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Chapter 1: Fundamentals (Cooper)
Terms in this set (17)
What does the quadragia effect tell us about orthopedic occupational therapy?
Interconnectedness of the digits.
If you passively hold your ring finger extended with your other hand and then try to make a fist, you will notice how limited the whole hand can feel when just 1 finger is help stiff.
We need to evaluate beyond the isolated areas not originally injured
When planning treatment interventions, what must a therapist know in addition to the patients limitations in ROM, strength, and ADL?
What structures are restricted and how these restrictions affect function
What interventions are appropriate in each stage of wound healing?
Fibroplasia- (Proliferation) 2-6 weeks- AROM and orthotics are used to promote balance in the hand and to protect the healing structure (laying down new tissue, prevent adherence)
Maturation- lasts years- Gentle resistive exercises, client should be monitored for an inflammatory response. Dynamic or static orthoses may also be helpful (making it more like tissue it replaced. remediate -strengthen)
What is the typical deformity position of the hand and wrist due to edema after injury?
Wrist flexion, metacarpophalangeal (MP) hyperextension, PIP and DIP flexion, thumb adduction. Caused by dorsal edema
I what position should the therapist fabricate an orthosis for a patient acquiring these deformities after trauma?
Antideformity (intrinsic plus) position recommended after injury unless it is contraindicated by the diagnosis
(MCP flexed, IPs extended, wrist extension, thumb abduction and opposition)
What is intrinsic tightness?
What is extrinsic tightness?
How can you differentiate between the two?
-small muscles of hand, interosseous muscle tightness- passive PIP & DIP flexion is limited when MP joint is passively extended or hyperextended (Passive insufficiency to muscle tendon units that dont cross the wrist) IE-(When MP extended, trying to flex IP but can't )
-Longer musculotendinous units that originate proximal to the hand, extrinsic extensor tightness- PIP & DIP flexion is limited when the MP joint is passively flexed. (passive insufficiency: muscle tendon unit attachment is proximal to the wrist) EF (MP flexed, trying flex IP)
-extensor flexor tightness
-extensor extensor tightness
When MCP is extended you should be able to flex IPs. But has a hard time making a fist.
Intrinsics: flex MCP, Extend IP
-Hard time extending fingers with wrist extended
-Hard time making fist if wrist is flexed
What is the difference between a lag and a contracture?
-Caused by (3)
-problem with something on which side
-and how to fix (2)
-Caused by? 3
--joint flexion contracture is characterized by..
-problem with something on which side?
-how to fix?
Lag- When PROM is greater than AROM at a joint, active limitation is called lag. Caused by adhesions(2 things stuck to each other e.g skin tendon), disruption or the musculotendinous unit, or weakness.
-problem with something on the extensor side
-Fix by strengthening what is weak or lengthening adhesion
Contracture- When passive limitation of a joint motion exists. Caused by collateral ligament tightness, adhesions, or mechanical block. A joint flexion contracture is characterized by a stiff joint joint in a flexed position that lacks active and passive extension
-Problem with something on flexor side (shortened, no AROM, PROM)
-fix by lengthening what is shortened
What considerations do you need to make if "aggressive PROM is ordered"
Pain-free controlled stretching and remodeling should be used for treatment for fragile hand tissue. Upgrade program and encourage maximum results
Methods to decrease scar sensitivity?
treat with desensitization. If it causes functional limitations, provide protections, such as padding or silicone gel. Scar maturation can be facilitated by light compression (elastic support sleeve)
serial static orthosis
static progressive orthosis
Static orthosis- orthosis that has no moving parts, no client-adjustable parts, and no resilient (stretchy) components; often used for immobilization
Serial static- a static orthosis that is used for mobilization (to increase ROM) and the therapist re-molds or replaces the orthosis every few days to every couple of weeks to reposition the joint as it gains motion
Static progressive- an orthosis that has no resilient (stretchy) components, that is used for mobilization (to increase ROM), and that has client adjustable positioning built in. Client-adjustable positioning may take the form of a screw mechanism. Velcro that can change the position of a sling
Dynamic- an orthosis that has resilient (stretchy) components. Dynamic orthoses are best used to replace motion that the client is either too weak to do or not allowed to actively do because of structural stability concerns. dynamic orthoses are sometimes used for mobilization (to increase ROM) however this use is difficult and controversial
-What is provided? Helpful for clients with?
-used for what 3 things
Differential tendon gliding exercises:
-Used for clients with?
-standard exercise for?
-What injuries? 2
-What allows sliding of...
Proximal support is provided to promote isolated motion at a particular site. Helpful for clients with limitation of either AROM or PROM or both. Exert more force than non-blocking exercises.
-Used for strengthening multijoint muscle tendon units, stiff joint, lengthen adhesion.
-FDP is weak and having trouble contracting , might immobilize wrist to get good FDP contraction.
Mainstay of most home programs because they are easy to perform and they promote motion very effectively. Used for clients with hand or wrist stiffness.
Standard exercise for conservative management of carpal tunnel syndrome. Rolling a thick highlighting pen up and down in the palm is an effective way
-FDS, FDP surgical repair, trauma. Don't want sticking together.
-Hook fist allows the sliding of FDS, FDP
Place and hold
-how to do it? watch for
-used when 2
-used for? 2
Perform AAROM to position the finger. Then ask the client to sustain that position comfortably while releasing the assisting hand. Watch for co-contraction or force that is too strenuous as the client tries to sustain the exercise position.
Can be helpful when PROM is greater than AROM.
-involves finger movement
-when strength is 2-/5 or don't want tension on muscle tendon unit
Using more repetitions with a lower load, promotes endurance. Can take many forms including PREs, graded grippers, rubber bands, squeeze balls, putty. Used for strengthening and to improve excursion of adherent tissue.
Trying shoes, folding clothes, writing with adapted pen, hammering. It is essential that the client incorporate the gains made from exercising into functional UE use at home and at work. Practicing relevant activities can reinforce this.
-should see what
-documentation should include
- 2 parts
Compare before to after:
• After better than before:
• After the same as before:
• After worse than before:
Compare before to before:
• Before 1 better than before 2:
• Before 1 the same as before 2:
• Before 1 worse than before 2:
-Generally, you should see improvement in the area you are targeting with your
intervention each treatment session
-Thus your documentation should include:
-"Before" measurement taken each session before ANY treatment (that
measures whatever you are targeting that session)
- "After" measurement each session when you are finished
-it worked, keep doing it
-it didnt work or didnt work yet, do something different (change) maybe do a few more times
-Dont do it again, maybe dont challenge so much
-they are getting worse. ask why
-staying same, look at home program
Occupational profile and measurement of body structures
-each looks at?
-Occupational profile- Drives long term goals
-Body structures- detective-underlying problems
Vascular status evaluation
implications of positive test
Capillary refill test
-Apply pressure to the distal volar portion of the digit or the nail of the digit until the tissue turns white. Release and measure number of
seconds it takes for color to return to normal.
It takes more than 2 seconds for color to return to normal after pressure is released
Color returns to normal in 2 seconds or less.
Implications of positive test result:
Vascular status is impaired. Care will need to be taken with any intervention for which impaired vascular status is a precaution or contraindication. Healing will likely occur slower.
Modified Allen's test
implications of positive test
Modified Allen's test
With index and middle fingers, apply firm pressure to the ulnar and radial arteries just proximal to your patient's wrist creases. Have the
patient grasp and release several times until the palm has turned white. With your patient's hand in a relaxed position, release the pressure from one side only of the wrist (allowing blood flow through that artery only), and measure the number of seconds it takes for color to return to normal in the hand. Repeat the test for the other artery on the other side of the wrist.
It takes more than 5 seconds for color to return to normal in the hand after pressure is released
Color returns to normal in 5 seconds or less.
Implications of positive test result:
Vascular status is impaired. Care will need to be taken with any intervention for which impaired vascular status is a precaution or
contraindication. Healing will likely occur slower.
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