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NBCOT Exam Important Terms

Terms in this set (165)

7 Core Concepts
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Altruism
The individual's ability to place the needs of others before their own
Equality
The desire to promote fairness in interactions with others
Freedom
The desires of the client must guide OT's interventions
Justice
Relating "in a fair and impartial manner to individuals with whom they interact & respect and adhere to the applicable laws & standards regarding their area of practice"
Dignity
Treating each client respectfully and as an individual by enabling the client to "engage in occupations that are meaningful....regardless of level of disability
Truth
"In all situations, occupational therapists, OTA's, and students must provide accurate information, both in oral and written form"
Prudence
Use of "clinical and ethical reasoning skills, sound judgment, and reflection to make decisions" within the OT's area of practice
7 Principles
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Beneficence
"Occupational Therapy personnel shall demonstrate a concern for the well-being & safety of the recipients of their services"
Is it beneficial? Terminate when services are no longer beneficial
Key words: well-being, safety, current, updated
*See examples in AOTA PDF
Nonmaleficence
"Occupational Therapy personnel shall intentionally refrain from actions that cause harm"
Mal means evil, harmful, bad, etc.
Avoiding any harm
Dating/sex with a client
Avoid situations that may cause:
Exploitation & conflict of interest
*See examples in AOTA PDF
Autonomy/Confidentiality
"Occupational Therapy personnel shall respect the right of the individual to self-determination"
Privacy & confidentiality
Benefits, risks, outcomes
*See examples on AOTA PDF
Social Justice
"Occupational Therapy personnel shall provide services in a fair & equitable manner"
Equal service
Ex: Advocating
*See examples on AOTA PDF
Procedural Justice
"Occupational Therapy personnel shall comply with institutional rules, local, state, federal, and international laws and AOTA documents applicable to the profession of occupational therapy"
Reimbursement guidelines
NBCOT Code oft Conduct
Maintain high standards & continued competency
Refrain from accepting gifts/money
Conducting research (obtain approvals)
Transparency (ensure compliance)

*Beneficence & Procedural Justice are similar
*See examples on AOTA PDF
Veracity
"Occupational Therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession"
Verify for trust & honesty
*See examples on AOTA PDF
Fidelity
"Occupational Therapy personnel shall treat colleagues & other professionals with respect, fairness, discretion and integrity"
Not divulging personal information to others
Understand roles & responsibilities
Ensure a collaborate & professional environment
Avoiding things that give rise to conflict of interest
*See examples on AOTA PDF
Sanctions
...
Reprimand
Private letter of reprimand from the Ethics Commission chairperson
Censure
A public formal notice of disapproval of the behavior
Probation
"Failure to meet terms will subject an AOTA member to any of the disciplinary actions or sanctions"
Suspension
Suspension of AOTA membership for a predetermined time period
Revocation
Permanent revocation of AOTA membership
Stereognosis (Astereognosis)
Recognition by touch of common objects

Inability to recognize objects, forms, shapes, and sizes by touch alone
Anomia
Loss of the ability to name objects or retrieve names of people
Anosognosia
An unawareness of a motor deficit
Example: a person is not aware that they have hemiplegia
Broca's (expressive) aphasia
Loss of expressive language indicated by a loss of speech production
Wernicke's (receptive) aphasia
A deficit in auditory comprehension that affects semantic speech performance, manifested in paraphasia or nonsensical syllables
Example: the person is able to not comprehend verbal directions for using an adaptive device; cannot follow verbal commands
Global aphasia
A severe loss of the ability to comprehend and express
Ideational apraxia
A breakdown in the knowledge of what is to be done or how to perform; a lack of knowledge regarding object use
Using objects incorrectly
Cannot sequence the steps of an activity (e.g., meal prep) and/or may not engage in a task
Examples: using a comb to brush teeth; placing butter into a cup of coffee
Motor apraxia/ideomotor apraxia
Loss of access to kinesthetic memory so that purposeful movement cannot be achieved because of ineffective motor planning although sensation, movement, and coordination are intact
Appears clumsy
Difficulty with bilateral activities
The person is unable to perform a task upon request but may perform the task spontaneously
Examples: awkward grasp patterns on toothbrush making oral care ineffective; difficulty manipulating coins from the hand into a vending machine coin slot
Body scheme disorder
Loss of awareness of body parts, as well as the relationship of the body parts to each other and objects including right-left indiscrimination
Examples: the person cannot determine which is their left arm; the person is not able to successfully use the cue "the bathroom is on the right."
Somatoagnosia
A body scheme disorder that results in diminished awareness of body structure and a failure to recognize body parts as one's own
Examples: the person denies ownership of a body part; the person attempts to dress the therapist's arm as if it was their own
Disorientation
Lack of knowledge of person, place & time
Example: the person states that it is March 8 despite it being March 25
Perseveration
The continuation or repetition of a motor act or task
Example: the person continues to pull up the sock even though it is already covering the foot
Spatial relations impairment
Difficulty relating objects to each other or to the self secondary to a loss of spatial concepts (up/down, front/back, under/over)
Example: the person has difficulty orienting clothing to the body correctly such as putting a shirt on backwards; the person has difficulty aligning fitted sheets to the bed
Aligning/moving their body in space during a transfer
Topographical disorientation
Difficulty finding one's way in space secondary to memory dysfunction or an inability to interpret sensory stimuli
Example: the person is not able to find their hospital room after completing an OT session; after completing an errand the person tends to wander and not find their way back home
Arnadottir Occupational Therapy Neurobehavioral Evaluation (A-ONE)
Utilized in the adult population presenting with cognitive/perceptual (neurobehavioral) deficits
Structured observations of BADL and mobility skills are performed to detect underlying neurobehavioral dysfunction
A system of error analysis is utilized to document the underlying performance components that have a direct impact on daily living tasks
Allen Cognitive Level Test
Population: Psychiatric disorders, acquired brain injury, and or dementia
Used as a screening tool to estimate an individual's cognitive level
The person performs three leather lacing stitches progressing in complexity
Six Levels (See Chapter 14)
Assessment of Motor and Process Skills (AMPS)
People 3+ years of age and older regardless of diagnoses
Examines person's functional competence in 2 or 3 familiar and chosen BADL or IADL tasks
Individual chooses activities to perform from a list of tasks
Therapist observes and documents the motor and process skills that interfere with task performance
Behavioral Inattention Test
Utilized with adults presenting with unilateral neglect
Catherine Bergego Scale
A standardized checklist to detect presence and degree of unilateral neglect during observation of everyday life situations
Also measures self-awareness of behavioral neglect
Examples: dressing, washing, eating, etc.
Lowenstein Occupational Therapy Cognitive Assessment (LOTCA)
People who have experienced a stroke, TBI or tumor
Measures basic cognitive functions that are prerequisite for managing everyday tasks
5 areas: orientation, visual, spatial perception, visual motor organization, and thinking operations
Mini-Mental State Exam
Brief 30-point questionnaire test that is used to screen for cognitive impairment
Commonly used to screen for dementia
Cognitive Disabilities Model
Originally developed for use with individuals who have psychosocial dysfunction, currently also being utilized with persons with neurologic dysfunction and neurocognitive disorders.
Each level describes the extent of a person's disability and difficulty in performing occupations.
After the person's level has been established, routine tasks are presented that the person can perform or that have been adapted so that he/she can perform them. Focus is placed on adaptive approaches and strengthening residual abilities
Barthel Index
Focus: Measurement of a person's independence in basic ADL and functional mobility before and after intervention and the level of personal care needed by the individual
Feeding, transferring, grooming, toileting, control of bowel, control of bladder, bathing, dressing, walking, climbing stairs
Population: Adults and elders with physical disabilities and/or chronic illnesses, typically used in medical model settings
Cognitive Performance Test (CPT)
Six functional ADL tasks that require cognitive processing
Dressing, shopping, making toast, making a phone call, washing, traveling
Level 1-lowest, 6-highest, scores 6-36
Population: Adults and elders with psychiatric or cognitive dysfunction
FIM System and WeeFIM System
Focus: the assessment of the severity of a disability as determined by what the individual actually does and the amount of assistance needed by the individual to complete each task
Performance areas: self-care, sphincter management, mobility, locomotion, communication, social interaction
Method: observation of activity performance with or without the assistance of a helper determined by the person's ability to do the task
Scale from 1-7, graded from dependent to independent and the amount of assistance required needed for task performance
Population: Adults with disabilities who are not functionally independent for the FIM & children from 6 months-7 years for WeeFim
Katz Index of ADL
Focus: assessment of level of independent functioning and type of assistance required in six areas of ADL: bathing, dressing, toileting, transferring, continence, and feeding.

Method: Evaluator observes activity performance or interview the individual about performance

Scoring and Interpretation
1) Evaluator rates each of the six activities as independent, some assistance required, or dependent
2) Specific criteria for each rating are provided for each activity
3) The individual ratings for the 6 activities are converted into a global letter score
A = Independent in all 6 activities
B = Independent in any 5 activities
C = Independent in all but bathing and one other activity
D = Independent in all but bathing, dressing and one other activity
E = Independent in all but bathing, dressing, toileting and one other activity
F = Independent in all but bathing, dressing, toileting, transfers and one other activity
G = Dependent in all activities

Population: Adults and elders with chronic illness
Klein-Bell Activities of Daily Living Scale (K-B Scale)
Focus: assessment of independent functioning in ADLs as evidenced by achievement of 170 items in six areas (dressing, elimination, mobility, bathing/hygiene, eating, emergency telephone communication)
Method: Evaluator observes and scores the individual's performance of each item and the behavioral components of each task
The use of assistive devices to perform activities is allowed
Rated as "achieved" or "failed"
Population: 6 months to older adults with any diagnosis
Kohlman Evaluation of Living Skills (KELS)
Focus: Determination of an individual's knowledge and/or performance of 17 basic living skills needed to live independently in five main areas (self-care, safety and health, money management, transportation and telephone, work and leisure. A score of "independent" or "needs assistance"
A checklist summarizes the client's performance (no total score)
Population: Adolescents and adults in acute psychiatric hospitals, elders, and those with a diversity of diagnoses.
Milwaukee Evaluation of Daily Living Skills (MEDLS)
Focus: assessment of actual or simulated performance of basic living skills needed to function in the individual's expected environment (basic communication, personal care and hygiene, medication management, personal health care, time awareness, eating, dressing, safety in the home & community, use of telephone, transportation, maintenance of clothing, use of money)
Method: a screening form is used to determine which of the subtests are relevant to the individual and their expected environment
Person's normal routine
Population: originally developed for adults (18 or older) who have chronic mental illness and who have resided, for at least 6 months, in a psychiatric hospital, halfway house, group home, or SNF, or have participated in for at least 2 years in an outpatient day treatment program, but its use has expanded to other populations with ADL deficits
Routine Task Inventory (RTI)
Focus: Measurement of an individual's level of impairment in ADLs according to Allen's model of cognitive levels.
Observation, Self-report, and report of caregiver are used for the questionnaire
Population: Adults and elders with cognitive impairments.
Scoreable Self-Care Evaluation
Focus: Measurement of functional performance and identification of difficulties in 18 basic living tasks in four main areas (personal care, housekeeping chores, work and leisure, and financial management)
Population: Adolescents, adults, and elders with psychiatric illnesses in acute hospital settings or living in the community.
Test of Grocery Shopping Skills (TOGSS)
Assessment for determination of a person's ability to shop for groceries in a grocery store using a grocery list. Knowledge of grocery shopping skills (KOGSS) can be used to assess person's knowledge of grocery shopping. Performed in the community grocery store given a list of 10 items of specific sizes and asked to locate and select the items at the lowest price.
Therapist observes and KOGSS is completed as a self-report.
Three sub-scale scores of accuracy, time, and redundancy.
Observe and assess strategies used and higher KOGSS scores indicate greater knowledge.
Originally developed for those with serious mental illness but also cognitive impairment which interfere with community living skills.
Preschool Play Scale
Focus: Observation of a child's play behavior within four play dimensions
1. Space management
2. Material management
3. Imitation
4. Participation
Preschool Play Scale
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Canadian Occupational Performance Measure (COPM)
A client-centered outcome measure used to assess self-care, productivity, and leisure
Assists the individual in determining what life areas are important to focus on
Types of splints to reduce soft tissue contractures
...
Antideformity (safe position) burn splint
Wrist - 20 degrees of extension
MCPs - 90 degrees of flexion
PIPs & DIPs - 0 degrees of extension
Elbow or knee extension splint
Positioning in as much extension as possible
Wrist extension splint to prevent wrist drop
Functional splint with 45 degrees of wrist extension worn during the day
Thumb abduction splint to prevent thumb adduction contracture
Splint forms a "C" bar between the thumb and index web space
Lumbrical bar splints to reduce MCP hyperextension and IP flexion contractures
MCPs are splinted to block hyperextension
Resting hand, ball, and cone antispasticity splints
Purpose is to decrease tone in the hand & upper extremity
Soft neoprene splints to position thumb and forearm
Commonly used with clients with RA or CP to increase functional use of the hand
Splint to prevent foot drop
Below-the-knee splint to keep ankles at 0 degrees for possible future ambulation
Serial casting
Use of fiberglass or plaster of paris materials to position clients with increased tone and over time stretch out soft tissue contractures
No moving parts
Dynamic splinting
May involve metal and loop components; angle of pull needs to be 90 degrees for most effective outcome
RA - Common deformities & manifestations
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Boutinniere deformity
Flexion of PIP and hyperextension of DIP
Swan neck deformity
Hyperextension of PIP and flexion of DIP
Mallet finger
Flexion of DIP
Ulnar drift
Radial deviation of the wrist and ulnar deviation of the MCP joints
...
Subluxation of wrist, MCP, or both
Ankylosis or joint fusion
Extensor tendon rupture
Trigger finger
Mutilans deformity
Characterized by very floppy joints with shortened bones and redundant skin; caused by reabsorption of bone ends; most common in the MCP, PIP, radiocarpal, or radioulnar joints
...
6 patterns of thumb deformity
Subcutaneous nodules over bony prominences or extensor surfaces
Claw toe
Hyperextension of the MTP and flexion of the PIP and DIP
Hammer toe
Hyperextension of the MTP, flexion of the PIP, and hyperextension of DIP
Cock-up toe
Subluxation of the metatarsal heads
Hallux vulgus (bunion)
Fibular deviation of the first toe
4 Periods of RA
Acute
Subacute
Chronic active
Chronic inactive
4 Stages of RA
Stage 1: Early
Stage 2: Moderate
Stage 3: Severe
Stage 4: Terminal
Proximal Fracture
A metacarpal fracture, such as a boxer's (4th and 5th finger) fracture
Scaphoid
The most common fracture seen and missed in injuries to the wrist is the _______.
Lunate
______ fractures are associated with Keinbock's disease.
Avulsion injuries
Occur when the tendon separates from the bone and its insertion and removes bone material with the tendon
Exs: Swan neck deformity, Boutonniere deformity, and Mallet finger
Inflammation, repair and remodeling
3 common phases of fracture healing ?

______ provides the cellular activity needed for healing
_______ forms the callus for stabilization
_______ deposits the bone
Complex regional pain syndrome
The most severe complication of hand fractures is _______.
Colles fracture
Complete fracture of the distal radius with dorsal displacement - Most common type of wrist fracture
Smith's fracture
Complete fracture of the distal radius with palmar displacement
Bennet's fracture
Fracture of the first metacarpal base
Median nerve injury
Produces carpal tunnel-like symptoms, such as palmar numbness and numbness of first digit to half of the fourth digit, with generalized weakness and pain
Ulnar nerve injury
Results in ulnar claw deformity and numbness of the ulnar side of the hand and the fifth and half of the fourth digits, with generalized weakness of the ulnar side of the hand and pain.
Carpal tunnel syndrome
Wrist fracture that results in compression of the median nerve as it runs through the carpal tunnel
Radial head fractures
Account for 33% of elbow fractures. These fractures are usually caused by a forceful load through an outstretched arm.
3 types:
1) Type ___: (nondisplaced) can be treated with a long arm sling
2) Type ___: (displaced with a single fragment) is typically treated nonoperatively with immobilization for 2-3 weeks and early motion with medical clearance
3) Type ____: (comminuted) is treated operatively, with immobilization and early motion within the first postoperative week as medically prescribed
Complex Regional Pain Syndrome (CRPS)
Allodynia
Hyperalgia
Hyperpathia
Pain disproportionate to an injury that is either sympathetically maintained or independent of the sympathetic nervous system
Type 1: Develops after a noxious event
Type 2: Develops after a nerve injury

Symptoms:
______: Sensation misinterpreted as pain
______: Increased response to painful stimuli
______: Pain that continues after the stimuli is removed
Edema
Contractures
Bluish or red shiny skin
Abnormal sweating and hair growth
Muscle spasms
Decreased strength
Low tolerance for activity

Medical Treatment:
1) Stellate or sympathetic block: an injection of local anesthetic into the front of the neck or lumbar region of the back to block pain
2) Intrathecal analgesia: injection of pain medication into the spinal canal
3) Removal of neuroma: surgery to remove a thickened nerve
4) Installation of spinal cord stimulator: a small electrical pulse generator is implanted in the back to control pain
5) Installation of peripheral nerve stimulator: electrodes placed on the peripheral nerves to send electrical impulses to control pain

Interventions:
1) Gentle, pain-free AROM for short periods; no PROM
2) Stress loading: for example, scrubbing the floor, carrying a weighted handbag
3) Pain control techniques: TENS, splinting (static, then dynamic as tolerated), continuous passive motion
4) Edema control techniques: elevation, massage, AROM, contrast baths, compression
5) Desensitization techniques, fluidotherapy
6) Blocked exercises, tendon gliding
7) Joint protection, energy conservation
Cumulative Trauma Disorder (CTD)
Trauma to soft tissue caused by repeated force (also called overuse syndrome and repetitive strain injury) indicates the mechanism of injury but is not a diagnosis

Work-related risk factors

Symptoms: Muscle fatigue, pain, chronic inflammation, sensory impairment, decreased ability to work

Five grades according to severity, 1 being the least pain to 5 being the most pain

OT Intervention:
1) ______ phase: Reduction of inflammation and pain through static splinting, ice, contrast baths, ultrasound phonophoresis, iontophoresis, high-voltage electric and inferential stimulation
2) ______ phase: Slow stretching, myofascial release, progressive resistive exercise as tolerated, proper body mechanics, education on identifying triggers and returning to acute phase treatment with flareups; static splint during activities that cause pain
3) Return to work
a. Assessment of job site, tools used, and body positioning
b. Therapy using a work simulator, weight well, elastic bands, putty, functional activities, and strengthening activities
4) Functional capacity evaluation
5) Work hardening
Extensor retinaculum
Sagittal bands
Tendons cross wrist dorsally under the ______ _______, separating into 8 compartments to prevent bowstringing.
_______ bands center the extensor tendons over the MCP joint.
Flexor Tendons
Synovial diffusion
They glide and run under a tight pulley system
Pulleys are found on the flexor side to prevent bowstringing and consist of A1-A4 & C1-C4

Landmarks & structures:
Blood supply is limited, but nutrition is mainly provided by ?
Nerve supply is innervated by the ____, ____, and ____ branches of the hand
Duran
Protocols:
The ________ protocol is an early passive ROM program
The ________ protocol involves active extension of the digits with passive flexion via traction, typically a rubber band
The ________________ protocol begins within days of surgery to prevent adhesions and promote tendon gliding and excursion
An _________ protocol is advisable only for patients who are unable to care for themselves or who do not have the cognitive capacity to ensure safety postoperatively. This protocol is sometimes used with children to prevent rupture of the repair.
Splinting is used to prevent rupture because the repaired tendon is at its weakest 10 to 12 days post-surgery.

If the client cannot cognitively follow a protocol, the extremity is cast in a protected position for 6 weeks
Tendon glides
Sequence of movements used to promote full tendon excursion and full AROM and prevent adhesions (fingers straight, MCP flexion, hook fist, flat fist)
Radial nerve injury
Wrist drop, possible lack of finger/thumb extension
*Know nonoperative/operative treatment
Radial tunnel syndrome
Entrapment of the radial nerve in an area extending from the radial head to the supinator muscle
Symptoms: Burning pain in lateral forearm
*Know nonoperative/operative treatment
Anterior interosseous syndrome
Compression to the anterior interosseous nerve

Results in a motor loss involving the:
Flexor digitorum longus (FDL)
Flexor profundus (FP) to the index finger
Pronator quadratus (PQ)
Pronator syndrome
Entrapment of the proximal median nerve between the heads of the pronator muscles
Symptoms: deep pain proximal forearm with activity
*Know nonoperative/operative treatment
Median nerve injury
Ape hand deformity; sensory loss in index, middle, and radial side of ring finger; loss of pinch, thumb opposition, index finger MCP and PIP flexion and decreased pronation
*Know nonoperative/operative treatment
Double Crush Syndrome
Occurs when a peripheral nerve is entrapped in more than one location
Symptoms: Intermittent diffuse arm pain and paresthesias with specific postures
Carpal tunnel syndrome
Compression of median nerve; most common nerve compression of the upper extremity
Numbness & tingling in thumb, index, and middle fingers, especially at night
Diminished fine motor coordination
Evaluations:
1) _______ sign: tap on the median nerve at the wrist to elicit symptoms
2) ______ test: holding the wrist in full flexion for 1 min. to elicit changes in sensation
3) ______ test: timed test involving picking up, holding, manipulating, and identifying small objects
4) Semmes-Weinstein monofilament testing is used to test for loss of sensation

*Know nonoperative/operative treatment
Cubital tunnel syndrome
Ulnar nerve compression at the elbow
Second most common nerve compression of upper extremity
Causes includes dislocation or fracture of the elbow, OA, RA, diabetes, etc.
Sensation is decreased in little finger & ulnar half of the ring finger
Decreased grip & pinch strength
Evaluations:
1) ______ sign: tap over the cubital tunnel to elicit symptoms
2) ______ sign: flexion of the IP of thumb when a lateral pinch is attempted
3) _____ sign: the fifth finger held abducted from the 4th finger
4) The ______ test: holding the elbow in flexion for 5 mins. with the wrist neutral to elicit symptoms

*Know nonoperative/operative treatment
De Quervain's Tenosynovitis
Caused by cumulative microtrauma resulting in tenosynovitis of the thumb
Wrist pain affecting the tendons on the thumb side of the wrist
Repetitive & forceful hand or wrist movements
Claw deformity
Guyon's
Distal ulnar nerve compression or lesion at the wrist
Sensory loss occurs in the little finger and ulnar side of ring finger and palmar ulnar hand; if sensory loss is on the dorsal side of the hand, injury is proximal to ______ canal.
Loss of intrinsic ulnar innervated muscles and MCPs hyperextend & IPs flex, hand arches are flattened, and pinch strength is lost
Evaluations:
1) Froment's sign
2) Wartenburg's sign
3) Jeanne's sign: hyperextension of the thumb MCP
4) Semmes-Weinstein monofilament test

*Know nonoperative/operative treatment
Trigger finger
Inflammation or nodules near the A1 pulley
Treatment: splinting the MCP at 0 degrees for 3-6 weeks or surgical release of the A1 pulley
Protective reeducation
Educates clients to visually compensate for sensory loss and to avoid working with machinery and temperatures below 60 degrees
Discriminative reeducation
Uses motivation and repetition in a vision-tactile matching process in which clients identify objects with and without vision
...
Sensory recovery begins with pain perception, vibration, moving, and constant touch
Densitization
Process of applying different textures and tactile stimulation to reeducate the nervous system so clients can tolerate sensations during functional use of the upper extremity
Phonophoresis
Use of ultrasound to promote absorption of topically applied medication to accelerate tissue repair and decrease inflammation
Resting hand splints
Maintain the wrist at 20°-30º extension, thumb at 45º palmar abduction, MCPs at 35°-45º flexion, and PIPs and DIPs in slight flexion
Antideformity resting hand splint (burn intrinsic plus)
Maintain the wrist at 30-40 degrees of extension, thumb at 45 degrees palmar abduction, MCPs at 70-90 flexion, and PIPs & DIPs in full extension
Ball or cone antispasticity splints
Ulnar or volar based and provide thumb palmar or radial abduction, a hard surface in contact with finger flexors, and serial casting for the wrist, elbow, knee, or ankle to decrease soft tissue contractures.
Wrist cock-up splints
(dorsal or volar wrist immobilization) maintain hand arches, full thumb movement, and full MP flexion
Thumb spica splint
(volar thumb or radial gutter thumb immobilization) are used on the long or short opponens to provide CMC immobilization
Antifoot drop
Ankle splints include ________ splints to maintain 90 degrees of ankle dorsiflexion and ankle-foot orthoses
Dynamic splints
Have moving parts, and soft splints allow movement
Designed to correct contractures, increase passive motion, protect recent surgery, or substitute for lost active motion
To correct contractures
Mechanical stretch of prolonged gentle pull over 8-12 hours to remodel soft tissue
To increase passive motion
Finger loop angle of pull of 90 degrees; adjust splint as client improves to maintain 90 degrees angle of pull
To protect recent surgery
Dorsal blocking splint with hinged wrist and joint wrist blocks to maintain wrist extension at 30 degrees and MCP extension of 60 degrees while allowing wrist flexion
To substitute for loss active motion
Radial nerve injury splint, with dynamic MCP extension assist if needed
Primary
Secondary
Delayed primary
Wound closure:
______: wound is closed with sutures
______: wound is left open and allowed to close on its own
_____: wound is cleaned, debrided, and observed 4 to 5 days before suturing is closed
Inflammation, proliferaton, and remodeling
Wound Healing Phases?
Inflammatory phase
Includes clotting and vasoconstriction, white blood cell migration, and release of histamines and prostaglandins that cause vasodilation and increased tissue permeability
Acute phase lasts 24-48 hours to 7 days and subacute phase lasts 7-14 days
Local signs include redness, swelling, heat, and pain
Systemic signs include fever & leukocytosis
Proliferative phase
(Also called the fibroplastic, granulation, or epithelialization process), lactic and ascorbic acid stimulate fibroblasts to synthesize collagen, and cross linkage of collagen increases the tensile strength of repaired skin to 80%
Epitheliazation resurfaces the wound, tissue granulation forms new collagen and blood vessels, and myofibroblasts connect to the wound margins
Wound contraction lasts 5 days to 2-3 weeks. Linear wounds heal quickly, rectangular wounds moderately quickly, and circular wounds the most slowly
Remodeling phase
Scar tissue first consists of randomly arranged collagen fibers, and as the scar matures, the collagen is broken down and remodeled. The scar is more elastic, smoother and stronger.
Lasts 2 weeks to 1-2 years. If collagen synthesis exceeds collagen lysis, hypertrophic and keloid scars can form.
Tension theory posits that wearing pressure garments helps collagen fibers realign in a linear and lateral orientation
Dynamic splinting, serial casting, continuous passive motion, positional stretching, NMES, and gel pads can help to decrease hypertrophic scarring
Burns
...
Superficial (first-degree) burn
-Involves the superficial epidermis
-Pain is minimal to moderate; no blistering or erythema
-Healing time is 3-7 days
Superficial partial thickness burn
(Superficial 2nd degree burn)
-Involves the epidermis and upper dermis layers
-Pain is significant; wet blistering and erythema are present
-Healing time is 1-3 weeks
Deep partial-thickness burn
(Deep second degree burn_
-Involves epidermis and deep dermis layers, hair follicles and sweat glands
-Pain is severe, even to light touch
-Erythema is present, with or without blisters
-Can turn into full thickness burn because of infection
-Grafting may be considered to prevent infection
-May have impairment of sensation
-Hypertrophic scar potentially high
-Heal in 3-5 weeks
Full-thickness (third-degree) burn
-Involves the epidermis and dermis, hair follicles, sweat glands and nerve endings
-Burn is pain free; no sensation to light touch
-Burn is pale and nonblanching
-Requires skin graft
-Potential for hypertrophic scar is extremely high
Subdermal burn
-Full-thickness burn with damage to underlying tissue such as fat, muscle, and bone
-Charring is present and may have exposed fat, tendons, muscle, and bone
-If the burn is electrical, destruction of nerve along the pathway is present
-Peripheral nerve damage is significant
-Requires surgical intervention for sound closure or amputation
-Potential for hypertropic scar is extremely high
High-voltage direct current
Usually causes a single muscle contraction and throws its victim from the source. Client is more likely to have blunt trauma along with the burn.
Low-voltage alternating current
More dangerous than direct current at the same voltage. Causes greater muscle contraction, and, therefore, makes it more difficult for the person to voluntarily control muscles to release the electrified object
Compartment syndrome
The inelasticity of the eschar (burned tissue) can increase the internal pressure within fascia compartments and lead to this syndrome ?
Includes paresthesia, coldness, and decreased or absent pulse in the extremities
Escharotomy & debridement
Removal of burned or dead skin, allowing new vascularized skin to close up the wound
Autograft
Transplantation of the person's own skin from an unburned donor site to the burned receiving site
Split-thickness skin graft
Full epidermal and partial dermal layer are taken from the donor site.
Chance of graft survival is high.
Full-thickness skin graft
Full thickness of the epidermal and dermal layers plus a percentage of fat layers are taken from the donor site.
Chance of graft survival is less.
The outcome is functionally and cosmetically better if graft adherence occurs.
Meshed graft
When the donor graft is "meshed" and stretched to cover a greater area of the receiving area
Sheet graft
When the donor graft is removed and laid down on the receiving area as is
Anticontracture positioning
Positioning is critical because the position of greatest comfort is usually the position of contracture
Immobilization
2-3
5-7
Postoperation immobilization period:
_______ is important after skin graft operation to allow for graft adherence
Immobilization Period: Generally between 3-10 days
Immobilization period of donor site: _____ days
Walking is usually not resumed until ____ days after grafting in lower extremities
Optimal positioning: Goal is to promote the greatest surface area for graft placement
After immobilization, start with gentle AROM to avoid shearing of new grafts
Compression garments
Use of __________ is indicated for all donor sites, grafted sites, and burn wounds that take more than 2 weeks to heal spontaneously
_________ pressure garments are constructed to provide gradient pressure, starting at 35 mm Hg distally
Worn for 24 hours except during bathing, massage, and other skin care activity
Minimum of 2 sets of garments
To conform to body contours and prominences, additional flexible inserts or conformers are often added under the garments to distribute the pressure more evenly
COPD
Condition with damage to the alveolar wall and inflammation of the surrounding airways
Emphysema
Condition where alveoli rupture or enlarge, lungs lose elasticity
Neurodegenerative diseases
...
Akinesia
Impairment of voluntary and spontaneous movement initiation resulting in freezing, especially during gait activities
Bradykinesia
Slowed motor movements
Dysmetria
Decreased coordination of movements
Rigidity
Muscle stiffness that impairs movement
Cogwheel motions
Symptom of PD
Jerky, sometimes painful movements with joint mobility, most commonly in the upper extremities
Fasciculation
Involuntary muscle contraction and relaxation; observed as a muscle twitch
Festinating gait
Small rapid steps resulting from a forward-tilted head and trunk posture
Parasthesia
Numbness & tingling because of sensory nerve changes
Optic neuritis
Symptom of MS
Causes sudden loss of vision with pain in or behind the eye, with symptoms possibly subsiding after 3-6 weeks without residual impairments
Scotoma
Symptom of MS
Partial loss of vision
Scanning speech
Symptom of MS
Slow enunciation with a tendency to hesitate at the beginning of a word or syllable
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