Which assessment tool provides the most valid results.
volumeter
dynamometer (all 5 positions)
standardized pegboard
total active motion (TAM) evaluation
volumeter-physics, most valid test.
T/F Paraffin & hot packs are contraindicated for initial stages of CRPS
T-limb will demonstrate elevated temperature which will increase their hypersensitivity to temperature.
T/F Biofeedback does not work with ind. with CRPS
F-ind. can measure their muscle responses & stress levels & learn to release tension to reduce pain & prepare for increased tolerance to ROM & fun. movement.
An ind. with bilateral proximal weakness wants to feed self I. What A/E is best for client.
Mobile arm supports-compensate for UE weakness
An ind. with decreased UE ROM wants to feed self I. What A/E is best for client.
extended long-handled utlencils
An ind. with decreased grasp wants to feed self I. What A/E is best for client.
buuilt-up handled utencils
An ind. with no UE movement wants to feed self I. What A/E is best for client.
electric feeder
Flexor tendon repair
Early mobilization, what exercise is appropriate within limits of dorsal block splint according to Kleinert protocol
active extension, passive flexion
S/P 7 wks tendon repair according to Kleinert protocol
What intervention
Light ADLS, grooming
6-8 wks
S/P 9 wks tendon repair according to Kleinert protocol
What intervention
strengthening & heavier work act. (laundry)
8-12 wks
S/P 2 wks tendon repair according to Kleinert protocol
What intervention
0-4 wks passive exercises with dynamic splint
Criteria for Mobile arm supports
adequate power from neck, trunk, & shoulder girdle or elbow muscles
0-90 degrees PROM in shoulder flexion & ABD, adequate PROM in internal & external rotation, elbow flexion, & prontation
supportive environment
trunk stability, motivation
Interventions for the following stages for partial of full thickness burns
A. Acute
B. Sub-acute, surgical, postoperative stage
C. Rehabilitation Stage
A. maintenance of joint ROM & skin mobility
B. adaptive equipment
C. compression & vascular garments & prevention of scarring
Splint for ulnar n. injury
prevents hyperextension of the MCP & allows for flexion of MCP
Low-level radial n. injury requires a __________ _________ splint & provides wrist __________, MCP ___________, and thumb _____________.
dorsal dynamic splint
extension, extension, extension
Purpose is to prevent extensor tendons from overstretching as well as provide proper positioning of hand for fun. use.
How to elicit phasic bite
softly stimulate the infant's gums
What disorder involves tendonesis, nerve compression, & myofascial pain
What are the risk factors
Cumulative trauma disorders
repetition, high force, awkward joint posture, direct pressure, vibration, & prolonged static positioning.
5
normal
Full ROM against gravity
MAX resistance
4
good
full ROM against gravity
Mod resistance
4-
Good minus
full ROM against gravity
less than mod resistance
3+
Fair plus
Full ROM against gravity
Min resistance
3
Fair
Full ROM against gravity
no resistance
3-
Fair minus
unable to move full ROM against gravity
2
poor
full ROM gravity eliminated
2-
poor minus
less than full ROM gravity eliminated
1
Trace
tension is palpated in the muscle tendon, no motion occurs
0
Zero
no movement or tension
Ind. holding a heavy hand bag by the handles
What type of grasp
Hook Grasp
use of digits 2-5, thumb not always required for this grasp & can remain inactive
Needle being held
What type of grasp
two-point pinch
holding a glass half filled with water
what grasp
cylindrical grasp
key being placed in lock would be held with what grasp
lateral pinch
T/F A job analysis can only be performed by an OT and includes a detailed description of the physical, sensory, & psychological demands of a job.
T/F Examining the results of an analysis of an ind. job is the best method for obtaining detailed info about ind. job requirements.
F- OT or other professional can complete.
Examples of performance requirements include tasks such as lifting, walking, sitting, standing, reaching, seeing, hearing, & interpersonal skills.
T
Tip Prehension
Pick up penny
Flex IP of thumb & PIP and DIP finger
Bring tips of thumb & finger together
Hold pin, nail, coin
Lateral prehension
position pad of thumb against radial side of finger
holding pen, utensil, or key
Palmar prehension or three jaw chuck
position thumb in opposition to the tips of index & middle finger, forming pad-to-pad opposition
lift objects from flat surface and to tie a shoelace
Spherical grasp
holding a ball or other round object
T/F Proprioception is demonstrated when the OT passively positions the joint being tested & ind. imitates the position with the opposite extremity. Joint should not be moved through range to an extent that would elicit stretch or pain response, which would be at the end ranges of the joint. Movement should be rate of 10 degrees per second to prevent stretch reflex
T
Which movement of the thumb helps with picking up cans.
CMC palmar abduction
opens web-space
De Quervain Syndrome
Symptoms are pain, tenderness, and swelling over the thumb side of the wrist, and difficulty gripping
Assess thumb adductor while laterally pinching paper
ulnar nerve motor function
short-below elbow amputation
fixed elbow socket because natural forearm rotation is not possible.
Best transfer for ind. recovering from THR
stand-pivot to non-surgical side
T/F When ind. has pain due to neuroma, it is best to use PAMS such as percussion
F-neuromas are nerve endings adhered to scar tissues. Very painful.
Management-meds and refrain from sensory stimuli such as PAMS or donning/doffing prosthesis
Important to work on which muscle when working with double LE amputation or unilateral amputation
strengthen the UE with emphasis on triceps for trasnfers
First step when training ind. with below-elbow myoelectric prosthesis
how to open and close
To determine if a person is applying max effort or magnifying symptoms, how would you test using a dynamometer
Test in all 5 positions-if person is applying max effort, there will be a bell curve.
T/F An ind. with above elbow amputation (transhumeral) has a body-powered prosthesis. To train how to use the terminal device (TD) the OT should initially have the ind. lock the elbow in 90 degree flexion & teach only TD control.
T- locking the elbow places the TD in a functional position for completion of act. with the TD. The question is specific to the TD for teaching elbow control isn't taught during this session. Control of the elbow would occur I of the TD because the elbow joint must be locked for TD use in an above elbow prosthesis.
Rotator Cuff post-op care. What weeks?
1. PROM progressing to AA/AROM
2. Isometrics
3. Isotonic
1. 0-6 wks
2. 6 wks
3. Progress to isotonics after doing well wit isometrics
T/F Process for desensitization includes rough to hard to soft
F Soft-hard-rough
Steps to remove shirt for hemiplegia
1. gather shirt up at back of the neck
2. pull gathered fabric off over head
3. remove shirt from unaffected arm
4. remove shirt from affected arm
Wrist unit prosthesis
rotate TD to supination, midposition, and pronation with sound hand or for bilateral rotate against stationary object, between knees, or with contralateral TD.
Intervention: have ind. analyze the task & determine most efficient approach for grasp, avoid excessive or awkward movements.
Elbow unit prosthesis
depress arm while extending and abducting humerus to lock or unlock elbow mechanism
Practice flexing & locking elbow in several planes
Manually guide ind. through motions.
Begin with elbow unlocked
Ind. listens for click as lock activates
Have ind. exaggerate movements initially and use mirror
Use humeral flexion to lock elbow
Have ind. go beyond desired height as arm will drip due to gravity while ind. is in process of locking unit.
Turntable Prosthesis
rotate elbow turntable toward or away from body with sound hand or stable object.
teach ind. to analyze task to determine need to use this component more efficiently.
Flexor Tendon Splint
Kleinert protocol
dorsal block splint with rubberband attachments for active extension & passive flexion
wrist in 30 degress flexion, MPs 70 flexion, IPs extended
Duran: passive flexion & passive extension
T/F Active flexion is contraindicated for post flexor tendon repair surgery.
T-tendon repair can rupture if actively flexed.
Kleinert protocol for flexor tendon repair surgery
0-4 wks dynamic splint
6-8 wks light ADL such as grooming
8-12 wks strengthening & heaver work act such as laundry
Splint for radial n. laceration for healing & function
dynamic extension splint
osteogenesis imperfecta
brittle bones
Home program for extrinsic flexor tendons with limited finger flexion
tendon gliding
since tendon gliding exercises promote digital ans joint motions, they are mainstay of most HEP.
Pronator Teres syndrome
proximal volar forearm
same signs as CTS with aching pain in proximal forearm & no night pain
positive tinel's sign at forearm
median n.
Ind. has Fair minus (F-) in B UE. What would therapist work on during intervention if using biomechanical approach
Complete active ROM against gravity
F+: full ROM against gravity with slight
resistance.
F: full ROM against gravity with no resistance
F-: less than full ROM against gravity
Rotator cuff tendinitis conservative tx during sleep
sleep with shoulder extended and adducted
T/F For ind. with CRPS having her wash a car would be a recommended home activity.
T-washing car involves scrubbing & carrying of buckets which are stress loading.
Short below elbow amputation. Client is carpenter. What prosthesis is best.
Fixed elbow socket with heavy duty serrated drip TD
Ind. with short below elbow requires fixed elbow splint due to no natural forearm rotation.
T/F Contrast baths can be used with ind. with CRPS to reduce pain & edema.
T-gentlest PAM, other options include cold packs, retrograde massage, Coban wraps, and desensitization.
