Rheumatoid and Osteoarthritis Overview
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Questions and Answers

What is the primary goal of OT treatment for clients with arthritis?

  • Increase range of motion
  • Improve strength
  • Reduce pain
  • Improve function and independence (correct)
  • Which of the following is NOT a common symptom associated with Rheumatoid Arthritis?

  • Muscle weakness
  • Joint pain and stiffness
  • Fatigue and weight loss
  • Localized swelling (correct)
  • What is the main difference between the acute and chronic phases of Rheumatoid Arthritis?

  • The severity of pain
  • The presence or absence of remission (correct)
  • The effectiveness of medication
  • The level of joint inflammation
  • Which type of splint is typically used for DeQuervain's tenosynovitis?

    <p>Wrist splint (A)</p> Signup and view all the answers

    What does the term 'synovectomy' refer to?

    <p>Removal of the synovial membrane around a joint (A)</p> Signup and view all the answers

    Which of the following is NOT an adaptive equipment commonly used by clients with arthritis?

    <p>Weighted utensils (A)</p> Signup and view all the answers

    Which type of arthritis is characterized by progressive joint damage?

    <p>Osteoarthritis (A)</p> Signup and view all the answers

    Which of the following is NOT a principle of joint protection, as applied to OT intervention for arthritis?

    <p>Avoid all physical activity (A)</p> Signup and view all the answers

    What is macrotrauma?

    <p>Sudden injury from a major force. (A)</p> Signup and view all the answers

    What is the main characteristic of microtrauma?

    <p>Damage to tissue at a microscopic level. (D)</p> Signup and view all the answers

    What is an example of an intervention technique for edema control?

    <p>Stump wrapping to reduce residual limb volume. (D)</p> Signup and view all the answers

    Which of the following is NOT a component of preoperative care for amputation?

    <p>Teaching the patient to use a prosthetic limb. (D)</p> Signup and view all the answers

    What are the four cumulative factors that lead to back injuries?

    <p>Poor posture, poor body mechanics, decreased flexibility, and overall poor physical fitness. (A)</p> Signup and view all the answers

    What is the primary focus of postoperative care for an amputee?

    <p>Addressing emotional and psychological support needs. (B)</p> Signup and view all the answers

    Which of the following is NOT a recognized type of upper extremity (UE) prosthesis?

    <p>Transradial prosthetics (C)</p> Signup and view all the answers

    What is transcarpal amputation?

    <p>Amputation through various bones of the hand. (B)</p> Signup and view all the answers

    When referring to an above the knee amputation, which acronym is commonly used?

    <p>A.K.A. (A)</p> Signup and view all the answers

    What is the main goal of intervention for increasing muscle strength in an amputee?

    <p>Enhance prosthetic control and function. (D)</p> Signup and view all the answers

    Which of the following is NOT considered an intervention technique for UE amputation?

    <p>Driving education (C)</p> Signup and view all the answers

    What is a body-powered prosthesis?

    <p>A prosthesis controlled by movement of the shoulder. (B)</p> Signup and view all the answers

    What is a myoelectric prosthesis?

    <p>A prosthesis powered by muscles in the limb. (A)</p> Signup and view all the answers

    What is the main focus of intervention for increasing ROM in an amputee?

    <p>Preventing soft tissue contractures in the residual limb. (C)</p> Signup and view all the answers

    What does it mean to have a congenital amputation?

    <p>The amputation was present at birth. (B)</p> Signup and view all the answers

    What is spinal stenosis?

    <p>The narrowing of the spinal canal. (E)</p> Signup and view all the answers

    What is the primary goal of OT treatment in the acute phase of burn recovery?

    <p>Edema control and prevention of contractures (A)</p> Signup and view all the answers

    Which of the following is NOT a component of a typical upper extremity prosthesis?

    <p>Splint (C)</p> Signup and view all the answers

    What is the term for a benign tumor that can develop at the end of a severed nerve after amputation?

    <p>Neuroma (D)</p> Signup and view all the answers

    Which of the following is a key principle of proper positioning for a lower extremity amputee?

    <p>Daily ROM exercises (A)</p> Signup and view all the answers

    What type of burn affects the epidermis only?

    <p>Superficial burn (B)</p> Signup and view all the answers

    Which of the following is NOT a complication associated with burn injuries?

    <p>Improved body temperature regulation (A)</p> Signup and view all the answers

    What is the appropriate positioning for a wrist/hand burn in a splint?

    <p>Wrist extension 30 degrees, thumb abducted and extended, MCP flexion 50-70 degrees and IP extension (B)</p> Signup and view all the answers

    What is the primary goal of OT treatment in the rehabilitation phase of burn recovery?

    <p>Achieving independence while preventing deformities or contractures (B)</p> Signup and view all the answers

    Which of the following is a type of scar management technique?

    <p>Ultrasound combined with stretching (A)</p> Signup and view all the answers

    What is a voluntary closing terminal device (TD) on a prosthesis?

    <p>The TD is open at rest and the amputee's efforts close them. (C)</p> Signup and view all the answers

    What is a main difference between the treatment approaches of OT for clients with acute pain vs. chronic pain?

    <p>Acute pain management focuses on controlling pain, while chronic pain management focuses on improving function and activity levels despite the pain. (C)</p> Signup and view all the answers

    Which of the following are common conditions associated with chronic pain?

    <p>Cancer, arthritis, and fibromyalgia (B)</p> Signup and view all the answers

    What is the gate theory of pain modulation?

    <p>A theory that states that the pain signal can be blocked by other incoming sensory information. (C)</p> Signup and view all the answers

    What is a common type of upper extremity fracture?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the pain cycle?

    <p>The cycle of pain, muscle guarding, and inactivity. (B)</p> Signup and view all the answers

    What does ORIF stand for?

    <p>Open Reduction Internal Fixation (D)</p> Signup and view all the answers

    Which of the following is NOT a common type of fracture line?

    <p>Horizontal (D)</p> Signup and view all the answers

    What is TTWB?

    <p>Toe Touch Weight Bearing (C)</p> Signup and view all the answers

    What is the main function of the thalamus in the pain pathway?

    <p>Disperses pain signals throughout the body (A)</p> Signup and view all the answers

    What is a Mallet finger?

    <p>A fracture of the distal phalanx (B)</p> Signup and view all the answers

    What is Complex Regional Pain Syndrome?

    <p>A condition that affects the sympathetic nervous system, resulting in increased pain response. (B)</p> Signup and view all the answers

    What are the precautions with a client who has had a hip posterior approach surgery?

    <p>Avoid hip flexion, internal rotation, and adduction. (D)</p> Signup and view all the answers

    What are the precautions with a client who has acute pain?

    <p>Calm down the pain using hot/cold packs, exercises, and massages. (C)</p> Signup and view all the answers

    What are OT intervention goals for clients recovering from fractures?

    <p>Reduce pain, restore ROM, improve strength, enhance functional independence. (B)</p> Signup and view all the answers

    What is the difference between an open and closed fracture?

    <p>An open fracture involves a break in the skin, while a closed fracture does not. (A)</p> Signup and view all the answers

    What are the initial OT interventions for a client with acute pain?

    <p>All of the above (E)</p> Signup and view all the answers

    What are the precautions for a client with a back injury? (Select all that apply)

    <p>Weight bearing as tolerated (WBAT) or Full weight bearing (FWB) (A), Non-weight bearing (NWB) (B), Partial weight bearing (PWB) (C), Toe touch weight bearing (TTWB) (D), Limit hip flexion, internal rotation, and adduction. (E)</p> Signup and view all the answers

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    Flashcards

    Rheumatoid Arthritis

    Chronic autoimmune disease causing inflammation of joints and synovitis.

    Osteoarthritis

    Wear and tear of joints leading to cartilage damage.

    Symptoms of Rheumatoid Arthritis

    Systemic symptoms include fatigue, weight loss, joint pain, and deformities.

    Symptoms of Osteoarthritis

    Localized joint pain, swelling, stiffness, and deformities primarily at joints.

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    Bouchard's Node

    Node that occurs at the PIP (middle) joint due to arthritis.

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    Heberden's Node

    Node that occurs at the DIP (distal) joint due to arthritis.

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    DeQuervain's Tenosynovitis

    Inflammation of the tendon sheath around the wrist.

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    Joint Protection Aspects

    Education on respecting pain, using larger joints, and avoiding deformity positions.

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    Voluntary opening TD

    A type of prosthetic terminal device that is closed at rest and opens with the amputee's effort, such as shoulder flexion.

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    Voluntary closing TD

    A type of prosthetic terminal device that is open at rest and closes with the amputee's effort.

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    Components of UE prosthesis

    Parts include stump sock, harness, cable and components, and socket, each serving a specific function.

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    Neuroma

    A benign tumor that may develop at the proximal end of a severed nerve following amputation.

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    Phantom sensation

    Sensations felt by the patient that seem to originate from the amputated limb.

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    Phantom limb pain

    Painful sensations such as burning or squeezing felt in the area of the amputated limb.

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    Debridement

    The process of removing tissue or foreign objects from a wound to promote healing.

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    Hypertrophic scar

    A type of raised scar that remains within the original boundaries of the wound.

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    Keloid scar

    A raised scar that extends beyond the borders of the original wound.

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    Rule of Nines

    Method to assess burn area by dividing total body surface into areas that equal 9% each for adults.

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    ROM

    Range of Motion; movement capacity of a joint.

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    Acute Pain

    Pain lasting less than 6 months, often signals tissue damage.

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    Chronic Pain

    Pain lasting longer than 6 months, often lacks a clear cause.

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    Characteristics of Acute Pain

    Identifiable cause, localized, signals tissue damage.

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    Characteristics of Chronic Pain

    No identifiable cause, poorly localized, can have psychological effects.

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    Complex Regional Pain Syndrome

    Miscommunication in the nervous system causing increased pain response.

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    Pain Cycle

    The cycle where pain leads to muscle guarding and inactivity.

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    OT Intervention for Acute Pain

    Includes establishing trust and early interventions like splinting.

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    OT Intervention for Chronic Pain

    Focus on improving function rather than discussing pain.

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    Types of Fractures

    Closed and open fractures; differences in bone exposure.

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    Colles Fracture

    Fracture of distal radius from a fall, common in wrist.

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    ORIF

    Open Reduction Internal Fixation; surgical method to fix fractures.

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    NWB

    Non-weight bearing; no weight on the affected limb.

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    PWB

    Partial weight bearing; 50% weight allowed on the limb.

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    Movements to Avoid Post-Surgery (Back)

    No hip flexion, internal rotation, or adduction.

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    Muscle strain

    Tearing, bruising, or irritation of muscle fibers.

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    Facet joint sprain

    Tearing or inflammation of a facet joint ligament or capsule.

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    Slipped disc

    Bulging or herniated disc compressing nerves and blood vessels.

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    Spinal stenosis

    Narrowing of the spinal canal.

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    Spondylolisthesis

    Superior vertebra slips over an inferior one.

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    Macrotrauma

    Sudden injury from a major force.

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    Microtrauma

    Injuries occurring at a microscopic level over time.

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    Forequarter amputation

    Removal of the humerus with part or all of the scapula and clavicle.

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    Transhumeral amputation

    Amputation through the humerus, losing elbow function.

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    Phantom limb pain management

    Uses mirror therapy to alleviate pain in absent limbs.

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    Congenital amputation

    Absence of a limb or part at birth due to developmental defect.

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    Body-powered prosthesis

    Prosthesis operated through shoulder movements.

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    Myoelectric prosthesis

    Uses muscle activity to operate prosthetic device.

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    Postoperative care for amputation

    Focuses on emotional support and counseling post-surgery.

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    Edema control in amputation

    Reducing residual limb volume for better prosthetic fit.

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    Study Notes

    Rheumatoid Arthritis

    • Chronic, systemic autoimmune disease
    • Characterized by synovitis (inflammation of the fluid around joints)

    Osteoarthritis

    • "Wear and tear" arthritis
    • Causes cartilage damage in joints

    Rheumatoid Arthritis Symptoms

    • Systemic (throughout the body)
    • Joint pain, swelling, and deformities
    • Weight loss, fatigue

    Osteoarthritis Symptoms

    • Localized joint pain, swelling, and stiffness
    • Deformities, weakness
    • CMC (carpo-metacarpal) joint involvement

    Rheumatoid Arthritis Course

    • Acute (exacerbation) and chronic (remission) phases

    Osteoarthritis Course

    • Progressive

    Arthritis Medical Treatments

    • NSAIDs, DMARDs, BRMs
    • Analgesics, steroids
    • Synovectomy, tenosynovectomy, tendon surgery, arthroplasty, arthrodesis

    Joint Nodules

    • Bouchard's nodes at PIP (middle) joints
    • Heberden's nodes at DIP (distal) joints

    De Quervain's Tenosynovitis

    • Inflammation of tendon sheath

    Occupational Therapy (OT) Goals for Arthritis

    • Joint protection and energy conservation

    Joint Protection

    • Respect pain
    • Use larger joints for tasks
    • Avoid positions of deformity and unnecessary loading

    Energy Conservation/Work Simplification

    • Pre-plan, organize
    • Rest, good posture
    • Avoid extremes, diaphragmatic breathing

    Adaptive Equipment for Arthritis

    • Button hooks, zipper pulls
    • Jar openers, enlarged handles
    • Shoe horns, bath sponges, reachers, dressing sticks, tub seats, grab bars, raised toilet seats

    Splinting

    • Rest, support, prevent deformities

    Splinting Applications

    • Silver ring splint: swan neck, boutonniere
    • Soft splint: ulnar drift
    • Wrist splint: De Quervain's

    OT Treatment Phases for Arthritis

    • Acute Phase: ROM only, no resistance
    • Chronic Phase: ROM, gentle stretching, isometric strengthening

    Modalities for Arthritis

    • Heat: Decrease stiffness, increase ROM
    • Cold: Decrease inflammation, swelling

    Pain Definitions

    • Acute Pain: < 6 months
    • Chronic Pain: > 6 months

    Acute Pain Characteristics

    • Signals tissue damage
    • Identifiable cause, well localized, objective signs

    Chronic Pain Characteristics

    • Occurs after tissue damage and healing
    • Lack of identifiable cause, poorly localized, fluctuating subjective signs
    • Multiple failed treatments, psychological effects (anxiety, anger), litigation

    Chronic Pain Associated Conditions

    • Cancer, arthritis, fibromyalgia

    Complex Regional Pain Syndrome (CRPS)

    • Sympathetic nervous system miscommunication, increasing pain response
    • Reversable with early intervention

    Pain Etiology (Nociception)

    • Nociceptors: Pain receptors
    • Thalamus: Disperses pain signals
    • Somatosensory cortex: Pain localization
    • Frontal cortex: Response coordination
    • Descending analgesic pathways: Opioid suppression

    Pain Cycle

    • Pain -> Muscle Guarding -> Inactivity

    Acute Pain Precautions

    • Calm pain with modalities, exercises, massages

    Pain Mechanism Theories

    • Misinterpretation: Nerve fibers outside CNS
    • Centralized pain theory: Brain "ownership"
    • Gate theory: Pain signal inhibition (rubbing stubbed toe)

    Chronic Pain Precautions

    • Break pain cycle, avoid inactivity

    OT Intervention with Acute Pain

    • Trust building
    • Early intervention (splinting, PAMs, soft tissue, ADLs)
    • Strengthening and graded return to ADLs

    OT Intervention with Chronic Pain

    • Trust building
    • Avoid focus on pain
    • Focus on function, ADLs, body mechanics, compensation

    Pain Documentation

    • Location, description, intensity, aggravators, relief

    Fracture

    • Break or crack in a bone

    Fracture Types

    • Closed, open

    Fracture Lines

    • Transverse, oblique, spiral, comminuted, segmental, avulsed, impacted, torus, greenstick

    Specific Fracture Examples (UE)

    • Colles fracture: Distal radius, fall
    • Mallet finger fracture: Distal phalanx avulsion
    • Boxer's fracture: 5th metacarpal
    • Scaphoid fracture: Specific carpal bone

    Fracture Etiology

    • Trauma, disease (cancer, osteoporosis)

    ORIF

    • Open reduction internal fixation

    Fracture Healing Times

    • UE: 6-12 weeks
    • LE: 12-30 weeks

    OT Intervention Steps for UE Fractures

    1. Maintain non-immobilized joints
    2. Splinting
    3. Control pain, edema, scarring
    4. ROM (as prescribed)
    5. Strength and control
    6. Psychosocial adjustment
    7. Achieve highest function (ADL, adaptive equipment)

    Back Injury Precautions

    • NWB, PWB, TTWB, FWB

    Back Surgery Precautions (Hip Approach)

    • Posterior: No flexion, internal rotation, adduction
    • Anterior: No external rotation, adduction, extension

    OT Goals for Fracture Recovery

    • Max ADL level, safety, functional mobility, transfers, IADLs

    Muscle Strain

    • Tearing, bruising, bleeding, irritation of muscle fibers

    Facet Joint Sprain

    • Ligament/joint capsule tear or inflammation
    • Avoid twisting

    Slipped Disc

    • Bulging/herniated disc, nerve/blood vessel compression
    • Avoid forward bending

    Spinal Stenosis

    • Narrowing of spinal canal

    Spondylolisthesis

    • Superior vertebra slips over inferior
    • Avoid spinal extension

    Orthopedic Spinal Conditions - Signs/Symptoms

    • Localized/radiating pain
    • Muscle guarding/tenderness
    • Weakness, numbness, tingling
    • Mobility impairment

    Macrotrauma

    • Sudden injury from major force

    Microtrauma

    • Microscopic tissue injury from cumulative effects

    Cumulative Back Injury Factors

    • Poor posture, body mechanics
    • Decreased flexibility, poor fitness

    Amputation Types (UE)

    • Forequarter: Humerus, scapula, clavicle removal
    • Shoulder disarticulation: Humerus-glenoid fossa
    • Transhumeral: Through humerus, no elbow
    • Wrist disarticulation: Hand-forearm meeting point
    • Transradial: Below elbow
    • Elbow disarticulation: Forearm removal, humerus remains

    Amputation Types (LE)

    • Transcarpal: Through hand bones
    • Finger/phalangeal amputation: Passive prosthesis
    • Transmetatarsal: Through metatarsals
    • Hemipelvectory: Through pelvis
    • Transfemoral: Above knee disarticulation; A.K.A.
    • Knee disarticulation: Lower leg removal, femur remains
    • Transtibial: Below knee; B.K.A.
    • Symes: Foot removal at ankle joint

    Intervention for Increasing Muscle Strength (Amputation)

    • Cuff weights, exercise bands

    Intervention for Residual Limb Hygiene

    • Adaptive techniques for self-care pre-prosthesis

    Intervention for Phantom Limb Pain

    • Mirror therapy

    Intervention for Prosthetic Training

    • Shoulder flexion/bilateral scapular abduction to open/close prosthesis

    Intervention for Edema Control

    • Reduce residual limb volume to enhance prosthetic fit

    Intervention for Change of Dominance (Amputation)

    • Increase radial digital coordination

    Intervention for Psychological Support (Amputation)

    • Active listening, stages of grief

    Intervention for Increasing ROM

    • Prevent soft tissue contractors

    Intervention for Recreation/Leisure (Amputation)

    • Activity-specific prosthetic adaptations

    Congenital vs. Acquired Amputation

    • Congenital: Limb absence at birth
    • Acquired: Surgery/trauma

    Types of UE Prostheses

    • Passive hands/mitts
    • Body-powered
    • Myoelectric
    • Brain-powered

    Body-Powered Prosthesis

    • TD operated by shoulder flexion/protraction

    Myoelectric Prosthesis

    • TD operated by muscle electrode activity

    Preoperative Amputation Care

    • Psychological support, prosthetic options, post-op exercise, ADL techniques

    Postoperative Amputation Care

    • Emotional/psychological support, prosthesis benefits

    LE Amputation Intervention

    • Positioning, transfers, strengthening, ADLs, IADLs, dynamic balance, driving, pre/vocational, leisure, community reintegration

    UE Amputation Intervention

    • Stump care/hygiene, stump wrapping, ROM, desensitization, prosthetic wear schedule, skill training

    Voluntary Opening/Closing TD

    • Voluntary opening: Closed at rest, opened by action
    • Voluntary closing: Open at rest, closed by action

    UE Prosthesis Components

    • Stump sock, harness, cables/components, socket

    Neuroma

    • Benign tumor at the proximal end of severed nerve

    Phantom Sensation

    • Sensations from missing limb

    Phantom Limb Pain

    • Burning, shooting, squeezing sensations in amputated limb

    LE Amputation Positioning

    • Daily ROM, avoid pillows, neutral hip alignment, reduce contractures, edema, ulcers

    Burn Positioning (Anterior Leg)

    • Slight knee flexion

    Burn

    • Tissue damage from heat, radiation, electricity, chemicals

    Eschar

    • Necrotic tissue adhering to wound

    Hypertrophic Scar

    • Raised scar within border

    Keloid Scar

    • Raised scar beyond border

    Contracture

    • Shortening of soft tissue around joint

    Debridement

    • Wound tissue and foreign object removal

    Burn Types

    • Superficial (1st degree), partial (2nd degree), full thickness (3rd/4th degree)

    Burn Depth (Skin Layers)

    • Superficial: Epidermis
    • Partial: Dermis
    • Full Thickness: Subcutaneous/bone

    Rule of Nines/Lund and Browder Chart

    • Estimated burn area

    Burn Complications

    • Infection risk, body temperature regulation, shock, scarring, contractures, psychosocial adjustments

    OT Treatment - Acute Burn Phase

    • Edema control, contracture prevention

    OT Treatment - Rehabilitation Burn Phase

    • PROM/AROM, edema control, scar management, ADL's

    Scar Management Techniques

    • Wraps, compression garments, silicone, stretching, ultrasound, massage

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    Description

    Explore the key differences between Rheumatoid Arthritis and Osteoarthritis. This quiz covers their symptoms, treatment options, and progression. Test your understanding of these common forms of arthritis and their impact on health.

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