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  1. How should ROM & Strength be evaluated for person with RA or OA?
    • ROM: limit measurement to the primary areas of concern
    • Strength: apply pressure at the pain free end range, NOT the true end range
  2. Joint Protection Principles
    • Avoid staying in one position!
    • Avoid positions of deformity
    • Use strongest joints available for the job
    • Ensure correct patters of movement
  3. OTs and Joint Protection techniques
    • APE
    • Activity Demands-tools required
    • Performance Patters-conserve energy, breaks
    • Environment-where
  4. What do you do if pain is present during the inflammatory process?
    What do you do if pain is present during chronic phase?
    • -decrease activity
    • -avoid aggravating posture

    -if pain is produced during activity, esp for more than 1-2 hours, you've gone too far!
  5. WHY occupatoin?
    use the inherent properties of an occupation to address strength, ROM, and endurance
    Exercise: Warm UP
    Occupation: enhance carryover (of the strength gained in the exercise)
  6. Maintain muscle strength by balancing strength AROUND the unstable joints to reduce further injury
  7. Maintain joint ROM for RA
    During acute joint inflammation:
    When joint inflammation has subsided:
    • -maintain ROM, do one complete ROM exercise a day
    • -Increase ROM with gentle, controlled stretching to regain the loss during inflammation
  8. Tx to increase ROM is indicated if:
    • -You need ROM to function independently in your occupations
    • -ROM will not cause deformity
    • -Deformity is flexible
  9. Goal: to increase end ROM
    Tight muscles can be stretched more vigorously than tight joints.
    Change is only created when tissue is stretched to the point of maximal stetch.
  10. PROM is used when:
    • Weakness
    • Inflammation
    • Preparatory for engagement in occupations
    • WIP
  11. AROM is used when:
    • Patient is afraid of PROM
    • weakness or pain doesn't preclude it
  12. STRENGTHENING: modifiable parameters to increase strength:
    • Assistance level: plane (horizontal vs. sagittal) & force applied
    • Type of Contraction: Isometric, Ecc, Concentric
    • Duration: of contraction
    • Frequency: of exercises
    • Purposeful activity vs. exercise: .
  13. Positioning is essential to avoid development of the following:
    • Deformities
    • Edema
    • Contractures
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