinch
47
How many trials do you have the client complete of each pinch testing position?
3
48
The hierarchy of mobility begins with?
Bed mobility
49
When looking at the hierarchy of mobility, what type of skills are needed for each section (hint: break into 3 sections)?
Starting from the bottom of the hierarchy with bed mobility, the skills needed are to enable BADLs and relieve pressure areas; moving up the skills are needed to enable BADL/IADLs; at the top of the hierarchy skills are needed to participate in productivity and IADLs
50
Functional mobility is different than community mobility how?
Functional mobility is aimed at in-bed mobility, transfers, performing occupations during standing/sitting, walking (ambulation)/wheeling, using devices (wheelchair, powered mobility, canes), whereas, community mobility refers to moving around in the community, walking, wheeling, bicycling, taxis, driving and other transportation systems.
51
Occupational Therapists teach skills but also assess need for teaching use of adaptive devices, name some adaptive devices that may be used for bed mobility.
Rope ladder, overhead trapeze bar, bed rail, mechanical lift.
52
Assistance for transfers can be quantified into four levels, what are they?
Stand-by (supervision, close guarding, verbal cues, do not have hands on client), minimum (client does 75-100%), moderate (client does 50-75%), maximum (total-assist, mechanical lift or two people)
53
Walk through preparation for log rolling transfer.
- It is easier, if possible to have the bed flat (may raise bed to comfortable height to facilitate trunk from side-lying to sitting)
- Ask client to assist/participate as able
- Position in side lying
- Bend hips and knees to 90 degrees
54
Sit-to-stand transfer requires intact balance with the integration of:
- Adequate mobility at pelvis, hips, knees
- Postural alignment, postural adjustments, weight shifting
- Strength in core and lower extremities
55
Do crutches require upper-body strength?
Yes
56
When using axillary/underarm crutches it is important to provide education on which precaution to avoid damage to brachial plexus?
Provide education to avoid leaning on crutches.
57
Can you measure for crutches with the client's shoes on?
Yes, in fact you should be measuring crutch height with client wearing shoes.
58
When taking measurements for crutches, where do you measure from?
Measure from the floor to the axilla; subtract 2" or 2-3 finger widths from this measurement.
59
When adjusting hand grips for crutches, what level do you adjust them to?
Adjust hand grips to height of waist (~30 degree flexion at elbow); ensure wing nuts are secure.
60
When compensating for a unilateral condition (e.g., hip pain) the cane is held on the _______________ side.
Unaffected side.
61
A cane is used in tandem with stride on the ______________ side.
Affected.
62
When using a cane, for left affected side, the cane would be held on _________ side, and cane strike occurs in synchrony with ___________ hell strike.
Right side, left heel strike.
63
Name three benefits of using a cane:
- Promotes even center of balance
- Maintains postural alignment of hips and shoulders
64
Explain how to take measurements for a cane.
Measure with shoes on, stand with arm loose at side, measure from floor to wrist crease, elbow should be flexed ~20-30 degrees
65
Explain the key points of going up stairs with no rail while using crutches for a single affected leg.
- Step up with unaffected leg
- Put weight on unaffected leg, push down on crutches with hands and bring body weight over the step
- Lift affected leg onto the step
- Lift crutches onto the step
66
Explain the key points of going down stairs with no rail while using crutches for a single affected leg.
- Lower crutches onto step below
- Lower affected leg onto step below
- Make sure body weight is well balanced through hand/crutches
- Push down through crutches and hold weight as you place unaffected leg onto step below
67
Explain the key points of measuring for a walker.
- Measure with shoes on
- Stand with arms loose at side
- Measure from floor to wrist crease
- Elbow should be flexed ~20-30 degrees
- Consider width of walker and width of doorways
68
Explain walker use to a client with a single affected leg:
- Stand straight
- Move the walker ahead first, lifting all 4 legs; set them down at same time
- Take a step with your affected leg into the frame of the walker, then step with unaffected
- Use arms and walker to balance during weight shift
- Leave some space between you and the front of the walker
- Use brakes when not actively engaged in mobility
69
When using a walker and completing a sit-to -stand transfer, what is an important precaution to remind the client of?
Do NOT hold onto the walker when transferring from sit-to-stand
70
How to go up curbs with a walker:
- Place the walker up on the curb with all 4 legs down flat on the ground
- Step-up with the unaffected leg fist
71
How to go down curbs with walker:
- Place walker down to the lower level with all 4 legs down flat on the ground
- Step-down with affected leg first
72
Name the 8 steps of the WHO Wheelchair Provision Process:
1. Referral and Appointment
2. Assessment
3. Prescription
4. Funding and ordering
5. Wheelchair preparation
6. Fitting
7. User instruction
8. Follow-up, repairs and maintenance
RAP FW FUF
73
If a client's weight bearing status is non-weight bearing (0% of body weight), which ambulatory device may be appropriate?
crutches, wheelchair
74
If a client's weight bearing status is touchdown weight bearing (10-15% of body weight), which ambulatory device may be appropriate?
Walker (standard or wheeled), crutches
75
If a client's weight bearing status is partial weight bearing (30% of body weight), which ambulatory device may be appropriate?
Walker (standard or wheeled), crutches
76
If a client's weight bearing status is 50% weight bearing, which ambulatory device may be appropriate?
Cane
77
If a client's weight bearing status is full-weight bearing (75-100%), which ambulatory device may be appropriate?
Cane or no device
78
Generally, during intervention planning for restoring mobility, a client-centered approach involves...
The client and/or family contributing to goal setting and determination of successful outcome in mobility AND identifying the client's expectation for functional and community mobility.
79
Describe the three general phases of functional mobility intervention:
1. Takes place in the accessible environment of the hospital room or therapy clinic, working on aspects such as bed mobility and surface-to-surface transfers.
2. Takes into consideration the actual environments which the client will be returning to, realistic training takes place using simulated environments set-up in the therapy clinic or around the treatment facility.
3. Addresses community mobility and must consider the client's definition of his or her community and the chosen or available modes of transportation.
80
Balance is lost (unstable) when the center of gravity falls outside the __________________.
Base of support.
81
________________ enable humans to maintain balance by ensuring that our body's center of gravity remains within the base of support; muscles and muscle endurance help when center of gravity is outside of base of support.
Postural control mechanisms.
82
The center of gravity can be displaced in 3 ways, what are they?
1. By an external force applied to the body, as occurs during contact sports.
2. By external movement of the support surface, as occurs when we sit or stand in a moving vehicle
3. During performance of activities requiring self- initiated movement of the head, limbs, or trunk
83
Individuals with impairments in postural adjustments may be fearful of falling when sitting or standing without support, and even more so when attempting to move their limbs, name some examples of impairments in postural adjustments.
Sway back, lumbar lordosis, thoracic kyphosis, forward head, etc.
84
Inability to maintain balance in posturally threatening situations may result in ________________.
Maladaptive strategies.
85
Neurological balance declines with age and is linked to gait disorders, true or false?
True.
86
Individuals with lower extremity weakness have a decreased ability to recover from balance loss, related to an increased risk for __________,
Falling.
87
When screening for balance skills, balance is considered impaired when...
An individual is unable to maintain a sitting or standing position without support or assistance, whether while remaining static or during dynamic movement.
88
Name some signs indicating dysfunction in balance (in daily occupation), observed by analyzing individual's postural alignment:
- Shoulders uneven
- Leaning more to one side
- Unable to maintain sitting while unsupported
- Unsteady or uneven gait
- Impaired righting reactions
- Decreased depth perception
-Self-report of dizziness or lightheadedness
89
The Timed Up and Go Test is an evidence based test frequently used to assess:
Falls risk in older adults. Observation of challenges and/or longer than 14 seconds may indicate falls risk.
90
Remedial techniques for intervention for balance impairment may include:
- Increasing ROM, strength and/or endurance when motor dysfunction contributes to balance impairment (OT can focus on goals through task performance)
- Fall prevention
- Reaching can be improved by gradually increasing activity demands for reaching
91
Compensation strategies for balance impairments may include:
- Safe weight shifting
- Bracing with contralateral upper extremity
- Getting dressed in bed
- Alternate methods of lower body dressing
- Toileting hygiene while sitting
- Pull pants over knee before standing from toilet
- Standing activities in front of chair in case of balance lost
- Position directly in front to avoid reaching outside of base of support
- Wear terry clothe bathrobe to dry instead of towel
92
Explain the second step of the WHO Wheelchair Provision Process.
The second step is assessment, this step involves interview with client and/or family/caregivers, observations in current system, assessment in supine, assessment in sitting, measurements in sitting, simulation in sitting, goal setting (client-centered), assessment translation to equipment and plan.
93
During the assessment step of the wheelchair provision process it is important to consider the impacts the equipment choices will have on environmental access, name some considerations.
- Van entry heights
- Rolling resistance
- Lifting of chair (yes or no)
- Determination of drive wheel location (rear-wheeled drive for outdoor/rugged terrain, mid-wheel drive for indoor, tight-turning radius, front-wheeled drive)
94
The big question when goal setting during the assessment phase of wheelchair provision is...
"What are the goals for mobility?" (independent, supervised, diagnoses, age)
95
What is the Braden Scale used for?
For predicting pressure sore risk
96
A low score on the Braden Scale can be interpreted as...
Very high risk for pressure injury (6-9), very low risk (19-23)
97
The mat examination is a key part of wheelchair seating assessment. The purpose of the mat examination is to determine ...
Available range of motion for a seated posture, where support surfaces are required and what seated angles will be used.
98
Wheelchair seating system categories include primary and secondary support surfaces, what is included in these categories?
Primary support surfaces: primary weight bearing components (seat support (cushion), back support, foot supports, arm supports)
Secondary support surfaces: alignment in primary supports (lateral supports, head supports, knee supports)
99
In terms of stability, which wheelchair cushion material is more stable...less stable?
- Foams (stable)
- Hybrids (less stable)
- Gels and fluids (least stable)
100
In terms of pressure distribution, which wheelchair cushion material provides the most distribution...least?
- Air (most pressure distribution)
- Gels and liquids (less pressure distribution)
- Hybrid products (less pressure distribution)
- Foams (least pressure distribution)
101
When determining back support type for a wheelchair, there is an important balance between back support length/back support contour and support, explain this balance.
When back length and back contour are increased so is support, but when back length and back contour are increased there is also a decrease in freedom of movement.
102
Low back supports are primarily used for a client who....
- Only needs support for pelvis and lumbar vertebrae
- Is able to hold neutral position hands-free
- Only needs a small amount of support for functional balance
103
Mid back supports are primarily used for a client who...
- Only needs support below bottom of inferior angle of scapula (IAS)
- Requires support while using propulsion
- Hand-dependent
104
Tall back supports are primarily used for a client who...
- Needs support from pelvis to top of shoulder
- Clients using tilt
- Client may have arm movement and therefore needs shoulder free while keeping total back support
105
Explain the general height rules for wheelchair back supports.
Tall back = shoulder height - PSIS height
Mid back = IAS (inferior angle of scapula) height - PSIS height
Low back = bottom of rib - PSIS height
106
Who chooses the vendor in the wheelchair provision process?
The client chooses the vendor. If no vendor of choice, use multiple vendors to prevent perception of preferring one vendor over another.
107
As an OT are you allowed to share confidential price quotes between vendors?
NO
108
________ owns price quotes and can ask vendors to adjust if preferred vendor provided a higher quote. (wheelchair provision)
Client
109
Manual muscle testing is inappropriate following a neurological event with resultant changes in tone, true or false?
True, a manual muscle test following an upper motor neuron insult would lead inconclusive results because of changes in tone, not necessarily in muscle strength.
110
It is normal to have slightly more PROM than AROM, true or false?
True; however, if AROM is significantly less than PROM, there is a problem with how the underlying structures are functioning.
111
Explain bone-to-bone hard end-feel.
A stop in movement as the bony structures meet (normal for elbow and knee extension).
112
Explain soft-tissue approximation.
A stop in movement due to soft tissue (normal for elbow and knee flexion).
113
Explain capsular end-feel.
A movement that is somewhat firm or leathery but has some give (normal for shoulder external rotation and hip external rotation).
114
Explain spasm end-feel.
A tissue response with a harsh movement in the opposite direction; passive movement stresses a fracture or inflamed joint (always abnormal).
115
Explain springy end-feel.
Some hard rebound at the end of ROM (always abnormal).
116
Explain empty end-feel.
No "feel" but rather the client asks to stop because of pain (always abnormal).
117
As an OT you observe a capsular end-feel during elbow extension when the elbow is at 30 degrees, what do you think?
Abnormal. May be the result of capsular tightness from immobilization.
118
Shoulder flexion ROM should range from (average limits):
0-180 degrees
119
Shoulder extension ROM should range from (average limits):
0-60 degrees
120
Shoulder ABduction ROM should range from (average limits):
0-180 degrees
121
Shoulder horizontal ABduction ROM should range from (average limits):
0-45 degrees
122
Shoulder horizontal ADduction ROM should range from (average limits):
0-140 degrees
123
Shoulder internal rotation ROM should range from (average limits):
0-70 degrees
124
Shoulder external rotation ROM should range from (average limits):
0-90 degrees
125
Elbow extension-flexion ROM should range from (average limits):
0-150 degrees
126
Forearm supination ROM should range from (average limits):
0-80 degrees
127
Forearm pronation ROM should range from (average limits):
0-80 degrees
128
Wrist flexion ROM should range from (average limits):
0-80 degrees
129
Wrist extension ROM should range from (average limits):
0-70 degrees
130
Wrist ulnar deviation ROM should range from (average limits):
0-30 degrees
131
Wrist radial deviation should range from (average limits):
0-20 degrees
132
Thumb carpometacarpal flexion ROM should range from (average limits):
0-15 degrees
133
Thumb carpometacarpal extension (radial abduction) ROM should range from (average limits):
0-50 degrees
134
Thumb carpometacarpal ABduction ROM should range from (average limits):
0-50 degrees
135
Name some client-related factors that may affect accuracy and reliability of ROM measurements.
Pain, fear of pain, fatigue, and feelings of stress or tension.
136
AROM measurements are more reliable than PROM, true or false?
True, PROM measurements have the potential to be less reliable because of variability in the applied force.
137
In the neutral zero method for measuring ROM, ____________________ is considered to be "0 degrees" (zero start).
Anatomical position.
138
For ROM measurements to reflect actual change, the amount of change must exceed measurement error, which is found to be ____ degrees for both UE and LE.
5 degrees. Thus, an increase of 10 degrees in shoulder flexion is considered an improvement, but 5 degrees may be accounted for by measurement error.
139
In the break test, the muscle to be tested is placed in what position?
Positioned at its greatest mechanical advantage.
140
To obtain the maximal hand-grip strength, at least ____ attempts or trials should be recorded.
3
141
Explain tactile sensation.
The sense of touch, specifically the information received from varying pressure or vibration against the skin. Tactile sensation is considered a somatic sensation (it originates at the surface of the body, rather than internally).
142
Explain peripheral sensation.
Includes touch and pressure awareness, temperature, pain, and two-point discrimination.
143
Explain centrally mediated sensation.
Involving brain and spinal cord processes, has varying presentation - usually involves loss of proprioception (position sense) and stereognosis (blinded object awareness) - may include diminished awareness of touch.
144
Explain haptic perception.
Sense needed to determine force used in grip. Critical sense needed for successful and safe performance of daily activities
145
The following are sensation descriptors, explain each term:
- Anesthesia
- Paresthesia
- Hyperesthesia
- Anesthesia: absent sensation
- Paresthesia: an abnormal sensation, "asleep" or "pins and needles"
- Hyperesthesia: exaggerated sensation beyond expectation (hypersensitivity)
146
Nociceptors sense...
Pain and temperature
147
The following are pain descriptors, explain each term:
- Dysesthesia
- Allodynia
- Dysesthesia: an abnormal pain sensation
- Allodynia: pain from a non-painful stimuli
148
Name some indications that a sensory evaluation may be beneficial to perform with a client.
Known or expected diagnosis that affects the sensory system (peripheral nerve laceration/compression), observed occupational performance dysfunction (poor object handling or manipulation), and/or client expression of odd/unpleasant sensations (aversion to certain material, resistant to wearing a splint).
149
When and why would it be beneficial to use the wrinkle test as a sensory assessment?
It would be beneficial to use a wrinkle test when working in pediatric populations, or with dementia clients (clients may not be able to verbally explain feeling and sensation, or may not understand the therapist's question).
150
In the wrinkle test, if the skin does not wrinkle what does this mean?
The nerve is not functioning properly.
151
Briefly explain the procedure for sensory evaluation.
- Obtain a history of health issue related to sensory deficits and functional challenges.
- Ensure that client is relaxed, distractions are eliminated, fatigue avoided, vision occluded if necessary.
- Compare affected and non-affected sides if possible.
- Avoid non-neutral positioning of head, neck, upper arm
- Avoid sensory confusion with accidental stimuli on other parts of the hand
- General observation of task performance
152
Autonomic function can be screened through observation, explain the various factors to look for.
- Vasomotor: temperature, color, sensitivity to temperature
- Sudomotor: sweating (lack of sweating correlates with lack of discriminative sensation)
- Pilomotor: goosebumps
- Trophic: nutrition of nails, finger pulps, hair growth
153
"Positive" Tinel's sign indicates?
The "tapping" over a nerve elicits a sensory response (tingling, electric shock through the distribution of tested nerve) *Not positive for specific nerve being tested if tapping elicits a response in an area "where there shouldn't have been"
154
Explain Phalen's test.
Flexing the wrist 30-60 seconds (median nerve compression) to determine if it elicits a sensory response (tingling, pain)
155
Innervation density is measured how?
Moving two-point discrimination (m2PD) and/or static two-point discrimination (s2PD).
156
What is stereognosis?
Stereognosis is object identification.
157
Touch localization can be assessed using...
A grid, such as a hand grid to determine location of perceived sensation.
158
What sensation test is useful as a measurement after nerve laceration and repair?
Two-point discrimination (moving and static).
159
What sensation test is useful as a measure if early nerve compression is suspected?
Monofilament tests (threshold tests) and/or vibration awarness.
160
If sensation screening/assessment findings determine diminished or lost protective sensation, what should treatment planning (intervention) generally include?
Education. Compensatory techniques to avoid injury.
161
If sensation screening/assessment findings determine decreased but not completely lost sensation with potential for improvement, what should treatment planning (intervention) generally include? (commonly used for peripheral nerve injuries and/or stroke/brain injury)
Sensory retraining/re-education. Helps patients with sensory impairment to reinterpret sensation. Goals of sensory training are to maintain or restore the cortical hand representation and to regain optimal use of sensation of the hand.
162
If sensation screening/assessment findings determine hypersensitivity, what should treatment planning (intervention) include?
Desensitization program, scar management. Desensitization programs should be designed to decrease the discomfort associated with touch in hypersensitive area and may include repetitive stimulation of hypersensitive skin with items that provide a variety of sensory experiences (massage, textures ranging from soft to coarse).
163
If occupations involve potential for continuous low pressure (seating with paraplegia), what should be focused on in education for the client and what supports should be added?
- Teach frequent position changes
- Provide cushions/padding, protective garments
- Teach reliance on other senses (vision, use of body part with intact sensation, auditory cues)
- Inspect skin after prolonged pressure
164
If occupations involve potential for concentrated high pressure, what should be focused on in education for the client?
- Careful handling of sharp tools
- Enlarged handles on suitcases, drawers, tools, and keys
165
If occupations involve potential for extreme heat or cold, what should be focused on in education for the client if the experience limited sensation?
- Teach increased awareness
- Insulated coffee mugs
- Insulate exposed hot water pipes under sinks for wheelchair users
- Mittens (best) or gloves in cold weather
- Oven mitts or pot holders for cooking
- Utensils with wooden or plastic handles
166
If occupations involve potential for repetitive mechanical stress OT's should teach...
Avoidance of excessive friction between skin and objects and to decrease repetitions (work for shorter periods, rest, use a variety of tools, alternate hands or type of grip). Educate about special skin care to avoid injury and infection (blisters, cuts, bruises).
167
Explain passive and active sensory training.
Passive sensory training may be used for clients without any sensation to maintain cortical representation by improving sensation through long-term highly repetitive stimulation of the client's skin (repeated touch to increase tactile awareness in a specific region).
Active sensory training may be used for those beginning to have return of sensation by combining techniques of attention, learning, repeated practice, and use of alternative senses such as vision or hearing.
168
Explain sensory re-education (training) techniques after peripheral nerve injury and/or repair.
Phase 1: (passive focus) begin immediately after nerve repair with the goal to preserve the cortical representation of the denervated part (e.g., mirror visual feedback therapy).
Phase 2: (active focus) begins when the patient first appreciates some sensation and can learn to differentiate between sensations with the goal to regain functional use of the denervated part.
169
Name some examples of active sensory re-education interventions (for decreased but not completely lost sensation with potential for improvement).
- Object recognition using feature detection strategies
- Prehension of various objects with refinement of prehension patterns
- Control of prehension force while holding objects
- Maintenance of prehension force during transport of objects
- Object manipulation
- During stimulus localization, progress from firm to lighter pressure
- During object identification progress from larger to smaller items, progress from dissimilar to more similar items, progress from differentiation of a few objects to selecting, sequencing, or organizing many objects
- Daily training is necessary for successful sensory re-education
Teach patients techniques appropriate for after-therapy practice
170
Initially clients may use a splint or padding over affected area when experiencing hypersensitivity, this must be weaned as improvement occurs. Patients advance to next level after demonstration of tolerance of current level without signs of irritation, clinical activities that are used to decrease hypersensitivity in the next level of intervention may include...
- Weight-bearing pressure
- Massage
- Transcutaneous electrical nerve stimulation
- Vibration (battery operated toothbrush)
- Engagement of affected part in leisure, work, and daily occupations
171
What are the two-point discrimination norms?
3-5 mm on the fingertips for ages 18-70 years
5-6 mm on the fingertips for ages 70+
172
Because pain is subjective, self-report measures provide the most valid measure of the experience, true or false?
True.
173
What are physical agent modalities and how are they used in OT?
Interventions and technologies that use force or energy to promote healing process and reduce pain. These interventions are used in OT as a precursor to engaging in desired occupational activities.
174
Name some interventions for hand edema.
- RICE (rest, ice, compression and elevation) for first 48 hours
- Lotion massage, massaging fingers downward, massage palms downwards (manual lymph drainage)
- Coban wrapping for digits (always start wrapping on distal end)
- Kinesio-tape
- High voltage pulsed current
- Compression glove or sleeve
