93 Questions
What is the purpose of the Allen Cognitive Level test (ACL-90)?
To estimate cognitive functioning and capacity to learn
What is the testing method used to assess gross visual field in confrontation testing?
Therapist brings in targets from different areas in the field, and the client indicates when targets are seen and their location.
An individual with ideomotor apraxia may appear awkward or clumsy when using tools.
True
_____ involves the inability to recognize or remember specific colors for common objects.
Color agnosia
What does the Allen Cognitive Level 1 scoring measure?
Automatic motor responses & changes in ANS
What is Anomia?
Loss of ability to name objects or retrieve names of people.
______ is the acquired inability to read.
Alexia
Synovitis is inflammation of the muscle tissue surrounding the joint capsule.
False
Match the following terms with their definitions:
Ankylosis = Abnormal condition of stiffness Crepitis = Audible or palpable crunching or popping in joints Subluxation = Characterized by volar or dorsal displacement of joints Nodes = Bony enlargements indicative of cartilage damage from osteoarthritis
What is the primary use of the Allen Cognitive Level Test for populations with psychotic disorders, brain injury, and dementia?
Screening tool to estimate cognitive level of function
What motor actions are associated with ACL 2?
Approximate imitations, Pacing, bending, stretches
What is the primary activity associated with ACL 3?
Manipulation of familiar objects
ACL 4 is characterized by the ability to respond to visual stimuli.
True
Match the eye condition with its description:
Age-related macular degeneration (ARMD or AMD) = Drusen deposits in the retina causing scotomas Astigmatism = Oval cornea resulting in light rays converging at multiple points Diabetic retinopathy = Bleeding from blood vessels leading to vision loss Presbyopia = Age-related loss of accommodation
What is the term for the ability to initiate or accelerate atherogenesis?
Atherogenic
Match the following heart conditions with their corresponding descriptions:
Atrial Fibrillation (A fib) = Rapid irregular atrial rhythm of the heart myo wall Myocardial Infarction = Severe substernal pain lasting more than 20 minutes, necrosis of heart tissue Congestive Heart Failure = Inability of the heart to maintain adequate circulation of blood, leading to increased weight, cough, and fatigue
What is the term for the inflammation of lung tissue where alveoli fill with fluid?
Pneumonia
______ is a term that refers to the condition where the heart is unable to maintain adequate circulation of blood.
Congestive heart failure
Acute coronary syndrome leads to an increase in blood flow to the myocardial tissue.
False
What are some interventions for improving desensitization of the limb post-amputation?
Pain management, residual limb shaping & shrinking, promoting skin hygiene, promote care of insensate skin, maintaining & restoring passive & active ROM, maintaining & restoring UE strength & endurance
What are some common signs required for a classification of Osteoarthritis (OA) of the hand?
Deformity of at least 1 of 10 selected joints
Heat modalities are recommended for the hands in the context of Osteoarthritis (OA).
True
_______ Breathing involves inhaling through the nose and exhaling slowly with pursed lips.
Pursed Lip
Match the following splints with their respective conditions:
Resting hand splints = Acute stage Ulnar drift splint = Preventing deformity Dynamic MCP extension splint = Post-operative MCP arthroplasties Opponens splint = Median nerve injury
What are some treatment options for carpal tunnel syndrome during the acute phase?
rest, modify activity for wrist posture, vibration and decrease repetition, NSAID's, local steroid injection, tendon-gliding exercises, wrist neutral splint at night and during strenuous activity
What condition might you have if you experience aching or sharp pain along the proximal and medial forearm with decreased sensation in the dorsal and palmar surface of the small finger and ulnar half of the ring finger?
cubital tunnel syndrome
What muscle is most likely torn and contributes to lateral epicondylitis (tennis elbow)?
extensor carpi radialis brevis
What test might you perform to diagnose lateral epicondylitis?
Tinel test of radial nerve
What type of splint is recommended for lateral epicondylitis?
wrist cock-up splint (wrist 0-30 degrees extension)
What is the primary muscle involved in medial epicondylitis (golfers elbow)?
flexor carpi radialis
What test should be performed for de Quervain's syndrome?
Finkelstein's Test
What type of splint is recommended for de Quervain's syndrome (Trigger Finger)?
forearm-based thumb spica
What functional problems are associated with radial nerve injuries?
ineffective grip, inability to open hand to grasp large objects, propensity for wrist flexion contracture
What functional problems are associated with ulnar nerve injuries?
ineffective grip, inability to use pinch grip due to loss of thumb adduction control, sensory loss to ulnar side of hand
What are some functional problems associated with median nerve injury?
safety issues due to sensation loss to volar surface of hand, reduced grip strength, reliance on visual feedback
What is Behavioral Rehearsal used for?
teach new behaviors or provide support to individuals in exploring problem solutions
What is Corrective Learning related to?
helping patients recognize inappropriate behavior and replace it with more adaptive behavior
What are Habit Maps (frameworks of habits) used for?
perceiving familiar events and context, guiding habitual behavior
What is Maladaptive Behavior characterized by?
failure to recognize that behavior is unacceptable or inability to perform a desired skill
What does Performance Deficit involve?
failure to demonstrate a skill with necessary consistency in specific situations
List 3 primary treatments of hand or wrist fractures.
Closed reduction (nonoperative), ORIF (operative), External Fixation
What are the clinical signs of a high level median nerve injury?
Ulnar flexion of wrist, loss of palmar abduction and opposition, loss of pronation, sensory loss
What are the clinical signs of a low level median nerve injury?
Loss of thenar eminence, loss of palmar abduction, loss of opposition, sensory loss
What are the clinical signs of a low ulnar nerve injury at wrist level?
Clawing of the ring and small fingers, loss of hypothenar muscles, loss of intrinsic muscles, greader IP flexion deformity
What are the clinical signs of high ulnar nerve injury at or proximal to the elbow?
Clawing of the ring and small finger, wrist positioned in radial extension, slight IP joint flexion deformity, loss of hypothenar muscles, loss of intrinsic muscles
What is one of the main functions of splinting for an ulnar nerve injury?
To prevent hyperextension of the MCP's of the ring and small finger by using an extension block splint, placing the ring and little finger in slight flexion at the MCP's, pronation of forearm, wrist flexion, thumb in palmar abduction
What are the clinical signs of high radial nerve injury (above supinator)?
Incomplete MP joint extension, loss of sensation in radial nerve distribution in forearm and hand, radial wrist extension, loss of finger and thumb extension
What are the clinical signs of posterior interosseous nerve syndrome or radial nerve compression?
Radial wrist extension, loss of finger and thumb extension, incomplete MP joint extension of fingers and thumb, distal sensory loss
What is the most common wrist injury?
Colles fracture of the distal radius
What is the 2nd most injured bone in the wrist?
Scaphoid
What disease is characterized by avascular necrosis of the lunate bone?
Kienbock's Disease
Name and describe the 3 categories of nerve injuries.
Neuropraxia: bruising contusion of nerve without wallerian degeneration, nerve recovers function without intervention within a few days or weeks; Axonotmesis: nerve fibers distal to site of injury degenerate but internal structure of nerve remains intact, typically 6 months recovery, no surgical intervention needed; Neurotmesis: complete laceration of both nerve and fibrous tissues, surgery required
At what point after a nerve repair might a surgeon consider a tendon transfer?
1 year if a motor nerve has not reinnervated its muscle
Where is zone 2 or no man's land located?
Between the distal palmar crease and the insertion of the flexor digitorum superficialis
What is the primary disadvantage of using the Kleinert Technique for flexor tendon repair?
Excessive tension on the rubber band or incomplete PIP extension within the splint
How might flexor tendon injuries be treated in individuals with multiple injuries, fractures, or tendon injuries?
Complete immobilization for roughly 3-4 weeks
What resides in zone IV and V of the hand?
IV = Carpal Tunnel, V = forearm
What resides in zone I and III of the hand?
I = insertion of flexor digitorum profundus to insertion of flexor digitorum superficialis, III = A1 Pulley to the distal edge of the carpal tunnel
Describe the Duran Method or controlled passive motion approach in treating flexor tendon repair.
Dorsal blocking splint is worn to keep the wrist flexed and MCP at 70 degrees flexion. Day 3 post-surgery, client instructed on a regimen of passive flexion and extension. At 4.5 weeks, dorsal splint removed, and rubber band traction is used.
When are tendon gliding exercises introduced to flexor tendon repairs?
6 weeks postop after discontinuation of splints
When can passive extension be introduced post flexor tendon repair?
At 8 weeks post-op
Where is pitting edema most likely found on the hand and why?
On the dorsal surface, where venous and lymphatic systems provide return of fluid to the heart
Describe the procedure for using a contrast bath for edema.
Start with a cool bath for 1 min, then warm bath for 1 min, total of 20 min. Repeat the cycle for maintenance post hand injury.
Which shoulder dysfunction is being described when there is loss of AROM & PROM in shoulder particularly ext rotation and to a lesser degree, abduction and internal rot?
Adhesive capsulitis
What shoulder condition is being described when there is a painful arc of motion between 80-100 degrees elevation or at end range of active elevation?
Subacromial impingement
What shoulder condition is being described when there is painful AROM or resistive rotator cuff muscle use?
Rotator cuff tendinitis
What shoulder condition is being described when there is significant substitution of scapula with attempted arm elevation?
Rotator cuff tear
Which test is being described where the examiner passively overpressures the client's arm into end-range elevation, causing a jamming of the greater tuberosity against the anterior inferior acromial surface?
Impingement Test--subacromial impingement
Which shoulder test is being described where the client is passively abducted to 90 degrees with the palm down, and then asked to lower the arm?
Drop arm test--rotator cuff tear
What is the Adson Maneuver, and what condition would a positive test suggest?
Adson Maneuver involves abduction of both arms to 90 degrees, shoulder external rotation, and elbow flexion to 90 degrees for 3 minutes while alternating between an open hand and clenched fist. A positive test suggests Thoracic Outlet Syndrome.
Describe the Roos test and the condition a positive sign would suggest.
Roos test involves abducting both arms to 90 degrees, shoulder external rotation, and elbow flexion to 90 degrees for 3 minutes while alternating between an open hand and clenched fist. A positive sign suggesting inability to maintain position or symptoms arising before the end of 3 minutes is indicative of Thoracic Outlet Syndrome.
Describe Tinel's Sign and the most common condition a positive test is linked to.
Tinel's Sign involves tapping along the course of a peripheral nerve to elicit a tingling sensation in the fingertip. A positive test linked to carpal tunnel syndrome.
Describe Phalen's Test and reverse Phalen's Test.
Phalen's Test is done by pressing the back of hands together with fully flexed wrists. Reverse Phalen's Test is done by pressing palms together with fully extended wrists for 1 minute.
Describe the carpal compression test.
Pressure is placed over the median nerve in the carpal tunnel for up to 30 seconds looking for provocative signs.
Describe the elbow flexion test and the condition that would elicit a positive sign.
The elbow flexion test involves the client fully flexing the elbows with the wrists fully extended for 3-5 minutes. A positive sign is tingling along the ulnar nerve area of the forearm and hand, indicating Cubital Tunnel Syndrome.
What is Wartenberg's Sign?
Wartenberg's Sign is when the client is unable to adduct the small finger when the hand is placed palm down on the table with the fingers passively abducted.
Describe a quick way to assess radial nerve motor function.
Ask the client to extend the wrist and fingers.
Describe a quick way to assess median nerve motor function.
Ask the client to oppose the thumb to the fingers and flex the fingers.
In which direction should sensory mapping of the volar surface of the hand be done, and how frequently should mapping be done during nerve regeneration?
Sensory mapping should be done from proximal to distal, and radial to ulnar directions. Mapping should be repeated monthly during nerve regeneration.
Name and describe two objective tests for sympathetic function done with nerve injuries.
Two objective tests for sympathetic function are the Wrinkle Test, where denervated skin does not wrinkle, and the Ninhydrin Test, which evaluates sweating of the finger.
Name some signs of sympathetic dysfunction seen in peripheral nerve conditions.
Some signs of sympathetic dysfunction include smooth, shiny skin, nail changes, and tapering of fingers (pencil-pointing).
What is the normal 2-point discrimination distance at the fingertip?
6 mm or less
Describe the modified Moberg Pick-Up Test.
The modified Moberg Pick-Up Test involves placing 9 or 10 small objects on a table, asking the client to pick them up and place them in a small container as quickly as possible with vision. The test is then repeated with vision occluded.
Why would you measure hand volume at different points during the day?
Measuring hand volume at different points during the day helps assess the effect of interventions, activities, rest, and the benefits of splinting on the client's edema.
When using a dynamometer or pinch gauge, how many trials do you take to find the average?
A mean of 3 trials for each hand should be noted.
Should a physical assessment be done before or after a functional assessment postoperative nerve repair?
A physical assessment should be done before a functional assessment postoperative nerve repair to analyze how physical dysfunction impacts functional impairment.
Describe the intervention process postoperative nerve repair.
Postoperative nerve repair intervention involves immobilization (2-3 weeks) with minimal tension on the repaired nerve, followed by protective ROM (4-6 weeks) with protective stretching and active ROM. Dynamic splinting is then used to reduce contractures and strengthen weak muscles.
Name three types of modality tests for nerve injuries.
- Pain
- Heat/cold
- Touch pressure
Name two functional tests used with nerve injuries.
- Two-point discrimination
- Moberg Pick-Up Test
List three objective tests for nerve injuries.
- Wrinkle Test
- Ninhydrin Test
- Nerve-conduction Test
Describe the sensory distribution of the Median Nerve.
The sensory distribution of the Median Nerve includes the volar surface of the thumb, index, middle, and radial half of the ring finger.
Describe the sensory distribution of the Ulnar Nerve.
The sensory distribution of the Ulnar Nerve includes the dorsal and volar surface of the small finger, dorsal and volar surface of the ulnar half of the ring finger.
Describe the sensory distribution of the Radial Nerve.
The sensory distribution of the Radial Nerve includes the posterior upper arm and forearm, dorsum of the thumb, index, middle, and radial half of the ring finger distal to the PIP joint.
Study Notes
NBCOT Exam Prep
- The NBCOT exam prep guide includes a 6-week study schedule, NBCOT practice questions, and tips for testing strategies.
OTR Review
- The OTR review section includes over 600 OT terms and questions, covering topics such as:
Psycho Social and Neurological
- Psychotic disorders, brain injury, and dementia are populations that may use the Allen Cognitive Level Test (ACL)
- ACL measures cognitive level of function and is used as a screening tool
- ACL 1: total assist, automatic actions/reflexive, attention span in seconds
- ACL 2: max assist, postural actions/gross body movement, attention span in minutes
- ACL 3: mod assist, repetitive actions, attention span in 30 minutes
- ACL 4: min assist, goal-directed/familiar activities, attention span in hours
- ACL 5: independent learning/exploratory, reasoning and problem-solving, attention span in weeks
- ACL 6: planned action, conceptual, independent, absence of cognitive disability
Vision
- Age-related macular degeneration (ARMD or AMD): damage to macula, leading to vision loss
- Dry: drusen deposits form in retina, increasing in number to form scotomas
- Wet: abnormal vessel growth under retina, leading to fluid leak and damage
- Astigmatism: oval-shaped cornea, causing light rays to converge at multiple points
- Diabetic retinopathy: bleeding from small blood vessels in retina, leading to vision loss
- Fixation: focusing on an object, foundation of oculomotor control
- Fovea: center 10° of visual field, responsible for identifying details
- Visual acuity: ability to recognize small details, allows for speed and accuracy in processing
- Glaucoma: increased eye pressure, leading to vision loss
- Acute narrow-angle glaucoma: acute episode, severe eye pain, headaches, nausea
- Chronic open-angle glaucoma (COAG): chronic episode, decreased visual acuity and peripheral fields
- Hyperopia: farsightedness, difficulty seeing close objects
- Legal blindness: visual acuity of 20/200 or less in better eye with best optical correction, or visual field of 20° or less
- Macula: area of best vision
- Myopia: nearsightedness, difficulty seeing far objects
- Normal limits of visual field: superior 60°, inferior 75°, nasal 60°, temporal 100°
- Presbyopia: age-related loss of accommodation
- Retina: multilayer, sensory structure for the eye, initiates impulses to visual cortex via optic nerve
- Saccadic eye movement: quick eye movements that change fixation from one point to another
- Smooth pursuits/tracking: maintaining continued fixation on a moving target
Cranial Nerves and Vision
- Cranial nerves impacting vision:
- Optic nerve (II)
- Oculomotor nerve (III)
- Trochlear nerve (IV)
- Trigeminal nerve (V)
- Abducens nerve (VI)
Visual Perceptual Hierarchy
- Foundational skills:
- Oculomotor control
- Visual field
- Visual acuity
- Intermediate-level skills:
- Attention
- Scanning or visual search
- Pattern recognition
- Advanced-level skills:
- Visual memory
- Visuo-cognition
Visual Field Assessments
- Confrontation testing: gross assessment of visual field
- Central field assessments:
- Darnato 30-Point Campimeter: portable test card measuring central 30° of visual field
- Pepper Visual Skills for Reading Test (VSRT): functional test indicating scotomas and their effects on function
Saccadic Eye Movements
- Assessed using:
- biVABA
- VSRT
- Holding two different targets 16 inches from client's face, asking them to look from one to the other
Convergence and Divergence Assessments
- Convergence assessment: moving target towards client's nose, observing eye movements
- Divergence assessment: moving target away from client's nose, observing eye movements
Visual Attention Assessments
- Cancellation tests
- biVABA
- Figure and shape copying tests
- Line bisection test
Apraxia and Agnosia
- Apraxia (motor): inability to carry out a movement, despite intact sensory system, muscles, and coordination
- Ideational apraxia: difficulty with sequencing steps within a task
- Ideomotor apraxia: production error, using tools awkwardly or clumsily
- Agnosia: inability to recognize objects using only visual means
- Color agnosia: inability to recognize specific colors
- Color anomia: inability to name specific colors
- Object agnosia: inability to recognize objects using only vision
- Metamorphopsia: visual distortion of objects
- Prosopagnosia (facial agnosia): inability to recognize a known face or individual
- Simultanagnosia: inability to recognize and interpret an entire visual array at once
Visual Perception
- Visual spatial perception: ability to distinguish the space around one's body and objects in the environment
- Figure-ground: ability to recognize the foreground from the background based on differences in color, luminance, depth, texture, or motion
- Form constancy: ability to recognize a form, shape, or object despite changes in location, position, color, or size
- Spatial relations: ability to perceive the position of one's self in relation to objects in the environment
- Depth perception: ability to judge distances and depth
- Stereopsis: ability to see things in three dimensions, lack of which can affect depth perception and make the environment appear flat
- Topographical orientation: ability to navigate from one place to the next
Other
- Stereognosis: ability to identify everyday objects using tactile properties and no vision
- Graphesthesia: ability to identify forms, numbers, letters written on hand
- Autotopagnosia: inability to identify body parts on self or someone else or the relationship between parts
- Finger agnosia: inability to recognize which finger was touched or is being used
- Anosognosia: lack of recognition or awareness of one's deficits
- Right/left discrimination: ability to identify, discriminate, and understand the concept of right and left### Brain Functions and Cognitive Development
- The occipital lobe is responsible for scanning, identification of objects, awareness, and discrimination
- The frontal lobe is responsible for planning, problem-solving, organizing, attention, and initiation of movement
- The parietal and temporal lobes are involved in visual spatial relations, understanding spoken and written language, and verbal memory
Visual Inattention and Interventions
- Hemi-inattention: decreased search to left field due to right hemisphere deficit
- Interventions for hemi-inattention:
- Provide bilateral activities
- Guide the affected side through activities
- Increase sensory stimulation to the affected side
Cognitive Assessments and Interventions
- Allen Cognitive Level test (ACL):
- Evaluates cognitive functioning and capacity to learn
- Scores range from 3.0 to 5.8 based on completion of stitches and method described by author
- Interventions for cognitive impairments:
- Decrease external auditory stimuli
- Give the individual increased response time
- Use visual cues and gestures
- Use concise sentences
- Investigate the use of augmentative communication devices
Language and Communication Disorders
- Anomia: loss of ability to name objects or retrieve names of people
- Brocha's aphasia: loss of expressive language, resulting in decreased speech production
- Wernicke's aphasia: deficit in auditory comprehension, resulting in paraphasia or nonsensical syllables
- Global aphasia: combination of Brocha's and Wernicke's aphasia, resulting in severe impairment of spoken and written language
Visual Functioning and Development
- Erhardt Developmental Vision Assessment (EDVA) and Short Screening Form (EDVA-S): evaluates visuomotor development and identifies delays and gaps in skill sequences
- Brain Injury Visual Assessment Battery for Adults (biVABA): assesses visual skills, including acuity, color perception, depth, and visual fields
Cognitive and Behavioral Interventions
- Lowenstein Occupational Therapy Cognitive Assessment (LOTCA): measures basic cognitive functions prerequisite for managing everyday tasks
- Cognistat Neurobehavioral Cognitive Status Examination: explores, quantifies, and describes performance in central areas of brain-behavior relations
Orthopedic and Surgical Interventions
-
Total Hip Arthroplasty (THA): replaces acetabulum and femoral head
-
Minimally invasive technique: uses two 2-inch incisions, no detachment of muscles required
-
Open reduction and internal fixation (ORIF): surgical alignment of fractured bones using screws, pins, wires, or nails### Hip Fractures & Hip Replacements
-
Precautions: no hip flexion > 90 degrees, no internal rotation, no adduction (no crossing legs/feet)
-
Intervention areas:
- Client education (fall prevention, home modification, safe transfers, transportation)
- Bed mobility & bedside ADL
- UE strengthening
- Functional ambulation & transfers with appropriate WBing status & ambulation device
- Use of AD
- Practice role activities using proper WBing status and ambulatory device
- Caregiver training (educate precautions, transfers)
Low Back Pain
- Pathology:
- Scoliosis (lateral curvature of spine)
- Kyphosis (outward curvature of spine/hunch back)
- Sciatica (nerve is entrapped by disc herniation)
- Spinal Stenosis (narrowing of the intervertebral foramen)
- Facet Joint Pain (inflammation or joint changes of spinal joints)
- Spondylolysis (stress fracture of the dorsal to the transverse process)
- Spondylolisthesis (slippage of one vertebra on another)
- Herniated Nucleus Pulposus (stress may tear fibers of the disc, results in outward bulge of enclosed nucleus pulposus)
- Intervention areas:
- Client education
- Back stabilization & neutral spine
- Body mechanics
- Adaptive equipment
- Ergonomics
- Energy conservation
- Stress reduction/coping techniques
- ADLs:
- Bathing: shower not bath, keep items within easy reach, use long handled brushes/sponges
- Dressing: sit while dressing, keep back straight or lie flat on bed, avoid bending forward
- Functional mobility: logroll, maintain straight back and neutral spine, tighten abdominal muscles to support back
Amputations
- Classification system:
- Transhumeral (short above-elbow amputation)
- Transradial (radius ulna, BE)
- Transfemoral (above knee, AK)
- Transtibial (BK)
- Syme's ankle (complete tarsal) disarticulation
- Precautions:
- Joint complications: decrease ROM
- Skin complications: delayed healing, extensive skin grafts, reduction of edema
- Sensory complications: pain, body scheme/image
- Psychological complications: severe depression, suicidal impulses
- Intervention areas:
- Improve body image, self-image, psychosocial adjustment
- Promote I fxn during ADLs and IADLs
- Promote wound healing
- Improve desensitization of the limb
- Pain management
- Residual limb shaping & shrinking
- Promote proper skin hygiene
- Maintain & restore passive & active ROM
- Maintain & restore UE strength & end
Osteoarthritis (OA)
- Diagnostic criteria:
- Hard tissue enlargement of 2+ of 10 selected joints
- Hard tissue enlargement of 2+ distal IP joints
- Fewer than 3 swollen metacarpal joints
- Deformity of at least 1 of 10 selected joints
- Precautions:
- Pain, fatigue
- Inflamed or unstable joints
- Perform resistive activity or exercise with caution
- Possible sensory impairments
- Fragile skin 2* disease or Rx side effects
Rheumatoid Arthritis (RA)
- Precautions:
- Potential intolerance of thermal modalities
- Respect pain as a signal to stop the activity
- Reduce the force
- Maintain muscle strength and joint ROM
- Use each joint in its most stable anatomical and functional plane
OA and RA
- Principles of joint protection:
- Respect pain as a signal to stop the activity
- Reduce the force
- Maintain muscle strength and joint ROM
- Use each joint in its most stable anatomical and functional plane
- Avoid positions of deformity & forces in their direction
- Use the largest, strongest joints available for the job
- Ensure correct patterns of movement
- Avoid staying in one position for long periods
- Avoid starting an activity that cannot be stopped immediately if it proves to be beyond capability
- Balance rest and activity
- Home environmental modifications:
- Remove doors of cabinets or attach loops to door handles
- Lower the height of above counter cupboards
- Use swivel or pull-out shelves
- Replace standard oven with a microwave oven on a surface that accommodates available reach
Fibromyalgia
- Intervention areas:
- Self management approaches
- Patient education (fatigue management, energy conservation, body mechanics, pacing)
- Lifestyle changes
- Basic sleep hygiene measures
- Fatigue management
- Cognitive dysfunction
- Pain & stress management
Cardiopulmonary Conditions
- Precautions:
- Exercise intolerance
- Chest pain or pain referred to teeth, jaw, ear, or mouth
- Excessive fatigue, SOB
- Lightheadedness or dizziness
- Nausea or vomiting
- Unusual weight gain of 3-5lbs in 1-3 days
Pulmonary Rehabilitation
- Intervention areas:
- ADL evaluation and training
- Breathing techniques
- UE strengthening
- Work simplification and energy conservation
- Stress management
Breathing Techniques
- Pursed lip breathing:
- Breathe in through your nose
- With your lips pursed, exhale air slowly
- Exhale twice as long as inhaling, if possible
- Diaphragmatic breathing:
- Sit in a relaxed position (elevate feet preferably)
- Place hand on your abdomen, feel stomach push out as you inhale through your nose
- Feel your stomach go down as you slowly breathe out through pursed lips
Respiratory Diseases
- Precautions:
- Oxygen saturation below 90%
- Altered breathing patterns
- SOB
- Perspiration
- Anxiety
- Cough
- Cyanosis (bluish discoloration of skin 2* decreased circulation, decreased O2 in blood)
OA & RA
- Splints:
- Resting hand splints in the acute stage
- Wrist splint only if arthritis specific to wrist
- Ulnar drift splint to prevent deformity
- Silver ring splints to prevent boutonniere & swan neck deformities
- Dynamic MCP extension splint with radial pull for post-operative MCP arthroplasties
- Hand base thumb splint for CMC arthritis
- Intervention areas:
- ROM: focus on AROM, should be pain-free
- Strengthening: avoid during inflammatory stage, avoid deformity positions
- AE to prevent deformity, decrease stress on small joints, & extend reach
SPLINTS for Nerve Injuries
- Brachial plexus injury: flail arm splint
- Radial nerve palsy: dynamic wrist, finger, & thumb extension splint
- Median nerve injury: opponens splint, C-Bar or thumb post splint
- Ulnar nerve injury: dynamic/static splint to position MPs in flexion
- Combined median ulnar: figure-of-eight or dynamic MCP flexion splint
- Carpal tunnel syndrome: wrist splint positioned 0-15* extension
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