Common Orthopedic Conditions and OT Interventions PDF

Common Orthopedic Conditions & OT Interventions  Spinal Conditions Causes & Diagnoses Impacts Med/Surg Treatments Bone spurs Neurological symptoms Spinal fusion Herniated/...

Common Orthopedic Conditions & OT Interventions  Spinal Conditions Causes & Diagnoses Impacts Med/Surg Treatments Bone spurs Neurological symptoms Spinal fusion Herniated/degenerated – radiculopathy, Laminectomy discs sciatica Foraminotomy Arthritis/ankylosing Significant pain Discectomy spondylitis Mobility limitations Artificial disc Fractures Increased risk or replacement Facet joint problems incidence of falls Interlaminar implant Osteomyelitis Decreased strength Kyphoplasty Spinal stenosis due to immobility (fall Spondylolisthesis cycle) Spinal Conditions - Pathophysiology Spinal Issues Primary focus is education, prevention, & adaptation - OT  Body mechanics – log roll, *spinal Intervention precautions*  Donning/doffing orthotics - cervical collar, Aspen collar, TLSO  AE – BSC, raised toilet seat, etc.  Environmental or task modification – Positioning, raised surfaces, ergonomics  Pain management - biopsychosocial Log Roll Technique  Complete the following activities with a partner or small group. 1. UB/LB Dressing: Practice donning and Activity: doffing a shirt, socks, and pants with spinal precautions. Use AE and AD as needed. Spinal 2. Log Roll: Instruct a peer in how to get into Precautions and out of bed using the log roll technique. Hip Fractures  Most common fracture in the elderly - average age of patients with hip fx is 80 years  About 75% to 80% of injuries occur in women  Mortality rates reach 10% at one month and approach 30% at one year o For survivors, 11% are non-ambulatory, 16% require admission to LTC, and 80% require a walking aid  Nonmodifiable risk factors: lower SES, older age, female sex, prior fx, metabolic bone disease, and bony malignancy  Modifiable risk factors: low BMI, having osteoporosis, increased fall risk, medications that increase fall risk or decrease bone mineral density, and substance use  Hip Pain & Disability Causes Impacts Med/Surg Treatments Osteoarthritis Significant pain OTC/Rx Medications Rheumatoid arthritis Mobility limitations - analgesics, anti- Avascular necrosis Fractures Decreased inflammatories Obesity strength, ROM, and Injections – Steroid, balance (deconditioning) Enbrel due to immobility Anti-depressants Increased risk or Heat or cold therapy incidence of falls (fall Activity modifications cycle) AE & AD Psychological changes – ORIF depression, anxiety External fixation THA - Posterior, anterior, or lateral Hemiarthroplasty Revision surgery Types of Hip Surgery (p. 586)  It is important to know which approach the surgeon used to determine which hip precautions the client must follow   Most THA/THR patients are WBAT 1-3 days p/o  Always check with physician to verify and monitor orders closely  FWB – 100% weight Weightbeari  NWB – 0% weight ng  PWB – 1-50% weight Restrictions  TDWB – foot touch 0% weight  TTWB – toe touch 0% weight  WBAT – to client pain tolerance or strength   REVIEW: Anterior & posterior hip precautions  Typically followed for 6-12 weeks post-op Hip  Failure to comply can result in Precautio dislocation of the joint ns (p.  Emerging research indicates that 586) "pose avoidance protocols" are less restrictive and offer comparable outcomes for post-surgical clients! (p. 585)  1. Using the textbook, reputable online sources, and other tools, work with a partner to create a handout comparing o POSTERIOR hip precautions o ANTERIOR hip precautions Activity: Hip 2. UB/LB Dressing: Using your handout, instruct a "client" in donning and Precautions doffing socks and pants with posterior R hip precautions. Use AE and AD as needed. **You will need to have ANTERIOR and POSTERIOR hip precautions memorized and understand appropriate interventions.**  TKR/TKA - Designed to ↓ pain, ↑ ROM & stability of the knee - Most common DX = OA - Multiple designs enable partial to full joint replacement - Early AROM P/O - Weight-bearing restrictions with some types - CPM may be used P/O OT Intervention for TKA/TKR  Pain management  Positioning to regain knee flexion and promote full knee extension  Psychological adjustment  Resumption of ADL, IADL  Functional mobility and AD training  Occupational issues are usually fewer than for THA   Evaluation to establish baseline  Occupational profile – daily routines, PLOF, home envmt, goals, supports, etc.  ROM & strength  Pain, sensation, coordination  Cognition  ADL, IADL OT Priorities  Functional mobility  Patient/caregiver education/training Post-op  Precautions  AE and task/environmental modification  Mobility – importance of movement, transfers, AD use  Discharge planning – what supports do they have? What do they need?  OT Intervention for Hip & Knee Conditions (1 of 2) Settin Intervention Priorities Therapeutic Activities g Acute Instruction and reinforcement of Transfers – bed mobility, rehab hip/knee precautions and sitstand, car, shower, etc. positioning Active movement! Functional mobility with AD ADL performance & independence BADL – UB/LB dressing, bathing, Safety awareness grooming Functional mobility (ADL, IADL - Simple meal prep, household navigation) homemaking, pet care Instruction in energy Discussion of resuming sexual conservation, work activity simplification/task modifications Address pain or anxiety  OT Intervention for Hip & Knee Conditions (2 of 2) Setting Intervention Priorities Therapeutic Activities Subacute Restorative Establish HEP and supportive rehab or Return patient to PLOF – or better routines Community for BADL, IADL, work, leisure Simulate more complex leisure, Address physical symptoms – IADL, and work activities pain, edema, ROM, strength, Identify AE or modifications for endurance specific tasks (ex. Couch/bed cane) Compensatory Home safety assessment AE for specific occupations Pain management Prevention education Task modifications Energy conservation & joint protection Prevention/Education: Falls risk reduction Joint protection Safe body mechanics Mental health supports Resources for other occupations   Dressing stick  Sock aid  Long-handled sponge  Long-handled shoehorn Common  Reacher Adaptive  Elastic shoelaces Equipment  Elevated toilet seat  Leg lifter  Shower chair/bench  Bed/chair cane