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Adhesive Capsulitis (Frozen Shoulder)
Decreased AROM/PROM, esp in external rotation
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Subcromial Impingement
Painful arc of motion between 80-100 degrees in shoulder flexion
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Rotator Cuff Tendonitis
- Tendonitis: from overuse in daily activities = reaching, lifting, pulling, pushing
- -pain (no inflammation)
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Rotator Cuff Tear
- Tear: from injury (trauma), progressive impingement, degenerative changes in tendon
- Presentation: difficulty with above shoulder activities (less than 90 degrees flexion), many will hike shoulder up using trapezius to compensate
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Treatment for Nonsurgical treatment of rotator cuff tear:
- Avoid sleeping with arm above shoulder level
- Avoid sleeping with arm aDDucted and Internally rotated
- PROM then AROM
- Strengthen scapula & rotator cuff muscles
- ISOMETRIC exercises
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Immediately following surgical repair of the rotator cuff:
- PROM & AAROM for 4-6 weeks
- Pain-free pendulum exercises
- Passive shoulder flex/ext/aBd
- Internal/External rotation with shoulder ADDucted, NOT Ab!!
- Ice-before during after exercises
- Use one handed techniques
- Shoulder immobilized between exercises
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Sensory Treatment Approaches for:
- 1. Loss of Protective Sensation
- 2. Hypersensitivity to touch
- 3. Diminished sensation with potential for sensory regeneration
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Loss of Protective Sensation
- Results from: Stroke, TBI, Spinal Cord Injury, Peripheral Nerve Injury
- Treatment goal: teaching precautions to prevent injury!
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Hypersensitivity to touch
- Results from: Nerve trauma, Soft tissue damange, Burns, Amputation (phantom)
- Treatment:
- HABITUATION: desensitization treatment that uses repeated stimuli to decrease in hypersensitive response.
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Hypersensitivity can lead to:
- Non-use, or avoiding use
- Holding affective part protectively (posture)
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Discrimination Sensory Reeducation!
- Results from: Peripheral Nerve Damage, CVA
- Functional use of a body part with reduced sensation IS POSSIBLE, but spontaneous use is unlikely...therefore:
- Goal: learn to reinterpret sensation, regian the use of residual sensation = neuroplasticity! Reorganize cortical map!
- -to use this technique patient must have PROTECTIVE SENSATION INTACT & be able to feel 4.31 MONOFILAMENT (semmes-weinstein)
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Localization vs. Graded Discrimination
- Localization: localization of touch near the light-touch threshold, feel it and accuretly identify where it is.
- Graded Discrimination: from gross to fine discrimination...feel how they are the same or different, object identification (feather or end of a pencil)
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Procedures for Localization & Graded Discrimination
- Eyes Closed:localized touch or object manipulation
- Eyes Open:follow touch (localization) or manupulation (graded discrimination)
- Eyes Closed:reapeat
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Sensory Reeducation Techniques
- In early phase, patient learns to match sensory perception of stimuli with visual perception
- After time, focus is on functional task, like object identification through only touch
- Establish achievable STG
- Daily training is a must!
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Sensory Reeducation after CVA
- Encourage BILATERAL use during tasks
- CUE patients to attend to tactile aspects of the task including object identification without vision
- Early incorporation of affected hand into activities to prevent abnormal grasp & movement patterns
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In what position can the hand be immobilized in for long periods of time without much stiffness?
- Intrinsic Plus!
- -MP joints flexed
- -DIP & PIP extended
- -Wrist slightly eextended
- -Thumb in palmer opposition
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Functional (Resting) Hand splint
- MCP flexed
- DIP & PIP flexed
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Dorsal Splint Length
2/3 of forearm!
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Motor Unit Disorders can be
Neurogenic:
Neuromuscular/Myopathic:
- Neurogenic: lower motor neuron (cell body & peripheral nerve)
- Neuromuscular/Myopathic: neuromuscular junction or muscle itself
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Guillain-Barre (neuropathy)
- autoimmune disease-destroys myelin sheath
- Neuromuscular paralysis
- Ascending from feet to trunk
- Distal to Proximal
- 3 stages: Early, Plateau, Recovery
- Early: medical mgmt, OT not so much
- Plateau: prevent secondary problems, positioning - paralyzed, can't do much
- Recovery: OT! ROM, strength, energy conservation, safety
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Pliomyelitis (neuropathy)
Post-Polio
- viral disease, enters via fecal matter orally
- Causes: paralysis, weakness, atrophy, esp in the LE!
- 3 types: Spinal (LE paralysis), Bulbar (facial paralysis), Bulbospinal (both)
- Post-Polio: symptoms reoccur after 30 years, causing weakness, paralysis, contractures, atrophy, fatigue, pain
- BIG PSYCHOSOCIAL
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Axillary (peripheral nerve damage) c5-6
- DELTOID muscle: weakness & paralysis
- OT: arm sling-joint protection, allow to heal, PROM/AROM, retrograde massage, grading, EMG biofeedback
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Brachial Plexus (peripheral nerve damage) c5-8, T1
- Erb-Duchenne: waiter's tip, muscles of shoulder and elbow affected, hand movement retained
- -internal rotation/adduction, elbow extension, wrist flexion
- Klumpke's: claw-hand, distal musculature of the wrist, flexors and intrinsic muscles of the hand
- OT: PROM, tactile stimulation, retrograde massage, resting splint
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Long Thoracic Neck (peripheral nerve damage) c5-7
- scapular winging (serratus anterior)
- can't flex shoulder more than 90, protract shoulders of Ab/AD scapula
- screening: wall push-up
- OT: DME (long handled devices), PROM, glenohumeral rhythm, surgery, retrograde massage
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Myasthenia Gravis (neuromuscular disorder)
- disorder of chemical transmission at the neuromuscular junction
- autoimmune attacks ACH receptors
- more men
- Skeletal Muscles accected in FACE
- -drooping eye lids, blurred vision, slurred speech, mastication difficulties
- OT: eating, self-image
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Duchenne MD (myopathic disorder)
- males only
- degeneration of muscle fibers causing progressive weakness
- pelvic girdle & legs --> shoulders & trunk
- proximal to distal
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Facioscapulohumeral MD (myopathic disorder)
- degeneration of muscle fibers causing progressive weakness
- FACE & SHOULDER GIRDLE (scapula, humerus)
- slow progression, usually NOT in LE
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Myotonic MD (myopathic disorder)
- degeneration of muscle fibers causing progressive weakness
- & myotonia: spasm/delayed muscle relaxation after vigorous contration
- -fingers & face, cranial muscles & distal limb weakness
- -affects before adolescence or after 60 years!
- -The earlier the onset, the faster the progression
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