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Rehab > Rehab Final > Flashcards

Rehab Final Flashcards

1
Q

UE Assessment- Biomechanical

A
  1. Understand the underlying injury - mechanism & timeframe
  2. Anatomy
  3. Soft-tissue mobility
  4. Edema
  5. ROM
  6. Strength
  7. Coordination
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2
Q

Upper Quadrant consists of?

A

Scapula, shoulder, elbow, hand

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3
Q

UQ UE injuries are?

A

very common; specifically work related, also from disease and congenital abnormalities

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4
Q

What percentage of severe stroke patients recover hand function?

A

15%

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5
Q

What is the hand vital for?

A

human function, complex movements

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6
Q

What can loss of hand function impact?

A

livelihood and occupational performance

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7
Q

What is a specialty area in OT?

A

Hand therapy

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8
Q

Common shoulder conditions

A 
Rotator Cuff Tear (SITS)
Adhesive capsulitis 
Shoulder impingement 
Bicep tendonitis 
Shoulder bursitis 
Thoracic Outlet Syndrome 
Frozen shoulder
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9
Q

Elbow and hand conditions

A 
Lateral epicondylitis 
Cubital tunnel syndrome 
Thumb UCL instability (skiers or gamekeepers thumb) 
CMC arthritis 
Carpal Tunnel Syndrome 
Nerve lacerations 
Tendon lacerations 
Forearm and hand fractures
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10
Q

Observation of UE, inspection of skin (color of hand)

A

pallor, cyanosis, erythema

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11
Q

Observation of UE, inspection of skin - trophic changes

A

change in the appearance of nails, increased dryness or moistness of skin, open wounds, necrotic tissue

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12
Q

Certified Hand Therapist

A

specialization required advanced study & clinical experience

  • American Society of Hand Therapists
  • CHT certification- advanced certification with exam
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13
Q

Psychosocial UE

A

Decreased function; depression/anxiety; body image; PTSD- traumatic accidents; emotional support

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14
Q

Neuropraxia

A

contusion of the nerve (recovers few days-weeks)

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15
Q

Axonotmesis

A

nerve fibers distal to the injury degenerate but the nerve remains intact (6 months or more)

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16
Q

Neurotmesis

A

complete laceration of nerve & fibrous tissues, needs surgical repair; may need nerve grafting. (6-9 months) regeneration is one inch per month.

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17
Q

Nerve Injuries

A

can occur at any point from nerve roots (brachial plexus) to fingers
-Understanding of PNS

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18
Q

Nerve Injuries Observations

A

weakness, atrophy, paralysis, sensory loss, contractures

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19
Q

Immobilization

A

use of splints, casts or fixators to keep the structures from moving

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20
Q

early mobilization

A

partial immobilization with specific movement prescribed

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21
Q

what is the purpose of immobilization?

A
  1. rest of injured structures

2. support the injured joint (promoting motion, optimum position)

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22
Q

what is the purpose of early mobilization?

A

prevents stiffness; pain tolerance; optimum positioning; often with specifications (ROM angles) to maintain integrity of surgical intervention; phased mobilization (after pain control)- stretching

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23
Q

Tendon Glides

A
  1. Incorporates thumb ROM
  2. The exercises allow the flexor tendons to glide to their maximum potential and can greatly facilitate therapeutic activities
  3. Incorporate in a comprehensive intervention program
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24
Q

Anesthesia

A

complete loss of sensation

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25
Q

Paresthesia

A

abnormal sensation- tingling or crawling sensation

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26
Q

Hypoesthesia

A

decreased sensation

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27
Q

Hyeresthesia (hypersensitivity)

A

increased tactile sensitivity

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28
Q

Analgesia

A

complete loss of pain sensation

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29
Q

Hypoalgesia

A

diminished pain sensation

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30
Q

Hyperalgesia

A

increased pain

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31
Q

Dyesthesia

A

unpleasant sensation that may be spontaneous or as a result of stimulation

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32
Q

allodynia

A

pain caused by a stimulus that would normally not cause pain

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33
Q

What often occurs in conjunction with sensory impairment?

A

Sympathetic issues; change in vasomotor function, sudomotor, pilomotor, trophic changes, slow healing

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34
Q

vasomotor function

A

skin temp, skin color

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35
Q

sudomotor function

A

sweating - too much, too little

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36
Q

pilomotor changes

A

no goose bumps

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37
Q

trophic changes

A

atrophy of nails and/or finger pulps, change in hair

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38
Q

what do physical agents do?

A

may be used to reduce or modulate pain, reduce inflammation, increase tissue extensibility and range of motion, promote circulation, decrease edema, facilitate healing, stimulate muscle activity, and facilitate occupational performance

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39
Q

State Regulations are State Specific

A 
Continuing Education
Institution Specific requirements
Demonstrating competence 
PAMs coverage and billing
Evidence based practice
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40
Q

Role of OTA in use of PAMs

A

The OTA may use PAMs as a therapeutic modality if she has been trained; OT supervising must be competent in the use of PAMs; rules dependent on specific state licensure, Maine has no restrictions on use of PAMs by OT practitioners

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41
Q

Use of PAMs in OT

A
  • Preparatory to functional activity
  • Concurrent to functional/purposeful activity
  • Necessary component to a person’s routine
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42
Q

PAMs documentation

A

Provide an accurate description of the intervention as well as patient’s response to treatment; include description of the type of agent used, method of application, the name/number of the machine (if applicable area treated), position of the patient, treatment parameters/time

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43
Q

Billing PAMs Unattended vs. Attended (Not reimbursed - but documented)

A

Supervised- the application of a modality that does not require direct one-to-one patient contact; application of a modality to one or more areas; hot or cold packs, traction, mechanical, electrical stimulation, vasopneumatic devices, paraffin bath, whirlpool, dialthemy, infrared

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44
Q

Billing PAMs Attended- reimbursed and documented

A

The application of a modality that requires direct patient contact; application of a modality to one or more areas; electrical stimulation (manual); each 15 mins; iontophoresis, contrast baths, ultrasound, Hubbard tank, unlisted modality

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45
Q

Superficial thermal

A

hydrotherapy/whirlpool, cryotherapy, fluidotherapy, hot packs, paraffin, water, infrared

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46
Q

Deep thermal

A

therapeutic ultrasound, phonophoresis, shortwave diathermy

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47
Q

Electrotherapeutic

A

transcutaneous electrical nerve (TENS), neuromuscular electrical stim (NMES), iontophoresis

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48
Q

Superficial heat (heat pack, fluidotherapy)

A

Reduce pain (analgesia); decrease muscle spasm; increase tissue extensibility (connective tissue, scars, superficial joint capsules and tendons); increase blood flow- increased O2 and nutrients, antibodies, leukocytes, enzymes which can assist in tissue healing; increases metabolic rate - release of histamines and prostaglandins into blood stream

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49
Q

Contraindications & Precautions with heat

A

Client skin should be observed throughout treatment; Do NOT use with edema; proper positioning; client complains - remove heat source; do not use with clients who have: impaired sensation / circulation, tumors/cancer, acute inflammation/edema, DVT, pregnancy, tendency to bleed, impaired cognition, advanced cardiac disease

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50
Q

Paraffin - superficial heat

A

Dip & wrap; 5-8 times; wrap in plastic then bath towel; paraffin glove stays on 15-20 mins; wash hands before using and throw out after use on client; paraffin 47-54 degree celsius / 117-129 F

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51
Q

Cold (cryotherapy)- superficial

A

Cooling of tissue decreases the amount of oxygenation; decrease edema and inflammation in acute injury - most effective when combined with compression; edema reduction; pain reduction; reduction of muscle spasm & spasticity

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52
Q

Precautions & Contraindications for Cryotherapy

A

Continually monitor client skin
Never apply gel pack directly to skin
Apply cold pack no more than 20 mins
Tissue damage occurs at 59 F
Frostbite occurs below 14-39 F
Don’t use with clients who have cold sensitivity
Do not use in areas of impaired circulation
Do not apply over deep open wound
Be careful with impaired sensation or cognition

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53
Q

Therapeutic Ultrasound: Conversion

A

sound waves are converted in to heat, and/or tissue vibration

54
Q

What does therapeutic ultrasound do?

A

heats tissue; decrease pain; decrease inflammation; tissue healing; phonophoresis (anti-inflammatory medicine)

55
Q

Two types of ultrasound

A

Thermal & non-thermal

56
Q

Thermal ultrasound

A

heats tissues (100% duty cycle)

57
Q

Nonthermal ultrasound

A

wound healing vibration of tissues, but no heat (less than 100% duty cycle)

58
Q

Frequency

A

the number of completed wave cycles that pass a fixed point in one second

59
Q

Frequency MHz

A 
1MHz = low, slow, deep (up to 5 cm) 
3MHz = high, fast, shallow (up to 3 cm)

Higher frequency - more cycles per second
Lower frequency = fewer cycles per second

60
Q

Ultrasound terminology - continuous ultrasound

A

Continuous ultrasound- uninterrupted flow of sound waves, causes heating of tissue

61
Q

pulsed ultrasound

A

interrupted sound wave, does not cause heating

62
Q

Duty Cycle

A

amount of time US is on the client (continuous or pulsed); continuous = 100%, pulsed = 50 -75 %, lower duty cycle = less than 50%

63
Q

Precautions and Contraindications- Ultrasound

A

Never use over eye, heart, pregnant uterus, or reproductive organs
Do not use over malignant tumors
Decreased circulation
Avoid growth plates in children
Always keep transducer moving to avoid- “hot” spots
If client complains of pain, decrease intensity or move head more
Metal can cause a standing wave - be cautious

64
Q

Electrical Stim

A

flow or movement of electrons or charged particles from one point to the other; restores the balance between positive and negatively charged particles
electricity may cause magnetic, chemical, mechanic and thermal effects on human tissue

65
Q

TENS

A

pain control; healing of injured muscle or bone; chronic pain; use with ADL

66
Q

NMES

A

muscle contraction; neuro-diagnoses (stroke, TBI); improve function, use with ADL

67
Q

Iontophoresis

A

Deliver anti-inflammatory medication; decrease pain, inflammation, assist with scar breakdown; non-functional based modality

68
Q

electrodes

A

may be self-adhesive or require additional adhesive; skin should be clear prior to application; electrodes come in many different sizes; larger electrodes are more comfortable than smaller electrodes

69
Q

bipolar placement

A

one electrode placed over motor point, the other electrode placed elsewhere on muscle belly, used in TENS and NMES

70
Q

monopolar placement

A

active electrode is placed over treatment area, other electrode is placed at a distance from the first electrode; higher current density. used for stimulation of trigger points and in wound healing.

71
Q

Frequency (pulse rate)

A

Acute pain: higher pps (hz)

Chronic pain: lower pps (hz)

72
Q

Intensity (amplitude)

A

Average tolerates is 35-80amps, OT finds the amps for pain control (TENS) or muscle contraction (NMES)

73
Q

rise and fall (ramp)

A

gradual increase to desired level; typically 2-5 seconds

74
Q

TENS

A

pain control- low frequency - electroanalgesia effect brain releases endorphins; high frequency - blocks peripheral nerves through A and C fibers, nociceptors; post surgical; chronic or acute; impacts the pain cycle; inconclusive evidence, most respond favorably; constant electrical stimulation with modulated current to peripheral nerves; OT controls the frequency, amplitude

75
Q

Neuromuscular Electrical Stim

A

purpose: cause selective muscle contraction; only works on muscles that are partially or fully innervated; may be useful for clients with CNS injuries; may be used to strengthen muscles, prevent muscle atrophy, increase ROM, facilitate voluntary motor control, decrease edema, decrease spasticity & muscle spasm, and act as a substitute for orthotic devices

76
Q

Iontophoresis

A

method of delivering medication to a specific localized area; use direct electrical current to ionically force the medication through the skin; generally used in OT to treat inflammatory conditions, modify scar tissue, and to assist in the healing process

77
Q

Precautions for Estim

A

absent or diminished sensation; peripheral neuropathies; bony prominences; erythema - skin irritation; previous reaction to electricity or skin gels

78
Q

Contraindications for E-Stim

A

Pregnancy; pacemaker; cardiac disease; cancer; DVT (blood clot); infections; carotid sinus/artery; seizure hx; infections; rapid fatigue syndrome

79
Q

Dry Needling

A

specialty course with certification; increases blood flow; helps with pain; releases tightness

80
Q

Epidermis

A

environmental protection; temp regulation

81
Q

Dermis

A

keratinocytes (help control infection); fatty tissue/subcutaneous

82
Q

Types of burns

A

heat burns; chemical burns; electrical burns; frostbite; disease: Stevens-Johnson syndrome, toxic epidermal necrolysis; incidence has declined since the 60s; increased hospitalizations due to improved medical interventions

83
Q

Superficial partial thickness (also donor sites- skin grafting)

A

first degree burn

84
Q

Partial thickness

A

second degree burn

85
Q

Full thickness

A

third degree burn

86
Q

Percentage of body involved

A

Rule of 9’s
Greater than 15% leads to hospitalization
Impact of PMH, chronic conditions

87
Q

Phases of healing - inflammatory

A 
vascular and cellular responses, painful phase. 
Wound debridement (cleaning of bacteria and dead skin)
88
Q

Phases of healing - proliferation

A

re-growing of skin; vascularization; deposit of collagen

89
Q

Phases of healing- maturation

A

fibroblasts leave and collagen takes over; scar softens, they are never as strong as original skin (80%)

90
Q

Hypertrophic scars

A

raised, thick rigid, leads to skin tightness. Loss of ROM

91
Q

Keloid scars

A

thick and raised, extend outside the area of injury. Take longer to develop, quite unsightly.

92
Q

What does scarring cause?

A

increased self-conscious behaviors, often people avoid public.

93
Q

Complications

A

Respiratory - smoke inhalation, facial burns- damage to internal structures (heat); infection control (sepsis); pain management; cardiovascular (shock)

94
Q

Medical Management for Burns

A

Fluids & edema; hydrotherapy (whirlpool, loosens dead tissue for debrieding); surgical interventions (skin grafting); vacuum assisted (wound-vac)-negative pressure; nutrition- metabolic rate changes

95
Q

Rehab Phases Team

A

MD, RN, PT and OT, respiratory therapy, nutritionists, SW, psychologist, SLP, orthoptist, rec therapy, pastoral/clergy, cultural needs.

96
Q

Overall goal for rehab phase:

A

providing support, promoting healing, preparing for self-care, reinforcing importance of AROM, pt. education
-acute care phase, surgical/post-op phase, rehab phase, reconstructive phase

97
Q

acute care & post surgical phase - OT

A

eval within the first 24-48 hours if possible; functional status; ROM & strength; activity and mobility tolerance; psychological status; supports; anticipated discharge; *child Developmental Level

98
Q

Acute Care Post Surgical Phase - OT Interventions (Burns)

A
  1. Positioning to prevent contractures; dependent on injury location, assure position was optimal for function, resources
  2. Splinting - pre and post operative, anti deformity position (intrinsic plus for hands)
  3. ADLs
  4. Therapeutic Ex & Activity
  5. Education
99
Q

Functional Interventions (Burns and Wounds)

A

Build up utensils, writing tools, and toothbrushes with cylindrical tubing; pad walker handles with wash cloth and tape to enhance gross grip ability; Coban or compression gloves to keep hand wounds/dressings clean; train grasp and manipulation of urinal, toilet paper, toothpaste, toothbrush, writing/drawling tools, etc; Enhance grip/pinch with light resistance thera putty placed in medical glove

100
Q

Other Intervention Focus (Burns & Wounds)

A

Posture and movement: speed of movement, slow and guarded>”normalize” speed; quality of movement; posture; compensatory movements/substitutions; pain with task; anxiety; fear; distraction/calming techniques

101
Q

Rehab Phase: Sub-acute & outpatient (Burns and Wounds)

A

Eval upon admission; functional status; ROM & strength; splints applied at hospital/protocol; activity and mobility tolerance; psychological status; supports; anticipated discharge

102
Q

OT interventions (sub-acute & outpatient- burns/wounds)

A

splint management - re-molding or remarking as necessary; ADLs; therapeutic exercise and activity; education; scar massage; re-assessment of goals; compression therapy; edema mgmt

103
Q

Home Exercise Program (Burns and Wounds)

A

Wound care & positioning; skin and scar care; self-care: optimizing activity and function; splints/orthotics- monitor and clean, schedule of wearing; pressure garments- schedule; exercises

104
Q

Splint Management Burns & Wounds: Continuous use (Acute phase & early rehab phase)

A

protection of joints of tendons at risk; full thickness dorsal hand burns; uncooperative or unconscious patient; following skin grafting; edema reduction; reduction of contractures

105
Q

Splint Management Burns & Wounds: Intermittent use (Rehab & beyond)

A

To maintain gains in ROM; alternate splints (burns on both sides of the hand); use at night only; maintenance of normal joint range

106
Q

Scar Management

A

Compression garments- Custom OTs measure for these- order through a manufacturer
Fitted 3 weeks after wound healing, should be worn 22-23 hours of the day for optimum results, only come off for 30 min MAX, typically wear for 12-18 months; topical agents

107
Q

Burn Complications

A

Heterotrophic Ossification- formation of bone. Impacts joint function, hard to manage surgically.
Neuromuscular complications - peripheral neuropathy, caused by metabolic insufficiencies, infections, etc.
Disfigurement

108
Q

Psychological Impairments- Burns & Wounds

A

Move through the stages of grief- OT support throughout (acute phase-discharge); inability to reach acceptance significantly impacts therapy and complicates recovery

109
Q

Denial

A

I’m going to be fine once these heal. Do not take into consideration the life long changes.

110
Q

Anger

A

Express anger to medical staff “leave me alone”

111
Q

Bargaining

A

Putting things off, especially therapy

112
Q

Depression

A

Sadness associated with the loss of normal life

113
Q

Acceptance

A

Acclimation to new living, move forward

114
Q

OT role wound care prevention

A

Activity analysis, positioning, appropriate equipment usage, environmental modifications, and lifestyle/risk reduction- we can help keep skin intact.
Activities and roles- but ensuring it in a safe and skin-protecting manner is an area that many OTs can identify with.

115
Q

OT role wound care- managing wounds

A

Vital skill for a clinician
monitor and observe their skin.
Accurately assess, know the correct terminology to use, positioning,
High risk areas and teach a person how to monitor and assess their own skin.

116
Q

OT role wound care - lifestyle modification

A

Many clients will have wounds when they come to us, which may take some time to heal. This issue is a perfect intersection between functional engagement and skin/wound care

117
Q

OT role wound care - After wound healing

A

Discuss risk factors, ongoing skin management (both self-administered or directing a caregiver). OTs can work with clients to make sure that their life supports them not getting a wound again.

118
Q

Orthotic

A

a force system designed to control, correct, or compensate for a bone deformity, deforming forces, or forces absent from the body

119
Q

Splint

A

an orthopedic device for immobilization, restraint, or support of any part of the body

120
Q

OT Role - splints

A 
activity analysis 
assessment of function and anatomical structures
fabrication
adaptation
progression and monitoring
121
Q

What is the purpose of splinting?

A

Increase comfort, prevent or decrease deformity, protect structures, maintain tendon length, position joints, stretch & elongate tissues, increase function / movement, limit movement / immobilize

122
Q

Articular splint

A

most common; stabilize one or more joint/structure

123
Q

Non articular splint

A

stabilize one structure

124
Q

immobilization orthosis

A

prevent movement for the protection of joint/structure, rest

125
Q

mobilization orthosis

A

allow for minimal supported movement

126
Q

static

A

no movement, protect reduce pain and prevent muscle shortening

127
Q

dynamic

A

includes one or more components to produce motion (supported)

128
Q

Serial Static orthosis

A

slow progressive increase in ROM by repeated remolding

129
Q

Considerations when splinting

A

Bones & bony prominences; arches of the hands; nerves of the hand; blood vessels of the hand; muscles of the hand; skin of the hand; pain, wounds, ability to tolerate heat of plastic, patient’s ability to don/doff, compliance, wearing schedule, skin sensitivity

130
Q

Maintain as much function as possible when splinting

A

Understand the biomechanics of the joints included; grasp and pinch patterns; opposition; hand dominance; specific tasks

Rehab (1 decks)

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