Flashcards in Physical Rehab Deck (136):
Treatment of contractures
1) superficial and deep heat to increase tissue extensibility
2) slow stretch
3) static splinting
Posterolateral hip precautions
-no hip flexion greater than 90 degrees
-no internal rotation
Anterior Hip precaution
-no external rotation
-no hip extension
widespread pain affecting the entire musculoskeletal system
s-Client education to avoid pain triggers/manage stress
-gentle regular aerobic exercise, gentle daily stretching, strengthening activities, cognitive-behavioral therapy
Low Back Pain
Result of poor physical fitness, obesity, reduced muscle strength and endurance
when the nerve is trapped by a herniated disc
facet joint pain
inflammation or changes of the spinal joints
slippage of a vertebra out of position
Lower back pain - OT Intervention
-neutral spine back stabilization techniques to decrease pain
-AE-increase strength and endurance
-pain management, stress reduction, coping
Rheumatoid Arthritis (RA)
chronic, systemic, inflammatory condition of the synovial membrane of the joints that can lead to destruction of ligament, tendon, cartilage and bone.
Most common joints affected: PIP, MCP, all thumb joints, wrist, elbow, ankle
-pain, redness, warmth, tenderness, stiffness, ROM limitations, muscle weakness, weight loss, fatigue and depression
-AE to compensate for ROM
-AROM can be used through full pain-free range.
-PROM used during acute flare ups to prevent stress
on inflamed joints
-Isotonic exercises can be used during remission of RA
-Aerobic exercises=low impact such as walking, stationary bicycling, dancing-Splinting
noninflammatory condition that causes a breakdown in cartilage resulting in reduced joint space and eventually painful bone-on-bone contact.
-paraffin, fluid therapy, hot packs, Estim=reduce pain and increase ROM
-pinching exercises w/CMC joint causes stress on the joint
progressive condition characterized by low bone mass/density leading to fragile/fractured bones
-Adaptations/Modifications to compensate for pain, stiffness, decreased ROM (devices w/built-up or extended handles)
-Encourage low-impact WB activities=walking
-Encourage good positioning/posture during activities
-Home visit=to reduce chance of falls
-Energy conservation/joint protection
Cerebrovascular Accident (CVA) - Stroke
neurological dysfunction caused by a lesion in the brain
-trunk/postural control-fall risk
-limits functional activity
-dependence for ADLs
-impairment in standing, WB, weight shifting, stepping activities
Feeding TBI - OT Intervention
-isolated/quiet room to prevent distraction
-rocker knife, plate guard, non-spill mug
Ataxia - OT Intervention
compensatory strategies for control such as weighting body parts-hand-over-hand exercise
-follow steps/pictures or words on a note card
Client's w/abnormal tone or posturing should...
lay on their side or semiprone to help normalize tone/provide sensory input.
UE are in spastic flexed position w/internal rotation and adduction. LE are in spastic extended position, internally rotated, and adducted
UE/LE are in spastic extension adduction, and internal rotation. Wrist/fingers flex while plantar portions of the feet flex/invert, the trunk extends and the head retracts.
abnormal movement resulting from cerebellum damage
Burn size on Adults
Rule of nines head/neck
-9% arm (you have two so 18%)
-18% leg (you have two so 36%)
Superficial (1st degree) burn
involves superficial epidermispain is min to modhealing time is 3-7 days
Superficial partial-thickness (2nd degree) burn
upper epidermis and upper dermis layersPain is significant, wet blistering w/erythemahealing time is 1-3 weeks
redness of the skin or mucous membranes
Deep partial-thickness (deep 2nd-degree) burn
Involves the epidermis/deep dermis layers, hair follicles and sweat glands
-Pain is severe - even to light touch
-can turn into a full-thickness burn due to infection
-Grafting may be considered to prevent infection
-Impairment of sensation
-Potential for hypertrophic scar
-Healing time is 3-5 weeks
excessive amounts of collagen which gives rise to a raised scar (over cut or burn)
Full-thickness (3rd-degree) burn
Involves epidermis/dermis, hair follicles, sweat glands, and nerve endings
-No sensation to touch!
-Burn is pale w/no blanching
-Requires skin graft!
-Hypertrophic scarring is high!
when you touch your skin near a burn a white spot means you have good circulation
Full-thickness burn to tissue, fat, muscles and bone-charring is present, destruction of nervePeripheral nerve damage
-Needs surgical intervention for wound closure/amputation
surgical incision into the burn tissue to relieve pressure on extremities
human cadaver graft (temporarily)
pig skin graft (temporarily)
Own skin (permanent)
Cultured epithelial autografts (CEA)
own skin is grown and then grafted (permanent)
OT Intervention: Splinting in antideformity positions
-Intrinsic plus for hands
-Opposite client's posture
-Generally in extension for neck, elbows and knees
-Shoulder in abduction
-Hip in extension
-Anti-frog leg and anti-foot drop for lower extremity
OT Interventions - Burns - Acute Phase
ROM, muscle strength and pain
-Splinting, positioning in anti-deformity positions, edema management
How long do you wait until you can do passive/active ROM w/exposed tendons or recent grafts
How long should you wait after pain meds have been given?
Formation of bones in abnormal areas.
-Loss of ROM is rapid
-Use AROM exercise within the pain-free range to preserve as much joint movement as possible
Are silastic gel sheeting used on open wounds?
What are silastic gel sheeting used for?
Temporary use in the management of both old and new hypertrophic scars or keloid scars
Pressure garment purpose
To provide pressure at the burn sight to decrease scarring and help circulation so less swelling is observed and to decrease a risk of infection
How often a day should you wear your pressure garment
24 hours a day and remove for washing
What is the initial skin treatment after a burn?
moist gauze wraps
How long do patients wear gauze wraps?
Depends on skin healing. Some pts may need to wear the gauze for 2-3 weeks...
What do you place on the skin that has adequately healed?
What is xeroform?
Is placed on any small burn that has the potential for cracking or bleeding. This is placed on the area under the pts tubigrip
What is tubigrip?
Helps to decrease swelling, prevent keloid scarring, decrease pain to sensitivity to the air, and to prepare the skin for a custom-made Jobst compression garment
firm, rubbery lesions or shiny, fibrous nodules
What does a Jobst compression garment do?
Provide additional pressure and therefore serve to further decrease swelling, pain, scarring, skin sensitivity and remodeling of skin.
Order of garments for burn pts
wet gauze wraps
Jobst compression garment
OT Intervention: Coronary Artery Disease
-home program guidelines
Chronic obstructive pulmonary disease
damage to the alveolar wall and inflammation of the conducting airways
Cerebral Palsy (CP)
Difficulty maintaining normal muscle postures because of a lack of muscle coactivation and the development of abnormal compensatory movement patterns.
-Using AE-Maintain AROM/PROM
-Instruct on seating/positioning
-Constraint-induced movement therapy
Affects the upper and lower extremities on one side of the body
Affects the upper/lower extremities (all 4 limbs) on both sides of the body
Mild in both arms are affected while both legs affected more (top half vs. bottom half of body)
Age-related macular degeneration (AMD) - Dry
Causes deposits of yellow-colored extracellular material within the macula of the eye, causing possible atrophy of the retina and a gradual loss of central vision.
Primary open-angle Glaucoma
When the optic nerve is damaged from increased pressure.
Angle closure glaucoma
Acute condition which fluid becomes blocks, quickly raising intraocular pressure.
changes in the blood vessels of the retina.
When the tendon separates from the bone and its insertion and its insertion and removes bone material w/the tendon
Is mallet finger an avulsion?
Yes - is splinted in full extension for 6 weeks
Describe (inflammation) part of fracture healing
provides cellular activity needed for healing
Describe (remodeling) part of fracture healing
When does controlled AROM begin after fracture?
What is the most severe complication of hand fractures?
Complex regional pain syndrome
Colles Wrist Fracture
Complete fracture of the distal radius w/dorsal displacement
Smith's Wrist Fracture
Complete fracture of the distal radius w/palmar displacement
Bennet's Wrist Fracture
Fracture of the first metacarpal base
Median Nerve Injury is?
Produces carpal tunnel-like symptoms such as palmar numbness and numbness of first digit to half of the fourth digit w/generalized weakness and pain
Ulnar Nerve Injury is?
Results in ulnar claw deformity and numbness of the ulnar side of the hand and the fifth and half of the fourth digits w/generalized weakness of the ulnar side of the hand and pain.
Radial Head Fractures (elbow fracture) - Type 1
Nondisplaced-treated w/a long arm sling
Radial Head Fractures (elbow fracture) - Type 2
Displaced w/a single fragmenttreated nonoperatively w/immobilization for 2-3 weeks and early motion w/medial clearance
Radial Head Fractures (elbow fracture) - Type 3
Comminuted-treated operatively, w/immobilization and early motion within the first postoperative week
Radial Head Fractures (elbow fracture) - Interventions
Orthotics - for immobilization as neededROM within the 1st weekA sling for type 1 fractures
Proximal humeral fractures - Interventions
-Orthotics (humeral fracture brace)-ROM as early as 2 weeks
-Sling to immobilize the fracture
-ROM consists of aggressive stretching and can start 4-6 weeks after the fracture as by MD
-Home exercise program
What is complex regional pain syndrome (CRPS) or called reflex sympathetic dystrophy?
pain to an injury
-bluish/red shiny skin
-Gentle, pain free AROM
-(NO PROM or PAINFUL TREATMENT!)
-Stress loading - scrubbing floor, carrying a weighted handbag)-Pain control - TENS, splinting
OT Intervention to CTD - Acute Phase
Reduction of inflammation and pain through static splinting, ice, contrast baths, ultrasound, Estim
OT Intervention to CTD - Subacute Phase
Slow stretching, myofascial release, progressive resistive stretch exercise, proper body mechanics, static splint during activity
OT Intervention to CTD - Return to Work
Assessment of Job site, tools, body positioning-Work simulator, elastic bands, putty, functional activities, strengthening-Work hardening
soft tissue therapy for pain
Radial Nerve Injury
-posture of hand is wrist drop, possible lack of finger/thumb extension
-Wrist cock-up splint with or without dynamic finger/thumb extension assist, passive/active ROM, isotonic strengthening exercises
-Static wrist extension splint 30 degrees, after 4 weeks adjust splint to 10-20 degrees
Radial Tunnel Syndrome
Entrapment of the radial nerve in an area extending from the radial head to the supinator muscle
-Burning pain the lateral forearm
-Long arm splint, elbow flexed, forearm supinated, wrist netural, Massage/TENS for pain, ROM, nerve glide
-Long arm splint, elbow flexed, forearm supinated, wrist neutral for 2 weeks, then wrist cock up for 2 more weeks
Anterior Interosseous Syndrome
Compression to the anterior interosseous Nerve
-Results in a motor loss involving the flexor digitorum longus, flexor profundus and pronator quadratus
Entrapment of the proximal median nerve between the heads of the pronator muscles
-Deep pain proximal forearm w/activityNonoperative treatment
-Splint elbow 90-100 degrees flexion, forearm neutral, TENS for pain, gentle stretchingOperative
Median Nerve Injury
Causes Ape hand deformity
-Ape hand deformity, sensory loss in index, middle, and radial side of ring finger, loss of pinch, thumb opposition
Nonoperative treatment-Static thenar web spacer splintOperative treatment-Dorsal wrist blocking splint worn
Double crush syndrome
Occurs when a peripheral nerve is entrapped in a more than one location
-Intermittent diffuse arm pain and paresthesias w/specific postures
-avoid movements/postures that aggravate symptoms-nerve gliding exercises
-exercises for scapular stability-posture/core trunk strengthening
Carpal Tunnel syndrome
Entrapment of the median nerve as it courses through the carpal tunnel.
Sensory impairment involves numbness/tingling in the thumb/index/middle fingers
Diminished fine motor coordination
-Wrist cock-up splint= to relive pressure on the median nerve in the carpal tunnel and control edema.
-Nerve/tendon gliding exercises
-Activity modification=ergonomic handles, gel pads, or padding on handles
-Client education=avoidance of postures/activities that aggravate the condition (wrist flexion).
-Postural retraining/proximal conditioning exercisesPostoperative Treatment-wound care/scare mobilization-pain management-splinting
-AROM of wrist, thumb, fingers (1-2 days after surgery)
-Nerve/tendon gliding exercises
-Strengthening begins 3-6 weeks
Cubital tunnel syndrome
Proximal ulnar nerve compression at the elbow between the medial epicondyle and the olecranon process.
-Sensation is decreased in the little finger/ulnar half of the ring finger
-Motor problems such as decreased grip/pinch strength
-Edema control-pain management
-elbow splint-ulnar nerve gliding-proximal conditioning activities-posture/ergonomic training
-splint the elbow, wound care, edema control, pain management
de Quervain syndrome
cumulative microtrauma resulting in tenosynovitis of the thumb muscle tendon unit
Caused by forceful, repetitive thumb abduction
-forearm-based thumb spica splint w/wrist in neutral/thumb radially abducted-
computer ergonomics education
-gentle ROM/tendon gliding exercises
-Grip/pinch strengthening begins at 2 weeks
-Scar management/desensitization techniques
The distal ulnar nerve compression or lesion at the wrist
Sensory loss occurs in the little finger/ring finger and the palmar ulnar hand
-padded antivibration glove can be used during activity to avoid further nerve irritation
-Activity modification: ergonomic handles, gel pads, padding on handles of vibratory equipment (lawnmower)
-Client education: avoid postures, activities that aggravate the condtion
-bulky dressing is applied for 3-10 days
-Dorsal blocking splint is used to maintain the wrist flexion.
-AROM of the wrist/hand begins at 6 weeks.
-Sensory reeducation begins at 10-12 weeks.
Digital stenosing tenosynovitis (trigger finger)
-Splinting the MCP at zero degrees for 3-6 weeks.
-Protective reeducation for clients to compensate for sensory loss.
-Desensitization of applying different textures/tactile stimulation to reeducate the nervous system.
Cryotherapy (ice massage, ice, cold packs, cold water immersion baths)
Pain relief decrease edema decrease muscle spasms decrease inflammation
-clients w/impaired circulation
-peripheral vascular disease
-hypersensitivity to cold-impaired sensation
Thermotherapy (warm whirlpools, fluidotherapy, hot packs, contrast batths, and paraffin baths)
Increase blood flow increased cell metabolism increased inflammation increased muscle contraction increased oxygen consumption decreased muscle spasms decreased pain
-clients w/acute inflammation
Ultrasound heats tissue (1-5 cm depth)
Thermal effects - increase tissue extensibility and blood flood, decrease pain, joint stiffness, muscle spasms, chronic inflammation.
Nonthermal effects - increase protein synthesis and bone healing and decrease inflammation
Precautions/contraindications: avoid w/pregnancy, over eyes, pacemaker, bleeding, infections, cancer, over blood clots, cognitive impairments, sensory impairments.
NMES - wound healing, maintains muscle mass, increase ROM, decrease edema, facilitates voluntary muscle control, decrease spasm/spasticity.
TENS - controls painIontophoresis - decreases inflammation and controls pain
Precautions/contraindications: do not use over pacemaker, eyes, clients w/epilepsy, cancer, infection, decreased sensation, cardiac disease/stroke.
Low-level laser/Light therapy
decreased pain, edema, inflammation, increased wound healing and decrease scar tissue.
Precautions/contraindications: wear protective eyewear, eyes, infection or cancer.
Wound closure - Remolding phase
wearing pressure garments helps collagen fibers realign. dynamic splinting, serial casting, passive motion, stretching, NMES and silastic gel pads can help decrease hypertrophic scarring
What are neurodegenerative diseases?
progressive and usually chronic conditions resulting from damage to the peripheral nervous system, central nervous system or both
Multiple sclerosis (MS)
chronic/progressive disease of the CNS. your body attacks the myelin sheath around the brain/spinal cord. This produces scar tissue/plaque of the nerve fibers.
-impaired balance/coordination (ataxia)
-partial/complete paralysis of a part of the body, muscle spasticity in LE
-Intention tremors (when a person attempts to engage in activity
-Short term memory loss
-Decreased processing speed
-difficulty w/new learning, abstract reasoning, problem solving
OT Rehabilitation Treatment: to minimize the severity, amount, and length of exacerbations in order to improve function.
-AE= optical devices, large-print material, large button tech, talking watches, audiobooks
-bladder training/educate on self-catheterization or use of sanitary pads, absorbent underwear
-body mechanics to avoid stressing joints
-yoga/group exercise classes-stress importance of resting/avoid fatigue
-Aquatic therapy can reduce the effects of weakness
-proximal stabilization for improved distal movements!!!!
-hand-over-hand techniques for fine motor tasks (unaffected arm over the hand w/tremor to dial phone)
-external memory aids (day planners)
-allow for increased time,delegation, and repetition when learning new ideas
-stress management/relaxation tech
-AE equipment w/built-up handles, weighted utensils for feeding or wrist weights during self-care activities to reduce tremors!!!!!
-Hot temperatures, heat modalities, fluidotherapy, increased emotional/physical stress, excessive physical activity or overexertion,
is a sensation of tingling, tickling, pricking, or burning of a person's skin
MS Stage: Relapse-Remitting
fluctuating course of relapses w/associated neurologic deficits, followed by periods of relative quiet
MS Stage: Secondary Progressive
cessation of fluctuations w/slow deterioration
MS Stage: Secondary progressive w/relapses
fluctuation w/relapses and deterioration between relapses
MS Stage: Primary progressive
deterioration from beginning
MS Stage: Progressive relapsing
Parkinson's Disease (PD)
Progressive condition. Degenerative changes occur in the basal ganglia (gray matter that contributes to complex movements). Also the substantia nigra becomes depigmented affecting dopamine production (a neurotransmitter that influences the speed/accuracy of motor skills, postural stability, cognition and affect and expression.
-Tremor= resting tremor which affects one side and is called a ''pill-rolling'' movement of the hand. Tremors disappear when the person is asleep or calm and increase w/stress/cognitive tasks.
-Muscle rigidity/stiffness= tone is increased affecting movement. Pts demonstrate cogwheel motions (jerky, painful movements). Fatigue is a big issue because of an increased effort to produce voluntary movements.
-Bradykinesia= extreme slowness when initiating/performing volitional movements (shuffling gait, moving from sitting to standing, freezing, increased time for fine motor tasks (shaving/fastening clothes).
-Posture= is stopped, with a lack of arm swing during mobility, fall risk when balance is challenged.
a condition in which people experience symptoms similar to those of PD caused by ingestion of drugs/toxic chemicals
5 Clinical Stages of PD
Stage 1: unilateral symptoms, typically resting tremor, no/minimal loss of function
Stage 2: bilateral symptoms, trunk mobility/postural reflexes problems
Stage 3: impaired balance secondary to postural instability resulting in mild/mod impairment in function
Stage 4: decrease in postural stability, decrease in function, impaired mobility, need for assistance w/ADLs, poor fine motor/dexterity
Stage 5: total dependence for mobility/ADLs
Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) (ALS)
A progressive, degenerative disease in which motor neurons in the brain, spinal cord, and peripheral system are destroyed and replaced by scar tissue. This results in plaques that lead to progressive muscle atrophy.
-progressive and move distal to proximal.
-weakness of the small muscles of the hand
-muscle atrophy (from distal to proximal)
-Cramping/twitching of muscles
-Cognition/sensation, vision/hearing, bowel/bladder control are typically not affected!!!!
-Life expectancy is 1-5 years!!!!
-compensatory "focusing on adapting to disability and preventing secondary complications.
-positioning, transfers, skin integrity, safety education
-Augmentative communication equipment
-Neck collar or universal cuff is used for UE stability during self-care or fine motor tasks.
-Mobility aids (foot-drop splint, cane, walker) minimize exertion during ambulation, compensate for LE weakness/reduce risk of falls
-Ideal W/C=high backed, reclining
-Adapt food=thicken liquids, downgrade to diet to soft foods
-Manual swallowing techniques
when muscles waste away
ALS 6 Stages
Stage 1: person can walk, is Indep w/ADLs, some weakness
Stage 2: person can walk and has mod weakness
Stage 3: person can walk but has severe weakness
Stage 4: person requires a w/c for mobility, needs some assistance w/ADLs, has severe weakness in the legs
Stage 5: Person requires a w/c for mobility, in dependent for ADLs, has severe weakness in the arms/legs
Stage 6: person is confined to bed/dependent for ADLs and most self-care tasks.
Inflammatory disease that causes demyelination of axons in peripheral nerves.
-Acute weakness occurs in at least two extremities
-Plateau phase: Most disabling symptoms
-Recovery Phase: Tends to start at the head/neck and travel distally.
-Pain, fatigue, edema, mild sensory loss
-Autonomic Nervous System
-Communication tools=signs/picture boards
-Adjust supine/sitting positions that optimize function/comfort and reduce risk of skin breakdown.
-Position pt for trunk, head, UE stability OT Intervention
-Dynamic splints to help ROM-AE-Energy conservation/fatigue management
Autonomic Nervous System (ANS)
result in postural hypotension (when someone rises from a horizontal position, blood pressure drops to low levels
-facial flushing, diarrhea, impotence, urinary retention, increased sweating
Huntington's Disease (HD)
Hereditary neurological disorder that leads to severe physical/mental disabilities. Progressive loss of nerve cells in the brain, affecting movement, cognition, emotions and behavior.
-Choreiform movements of hands
-based gait pattern
-smaller movements of hand-eye coordination
-difficulty w/mental calculations, sequencing of tasks/memory
address cognitive components of memory/concentration-establish daily routine, checklists, tasks analysis to break down tasks into manageable steps-avoid open-ended questions to pts
engagement in purposeful activities
-simple written cues/words to promote completion of self-cares
-walker or w/c
-routine breaks to deal w/fatigue
-positioning techniques/AE-wrapping legs around the chair legs to stabilize the pelvis and placing the elbows on the table to stabilize the upper trunk
-Utensils w/built-up handles
-switch to soft foods to accommodate changes in oral-motor function-ring on zipper for easier fastening
-built-up handle on toothbrush
-sitting in a sturdy chair
attention to positioning
-splinting to prevent contractures
-daily schedules/routines constant
rapid, involuntary, irregular movements, increasing during stressful situations and lessening or absent during voluntary motor activities/sleep
abnormal, sustained posturing of a body part, typically in the arms, head or trunk
excessive tone, tension
Dementia - Alzheimer's Disease (AD)
-progressive Impairment of memory, executive function, attention, language, visual processing, praxis
-slow/progressive until death
-decline in Cognitive abilities=decision making, language skills, problems recognizing family/friends
Dementia - Vascular Dementia
series of small strokes leading to lesions on the brain
-cognitive decline similar to AD but often less severe memory involvement
Dementia - Frontotemporal Dementia
-progressive aphasia, symptoms similar to AD or PD
Dementia With Lewy Bodies
-decline in acetylcholine and dopamine levels
-deficits in attention/executive function, memory Impairment, visual hallucinations, parkinsonism, autonomic dysfunction, rapid eye movement
-aphasia, apraxia, spatial disorientation
inability to speak, read, or write
inability to perform particular actions because of brain damage
inability of a person to correctly determine their body position in space.
recall of recent events
recall information on how to perform a task, such as knowing how to write/ride a bike
Personal episodic memory
recall of time-related information about oneself, such as where/whether one ate breakfast
ability to remember the names of objects
overflexion of a limb
involuntary resistance to passive movement of the extremities
-reassurance in a calm/caring manner
-avoid Using restraints