Adult Final

Front 1

Identify the four steps of a basic hand assessment

Back 1

1. Listen

2. Look

3. Feel

4. Move

Front 2

Identify seven things to look for on physical examination of the hand

Back 2

1. Skin condition

2. Edema

3. Surgical incisions

4. Scar

5. Deformity and posture

6. Atrophy

7. Functional limitations

Front 3

Identify seven things to feel for on a physical examination of the hand

Back 3

1. Malalignment

2. Tenderness

3. Ligament laxity

4. Sweating

5. Temperature difference

6. Pain with compression

7. Passive motion if safe

Front 4

Identify two ways to measure edema

Back 4

1. Girth

2. Volumetric

Front 5

Identify the motor and sensory tests for screening of median nerve

Back 5

Motor = resisted APB

Sensory = tip of index

Front 6

Identify the motor and sensory tests for screening of ulnar nerve

Back 6

Motor = resisted ADM

Sensory = pulp of 5th digit

Front 7

Identify the motor and sensory tests for screening of radial nerve

Back 7

Motor = victory sign

Sensory = dorsum of 1st webspace

Front 8

Identify eight possible therapeutic goals when working with hand injuries

Back 8

1. Manage pain and edma

2. Restore functional ROM

3. Restore normal muscle-length tension relationship

4. Manage scar tissue - functional scar

5. Restore functional strength and endurance

6. Prevent secondary complications (i.e. contractures)

7. Facilitate independence in ADLs

8. Facilitate return to valued occupations

Front 9

Identify six treatments for pain modulation

Back 9

1. Ice/heat

2. Active motion

3. Compression

4. Elevation

5. Medication

6. CBT

Front 10

Identify six treatments for edema control

Back 10

1. Tubigrip

2. Elevation

3. Coban tape

3. Retrograde massage

4. AROM

5. Ice

Front 11

How do you restore functional mobility?

Back 11

Active ROM OR Passive ROM exercise, if safe for healing structures

Front 12

Identify four treatments to restore soft tissue length-tension

Back 12

1. Static progressive splinting

2. Serial static splinting

3. Passive and active ROM

4. Functional use

Front 13

When doing strengthening exercises, what should be restored first?

Back 13

Normal movement patterns

Front 14

What is a wound?

Back 14

A break in the continuity of body structures caused by violence, trauma, surgery

Front 15

Identify the three phases of wound healing

Back 15

1. Inflammatory phase

2. Fibroplasia phase

3. Maturation phase

Front 16

At what stage in healing does inflammatory phase occur?

Back 16

3-5 days

Front 17

At what stage in healing does fibroplasia phase occur?

Back 17

5-20 days

Front 18

At what stage in healing does maturation phase occur?

Back 18

21 days-2 years

Front 19

What happens during the inflammatory phase?

Back 19

Increase blood supply brings fibrin to create clotting, edema present. White blood cells hang out, engulf cellular debris

Front 20

What is a therapy implication for the inflammatory phase?

Back 20

Often see hand surgery clients 1-3 days post operatively

Front 21

What happens during the fibroplasia phase?

Back 21

Fibroblasts synthesize collagen and connective tissue = scar formation

Front 22

What happens during the maturation phase?

Back 22

Collagen fibers reorganize to increase wound strength; scar tissue remodels.

Front 23

What is tensile strength at week 3 of an injury?

Back 23

20% that of uninjured skin

Front 24

A scar is strong but less ______ than uninjured skin. What implications does this have for recovery?

Back 24

Less elastic; vulnerable to breakdown from excessive stress

Front 25

What occurs 24-48 hours post injury?

Back 25

Wound site is clear of bacteria and cellular debris

Front 26

What happens immediately after an injury?

Back 26

Clotting cascade begins

Front 27

What happens 48 to 96 hours post injury?

Back 27

Monocytes attracted to wound site and are transformed into macrophages

Front 28

What are the four steps of fibroplasia phase?

Back 28

1. Angiogenesis

2. Epithelialization

3. Granulation

4. Tissue formation/collage deposition

Front 29

What occurs in angiogenesis?

Back 29

New vascular networks for supply nutrients form

Front 30

Fibronectin forms a fibre network during the remodelling phase; what are the two functions of this network?

Back 30

1. Template for collagen deposition

2. Platform for migration of cells and cellular growth

Front 31

As more collagen is laid down, what increases?

Back 31

Tensile strength to the wound

Front 32

Long term edema contributes to what four things

Back 32

1. Increased scar formation

2. Development of tight structures

3. Decreased motion

4. Decreased function

Front 33

During the inflammatory stage, the edema has what properties and should be managed in what way?

Back 33

Liquid soft

Compression, elevation, gentle active motion and massage

(DON'T use excessive heat or exercise)

Front 34

During the fibroplasia stage, the edema has what properties and should be managed in what way?

Back 34

"Exudate," more viscious

Same methods as inflammatory + lympahtic massage, AROM and tendon gliding to minimize adhensions

Front 35

During the maturation stage, the edema has what properties and should be managed in what way?

Back 35

Can be thick

Massage, compression garments, PROM and AROm to prevent adhesions, and orthotic intervention to assist with formation of functional scar and remodelling

Front 36

In what four ways are wounds classifies

Back 36

1. Intentional vs. unintentional

2. Closed vs. open

3. Contamination

4. Color

Front 37

What does a red wound mean?

Back 37

Health, evidence of granulation tissue

Front 38

What should you do for a red wound?

Back 38

Gentle cleansing and protection with topical antimicrobial agent/moisture retentive dressing

Front 39

What does a yellow wound mean?

Back 39

Shows evidence of drainage

Front 40

What should be done for a yellow wound?

Back 40

Cleansing to remove nonviable tissue, dressing to absorb drainage if needed

Front 41

What does a black wound mean?

Back 41

Necrotic tissue

Front 42

What should be done for a black wound?

Back 42

Surgery or similar

Front 43

What are four signs of wound infection patients should be aware of?

Back 43

1. Increased redness

2. Increased temperature

3. Increased pain

4. Tracking up the arm

Front 44

What are three major considerations of wound management?

Back 44

1. Bacterial balance

2. Necrotic tissue

3. Moisture balance

Front 45

What can be used to treat wound infections?

Back 45

Antibiotics

Front 46

Why is necrotic tissue bad?

Back 46

Impairs development of granulation tissue, impedes healing and is a medium for bacteria overgrowth

Front 47

Why is it important to keep moisture in a wound balanced?

Back 47

Wound with too much moisture can damage surrounding tissue, which can slow down healing

Front 48

What is progressive desensitization program and what is the functional purpose?

Back 48

Massage, textures, immersion, vibration on wound to increase functional use of affect hand/reintroduce it to sensation

Front 49

What is a serial static splint?

Back 49

Slow, progressive increases in ROM by repeated remolding of the splint or cast.

Front 50

What is a static progressive splint?

Back 50

A static mechanism that adjusts the amount or angle of traction acting on a part. Increase allows for elongation of tissues (better for very stiff contractures)

Front 51

What is a static splint?

Back 51

No movable components and immobilizes a joint or part. Fabricated to rest or protect, to reduce pain, or to prevent muscle shortening or contracture.

Front 52

Identify 5 meanings associated with hands

Back 52

1. Work

2. Socialization

3. Independence

4. Communication

5. Sense of self

Front 53

Identify four psychosocial impacts of hand injury

Back 53

1. Change one's body image

2. Interfere with occupations

3. Interfere with relationships

4. Change family/personal relationships

Front 54

Identify 3 myths about adjustment to hand injury

Back 54

1. Magnitude of accident dictates magnitude of psychosocial response

2. If they look OK on outside, must be OK on inside

3. Injury to non-dominant hand is not as significant as injury to dominant hand

Front 55

Identify five issues that may negatively influence recovery andpsychological adjustment

Back 55

1. Inability to perform occupations

2. Unsupportive relationships

3. Attribution of responsibility for injury

4. Pre-injury psychosocial issues

5. Litigation and compensation

Front 56

Identify five potential psychosocial issues following a traumatic hand injury

Back 56

1. Flashbacks/nightmares (most prevelant)

2. Anxiety

3. Depression

4. Adjustment problems

5. Cognitive difficulties

Front 57

Identify an assessment tool that might be used to look at psychosocial issues post hand injury

Back 57

Impact of Event Scale - used to identify people with distress related to trauma, looks at intrusive and avoidance symptoms

Front 58

PTSD is characterized by what three clusters of symptoms?

Back 58

1. Recurrent re-experiencing of event

2. Avoidance of trauma stimuli

3. Hyper-arousal

Front 59

What are two kinds of coping?

Back 59

Problem focused coping

Emotion focused coping

Front 60

Identify eleven possible coping strategies

Back 60

1. Comparing

2. Positive thinking

3. Relying on personal capacity

4. Distancing

5. Distracting attention

6. Accepting the situation

7. Seeking social support

8. Maintaining control

9. Solving practical problems themselves

10. Pain relieving actions

11. Active processing of trauma experience

Front 61

What are five possible social issues post hand injury?

Back 61

1. Social isolation/anxiety due to avoidance of social situations

2. Avoidance of public interactions resulting in increased dependence

3. Role changes

4. Financial stress

5. Relationship stress

Front 62

What are eight things therapists can do to mitigate risk of psychosocial symptoms post hand injury?

Back 62

1. Listen and empathize

2. Facilitate ADL independence ASAP

3. Facilitate return to roles

4. Encourage good sleep

5. Encourage normal social routine

6. Ask about changes

7. Screen for psychosocial difficulties and refer ASAP

8. Focus on function

Front 63

What is the Injured Works Survey?

Back 63

Brief screening tool developed to identify patients with hand injuries needing further psychosocial assessment and intervention

Front 64

What is a bifocal lens?

Back 64

Therapist views and analyzes performance issues while looking through a lens that provides both biological and occupational focus

Front 65

What framework should be used for orthotic practice? Why?

Back 65

Bio-occupational; should consistently use both, because using only one does not give a full image of the client's OPI

Front 66

What are three purposes of orthotics?

Back 66

Protective

Corrective

Assistive

Front 67

What is the overall goal of orthoses?

Back 67

To improve occupational performance

Front 68

What do protective orthoses do?

Back 68

Immobilize the joint, block joint motion, and promote joint alignment; stabilize an unstable joint, tendon or fractured bone

Front 69

What kind of force does protective orthoses exert on a joint?

Back 69

Traction force

Front 70

What do protective orthoses protect?

Back 70

Vulnerable or healing structures

Front 71

What do corrective orthoses do?

Back 71

Correct joint contracture or subluxation of joints or tendons

Front 72

What do assistive orthoses do?

Back 72

Assist movement of joints during functional activities when muscles are weak or paralyzed

Front 73

What do assistive orthoses reduce?

Back 73

Muscle tone of spastic muscles to promote joint mobility

Front 74

How does tissue respond to gentle prolonged stretch in the ELASTIC range?

Back 74

Promotes growth of soft tissues

Front 75

How does tissue respond to reduction or removal of tension?

Back 75

Promotion of resportion of tissue

Front 76

What happens to tissue when stretched by a tensile force that exceeds the normal elastic limit?

Back 76

Microscopic tearing of fibers = inflammation = small hemorrhages = scarring of tissue, restriction of mobility :(

Front 77

What is the position of rest?

Back 77

Position in which has least amount of tension on muscles and tendons and best biomechanical position for efficient function when orthotic removed

Front 78

What is a loose packed position and what is its purpose?

Back 78

Resting position (least joint surface congruency), purpose is protection

Front 79

What is a closed packed position and what is its purpose?

Back 79

Position with most amount of joint congruency and that maintains tissue length; purpose is correction

Front 80

What is the loose packed position of the radiocarpal joint?

Back 80

Neutral with slight ulnar deviation

Front 81

What is the loose packed position of the MCP joint of fingers?

Back 81

Slight flexion

Front 82

What is the loose packed position of the MCP joint of thumb?

Back 82

Midway between abduction adduction and flexion extension

Front 83

What is the loose packed position of the interphalangeal joints?

Back 83

Slight flexion

Front 84

What is the close packed position of the radiocarpal joint?

Back 84

Extension with radial deviation

Front 85

What is the close packed position of the MCP joint in the fingers?

Back 85

Full flexion

Front 86

What is the close packed position of the MCP joint in the thumb?

Back 86

Full opposition

Front 87

What is the close packed position of the interphalangeal joint?

Back 87

Full extension

Front 88

Identify the five categories of orthoses

Back 88

1. Non-articular

2. Static

3. Serial static

4. Static progressive

5. Dynamic

Front 89

What is a non-articular orthosis?

Back 89

Does not cross any joint and has no direct influence on joint mobility, e.g. fracture bracing

Front 90

What does a non-articular orthosis do?

Back 90

Protect or correct a body segment or bone

Front 91

What is a static orthosis?

Back 91

Immobilizes one or more joints

Front 92

What four things are static orthosis designed to do?

Back 92

1. Maintain tissue length

2. Rest injured/inflamed tissues

3. Unload tissues to promote resportion of lax structures

4. Reduce muscle tone

Front 93

What is a serial-static orthosis

Back 93

Immobilizes one or more joints - different from static in that it is serially remolded as tissue length changes

Front 94

What two things is a serial static orthosis designed to do?

Back 94

1. Reduce muscle tone of spastic muscles

2. Corrects contractures by applying gentle, prolonged stretch to promote growth of contracted soft tissues

Front 95

What does a static progressive orthosis do?

Back 95

Applies gentle prolonged stretch to promote growth of contracted soft tissue

Front 96

What does a static progressive orthosis correct?

Back 96

Contracures

Front 97

How would you make a static progressive orthosis?

Back 97

Attach an elastic or non elastic component to a thermoplastic base and adjust by small increments, to apply a gentle stretch

Front 98

What is a dynamic orthosis used for?

Back 98

To provide passive assist for weak or absent motor function due to paralysis *OR* to apply gentle stretch, similar to static progressive orthoses, but at a different point in the tissue healing process

Front 99

What does a dynamic orthosis do?

Back 99

Applies passive force in one direction while permitting active motion in the opposite direction using rubber bands, etc.

Front 100

Identify five optimal orthotic outcomes

Back 100

1. Pain relief

2. Appropriate extensibility of soft tissues for adequate ROM, joint stability, functional use

3. Protection of vulnerable tissues

4. Enablement of valued activities and participation

5. Enhanced emotional well-being

Front 101

What is pressure?

Back 101

Force per unit of area

Front 102

What is the equation for pressure?

Back 102

Force over surface area

Front 103

How can you reduce pressure when fabricating orthotics?

Back 103

Decrease force or increase surface area

Front 104

What do contours of an orthosis increase?

Back 104

Rigidity and strength of orthosis

Front 105

Good contour of an orthosis decreases what?

Back 105

Pressure

Front 106

What does appropriate strapping decrease in an orthoses?

Back 106

Pressure

Front 107

On an orthosis, the location of the straps should optimize what?

Back 107

The lever arm and joint controlling forces

Front 108

What should you ensure is long enough to support the limb in the orthosis?

Back 108

Lever arm

Front 109

The forearm trough of an orthosis should extend how far? Why?

Back 109

Half-way up sides of limb > contour and increased level arm improve support of limb

Front 110

The length of the orthosis should extend how far up the forearm? Why?

Back 110

2/3 the length of the forearm > to increase the lever arm, thereby improving support of hand/wrist

Front 111

What two things should you consider when placing straps on orthosis?

Back 111

1. Location optimizes lever arm

2. They are appropriate width and conformity to distribute securing force over large surface area

Front 112

Identify six reasons an orthosis might not be used

Back 112

1. Discomfort and pressure

2. Embarrassed by appearance

3. Lack of comprehension

4. Occupational hindrance

5. Cultural beliefs

6. Too heavy

Front 113

Why shouldn't we use the term compliance?

Back 113

Not client-centered - should focus on why orthosis isn't right for them instead

Front 114

What are the guiding principles for taking a biopsychosocial approach to orthotics?

Back 114

1. Client centered

2. Consider psychosocial factors

3. Optimize body structure/function

4. Enable activity and participation

5. Well engineered

6. Optimize usability

7. Provide choice

8. Optimize comfort

9. Minimize harm

10. Optimize cosmoses

11. Use a less is more approach

12. Provide comprehensive patient education

13. Monitor and modify

14. Evaluate outcomes

Front 115

What is the goal of an orthosis for joint effusion?

Back 115

Rest inflammed joints to reduce inflammation and pain

Front 116

What is the goal of an orthosis for overstretched tendons?

Back 116

Unload slack tendons to promote resportion of redundant collagen fibers

Front 117

What is the goal of an orthosis for ruptured or lacterated tendons?

Back 117

Protect healing tendons and/or to facilitate controlled tendon extension to promote healing

Front 118

What is the goal of an orthosis for contracted soft tissues?

Back 118

Promote growth of contracted tissue

Front 119

What kind of orthosis would you use for joint effusion?

Back 119

Static

Front 120

What kind of orthosis would you use for overstretched tendons?

Back 120

Static

Front 121

What kind of orthosis would you use for ruptured or lacerated tendons?

Back 121

Static to protect, dynamic to promote healing

Front 122

What kind of orthosis would you use for contracted soft tissue?

Back 122

Serial static, serial progressive or dynamic

Front 123

How does rheumatoid arthritis affect joints?

Back 123

Painful, swollen, stiff; symmetrically; primarily affects small joints but also large; movement decreases pain

Front 124

How does osteoarthritis affect joints?

Back 124

Pain without swelling, asymmetrically, affects large weight-bearing joint such as hips, knees, spine; movement increases pain

Front 125

What is rheumatoid arthritis?

Back 125

Chronic auto-immune inflammatory condition, brought on by body's immune system attacking its own joint tissues, bones

Front 126

What kinds of joints are most commonly affect by rheumatoid arthritis?

Back 126

Synovial

Front 127

What are the 7 classification criteria for active RA?

Back 127

1. Morning stiffness 1 hour +

2. Arthritis in 3+ joint areas

3. Arthritis in 1 hand joint

4. Symmetrical

5. Rheumatoid nodules

6. Positive serum rheumatoid factor

7. Radiographic changes

(4/7 = active RA)

Front 128

What is synovitis?

Back 128

Inflammation of synovial membrane - first sign of joint pathology

Front 129

What is effusion?

Back 129

Swelling in body cavity caused by excess of synovial fluid

Front 130

What happens in RA when the synovial membrane proliferates?

Back 130

Grows over articular cartilage, cutting off from synovial fluid and erroding bone and soft tissues. Articular cartilage erodes.

Front 131

Without cartilage, what can grow across joint space?

Back 131

Fibrous and bony tissue, resulting in fibrous ankylosis which can result in bony ankylosis

Front 132

Identify six things that suggest joint pathology

Back 132

1. Synovitis

2. Instability of joints and tendons

3. Malalignment/deformity

4. Weakness

5. Limited ROM

6. Functional limitations

Front 133

Deformity in joints is more likely to occur when?

Back 133

When joints are active

Front 134

Unstable joints are more susceptible to joint what?

Back 134

Deforming forces

Front 135

Movement may aggrevate what?

Back 135

Synovitis and tenosynovitis but also important for fluid circulation, strength of connective issue, and tendon glide

Front 136

What is known to reduce synovitis and tenosynovitis?

Back 136

Rest

Front 137

What are seven things that can relieve pain and inflammation in joints?

Back 137

1. Mobility aids

2. Orthoses - protective

3. Ice

4. Medications

5. Balance of rest and activity

6. Joint protective

7. Adaptive equipment

Front 138

Identify six OT interventions for arthritis

Back 138

1. Energy conservation

2. Joint protection

3. Ax and provision of adaptive equipment

4. Orthotic intervention

5. Psychosocial support

6. Work, home, activity modification

Front 139

What six common issues in RA contribute to hand deformity and with it, loss of meaningful occupation?

Back 139

1. Joint laxity

2. Joint subluxation

3. Tendon subluxation

4. Tendon rupture

5. Bone erosion

6. Cartilage loss

Front 140

What is subluxation?

Back 140

Partial loss of joint alignment

Front 141

What leads to joint laxity and instability in RA?

Back 141

Capsule and ligaments overstretched

Front 142

How should you position unstable joints for someone with RA?

Back 142

Loose-packed position to promote resorption of lax connective tissues

Front 143

What results in MCP volar subluxation and ulnar drift in someone with RA?

Back 143

Lax collateral ligaments and fibrous sheath stressed by strong flexion forces

Front 144

Tendon subluxation leads to _____ drift

Back 144

Ulnar

Front 145

Laxity in sagittal bands leads to what?

Back 145

Ulnar subluxation of extensor tendons

Front 146

What can an intrinsic spasm lead to?

Back 146

Intrinsic muscle tightness, MCP flexion contracture

Front 147

MCP joint volar subluxation is secondary to what?

Back 147

Lax ligaments and pull of flexor/extensor tendons

Front 148

What five things contribute to ulnar drift of the fingers and MCP joint subluxation?

Back 148

1. Joint laxity

2. Ulnar subluxation of extensor tendons

3. Ulnar pull of flexor tendons

4. Lumbrical and interossei muscle spasm

5. Joint subluxation

Front 149

Dorsal subluxation of lateral bands leads to what?

Back 149

Swan neck deformity

Front 150

What does swan neck deformity look like?

Back 150

Flexion of DIP/MCP, extension of PIP

Front 151

What kind of orthosis can be used to address swan neck deformity?

Back 151

Oval ring

Front 152

What is the intrinsic stretch and test?

Back 152

Extent MCP, DIP; flex PIP = if this can be done, intrinsic muscles can have normal length

Front 153

What can cause fixed intrinsic plus position? What does this contribute to?

Back 153

Spasm or contracture of lumbricals; swan neck deformity

Front 154

Volar subluxation of lateral bands leads to what?

Back 154

Boutonniere deformity (flexion of PIP, extension of MCP and DIP)

Front 155

Three ways joints change in OA

Back 155

1. Uneven cartilage thinning

2. Secondary bone formation around joint margins

3. Hardening of subchondral bone

Front 156

What is OA?

Back 156

Group of conditions associated with defective articular cartilage and changes in nderlying bones

Front 157

What are two risk factors of OA?

Back 157

Mechanical forms causing abnormal joint lifting and aging

Front 158

What are Heberden's Nodes?

Back 158

hard or bony swellings that can develop in the distalinterphalangeal joints (DIP) caused by formation ofosteophytes (calcific spurs) of the articular (joint)cartilage in response to repeated trauma at the joint.

Front 159

What are Bouchard's Nodes?

Back 159

bony growths in the proximal interphalangeal (PIP) jointsof the hand.

Front 160

Thumb CMC OA is a common functional issue; what causes it?

Back 160

Joint laxity and bone subluxation

Front 161

What are two symptoms of thumb CMC OA?

Back 161

1. Pain at base of thumb

2. Positive grind test

Front 162

What is a grind test?

Back 162

Provocative test to reproduce joint tenderness by axial loading with rotation of thumb

Front 163

During lateral pinch, compression force at _______________ surface is 12x that generated at thumb and index finger

Back 163

Trapezio-metacarpal surface

Front 164

What is the rationale for thenar muscle strengthening?

Back 164

Strong pull of adductor pollicis + weak opposing intrinsic muscles, inefficient extrinsic muscles

= adduction deformity of the thumb

Front 165

Lateral pinch promotes ulnar drift when?

Back 165

First dorsal interosseous muscle is weak

Front 166

Evidence suggests hand exercises for OA can do what three things? They are appropriate in what circumstances?

Back 166

1. Increase grip

2. Improve function

3. Reduce pain

> appropriate when joint is not inflamed and is stable and pain free

Front 167

What orthoses would you use for CMC OA?

Back 167

Long and short opponens orthoses

(both reduce pain and subluxation, but patients prefer short)

Front 168

Offering clients a choice of CMA OA orthosis allows what?

Back 168

Vary use, depending on degree of inflammation and type of activity

Front 169

Custom CMC orthoses are more appropriate for what clients?

Back 169

Acutely inflammed

Front 170

Stretching exercises help maintain what in OA and RA?

Back 170

ROM

Front 171

Strengthening exercises help maintain what in OA and RA?

Back 171

Maintain and increase grip strength

Front 172

Joint protection education for OA/RA improves what?

Back 172

Function

Front 173

What is an alternative splinting option for CMC OA?

Back 173

MCP joint moves from 30 degrees flexion to full flexion with CMC joint free

Front 174

What is one intervention for phantom limb pain?

Back 174

Desensitization and sensory re-education

Front 175

What does central slip do?

Back 175

Extension of finger

Front 176

What is compression neuropathy?

Back 176

An injury occurring at specific anatomical sites, the mechanism of which combines mechanical pressureand/or ischemia, usually resulting from multiple orrepetitive insults to the nerve

Front 177

What are the three layers of a nerve?

Back 177

1. Endoneurium (around nerve fiber)

2. Perineurium (around fasicle)

3. Epineurim (around nerve)

Front 178

Describe the 5 classifications of nerve injury

Back 178

1. Temporary conduction block, with remylenation, recovery in 12 weeks

2. Axonal disruption

3. Endoneurial and axonal disruption

4. Perineurium and contents disruption

5. Complete nerve transection, requires surgery

Front 179

What are the symptoms and impacts on sensation and motor function with a MILD nerve injury

Back 179

Symptoms: intermittent and position dependent

Sensation: decreased vibration threshold = increased perception of vibration

Motor: mild weakness

Front 180

What are the symptoms and impacts on sensation and motor function with a MODERATE nerve injury

Back 180

Symptoms: sensory deficits are intermittent and progressive

Sensation: increased vibration threshold = decreased perception of vibration

Motor: weakness may be noted

Front 181

What are the symptoms and impacts on sensation and motor function with a SEVERE nerve injury

Back 181

Symptoms: persistent sensory changes, loss of sensation

Sensation: abnormal 2 point discrimination

Motor: muscle wasting and weakness

Front 182

What are the treatment guidelines for mild nerve injury?

Back 182

Conservative measures - activity and job modifications, splinting, medication

Front 183

What are the treatment guidelines for moderate nerve injury?

Back 183

Conservative measures for 3 months then surgery if fails

Front 184

What are the treatment guidelines for severe nerve injury?

Back 184

Surgery

Front 185

What is the goal of clinical examination for nerve compression?

Back 185

Locate site of nerve compression and determine severity based on history and symptoms

Front 186

What are the five components of assessment for nerve compression?

Back 186

1. History

2. Screen for proximal nerve compression if appropriate

3. Sensibility evaluation - 2 point discrimination, pressure

4. Provocative testing - Tinel's, Phalen's

5. Motor testing

Front 187

What are three syndromes caused by the median nerve?

Back 187

1. Pronator syndrome

2. Anterior interosseous syndrome

3. Carpal tunnel syndrome

Front 188

What is the relevance of the palmar cutaneousbranch of the mediannerve?

Back 188

Superficial to flexor retinaculum, remains functioning during carpal tunnel syndrome

Front 189

Where does the median nerve lie with relation to FDS, FCR and PL tendons?

Back 189

Between FDS and FCR; dorsal to PL

Front 190

What are the main symptoms of carpal tunnel syndrome?

Back 190

Compression of the median nerve in thecarpal canal resulting in pain, tingling andnumbness in median nerve distribution

Front 191

What are four factors influencing pressure in the carpal tunnel?

Back 191

1. Anatomic (fracture, carpal dislocation)

2. Neuropathic (diabetes, pregnancy)

3. Mechanical (repetitive motion)

4. Obesity

Front 192

What is threshold in clinical examination for nerve compression and what does it reflect?

Back 192

Point at which stimulus is perceived; compression and laceration

Front 193

What is innervation density in clinical examination for nerve compression and what does it reflect?

Back 193

Number of nerve fibers innervating a specified area; decreases with nerve laceration and severe nerve compression

Front 194

Slowly adapting nerve fiber types perceive what?

Back 194

Constant touch, pressure, lateral stretch

Front 195

Quickly adapting nerve fiber types perceive what?

Back 195

Movement

Front 196

What are six general principles for sensibility and sensory testing?

Back 196

1. Quiet area

2. No distractions

3. Demonstrate test first in intact area

4. Eyes must be closed

5. Avoid giving feedback

6. Support hand to prevent motion

Front 197

What are Semmes Weinstein Monofilaments used to test and how is this test done?

Back 197

Slowly adapting fibers = threshold

Apply filaments and ask if patient feels - amount of pressure applied gradually increases

Front 198

What does a 2 point discrimination test used to evaluate?

Back 198

Innervation density

Moving 2pt tests quickly adapting fibers, static 2pt tests merkel cells

Front 199

What is Tinel's used to evaluate and how would you do it?

Back 199

Lightly tap middle of carpal tunnel, positive is tingling in thumb, index and middle fingers

Used to test carpal tunnel syndrome

Front 200

What is Phalen's used to evaluate and how would you do it?

Back 200

Evaluates carpal tunnel syndrome

Hold wrist in complete/forced flexion for 30-60s

Front 201

Identify four OT interventions for carpal tunnel syndrome?

Back 201

1. Orthotics

2. Egonomic ax and modification

3. Education

4. Modify work postures, tool handles

Front 202

What is the rationale for splinting for carpal tunnel syndrome?

Back 202

To relieve intra-carpal tunnelpressure, maximizing blood flow to themedian nerve.

Front 203

Identify four possible causes of tenosynovitis

Back 203

1. Rheumatologic disorder

2. Bacterial infections

3. Repetitive movements

4. Age, comorbidities

Front 204

What is tenosynovitis vs tendinosis? When would you suspect one vs. the other?

Back 204

Tenosynovitis is inflammation

Tendinosis is damage to tendon but no inflammation

-itis = acute, osis = chronic - suspect -osis if has been experiencing for a long time, if old

Front 205

What are three typical interventions for tendinitis?

Back 205

1. Orthotics to rest tissue

2. Ergonomic assessment and modification

3. Modalities and exercises

Front 206

What two tendons are involved in de quervain's tenosynovitis?

Back 206

Abductor pollicus longus and extensor pollicus brevis

Front 207

What is de quervain's tenosynovitis?

Back 207

Entrapment of the tendom sheath of the APL and/or EPB tendons at the radial styloid process - may be swelling and pain with thumb abduction and extension

Front 208

What symptoms might suggest de quervain's tenosynovitis?

Back 208

Pain over radial styloid

Thumb motion may be difficult or painful, esp. abduction, flexion, extension

Tenderness and swelling of 1st extensor compartment

Front 209

What are two provocative tests for de quervain's tenosynovitis?

Back 209

1. Resisted thumb extension

2. Finkelstein test

Front 210

How would you do a Finkelstein test?

Back 210

Wrap fingers around thumb, passively move wrist into ulnar deviation; "excruciating pain" at radial styloid = positive

Front 211

What are the symptoms of intersection syndrome?

Back 211

Radial wrist pain, crepitus with wrist motion, inflammation and swelling

Front 212

What causes intersection syndrome?

Back 212

Friction between 1st and 2nd compartment tendons (APL/EPB and ECRL/ECRB)

Front 213

What is the provocative test for intersection syndrome?

Back 213

Pain with resisted wrist radial deviation

Front 214

What are the symptoms of Wartenberg's syndrome?

Back 214

Radial wrist pain not dependent on thumb movement, paresthesia over dorsum of 1st webspace

Front 215

What causes Wartenberg's syndrome?

Back 215

Entrapment of superficial branch of radial sensory nerve between ECRL and BR tendons during pronation

Front 216

What are 2 provocative tests for Wartenberg's syndrome?

Back 216

1. Positive Tinel's over course of the nerve

2. Elbow extension + hyperpronation forearm + wrist ulnar flexion numbness and tingling over dorsoradial aspect of hand

Front 217

What is trigger finger/thumb?

Back 217

Common hand condition characterized by pain,swelling and clicking of a digit during flexion orextension. In advanced cases, digit can lock in flexion/extension

Front 218

What is the cause of trigger finger?

Back 218

Exact cause unknown

Front 219

What is the most common location of trigger finger in digits and at the thumb?

Back 219

Digit = A1 pulley volar to MCP joint

Thumb = sesamoid bones where FPB inserts

Front 220

What are five possible treatments for trigger finger?

Back 220

1. Orthotic

2. Education

3. Minimize edema/scar if secondary to injury

4. Medical

5. Surgery

Front 221

What is the rationale for orthotics for trigger finger?

Back 221

Decrease inflammation by altering mechanics of pressure at A1 pulley that occurs with loading and prevent nodule from getting caught on A1 pulley =decrease inflammation, provide rest and recovery

Front 222

How do you decide what orthotic is best for trigger finger?

Back 222

Use interview to identify when trigger finger occurs - with full fist OR with hook fist and full fist?

Front 223

What five things does a FIT chart assess?

Back 223

Personal capacity, occupational demands, environmental demands, goodness of fit, targets for change

Front 224

What are three models of addiction?

Back 224

1.Moral model (addicts chose to use drugs in a problematic manner)

2. Disease model (addiction is caused by biological factors)

3. Final common pathway (addiction comes from biological, psychological, and social factors but results in permanently re-wired brain)

Front 225

In what four ways is substance use occupational?

Back 225

1. Disrupts occupation

2. Enables occupation

3. Deprives occupation

4. Is an occupation

Front 226

What is one consideration about substance use as an occupation for treatment?

Back 226

During recovery, individuals can have 16-18 hours of time - excess free time is linked with relapse

Front 227

What are five person factors related to addiction and relapse?

Back 227

1. Genetics

2. Lack of coping skills

3. Cultural vulnerabilities

4. Concurrent disorder

5. Unresolved grief

Front 228

What are five environment factors related to addiction and relapse?

Back 228

1. Trauma, abuse, neglect, abandonment

2. Early exposure to substances

3. Social disadvantage and economic hardship

4. Inadequate parenting/role models

5. Stress

Front 229

What are five occupation factors related to addiction and relapse?

Back 229

1. Specific activity - risks

2. Method/route of engagement in use

3. Time allotted to engage

4. Routine

5. Paraphernalia

Front 230

What are two methods to address excess free time in addictions rehab?

Back 230

1. Activity schedule

2. Cope alert card (identifies high risk situation and plan to address it)

Front 231

What is a decisional balance scale in addictions rehab?

Back 231

Looks at benefits and cons of using and benefits and cons of changing

Front 232

What are eight interventions for stress management?

Back 232

1. Visualization

2. Progressive muscle relaxation

3. Box breathing

4. Sleep hygiene

5. Healthy eating

6. Social supports

7. Exercise

8. Social skill training

Front 233

What are four ways substance use can disrupt occupations?

Back 233

The 4 L's

1. Love - relationships

2. Liver - health

3. Legal

4. Livelihood - productivity

Front 234

What is a wellness toolkit?

Back 234

activities and coping methods that help someone feel well; includes a daily maintenance plan, triggers and an action plan, and early warning signs

Front 235

What is one of the strongest predictors of successful recovery from substance use?

Back 235

Engagement in vocation

Front 236

What three things have higher incidence among people who are homeless?

Back 236

1. Mental health concerns

2. Substance use

3. Various physical health issues, including arthritis, hepatisis c, asthma, etc.

Front 237

Why are mental health challenges more prevalent in individuals who are homeless?

Back 237

Can exacerbate symptoms of MI or untreated MI can be a risk of unemployment, poverty, and lack of social supports, leading to homelessness

Front 238

Why are physical health challenges more prevalent in people who are homeless?

Back 238

Being homeless can lead to poor physical health (e.g. access to food, exposure to elements, risk, violence, and lack of access to facilities) OR having poor physical health can be a risk for unemployment, poverty and thus homelessness

Front 239

What are five barriers to accessing healthcare for people who are homeless?

Back 239

1. No OHIP card

2. Refused healthcare in the past

3. Experienced discrimination

4. Negative experience with hospital security

5. Not able to follow treatment

Front 240

Why should OTs work with people who are homeless?

Back 240

1. Intersection between homelessness and mental and physical disability

2. Disrupts ability to do and learn IADLs

3. Limited occupational repertoires that cannot be improved by housing alone

Front 241

What are two environmental interventions for homelessness?

Back 241

1. Housing

2. Social and occupational advocacy

Front 242

What is Housing First?

Back 242

A recovery-oriented approach to homelessness that involves moving people who experience homelessness into independent and permanent housing as quickly as possible, with no preconditions

Front 243

What are the five core principles of Housing First?

Back 243

1. Immediate access to permanent housing with no readiness requirements

2. Consumer choice and self determination

3. Recovery orientation

4. Individualized and client driven supports

5. Social and community integration

Front 244

What are six IADLs you might work on with a client with a history of homelessness?

Back 244

1. Managing finances

2. Cooking

3. Grocery shopping

4. Meal planning

5. Activity scheduling

6. sleep hygiene

Front 245

What happens during the inflammatory phase of fracture healing?

Back 245

Fracture hematoma clots and serves as initial support of fracture gap; cells remove necrosed bone and debris and initiate tissue growth. This phase has LOW strength and fails with excess load.

Front 246

What happens during the reparative phase of fracture healing?

Back 246

New capillaries form, cells synthesize woven bone and initial soft callus converted to hard callus with appropriate stability and loading (but still can fail with excess load)

Front 247

What happens during the remodelling phase of fracture healing?

Back 247

Hard callus is mineralized into lamellar bone; blood blow returns to normal; bone remodelling to normal pre-injury state can take years

Front 248

Describe the four steps of fracture healing.

Back 248

1. Hematoma formation

2. Soft callus formation

3. Hard callus formation

4. Bone remodelling

Front 249

What three factors may confound fracture healing and how?

Back 249

By disrupting blood supply

1. Certain medications

2. Diabetes, infection, surgical trauma, crush injuries

3. Age

Front 250

What is one of the most influential factors in fracture healing?

Back 250

Motion

Front 251

The amount of motion across fracture site will determine what?

Back 251

Strength and rate of bone healing or FAILURE of healing

Front 252

What kind of forces facilitate healing?

Back 252

Compression or weight bearing forces that are intermittent

Front 253

What kind of forces have adverse effects on healing?

Back 253

Shear and angularM

Front 254

Motion should only be applied to a fracture when?

Back 254

It is stable

Front 255

What is the incidence of a metacarpal fracture?

Back 255

Metacarpal (30-50%)

Front 256

Where does a metacarpal fracture most commonly occur? How often does it take to heal?

Back 256

At the neck

3-5 weeks

Front 257

A transverse metacarpal fracture may do what?

Back 257

Dorsally angulate

Front 258

Oblique torque force will cause what to a metacarpal fracture?

Back 258

Shortening and rotation - scissoring may occur

Front 259

What is the incidence of a proximal phalanx fracture and how long does it take to heal?

Back 259

1. 15-20% of hand fractures

2. 3-5 weeks for prox., 5-7 weeks for mid-shaft

Front 260

What are three possible complications of a proximal phalanx fracture?

Back 260

1. Volar angulation

2. PIP joint unstable mid-shaft = bone shortening, tendon adherence

Front 261

What is the incidence of a middle phalanx fracture and how long does it take to heal?

Back 261

1. 8-12% of hand fractures

2. 7-12 weeks > may take longer in middle shaft due to large amount of cortical bone

Front 262

What is the incidence of a distal phalanx fracture? How long does it take to heal?

Back 262

40-50% of hand fractures

3 weeks

Front 263

What should you do if extensor tendon attachment is involved in a distal phalanx fracture?

Back 263

DIP extension orthotic for 6 weeks 24/7

Front 264

What kind of orthosis might you use for a distal phalanx fracture for protection?

Back 264

Volar finger orthosis

Front 265

If a distal phalanx fracture is caused by a crush, what might be needed?

Back 265

Desensitization to improve tolerance to touch and pressure (lots of nerve endings)

Front 266

What are the three kinds of distal phalanx fractures?

Back 266

1. Longitudinal

2. Tuft (end is all smashed)

3. Transverse (horizontal)

Front 267

What are four ways to classify a fracture

Back 267

1. Location on the bone

2. Angle of the fracture (transverse, oblique, longitudinal)

3. Number of fragments

4. Skin open or closed

Front 268

What is primary fracture healing?

Back 268

Fixation that compresses the fracture and provides stability permits direct bone re-grow (= internal fixation via surgery)

Front 269

What is secondary fracture healing?

Back 269

When motion is minimized across the fracture gap, healing goes through fibrous callus repair that is converted to bone (= a cast)

Front 270

Non operative treatment of a fracture is appropriate for what kind of fractures?

Back 270

STABLE fractures

1. Muscles are not likely to displace fragments

2. Fracture is not articular and not likely to be displaced with motion

Front 271

What are the general rehab guidelines for the primary stage of fracture healing (1-6 weeks)?

Back 271

1. Orthosis/cast of joints proximal and distal to fracture using safe position for splinting. To be worn at all times unless physician allows for removal for skin care and AROM

2. PROM at 4 weeks if fracture stable and enough healing has occurred)

Front 272

What are the general rehab guidelines for the secondary stage of fracture healing (3-6 weeks)?

Back 272

1. Discharge immobilization orthosis = key difference from primary stage (i.e. clinically healed metacarpal fracture)

2. AROM

3. PROM

Front 273

What are the general rehab guidelines for the tertiary stage of fracture healing (6-8 weeks)?

Back 273

1. Avoid resistive activity/work/ADL/avocational activity until fracture is “clinically healed” (versus x-ray)

2. May require orthosis to increase joint motion 3. Progressive strengthening

Front 274

When is it safe it do AROM and PROM after a hand fracture?

Back 274

AROM = when fracture is stable

PROM = when fracture is stable and initial healing has occured

Front 275

What are the four steps to clinically assess fracture healing/

Back 275

1. Apply firm pressure

2. Ask client to rate pain

3. Document and refer to bone healing chart

4. Based on that info, decide when to initiate PROM and progress to light strengthening

Front 276

What are three operative treatments for bone fractures?

Back 276

1. Closed reduction internal fixation

3. Open reduction internal fixation (unstable fractures, or where early mobilization is required)

3. Open/closed reduction external fixation (external fixator inserted into bone to maintain fracture alignment)

Front 277

What are the four kinds of metacarpal fractures?

Back 277

1. head

2. Neck

3. Shaft

4. Base

Front 278

What are three possible treatments for metacarpal neck fractures?

Back 278

1. Buddy taping

2. Ulnar gutter orthosis

3. Hand/finger based orthosis

Front 279

What are the two kinds of metacarpal shaft fractures?

Back 279

Oblique or transverse

Front 280

What starts to decrease after 30 degrees of dorsal metacarpal angulation in a metacarpal neck fracture?

Back 280

Grip power

Front 281

A metacarpal shaft fracture can shorten what?

Back 281

the metacarpal

Front 282

Proximal phalanx fractures tend to be what kind of fractures?

Back 282

Oblique or transverse

Front 283

Middle phalanx fractures tend to be what kind of fractures?

Back 283

Transverse

Front 284

Spiral and long oblique fractures tend to do what?

Back 284

Rotate

Front 285

Transverse and short oblique fractures tend to do what?

Back 285

Angulate

Front 286

Proximal phalanx fractures often angulate what way? Why?

Back 286

Palmarly because of interossei muscle

Front 287

Stable, closed and non-displaced fractures are treated what way?

Back 287

Either dorsal blocking orthosis and/or buddy-taping and immediate motion

Front 288

Displaced or mal-aligned fractures are treated what way?

Back 288

if stable after reduction are treated with an orthosis or casting

Front 289

What is the most commonly seen fracture?

Back 289

Wrist - most commonly fractured wrist bone is radius (and 3/4 of all wrist injuries are radius or ulna fractures)

Front 290

What occurs at the distal radio ulnar joint?

Back 290

Pronation and supination

Front 291

The distal radio ulnar joint is stabilized by what?

Back 291

The Triangular fibro-cartilage Complex (TFCC) comprised of a central articular disc and ligament on the periphery

Front 292

What are the two wrist joints? What do they do?

Back 292

1. radiocarpal

2. mid-carpal

> flexion and extension

> radiocarpal = radial and ulnar deviation

Front 293

How much force does the radiocarpal vs. ulnar carpus transmit? What happens if this is disrupted?

Back 293

Radiocarpal - 80%

Ulnar carpus = 20%

> leads to alternations in force transmission

Front 294

What happens if the force balanced in power grip is disrupted?

Back 294

The radius moves proximally during power grip. If force transmission is altered, flexor and extensor tendons that cross wrist pull the proximal row against the radius and TFCC which = axial compression

Front 295

What happens to the radius in pronation?

Back 295

Moves proximally causing a relative positive ulnar variance

Front 296

What happens to the radius in supination?

Back 296

Radius moves distally causing a relative negative ulnar variance

Front 297

What are three vulnerable structures for a FOOSH injury?

Back 297

1. Radius

2. Scaphoid

3. Ligaments

Front 298

What are four mechanisms of wrist fracture injury?

Back 298

1. Compression

2. Avlusion

3. Shearing

4. Combined

Front 299

What are the six kinds of wrist fractures?

Back 299

1. Colles fracture

2. Smith's fracture

3. Barton's fracture

4. Chauffeur's fracture

5. Ulnar styloid fracture

6. Scaphoid fracture

Front 300

What is a Barton's fracture?

Back 300

Intra-articular fracture of distal radius

Front 301

What is a Chauffeur's fracture?

Back 301

Fracture of radial styloid

Front 302

What is a Colles fracture?

Back 302

Extension fracture that occurs when FOOSH in extension

Most are ulnar styloid fractures

Front 303

What can occur after a colles fracture?

Back 303

Extra-articular dorsal angulation, with radial deviation/shortening

Front 304

What is a Smith's fracture?

Back 304

Flexion fracture - FOOSH injury that occursin hyperflexion or supinationWh

Front 305

What can a Smith's fracture result in?

Back 305

Palmar angulation, ulnar deviation

Front 306

Where do scaphoid fractures occur?

Back 306

Proximal 1/3, waist, tubercle

Front 307

What is the healing timeframe for a scaphoid fracture?

Back 307

Dependent on location, 6-12 weeks or longer

Front 308

How should a scaphoid fracture be managed?

Back 308

If non-displaced, casting

May require ORIF with screw and bone grafting

Front 309

What is ulnar variance?

Back 309

The ulnar order of distal radius is level with the radial border of the distal ulna; this difference is the variance

Front 310

What does positive ulnar variance lead to?

Back 310

Change in force transmission during gripping; LESS transmission through radiocarpal and MORE through ulnocarpus

Front 311

What is the result of positive ulnar variance?

Back 311

Irritation and compression of the TFCC and pain

Front 312

In cast immobilization, what position is the wrist placed in? What does this do?

Back 312

1. Flexed, pronated and ulnarly deviated position

2. Places FDS and FDP in relaxed position

3. Pressure in carpal tunnel increased

Front 313

What are six possible complications during fracture healing?

Back 313

1. Non union

2. Malunion

3. Infection

4. Chronic instability

5. Chronic regional pain syndrome

6. Arthritis

Front 314

what are four possible outcome measures following a hand fracture?

Back 314

1. patient rated wrist evaluation

2. Michigan hand outcomes questionnaire

3. Disabilities of the arm, shoulder, and hand

4. Upper extremity functional index

Front 315

What kind of orthosis might be used for a scaphoid fracture?

Back 315

Early: Volar wrist-thumb

As healing progresses: radial wrist thumb orthosis

Front 316

What might you consider when making a fracture orthosis for an elderly client living alone?

Back 316

1. Lightweight material for function

2. D-ring strapping to ease application

3. Cotton liner to prevent skin breakdown

Front 317

What might you do when splinting around protruding wires?

Back 317

Protective thermoplastic hood

Front 318

What does the 3 brain model hypothesize about trauma?

Back 318

Amygdala is directly related to the "noticing" brain and "soothing" brain; it not directly linked to prefrontal cortex. When traumatic sensory input occurs, amygdala reacts, institutional response occurs, and part of brain that reasons/problem solves does not interact with process.

Front 319

Under conditions of trauma and extreme distress, humans develop what five automatic defensive responses that are self protective?

Back 319

1. Flight

2. Fight

3. Freeze

4. Submit

5. Attach

Front 320

What are two goals of attachment?

Back 320

1. Protection against threats

2. Provide secure base to support exploration of environment

Front 321

What are the four kinds of attachment styles?

Back 321

1. Secure attached

2. Insecure attached

3. Insecure avoidant

4. Disorganised attached

Front 322

What kind of caregiving is associated with a disorganized attachment style?

Back 322

Child received abuse form caregivers/unable to receive support from them as caregivers hurt the,

Front 323

What kind of caregiving is associated with a insecure-anxious attachment style?

Back 323

During childhood, caregivers are inconsistently responsive….more likely to attend to physical needs or when the child is in high distress

Front 324

What kind of caregiving is associated with a insecure-avoidant attachment style?

Back 324

In childhood, caregivers are unresponsive to physical and emotional needs

Front 325

What kind of caregiving is associated with a secure attachment style?

Back 325

As a child, the caregiver forms a secure base of support, safe haven and is responsive to the child’s needs

Front 326

What is trauma informed care?

Back 326

That which implements an understanding of trauma in service delivery, and in which the goal is to augment trauma survivor's safety as they are receiving care

Front 327

What are three reasons trauma informed care is important?

Back 327

1. It can be challenging for clients to cope with symptoms of trauma in absence of a safe environment

2. Health care environments can be interpreted as unsafe

3. Risk of re-traumatization hinders clients from seeking and accessing necessary services for mental health concerns or engaging effectively in treatment

Front 328

The umbrella of safety includes what nine concepts?

Back 328

1. respect

2. rapport

3. taking time

4. sharing information

5. sharing control

6. respecting boundaries

7. mutual learning

8. understanding non-linear healing

9. demonstrating an understanding of sexual abuse

Front 329

What does SAVE the situation stand for?

Back 329

1. Stop - focus on present

2. Appreciate - and understand person's situation

3. Validate - the person's experience

4. Explore - next steps with the client

Front 330

When clients are experiencing high intensity distress, they needed skills that are what three things? What does this help do?

Back 330

1. Quick to implement

2. Easily accessible

3. Easy to recall

> helps in calming the emotional brain and activating the rational thinking brain

Front 331

What does the DBT crisis intervention skill STOP stand for?

Back 331

S - Stop, resist urge to respond

T - take a step back, leave the room and take a deep breath

O - observe; notice feelings and thoughts, don't judge as good or bad

P - proceed mindfully - what do I want, how will my urge make this situation better or worse

Front 332

What does the DBT crisis intervention skill TIPP stand for?

Back 332

T - tipping temperature of your face (splash cold water)

I - intense aerobic exercise for 20+ minutes

P - paced breathing

P - paired muscle relaxation

Front 333

What might someone with a secure attachment style's self-concept be like?

Back 333

Has Sufficient resiliency - Healthy self concept

Front 334

What might someone with a secure attachment style's relationship with the clinician be like?

Back 334

Belief that staff are reliable and trustworthy

“Help will be sufficient”

Decreased Staff burnout

Awareness of impact of help seeking on staff

Front 335

What are some recommendations for care providers working with individuals with secure attachment styles?

Back 335

Offering empathetic support consistent with all other practices

Front 336

What might someone with a insecure anxious attachment style's self-concept be like?

Back 336

Decreased faith in caring for oneself

Belief that care will be provided if helpless

Front 337

What might someone with a insecure anxious attachment style's relationship with the clinician be like?

Back 337

Become clingy and anxious

Compulsive care seeking

Dependant traits

Consistently finding others help to be insufficient

Approval Seeking

Front 338

What are some recommendations for care providers working with individuals with insecure anxious attachment styles?

Back 338

Clear boundary setting

Meet with client at Regularly Scheduled appts ONLY

Always be prompt for appts

Staying for agreed upon duration

Front 339

What might someone with a insecure avoidant attachment style's self-concept be like?

Back 339

Belief that no one will help them at time of distress…..staff will let them down

Staff are not reliable

Belief they are better off on their own

Front 340

What might someone with a insecure avoidant attachment style's relationship with the clinician be like?

Back 340

Distant

“Compulsive self reliance”

Restricted range of affect even when describing distress

Difficulty relating to others

Rebuffs attempts at empathy

Undermine symptoms

Reject recommendations for fear of future contact with staff

Front 341

What are some recommendations for care providers working with individuals with insecure avoidant attachment styles?

Back 341

Respect need for independence

Allow them to determine how much space they need

A genuine willingness to accommodate to their needs

Demonstrate how to identify emotions

Front 342

What might someone with a disorganized attachment style's self-concept be like?

Back 342

Difficulty understanding their experiences: “Incoherent Narrative”

Due to past trauma see world as “unsafe place”

See others as “threatening and rejecting”

See selves as undeserving of love and care

Front 343

What might someone with a disorganized attachment style's relationship with the clinician be like?

Back 343

Extreme Help seeking accompanied by dismissiveness

Present to be in crisis mode consistently

Difficulty self soothing

Have high expectations from staff to regulate their anxiety

Limited trust in providers

Front 344

What are some recommendations for care providers working with individuals with disorganized attachment styles?

Back 344

Acknowledge and validate their frustration and provide realistic expectations

Consistent Team Communication

Require long term therapy on emotional regulation fostering healthier relationships

Help rewrite a “coherent narrative”

Front 345

What would be the trauma-informed and strengths based approach to asking what is wrong?

Back 345

What has happened

Front 346

What would be the trauma-informed and strengths based approach to "disorder response"

Back 346

Symptoms adaptations

Front 347

What would be the trauma-informed and strengths based approach to attention seeking

Back 347

The individual is trying to connect in Best way they know how

Front 348

What would be the trauma-informed and strengths based approach to borderline

Back 348

The individual is doing the best they can given their early experiences

Front 349

What would be the trauma-informed and strengths based approach to controlling

Back 349

The individual is trying to assert their power

Front 350

What would be the trauma-informed and strengths based approach to manipulative

Back 350

The individual has difficulty asking directly for what they want

Front 351

What are four things to do when inquiring about trauma history?

Back 351

1. Direct inquiry about abuse history by HCP

2. Normalize inquiry

3. Stress incidence and frequency of issue and importance to health

4. Opens door for client to disclose if they choose

Front 352

What are eight response principles for disclosure of trauma history?

Back 352

1. Acceptance

2. Acknowledgment of prevalence

3. Validation

4. Express empathy

5. Address time limits

6. Discuss implications of abuse history

7. Identify needs for self care

8. Recognize action is not always required

Front 353

What are six unhelpful responses to trauma disclosure?

Back 353

1. No reaction or silence

2. You don't have to tell me this if you don't want to

3. Advice giving

4. Intrusive questions

5. Minimizing impact

6. Making assumptions

Front 354

What is vicarious trauma?

Back 354

Refers to the cumulative transformative effect on the helper working with the survivors of traumatic life events

Front 355

What kind of change can vicarious trauma create?

Back 355

Temporary or permanent change in the therapist’s personal and professional life and their view of the world and relationships with others. The therapist incur similar symptoms of trauma including hypervigilance, affect dysregulation, occupational imbalance, health problems, and so forth

Front 356

What are five self care principles for managing vicarious trauma?

Back 356

1. Restore occupational balance

2. Establish boundaries

3. Debrief

4. Review and balance case loads

5. Stress management

Front 357

What four things does prolonged exposure treatment do?

Back 357

1. Helps stop avoidance

2. Encourages confrontation

3. Helps reduce anxiety

4. Helps improve functioning and sense of mastery

Front 358

What two methods does prolonged exposure treatment use?

Back 358

1. Imaginal exposure

2. In vivo exposure

Front 359

What is in vivo exposure?

Back 359

Deliberate, systematic engagement with stimuli that arefeared despite being safe or having low probability ofdanger or harm

Front 360

What are three principles of in vivo exposure?

Back 360

1. Modification of the fear structure

2. New information is available for the modification

3. Anxiety habituation

Front 361

What three things does the Subjective Units of Distress Scale do?

Back 361

1. Help communicate anxiety

2. Help in monitoring progress

3. Allow for construction of exposure hiearchy

Front 362

How would you develop an in vivo exposure hierarchy?

Back 362

This is tool used to guide systematic exposure. Identify triggers w/ client and create a list; rate form least to most distressing.

Front 363

How would you use an in vivo exposure hierarchy to guide therapy?

Back 363

Have client conduct exposure targeting mildly distressing trigger. Reduce use of safety behaviours and problem solve behaviours. Have client periodically rate SUDs; remain here until SUDs decreases and then target next trigger in hierarchy.

Front 364

What are safety behaviours?

Back 364

Maladaptive coping strategies used when feeling anxious or anticipating anxiety. In short-term lead to relief but in long-term maintain or increase anxiety.

Front 365

What are the three stages of trauma recovery?

Back 365

1. Stabilization, reflection, grounding

2. Mourning and remembrance

3. Reconnection and increased personal growth

Front 366

What occurs during the stabilization, reflection, grounding stage of trauma recovery?

Back 366

Self care, symptom control, acknowledging trauma, functioning, and express of affect and impulses productively.

Front 367

What occurs during the mourning and remembrance stage of trauma recovery?

Back 367

Focus on narratives connected to the events, tell stores, in vivo exposure.

Front 368

What occurs during the reconnection and increased personal growth stage of trauma recovery?

Back 368

Reconciling with oneself, reconnecting with others, resolving the trauma

Front 369

What does the frontal cortex vs. limbic system do?

Back 369

1. Frontal: decision making, self control

2. Limbic: learning, emotions

Front 370

What is neuroception?

Back 370

Outside of conscious awareness or control

Front 371

How do we switch between circuits?

Back 371

Not cognitive - based on detection of safety vs. threat in internal and external environment. When challenged by threat, revert to older circuits to survive

Front 372

Explain what happens when an individual with PTSD experiences a trigger

Back 372

1. trigger (reminder of unsafe experience)

2. faulty reading of cues (neutral stimuli interpreted as danger)

3. reenactment (inappropriate autonomic/behavioural response - fight or flight)

4. environmental outcome

Front 373

What implications does neuroplasticity have for trauma?

Back 373

Neurons that fire together wire together - if certain stimuli become associated with trauma, your brain strengthens that pathway and makes it more efficient (can also be used in recovery context however)

Front 374

What is the modulation model?

Back 374

Looks at hyperarousal, hypoarousal and the window of tolerance - where an individual can think, feel and sense, and be in a calm focused state. W

Front 375

What impact does trauma have on the modulation model?

Back 375

Window of tolerance is more narrow and arousal can escalate beyond one's ability to tolerate it and they will be unable to integrate their experience. Tendency to overshoot and move from hyper to hypoarousal and back again.

Front 376

What are two skills to manage hypo and hyperarousal?

Back 376

Use your five senses (bring to present moment, increase awareness and capacity for self-care)

Practice being present (activates prefrontal cortex)

Front 377

Why is grounding important?

Back 377

Brings individuals back into window of tolerance, brings focus to present moment, and reduces emotional intensity. Directs attention to something else in order to feel safe.

Front 378

What are five grounding methods for hyperarousal?

Back 378

1. Focus on the breath

2. Count number of blue objects in room

3. 5-5-5 technique

4. Hold grounding stone

5. Smell soothing essential oil

Front 379

What are four methods of grounding for hypoarousal?

Back 379

1. Sit upright in chair with hands on knees and push your hands into your knees and straighten spine

2. Squeeze left arm

3. Smell activating essential oil

4. Stand up

Front 380

What is the difference between grounding and mindfulness?

Back 380

Grounding = distraction to lower emotional intensity

Mindfulness = practice of staying with sensation, whether pleasant or unpleasant, and can increase disregulation when far outside of window

Front 381

What is a traumatic re-enactment?

Back 381

When both survivor and provider get caught in traumatic transference. (The survivor experiences the provider in a way that is similar to a traumaticaspect of a historical relationship, and the provider finds him/herself pulledinto a dynamic with the survivor that may feel out of proportion to thesituation.)

Front 382

What is important to consider when fitting a spinal brace in Ontario?

Back 382

Can be considered setting a fracture which requires formal delegation (is a controlled act)

Front 383

What are mobility orders?

Back 383

Based on stability of patient's vertebral column = inform mobility decisions

Front 384

What are three kinds of spinal braces?

Back 384

1. Cervical

2. Thoracic

3. Lumbar

Front 385

What is arterial line?

Back 385

Goes in hand, used to take blood pressure/samples

Front 386

What is a CentralVenous Catheter?

Back 386

Usually inserted in arm or chest = used for medication, fluid, nutrients, blood products over a long time

Front 387

What is a PICC line?

Back 387

Inserted into arm, leg or neck; provides long term IV antibiotics, nutrition, medications

Front 388

What is a NG or OG tube?

Back 388

NG tube = nutrition through nose

OG tube = nutrition tube through mouth

Front 389

What is a G or J tube?

Back 389

G = directly into abdomen for nutrition

J = directly into small intensive for nutrition

Front 390

What is a foley catheter?

Back 390

Inserted to bladder to drain urine

Front 391

What is an external ventricular drain?

Back 391

used to relieve elevated intracranial pressure

Front 392

What are endotracheal tubes?

Back 392

Tube placed into windpipe through mouth or nose

Front 393

What are three things to consider in an acute setting?

Back 393

1. Having multiple lines and tubes does not exclude you from being able to work with clients

2. Know what equipment is and its purpose

3. Importance of infection control and interprofessional collaboration

Front 394

What are thirteen things to consider before walking into the room in an acute setting?

Back 394

1. Diagnosis

2. Other relevant medical issues

3. Prognosis

4. Activity orders

5. Assistance devices

6. Reason for referral

7. Physician and team progress notes

8. Spoken language

9. Lines/tubes and precautions

10. Recent tests

11. Blood/lab values

12. Communication with nurse and medical team

13. Safety/quality indicators, e.g. falls, delirium

(aka...review their chart)

Front 395

What five pieces of information might you get from a monitor?

Back 395

1. Heart rate

2. Blood pressure

3. Oxygenation

4. Temperature

5. Respiratory rate

Front 396

Identify six different vital signs

Back 396

1. Blood pressure

2. Mean arterial pressure

3. Heart rate

4. Oxygen values

5. CO2 levels

6. Cerebral perfusion pressure

Front 397

What are high flow oxygen systems?

Back 397

will meet or exceed patient’s flow demands andgive a fixed concentration of oxygen or FiO2

Front 398

What are low flow oxygen systems?

Back 398

oxygen delivery is varied based on the device,the patient’s respiratory rate and tidal volume

Front 399

Identify three oxygen delivery devices

Back 399

1. Nasal prongs (low flow)

2. Venturi mask (high flow)

3. Non-rebreather

Front 400

Identify five signs of respiratory distress

Back 400

1. Increased respiratory rate - 25-30

2. Decreased SpO2 < 88%

3. Sweating on face and head

4. Turning blue

5. Pursed lip breathing

Front 401

Identify four things to do when a patient is in respiratory distress

Back 401

1. Check vitals

2. Put patient on higher FiO2 to meet minimum O2

3. Sit patient up in bed for better lung expansion

4. Call someone

Front 402

What three things should happen in the first session in a crisis clinic?

Back 402

1. Detailed history

2. safety plan

3. identify treatment goals

Front 403

Identify three tools you can use for self-management in a crisis clinic context

Back 403

1. Cue cards to identify coping statements

2. Cue cards to identify strengths and accomplishments

3. Thought record

Front 404

What does it mean to 'examine the evidence' of a thought?

Back 404

Instead of assuming negative thought is true, look at evidence, e.g. if you never do anything right, look at instances you did something successfully

Front 405

What does the double standard method of examining thought distortion refer to?

Back 405

Instead of putting self down in harsh way, talk to yourself in same way you would to a friend with same problem

Front 406

What does the experimental technique refer to?

Back 406

Do experiment to test validity of negative thought, e.g. during episode of panic, run down flight of stairs to prove you will not have a heart attack

Front 407

What does thinking in shades of grey refer to?

Back 407

Instead of thinking of extremes, evaluate on scale of 0 to 100. can think of things as partial success rather than total failure.

Front 408

What does the survey method mean?

Back 408

Ask people questions to find out if your thoughts and attitudes are realistic. For example, ask friends if they feel nervous before a presentation.

Front 409

What does define terms mean?

Back 409

When you label yourself by a negative term, e.g. loser, ask what does that mean

Front 410

What does the semantic method mean?

Back 410

Substitute language that is less emotionally loaded, e.g. taking out should statements

Front 411

What does re-attribution mean?

Back 411

Instead of automatically assuming you re bad, think about all the factors that contributed to a problem. Focus on solving the problem.

Front 412

What is cost-benefit analysis?

Back 412

List the advantages and disadvantages of a feeling, negative thought, behaviour

Front 413

Identify eight ways to help clients in crisis if you're not working in mental health

Back 413

1. Don't be afraid to ask questions

2. Ask specifically about suicidal thoughts

3. Ensure their safety

4. Ask about supports

5. Liaise with team

6. Help make a plan

7. Listen and validate

8. call 911 if needed

Front 414

What are six crisis resources?

Back 414

1. Emergency department

2. Crisis phone lines

3. Gerstein centre

4. Mobile crisis team

5. Supports

6. safety plans

Front 415

Describe five qualities of ACT clients

Back 415

1. have a major/complex mental illness

2. have significant functional impairments

3. have difficulty effectively using traditional office-based outpatient services

4. have multiple previous admissions and ED visits

5. require a high level of support in the community

Front 416

Describe eight qualities of the ACT model

Back 416

1. Collaborative approach and shared caseload

2. Individualized recovery-oriented service

3. Continuity of care

4. Long term follow up if needed

5. Assertive community outreach

6. Frequent contact

7. Case management

8. After hours supports

Front 417

Identify six goals of ACT

Back 417

1. Support clients in achieving recovery goals

2. Promote independent living

3. Support clients in achieving optimal management of MI symptoms

4. Advocate for community resources

5. Provide holistic care

6. Support clients in developing meaningful roles

Front 418

What are six general roles an OT might assist with on an ACT team?

Back 418

1. Substance abuse counselling

2. Family education

3. Crisis intervention

4. Advocacy

5. Medication support

6. Housing support

Front 419

What are six of the OT's specific roles on an ACT team?

Back 419

1. Goal setting

2. Functional and environmental assessments

3. Independent living skills

4. Employment skills

5. Developing meaningful roles and occupations

6. Discharge planning

Front 420

Identify the five steps of the crisis intervention process

Back 420

1. Ensure client safety

2. Establish rapport and listen

3. ask questions and try to understand problem

4. Develop crisis plan

5. Monitor plan and reassess

Front 421

What are four things to consider when assessing suicide risk

Back 421

1. Ask directly

2. Ask if they have a plan

3. Ask if they have resources

4. Ask if how HCP can support them

Front 422

What are three considerations for managing safety concerns

Back 422

1. Is client agreeable to going to emergency dept?

2. Can you accompany client to emergency?

3. If not and you have serious concerns, Form 1, Form 2, or call police and ask for mobile crisis team

Front 423

What do housing crises often result from?

Back 423

Poor fit between housing environment and client's needs, skills, abilities

Front 424

What is the OT's role in a housing crisis?

Back 424

1. Meeting with housing manager

2. Assess the fit between the housing environment and client's skills, needs, abilities

3. Work with client to enhance fit through skill development, advocacy, environmental modifications

4. Liaise with housing worker if remains poor fit

Front 425

What are six things you should do for clients without housing?

Back 425

1. Ensure they have food and shelter

2. Contact central shelter intake program

3. Crisis bed

4. Out of the cold program

5. Meal programs and food banks

6. Complete access point application

Front 426

Identify six strategies for client demonstrating psychosis

Back 426

1. Priortize their safety and safety of others

2. If client able to engage, try to understand situation

3. Bring them somewhere quiet, redirect to safe area

4. If highly agitated, use verbal deescalation and ask for backup from other clinicians

5. Call for security if client or others are at risk

6. if in community: check with housing staff/family to get info, be aware of environment

Front 427

What are six things to consider when assessing risk during psychosis

Back 427

1. What is the client's baseline

2. Consider client's history

3. Require about homicidal ideation, plan, intent

4. Use clinical observation skills

5. Pay attention to your own discomfort

6. Communicate with team

Front 428

What are three ACT team challenge?

Back 428

1. Clients are hard to engage and find

2. Often need to triage clinical tasks when crises occur

3. Severity of MI may affect clients' level of insight and ability to voice needs

Front 429

What does motivational interviewing assume?

Back 429

That people are ambivalent about change- andmust work towards their own decision concerning thechange

Front 430

What is the aim of motivational interviewing?

Back 430

To produce an internal drive to change, usingnon-confrontational techniques

Front 431

What is the purpose of motivational interviewing?

Back 431

To effect change – evident of the negative consequences ofthe behaviour are elicited from the client, so that the clientsees and accepts the advantages of change

Front 432

What are three qualities of the spirit of motivational interviewing?

Back 432

1. Collaboration (vs. confrontation)

2. Evocation (vs. education)

3. Autonomy (vs. authority)

Front 433

What are the four main principles of motivational interviewing?

Back 433

1. Express empathy

2. Develop discrepancy

3. Roll with resistance

4. Support self-efficacy

Front 434

Where does motivational interviewing fall in the directing > following continuum?

Back 434

Guiding; uses aspects of both (telling people what to do AND seeking to understand)

Front 435

What are the two kinds of talk you hear with ambivalence?

Back 435

1. Change talk (statements that favour change)

2. Sustain talk (arguments for not changing)

Front 436

What are the six aspects of the Transtheoretical Model for Change?

Back 436

1. Pre-contemplation (no intention of changing)

2. Contemplation (aware problem exists but no commitment to action)

3. Preparation (intent on taking action)

4. Action

5. maintenance

6. Relapse

Front 437

What does OARS stand for with reference to early motivational skills and strategies?

Back 437

Open ended questions

Affirm (statements that recognize strengths)

Reflect (shows that you understand another's meaning)

Summarize

Front 438

Why is reflection crucial to motivational interviewing?

Back 438

Helps show empathy

Helps guide client toward change

Front 439

What is simple vs. complex reflection?

Back 439

Simple - conveys understanding but adds no meaning

Complex - adds meaning to what client has said

Front 440

What are the four kinds of complex reflections?

Back 440

1. Feeling: reflecting affect

2. Feeling and content: link thoughts, feelings, events

3. amplified reaction: restate in more extreme fashion

4. Double sided reflection: reflect back resistance with their other side and using AND

Front 441

What is summarizing used for in motivational interviewing?

Back 441

Reflects what person has said and shows you have been listening. Allows to draw together motivations, intentions and plan for change.

Front 442

How does motivational interviewing guide clients toward their goals?

Back 442

By eliciting and reinforcing change talk while limiting sustain talk

Front 443

What is preparatory vs. mobilizing change talk?

Back 443

Desire/ability/reason/need vs. commitment/activation/taking steps (DARN CAT)

Front 444

How do you provide info with a motivational interview spirit?

Back 444

FOCUS:

First ask permission

Offer ideas

Concise

Use a menu - provide more than 1 option

Solicit what client thinks

Front 445

What is mindfulness?

Back 445

“The intentional cultivation paying attentionof moment to moment on purpose in anon-judgmental manner”

Front 446

What are four aspects of the intention component of mindfulness?

Back 446

1. Stress regulation

2. Stress management

3. Self compassion

4. Awareness

Front 447

What is attention in mindfulness?

Back 447

Observing the moment-to-moment processes

Front 448

What are the three aspects of attitude in mindfulness?

Back 448

Non-judging

Accepting

Non-striving

Front 449

Identify five kinds of mindfulness used in health care

Back 449

1. Mindfulness based stress reduction

2. Mindfulness based cognitive therapy

3. Mindfulness based self compassion

4. DBT

5. Acceptance and commitment therapy

Front 450

What are seven impacts of mindfulness on cognition?

Back 450

1. Heightened state of presence and improved awareness

2. Improved sustained attention

3. Decreased mind wandering

4. Improved working memory

5. Improved memory retrieval

6. Improved cognitive flexibility

7. Enhanced learning

Front 451

How does mindfulness change the brain?

Back 451

Changes the structure and function ofthe brain regions involved in regulation ofattention, emotion and self-awareness

Front 452

What 6 brain regions are altered in mindfulness?

Back 452

1. Meta-awareness

2. Awareness of body

3. Memory formation

4. Emotional responses

5. Self-regulation

6. Attention

Front 453

What is the default mode network?

Back 453

When you switch off, distinctive network of brain areas not involved in focused attention bursts into action >> makes mind wander, takes attention away from where we are in space and where we are in time

Front 454

Identify six ways in which mindfulness is relevant to OT

Back 454

1. Evidence based task oriented interventions

2. Fits well with holistic approach

3. Provides means to empower clients to self-management and healthy lifestyle modification and allows insight into ways to increase participation

4. Meditation is an occupation

5. Meditation integrates physical, cognitive, psychological, spiritual components and fits with biopsychosocial approach to pain management

6. Process and outcome can positively impact neurological function

Front 455

Why is mindfulness important for self-care?

Back 455

1. Improves quality of HCP care

2. Uptake by HCP is best way to disseminate benefits through healthcare system

Front 456

What is an ALC patient?

Back 456

A patient who no longer requires the full range of services which acute careprovides

Front 457

What factors ALC rates?

Back 457

1. Age of population

2. Availability and integration of healthcare services

Front 458

Why are ALC patients still in the hospital?

Back 458

The shortage of diverse options that meet the needs of ALCpatients outside the hospital is the main reason ALC patients are not dischargedfrom hospital as soon as they no longer need acute care

Front 459

What is the cost of a hospital vs. long-term care vs. home care bed?

Back 459

Average daily cost:

842

126

42

Front 460

What does the discharge plan consider?

Back 460

Patient's home environment, support system, level of functioning

Front 461

Disposition of discharge planning has been linked to what six demographics of patients?

Back 461

1. Age

2. Socioeconomic status

3. Caregiver support

4. Living situation

5. pathology

6. Impairments

Front 462

What are seven discharge planning considerations?

Back 462

1. Patient and family wishes

2. Prognosis

3. Expected return of function/recovery

4. Community resources

5. Housing options

6. Baseline occupational performance

7. Current functional status (cognitive, physical, emotional, ADLs)

Front 463

What are eight things you might assess or recommend in a acute setting?

Back 463

1. Self-care

2. Home management

3. Child care

4. Return to driving

5. Return to work

6. Cognitive status

7. Home supports

8. Return to hobbies

Front 464

What are nine things you might treat or educate patients on in an acute setting?

Back 464

1. Energy management

2. Equipment

3. ADL retraining

4. Physical facilitation

5. Implementation of cognitive strategies

6. Family education

7. Coping strategies

8. Behavioral management strategies

9. Patient education

Front 465

What do CCACs provide?

Back 465

Provide access togovernment-fundedHome/communityservices, ConvalescentCare and to LongTerm Care homes.

Front 466

What seven things does a CCAC care coordinator do?

Back 466

1. Liaise with local CCAC coordinator to determine service plan options

2. Determine services required for transition

3. Determine professional services required

4. Orders medical supplies and equipment

5. Link to adult day programs and other supports

6. Assess eligibility for convalescent care, OHIP respite care, LTC

7. Conduct capacity evaluations for LTC

Front 467

What five skills do case managers use?

Back 467

1. Advocacy

2. Communication

3. Education

4. Identification ofservice resources

5. Service facilitation

Front 468

What is care coordination?

Back 468

Collaborative process of assessment, planning, facilitation, carecoordination, evaluation, and advocacy for options and servicesto meet an individual’s and family’s comprehensive health needsthrough communication and available resources to promotequality, cost-effective outcomes.

Front 469

What is the intensity of case management dependent on?

Back 469

Client's needs

Front 470

What is a general rehab facility vs. a specialty rehab facility?

Back 470

General = rehab unit or collection of beds for rehab, part of general hospital offering multiple levels of care

Specialty = provides more extensive and specialized inpatient rehab, usually a freestanding facility or special unit

Front 471

Identify four kinds of rehab programs?

Back 471

1. Slow stream

2. Active stream

3. High tolerance long duration

4. Complex continuing care

Front 472

What is complex continuing care?

Back 472

Provided for people with complex chronic and oftenfluctuating physical conditions such as complex chronic illness, end stage renalfailure, multi-system decline, diabetes, and/or advanced degenerative disorderssuch as multiple sclerosis.

Front 473

What seven things must you balance in discharge planning?

Back 473

1. Patient expectations

2. Family expectations

3. Team expectations

4. Institutional policy

5. Resource allocation

6. Unknown resources

7. Community constraints

Front 474

What is cancer?

Back 474

Disordered & uncontrolled growth of cellswithin a specific organ or tissue type. > Malignant tumors have no clear cutborder, invade surrounding tissue & havethe ability to spread to other parts of thebody

Front 475

What causes cancer?

Back 475

Results from a genetic change ordamage to a chromosome

Front 476

How does cancer spread?

Back 476

Direct extension

Through the blood

Through the lymphatic system

(Tumours begin at primary site and metastases occur when cancer cells break off and travel elsewhere)

Front 477

What are five tests that might be used to look for cancer?

Back 477

1. Physical exam

2. lab test

3. Imaging technique

4. Scope

5. Biopsy

Front 478

In what three ways are tumours clasisfied?

Back 478

1. Where is it growing

2. How fast is it growing? (high vs. low)

3. How big has it grown? (staging)

Front 479

What is the TNM staging system?

Back 479

Classification system for cancer.

T = size of tumour

N = degree of spread to lymph node

M = presence of metastasis

Front 480

What are five cancer treatment methods?

Back 480

1. Active surveillance

2. Surgery (biospy, resection, prophylactic)

3. Radiation

4. Drug therapies (chemo, hormone, immuno)

5. Stem cel transplants

Front 481

What are nine persistent and late effects of cancer?

Back 481

1. Second primary cancer

2. psychological distress

3. Lymphedema

4. Premature menopause, infertility, osteporosis

5. Hormone deprivation

6. Weight gain or loss

7. Cardiovascular disease

8. Fatigue

9. Cognitive impairment

Front 482

What is reported as the most common and distressing symptom experience by patients with cancer?

Back 482

Fatigue

Front 483

What five things can cancer-related fatigue affect?

Back 483

1. ADLs

2. Emotional and physical distress

3. cognition

4. Psychological wellbeing

5. Healthcare usage

Front 484

What are six ways OTs can intervene for cancer-related fatigue?1

Back 484

1. Identify factors impacting it

2. Assess impact on occupation

3. Energy conservation

4. Relaxation strategies

5. Equipment

6. Community resourcse

Front 485

What are six ways cancer pain can reduce QoL?

Back 485

1. Affect occupation

2. Cause emotional distress

3. Disturb sleep

4. Diminish appetite

5. Reduce movement/exercise

6. Increase feelings of occupation

Front 486

What are six ways OTs can intervene on cancer pain?

Back 486

1. Assess impact

2. Adapt activities

3. Education on pain

4. Education on relaxation

5. Equipment needs

6. Comfort supports as neded

Front 487

What five modifiable risk factors are highly associated with chronic disease?

Back 487

1. Tobacco

2. Alcohol

3. Nutrition

4. Physical inactivity

5. Obesity

Front 488

What are 11 OT roles in oncology?

Back 488

1. Social support

2. Cognition

3. Enable ADLs

4. Pain management

5. Positioning and seating

6. Environmental modifications

7. Adaptive equipment

8. Relaxation techniques

8. Energy conservation

10. Home safety assessments

11. Education

Front 489

What are six practice settings where OT can work in oncology?

Back 489

1. At home

2. In hospital

3. In a cancer centre

4. In rehab programs

5. In CCC

6. In palliative care unit or hospice

Front 490

What are twelve precautions and considerations when working with cancer patients?

Back 490

1. Bony metastases

2. Spinal metastases

3. Myelosuppression

4. Lung metastasis

5. Edma/lymphedema

6. DVT/PE

7. Steroid myopathy

8. Peripheral neuropathy

9. Seizures

10. Intracranial pressure

11. High/low blood pressure

12. Bowel and bladder changes

Front 491

What are some considerations with bony metastases?

Back 491

Risk of fracture. Avoid strength testing, use of weights,avoid bridging. Confirm activity and weight bearingorders.

Front 492

What are some considerations with spinal metastases?

Back 492

May cause spinal cord compression or instability andaltered sensation. Confirm activity order. Considersitting balance and seating needs.

Front 493

What are some considerations with myelosuppression?

Back 493

May have decreased blood counts especiallyhemoglobin, platelets, neutrophils. At risk for infectionor bleeding. Check counts prior to doing activity.

Front 494

What are some considerations with lung metastasis?

Back 494

May cause increased O2 requirements or desaturationwith activity. Check O2 orders. Consider equipmentneeds.

Front 495

What are some considerations with edema/lymphedema?

Back 495

Lymphedema refers to swelling in a part of the bodywhich may result from surgery to remove lymph nodesand/or radiation.Common among patients with gynecological,genito/urinary, gastrointestinal cancers; may impactmobility and ADLs; may cause sitting discomfort.

Front 496

What are some considerations with DVT/pE?

Back 496

Allow 24 hrs. of anticoagulation prior to activity.

Front 497

What are some considerations with steroid myopathy?

Back 497

May occur after prolonged administration of high dose steroids.Known to cause progressive proximal muscle weakness of theupper and lower extremities which may affect transfers. Maybenefit from graded activity.

Front 498

What are some considerations with peripheral neuropathy?

Back 498

Pain, tingling, numbness caused by damage to nerves which canbe caused by chemotherapy drugs. Teach compensatorystrategies (i.e.. Fine motor, footwear, altered sensation).

Front 499

What are some considerations with seizures?

Back 499

A seizure is a side-effect of a brain tumour and happensbecause of abnormal electrical activity in the brain. People whohave seizures can experience many different things that rangefrom a feeling of tingling in an arm or leg or the face (called focalseizures), all the way to a full body seizure (called generalizedseizures) where the patient falls to the ground, has twitching ofall limbs and may become unconscious.

Front 500

What are some considerations with intracranial pressure?

Back 500

The pressure inside of the skull. Brain tumours (the mass)and their treatment (associated swelling) cause a rise inpressure of the cerebrospinal fluid. Many patients receivesteroids to control swelling. Symptoms include headaches,seizures, neurological symptoms, decreased consciousnessand vomiting. Patients require education regardingpositioning and appropriate intensity exercise (mild-moderate).

Front 501

What are some considerations with high/low blood pressure?

Back 501

May have dizziness or fainting.

Front 502

What are some considerations with bowel and bladder management?

Back 502

May have be incontinent or need to frequent washroomfrequently.

Front 503

What is the Cancer Care Ontario Model?

Back 503

Prevention

Screening

Diagnosis

Treatment

<> recovery/survivorship

> end of life care

Front 504

What are four survivorship concerns

Back 504

1. Ability to access health care and follow up treatment

2. Late effects of treatment

3. prevention and management of secondary cancers

4. quality of life and overall wellbeing

Front 505

DBT is based on what model?

Back 505

Affect regulation - symptoms at surface but core problem is emotion regulation system

Front 506

Explain the DBT model of emotion dysregulation

Back 506

Problems that need to be solved lead to

> cue or trigger> emotional dysregulation
> attempts to reduce/avoid emotion

>> temporary relief

Front 507

What are the 4 DBT skills modules?

Back 507

1. Interpersonal effectiveness

2. Emotion regulation

3. Distress tolerance

4. Mindfulness

Front 508

What are the five steps to opposite action?

Back 508

1. What emotion do you want to change

2. Check the facts

3. Identify your action urges

4. Act opposite all the way to your action urges

5. Repeat until emotional sensitivity to prompting event decreases and urge to act on emotion decreases

Front 509

What is the opposite action for fear?

Back 509

Action urge is avoid

Opposite action is approach > do thinks you are afraid of over and over, notice you are safe, breathe

Front 510

What is the opposite action for anger?

Back 510

Action urge is anger

Opposite action is gently avoid

Do something nice rather than mean, put yourself in other's shoes, relax

Front 511

CBT is premised on what idea?

Back 511

It’s not situations that cause negative emotions, butthoughts about these events or the perception of theseevents. (Faulty thinking patterns result in anxiety/depression)

Front 512

How does CBT believe one can recover from anxiety or depression?

Back 512

Cognitive restructuring

Front 513

What does CBT treatment consist of?

Back 513

Correcting faulty or illogical thinkingby countering cognitive distortions using thought records,exposure strategies, behavioral activation, problemsolving and anxiety management strategies.

Front 514

What is the CBT model of anxiety?

Back 514

Trigger leads to what if, leads to worried thoughts, leads to anxiety, which lead to a cycle of behavioural avoidance and excessive behaviours and ineffective problem solving and cognitive avoidance, which lead to more worried thoughts

Front 515

What is the CBT approach to understanding problems?

Back 515

Look at the thoughts, behaviours, bodily sensations and emotions involved in a situation

Front 516

What are eight kinds of cognitive distortions?

Back 516

1. All-or-Nothing Thinking

2. Mental Filter

3. Disqualifying the Positive

4. Jumping to Conclusions:

- Mind reading

- Fortune Teller Error

5. Magnification

6. Emotional Reasoning

7. “Should” Statements

8. Personalization

Front 517

What seven components might be included in a thought record?

Back 517

1. Situation

2. Mood

3. Automatic thoughts

4. Evidence that supports that thought

5. Evidence that does NOT support that thought

6. Alternative thoughts

7. Rate mood now

Front 518

What are three objectives of a circumferential thumb CMC-MCP stabilizing orthosis?

Back 518

1. Relieve pain and stabilize CMC and MCP

2. Promote healing

3. Position thumb in functional position to oppose fingers

Front 519

What are five indications for a circumferential thumb CMC-MCP stabilizing orthosis

Back 519

1. Inflammation of the CMC joint with MCP joint

2. CMC arthoplasty

3. Thumb metacarpal fracture

4. Sprain of thumb MCP joint, most commonly ulnar collateral ligament injury

5. Median nerve injury causing paralysis of the thenar muscles resulting in loss of thumb opposition

Front 520

What three things should be unrestricted with a circumferential thumb CMC-MCP stabilizing orthosis?

Back 520

1. Thumb IP flexion

2. Finger MCP flexion at distal edge

3. Unrestricted wrist motion

Front 521

What's the wearing regimen for a circumferential thumb CMC-MCP stabilizing orthosis?

Back 521

as required to relieve pain, promote healing and enable hand function

Front 522

What are four benefits of a volar thumb-hole wrist orthosis?

Back 522

1. Provides optimal support to the carpal bones

2. Recommended for joint inflammation or instability

3. The volar surface of the hand is naturally well padded and tolerates the palmar base well

4. Can be used to mount flexion outriggers

Front 523

What is the benefit of a thumb-hole design over radial bar design?

Back 523

The bridge of thermoplastic that goes from the thumb web space and behind the thumb to thewrist, acts as a strut that increases the stability of the palmar support. Thus, thinnerthermoplastics are usually thickenough for most adult applications

Front 524

What are the five biological goals of the volar thumb-hole wrist orthosis?

Back 524

1. Reduce pain and inflammation

2. Protect against joint damage

3. Immobilize to promote healing

4. Prevent or correct contractures

5. Optimally position to control wrist radial deviation, prevent MCP ulnar drift, AND reduce carpal tunnel pressure

Front 525

What are eight indications for a volar thumb-hole wrist orthosis?

Back 525

1. Tendonotis/tenosynovitis or wrist

2. Joint inflammation

3. Skin graft

4. Unstable wrist joint

5. Wrist sprain

6. Congenital hand deformities

7. Paralyzed/weak wrist extensors

8. Carpal tunnel

Front 526

With a volar thumb-hole wrist orthosis ROM should be unrestricted at what three points?

Back 526

1. Elbow

2. Finger MCPs

3. Thumb

Front 527

What are four styles of a volar wrist-hand orthosis?

Back 527

1. Volar wrist hand - c bar style (goes through thumb web space)

2. Mitt style cradles thumb

3. Volar wrist and finger MCP - thumb and IPs free

4. Bisurfaced wrist hand - uses leverage of forearm base to lever wrist into extension

Front 528

What are the three purposes of the volar wrist-hand orthosis?

Back 528

1. Stabilize and support wrist, MCPs, and IPs of fingers and thumb

2. Promote healing, reduce pain and inflammation

3. Prevent or reduce contractures

Front 529

What are 11 indications for a volar wrist-hand orthosis?

Back 529

1. Hand trauma

2. Skin graft

3. Scleroderma

4. Dupuytren's release

5. Boxer's fracture

6. Burns

7. Inflammatory joint disease

8. Crush injury

9. Replantation

10. Flaccid paralysis

11. Spasticity

Front 530

What are the indicators for a D4-5 MCP Extension-Blocking Orthosis?

Back 530

Ulnar nerve injury at level of wrist; partial claw hand deformity where lumbricals and interossei are paralyzed. Client is able to fully flex digits but in extension D4 and D5 joints hyperextend and IP joints remain flexed

Front 531

What are the two objectives of a D4-5 MCP Extension-Blocking Orthosis?

Back 531

1. provide hyperextension block for D4 and D5 MCP joints while still allowing full flexion of MCP and IP joints

2. blocking hyperextension of the MCP joints will transmit force of extensor digitorum to the IP joints, allowing full extension

Front 532

What is the purpose of a Finger-based MCP flexion-blocking orthosis?

Back 532

Block MCP flexion caused by trigger finger

Front 533

A Finger-based MCP flexion-blocking orthosis should have unrestricted motion at what three points?

Back 533

1. Thenar and hyperthenar eminences

2. Finger PIP flexion

3. Finger MCP flexion of adjacent finger

Front 534

What is the goal of flexor tendon rehab?

Back 534

Maximize tendon excursion in order toachieve full finger composite flexion andextension and a return to valued functionalactivities

Front 535

Where is the A1 flexor pulley?

Back 535

MCP

Front 536

Where is the A2 flexor pulley?

Back 536

Proximal phalanx

Front 537

Where is the A3 flexor pulley?

Back 537

PIP joint

Front 538

Where is the A4 flexor pulley?

Back 538

Middle phalanx

Front 539

Where is the A5 flexor pulley?

Back 539

DIP joint

Front 540

Which pulleys are most important to repair?

Back 540

A2 and A4 - they are the biggest

Front 541

Describe the flexor tendon zones?

Back 541

1 = distal to insertion of FDS

2 = proximal part of A1 pulley to insertion of FDS

3 = distal end of transverse carpal ligament to proximal end of A1 pulley

4 = area of transverse carpal ligament

5 = musculotendinous junction of flexor tendons to prox. border of transverse carpal ligament

Front 542

What is flexor tendon zone 2 the most difficult to rehabilitate?

Back 542

FDS and FDP are really close together - if you have a laceration and repair and these two tendons are not moving then they may get stuck together

Front 543

What is the goal of Zone 2 flexor tendon rehab?

Back 543

Prevention of tendonadherence and promotionof tendon gliding zone 2

Front 544

What are three goals of surgical repair for flexor tendons?

Back 544

1. Provide the tendon withstrength to withstand earlymotion

2. Offer minimal resistance to tendon gliding

3. Repair tendon to promote function

Front 545

What are seven factors to consider before deciding on a therapy approach for a flexor tendon injury

Back 545

1. Mechanism of injury

2. Date of injury and tendon repair

3. Location

4. Percentage of laceration

5. Quality and type of repair

6. Other associated injuries

7. Client factors

Front 546

Suture strand number relates to what?

Back 546

Strength of repair, which affects therapy decisions. Suture strength = number of strands that cross tendon repairWh

Front 547

What is the motion protocol for a 2 strand repair vs a 4 and 6 strand repair?

Back 547

2 = passive motion

4 and 6 = passive and active

Front 548

What is the difference between 2 strand repair and 4 and 6 strand repair during weeks 1-3 of recovery?

Back 548

2 strand = passive mobilization

4 and 6 = Early AROM Protocol(perform PROM for thepurpose of improvingjoint motion anddecreasing work oftendon)

Front 549

What is the difference between 2 strand repair and 4 and 6 strand repair during weeks 4-12?

Back 549

NoneW

Front 550

What should you do in weeks 4-6 of strand repair?

Back 550

PROM plus specifictendon glidingexercises. Addblocking exercises at5-6 weeks. Addresslong flexor tightness

Front 551

What should you do in weeks 6-8 of strand repair?

Back 551

Graduatedstrengthening, tendongliding, blockingexercises and lightADL

Front 552

What should you do in weeks 8-12 of strand repair?

Back 552

Progressivestrengthening andincreased functional use.At 12 weeks, unrestricteduse.

Front 553

What are three benefits of early protected mobilization for flexor tendons

Back 553

1. Improves tendon excursion

2. Decreases adhesion formation

3. Improves clinical and functional outcome

Front 554

What are two factors to consider before deciding on a therapy approach for flexor tendons

Back 554

1. Need at least 4 strand repair in order to perform AROM

2. Must know BEFORE as otherwise could cause rupture (too much force), adherence (too little force), gap scar formation (tendon lengthening)

Front 555

Immobilization for flexor tendons is used in what circumstances?

Back 555

Complex or unreliable patients, e.g. children

Front 556

What are three ways extensor tendons differ from flexor tendons?

Back 556

1. No synovial sheath or pulleys along digits

2. There are many tendon insertions and connections therefore motion at proximal locations has less effect on injured tendon

3. Extensor tendons have less excursion

Front 557

How do extensor tendons differ from flexors in terms of recovery?

Back 557

Unlike flexor tendon injuries that require extensiveimmobilization proximally to prevent tendon retraction andtransmission of force, extensor tendon injuries require immobilizationof fewer joints depending on the zone

Front 558

What are the 7 extensor tendon zones?

Back 558

1 = dip

2 = middle phalanx

3 = pip

4 = proximal phalanx

5 = mcp

6 = metacarpal

7 = extensor retinaculum

Front 559

What causes a mallet finger?

Back 559

Forced flexion of the DIPjoint while finger is extended

Front 560

What is a bony mallet injury vs an extensor tendon injury?

Back 560

Bony = also fracture (hits straight on)

Extensor tendon = just muscle (hits while flexed)

Front 561

What joints do you have to immobilize for mallet finger?

Back 561

DIP joint

Front 562

How long should a mallet finger rothosis be worn?

Back 562

6-8 weeks, fulltime; if it is removed and DIP flexes, must start over for 6-8 weeks

Front 563

What is critical for successful treatment of mallet injury?

Back 563

Education e.g. condition, orthosis, skin, hygieneW

Front 564

What should you monitor in treatment of mallet injury?

Back 564

Orthosis fit, skin condition, PIP joint ROM

Front 565

What six things should you do at weeks 6 to 8ish of treatment of mallet injury?

Back 565

1. Initiate AROM 9 (NO PROM or blocking)

2. Assess ROM

3. Avoid gripping

4. Wear orthosis for forceful gripping

5. Initiate light ADLs

6. Wear orthosis at night

Front 566

What occurs at week 12 of treatment for mallet injury?

Back 566

Unrestricted functional strengthening

Front 567

What is the goal of extensor tendon rehab?

Back 567

Maximize tendon excursion in order to achieve fullfinger composite flexion and extension and areturn to valued functional activities

Front 568

What are the four levels of the spinal cord?

Back 568

Cervical

Thoracic

Lumbar

Sacral

Front 569

What do cervical spine nerves serve?

Back 569

head, neck, diaphragm& upper extremities

Front 570

What do thoracic spine nerves serve?

Back 570

trunk muscles

Front 571

What do lumbar spine nerves serve?

Back 571

lower extremities

Front 572

What do sacrum nerves serve?

Back 572

bowel, bladder, &sexual function

Front 573

What do ascending/afferent tracts do?

Back 573

Bring sensory info to brain

Front 574

What do descending/efferent tracts do?

Back 574

Bring info from brain to muscles

Front 575

What is a spinal cord injury

Back 575

Trauma orpathology to thespinal cordresulting in loss ofmovement andsensation, whichcan result in lossof function.

Front 576

What is tetrapelgia? What is affected?

Back 576

Injury to the spinal cord in the cervical region (C1-T1)

Upper and lower extremity function affected; bowel and bladder also affected

Front 577

WHat is paraplegia? What is affected?

Back 577

Injury to the spinal cord in the thoracic,lumbar or sacral region, T2 or below

Function in bowel, bladder, lower extremities& possibly trunk are affected

Front 578

What is traumatic vs. non-traumatic spinal cord injury?

Back 578

Traumatic = Damage to the spinal cord caused by an externalforce

Non-traumatic = Congenital or non-congenital damage to the spinalcord caused by disease or pathology,

Front 579

What is complete vs. incomplete spinal cord injury?

Back 579

Complete = all sensory and motor function lost below level of injury

Incomplete = preservation of some sensory & motorfunction below level of injury

Front 580

What is the ASIA scale?

Back 580

Standardized classification of neurologic impairmentdue to spinal cord injury; determines level and completeness of injury, tests motor and sensory components

Front 581

Does the ASIA scale measure non-traumatic injuries?

Back 581

No

Front 582

Describe the ASIA Scoring system form A-E

Back 582

A = Motor & Sensory Complete

B = Sensory Incomplete, MotorComplete

C = Motor Incomplete (half or more keymyotomes are < grade 3)

D = Motor Incomplete (half or more keymyotomes are > grade 3 / functional)

E = Normal Movement & Sensation

Front 583

What are seven implications of spinal cord injury on general health?

Back 583

1. Blood pressure

2. Pain

3. Spasticity

4. Sexual health

5. Respiration

6. Swallowing

7. Cognition

Front 584

What are four education interventions about sexuality post spinal cord injury

Back 584

1. Physiology

2. Positioning and devices

3. Directing caregiver

4. Coping with self esteem and body image challenges

Front 585

What are two ways spinal cord injury can affect emotional well-being?

Back 585

1. Relationships

2. Mood and thought content

Front 586

What are two interventions for emotional well-being post spinal cord injury

Back 586

1. Liase w/ team re: emotional status

2. Provide emotional support

Front 587

What are two bladder and bowel implications of SCI?

Back 587

1. Neurogenic bladder (Dysfunction of the urinary bladder due todisease of the CNS involved in control ofurination > causes difficulty to pass urine w/o catheter or other method)

2. Neurogenic bowel (Dysfunction of the bowel due to disease ofthe CNS involved in the control of bowelfunction = fecal incontinence, chronic constipation or both)

Front 588

What are seven interventions for bladder management post SCI

Back 588

1. Splinting to improve hand function

2. Education on catheters

3. Managing catheterization tools

4. Provide positioning strategies and assist with barriers

5. Equipment

6. Provide visual aids

7. Provide strategies for improving independence

Front 589

What are seven interventions for bowel management post SCI

Back 589

1. Teach techniques for independence

2. Equipment trial and prescription

Front 590

What are two skin care implications of SCI?

Back 590

1. Skin health

2. Pressure ulcers

Front 591

What are 7 skin care interventions post SCI

Back 591

1. Provide education about pressure distribution

2. Provide education about pressure ulcers

3. Teach client how to complete skin checks

4. teach client how to direct caregiver to complete skin checks

5. Pressure mapping

6. Consider skin health when prescribing seating and mobility devices

7. Prescribe hospital bed and mattress

Front 592

What are five self-care implications of SCI

Back 592

1. Feeding

2. Dressing

3. Grooming

4. Bathing

5. Toileting

Front 593

What are five self-care interventions post SCI

Back 593

1. Bottom up vs. top down

2. Energy conservation

3. Directing care

4. Tenodesis grasp training - C6-7, using wrist extension to grasp

Front 594

What are four eating interventions post SCI

Back 594

1. practice hand to mouth movement

2. U-Cuff

3. Built up utensils

4. Adapted utensils

Front 595

What are three drinking interventions post SCI

Back 595

1. Camel back

2. Adapted mugs

3. Long straws

Front 596

What are five dressing interventions post SCI

Back 596

1. Collaborate with physio re: balance, strength, etc.

2. Equipment / adaptive aids

3. Adapted clothing

4. practice in bed and wheelchair

5. Prescription of bed and mattress

Front 597

What are three grooming interventions post SCI

Back 597

1. U-Cuff or other splints

2. Built up electric toothbrush

3. Adaptive aids

Front 598

What are five bathing interventions post SCI

Back 598

1. Bathroom renovation recommendations

2. Equipment trial and prescription

3. Adaptive aids

4. Safety awareness

5. Practice transfers

Front 599

What are six toileting interventions post SCI

Back 599

1. Practice donning and doffing clothing

2. Adaptive aids for peri-care

3. Transfer practice

4. Safety awareness and equipment

5. Bathroom renovation recommendations

6. Equipment trial and prescription

Front 600

What are four housing interventions post SCI

Back 600

1. Equipment recommendations

2. Recommendations for home mods.

3. Liaise with social work re: funding

4. Safety recommendations for kitchen

Front 601

What are three driving interventions post SCI

Back 601

1. Provide info re: driver assessment

2. provide accessible parking pass

3. connect with vendors re: accessible vehicles

Front 602

What are three work interventions post SCI

Back 602

1. Energy conservation

2. Strategies for works station set-up

3. Refer to functional eval. centre

Front 603

What are five community integration interventions post SCI

Back 603

1. Provide resources for community services

2. practice grocery shopping and banking

3. Adapted wallets

4. Problem solve community mobility

5. Outings

Front 604

What is sexuality

Back 604

A central aspect of being human throughout life andencompasses sex, gender identities and roles, sexualorientation, eroticism, pleasure, intimacy andreproduction...”

Front 605

Sexuality has what five qualities?

Back 605

1. Natural and healthy

2. Fundamental part of human experience

3. Physical, emotional, spiritual, cultural, psychological

4. Connected to self worth, self esteem, roles, ability to give/receive love and affection

5. At base of Maslow's hierarchy of needs

Front 606

What is sexuality not

Back 606

1. Just sexual intercourse

2. Separate entity, divisible from person

3. Absent in face of illness or disability

4. Adequately addressed by HCP

Front 607

What are six patient barriers to raising sexual concerns?

Back 607

1. Embarrassment

2. Lack of privacy

3. Waiting for HCP to address it

4. Lack of knowledge about what is normal

5. Stigma/taboos

6. Cost

Front 608

What are seven HCP barriers to addressing sexuality?

Back 608

1. Waiting for patient to raise it

2. Lack of time

3. Discomfort

4. Lack of privacy

5. Role confusion

6. Lack of knowledge and training

7. Own attitudes, values, beliefs

Front 609

What is a consistent finding about sexuality and OT?

Back 609

Gap between ideology and practice (think it's important but isn't addressed)

Front 610

What are six reasons OTs should address sexuality?

Back 610

1. Essential component of holistic care

2. Enable people to engage in valuable meaningful occupations

3. Sex is ADL

4. Sexuality expresses and instills meaning

5. We work with clients on private stuff

6. Value in therapeutic relationshipW

Front 611

What's OT's confidence in addressing sexual health issues connected to?

Back 611

Education and training

Front 612

What enablement skill is important to addressing sexuality?

Back 612

Coaching

Front 613

What does the PLISSIT Model do?

Back 613

Offers an approach for communicating withpatients/clients about sexuality that allows the HCP togear this communication to their own level of comfortand competence

Front 614

What is the PLISSIT Model?

Back 614

Permission (to discuss sexuality; create open environment)

Limited Info (related to specific client; dispel myths)

Specific Suggestion (action steps for client - whether OT does this depends on problem/OT comfort in addressing it - may refer at this point)

Intensive Therapy

Front 615

What are seven benefits of kegel exercises

Back 615

1. Strengthen PC muscles

2. Increase blood floor and supply to pelvic region

3. Restoration of vaginal muscle tone and improved vaginal health

4. Increase thickness of vaginal wall and lubrication after menopause

5. Prevention and treatment of urinary stress incontinence

6. Recover from physical stress of childbirth

7. Improve sexual response and function

Front 616

What are three ways to challenge negative thoughts about sexuality?

Back 616

1. Remember you are your own worst critic

2. Focus on parts of your body you like

3. Balance with negative thought with one positive

Front 617

What are three ways to challenge negative thoughts about sexuality?

Back 617

1. Remember you are your own worst critic

2. Focus on parts of your body you like

3. Balance with negative thought with one positive