a. Pauciarticular: <__ joints after 6months of disease; __% of cases; uveitis prevalent.
b. Polyarticular: >__ joints after 6 months of disease; __-__% of cases; joint erosion
c.Systemic-onset JRA (_____disease): fever rash arthralgia; can occur with pleuritis, pericarditis, anema
- a. pauciarticular: <5 joints; 50%
- b. polyarticular: >5 joints; 30-40%
- c. Still's disease
2. Possible manifestations in adults (JRA):
a. ________: osteoporotic; early arthroplasty of large joints; joint ROM limitatios with resuling gait abnormalites; hyperemic overgrowth resulting in limb length discrepancies.
b.________: appearance more like adult RA; cervical fusion common; joint deformities.
c.______: growth retardation; multiple systems impaired
- a. pauciarticular
- b. polyarticular
- c. systemic
(obj 8) goals and long term management RA
-avoid any _____ to the acutely inflamed joint. This is because the tensile strength of the ligaments is compromised when they are inflamed. _____ may irreversibly lengthen ligament and joint capsule ,which an eventually cause altered joint alignment, altered pull of muscle vectors, and joint deformity.
-avoid ____ ____ to acutely inflamed joints.
-Do perform ___-___ AROM/AAROM several times during the day on the joint that is hot.
- Do return to regular exercise program when acute joint settles down.
- - stretching/stretching or PROM
- - resistance exercise
- - pain free
(obj 7) management RA
-Perform _____ to all joints and gentle ____ to joints that are limited.
-Resisted isometrics: initially ____, and progress to ____.
- -AROM, gentle AAROM/PROM
(obj 7) Isometric precautions
1. increased ____-____ pressure
2. decreased _____ circulation to active muscles.
- 1. intra-articular
- 2. blood
(obj7) Dynamic precautions:
- increased stress on ______ joints
- may require ____ grip
Other info on Dynamics:
-perform dynamic resistance through functional range and avoid extreme _____ ____.
-When doing resistive exercise, teach ways to avoid adding extrea force on involved hands
- respect ___
- balance ____ and ____
- avoid position of _____
-use ___/___ joints
- with joint instability, avoid ____ movements
- keep a ___ wrist during a power grip
- - pain
- - work and rest
- - deformity
- - larger/stronger/more stable
- - torsional
- - neutral
Joint protection principals for the Hand:
- built up ______ (eating, tools, pens etc.)
- use ___-style oven mits and dusting cloths alowing an open hand
- Save ____ grip and __-___ chuck for precise, minimal resistive activities like turning pages.
- Push an object with your _____ (open hand), rather than your fingers
- transfers and bed mobility: don't push down into a closed _____.
- -pincer grip and 3-jaw chuck
(obj10) Avoiding ulnar deviation (position of deformity)
-"_____-_____"-ulnar deviation. Use handled levers on door knob. Use mechanical jar openers.
-When gripping, don't lose wrist _____. Gentle "____" gripping should be done with neurtral wrist, not a flexed wrist.
-Stirring a pot: hold spoon like a _____ rather than like a ______.
- - dagger, flashlight
Substitute ____ joints to do activity.
Avoid hooking bags onto ____, use _____ or opposite _____.
Carrying open box: bad -> good
-grip open sides with _____
-grip bottom with _____
-support underneath with ____
-support underneath with _____
-____ or ____ box
- palms; use forearm or opposite shoulder
- push or roll
Clinical intentions/reasons for splinting: (4)
- 1. Reduce pain/inflammation: rest, compressio, neutral warmth
- 2. Reduce instability: immobilize unstable joints
- 3. Realign/correct: use static splints to reduce contracture formation; use caution with dynamic splints
- 4. Secondarily improve function: due to re-alignment
Therapist should be way of secondary complications from splint wearing like loss of ____. Monitor for ____ or increased ______.
- Paresthesia or increased swelling
Splints used primarily for reduction of ___ and ____ and can be worn throughout the _____ and then intermittently throughout the ____.
When splints are removed, the ____ ____ should be taken through full ____ ____ at least ___ times per day.
- pain and inflammation
- affected joints
- gentle ROM
- 3x per day
A person will be more compliant wearing a splint if it minimally _____ ____ and _____.
Trade off between more or less ____ and more or less _____. (ex: taking out metal stay of splint)
The metal stay of wrist cock-up splint maintains wrist in slight ____.
- impairs function and dexterity
- functional dexterity
_____ _____ _____: help control pain and hand swelling by providing gentle, even compression. Unique design provides pain therapy and hand support for sore hands, fingers and joints due to ____, ____ ____ or hand ____, as well as post op rehab.
____ finger design allow for freedom of movement.
- Isotoner therapeutic gloves
- arthritis, repetitive motion or hand injury