Therapy Ed Chapter 11: Biomechanical

Front 1

Name 6 assessments of coordination/dexterity

Back 1

1. Perdue pegboard2. Minnesota manual dexterity test3.O'connor tweezer test4. crawford small parts dexterity test5. nine hole peg test6. Jebson hand function test

Front 2

Why is perdue pegboard preferred over nine-hole peg test?

Back 2

perdue peg board can be both unilateral and bilateralit is more reliable

Front 3

What UE assessment tool includes 7 subtests in various areas of occupation

Back 3

Jebsen hand Function TestIncludes writing, page turning, picking up common objects, feeding, stacking, picking up large light objects, picking up large heavy objects

Front 4

what 2 UE assessment tools look at finger dexterity

Back 4

purdue pegboardnine hole peg test

Front 5

what assessment tool looks at eye hand coordination in the context of fine motor?

Back 5

o'connor tweezer test

Front 6

what UE assessment tool looks at gross hand and arm movements?

Back 6

Minnesota Manual Dexterity Test

Front 7

what are the 2 components of the perdue peg board?

Back 7

manual dexterity (30 sec)assembly job simulation (1 min)

Front 8

What are the 2 components of the Minnesota Manual dexterity test?

Back 8

placing test (1 hand)turning test (2 hands)

Front 9

How do you increase ROM?

Back 9

1. PROM and passive stretchused when there is contracture, or PROM = AROM2. AROMuse when PROM is greater than AROM3. cannot increase ROM if there is arthrodesis, ankylosis, long-standing contracture, or joint destructionIncorporate into occupation

Front 10

How do you know what type of passive exercise is appropriate?

Back 10

Review MD orders

Front 11

How do passive stretch and PROM differ?

Back 11

passive stretch includes over-pressure

Front 12

how do you apply passive stretch

Back 12

manual stretch within person's tolerance-hold for 15-30 seconds-pain should go away immediately when pressure released (otherwise too much pressure)-adding weight increases stretch. Be careful what objects you are using when doing this in the context of occupation

Front 13

What exercises are often prescribes s/p shoulder surgery

Back 13

codman's exercises (a type ofPROM)

Front 14

What are some additional methods of PROM

Back 14

dynamic and serial splintingequipment such as continuous passive movement and pulleys

Front 15

When is it appropriate to use AROM to improve range of motion?

Back 15

when PROM > AROM

Front 16

what are some methods to improve ROM via AROM?

Back 16

differential tendon glides (increase tendon excursion in case of adhesions)blocking exercises (isolate joint motion)encourage functional use/occ based activitiespreparatory interventions: wall walking, cane exercises, AROM

Front 17

Precautions when increasing ROM

Back 17

overstretch can create myositis ossificans (a type of heterotopic ossification)

Front 18

How do you increase ROM?

Back 18

1. PROM and passive stretchused when there is contracture, or PROM = AROM2. AROMuse when PROM is greater than AROM3. cannot increase ROM if there is arthrodesis, ankylosis, long-standing contracture, or joint destructionIncorporate into occupation

Front 19

How do you know what type of passive exercise is appropriate?

Back 19

Review MD orders

Front 20

How do passive stretch and PROM differ?

Back 20

passive stretch includes over-pressure

Front 21

how do you apply passive stretch

Back 21

manual stretch within person's tolerance-hold for 15-30 seconds-pain should go away immediately when pressure released (otherwise too much pressure)-adding weight increases stretch. Be careful what objects you are using when doing this in the context of occupation

Front 22

What exercises are often prescribes s/p shoulder surgery

Back 22

codman's exercises (a type ofPROM)

Front 23

What are some additional methods of PROM

Back 23

dynamic and serial splintingequipment such as continuous passive movement and pulleys

Front 24

When is it appropriate to use AROM to improve range of motion?

Back 24

when PROM > AROM

Front 25

what are some methods to improve ROM via AROM?

Back 25

differential tendon glides (increase tendon excursion in case of adhesions)blocking exercises (isolate joint motion)encourage functional use/occ based activitiespreparatory interventions: wall walking, cane exercises, AROM

Front 26

Precautions when increasing ROM

Back 26

overstretch can create myositis ossificans (a type of heterotopic ossification)

Front 27

How do you increase strength? what type of contraction is most efficient?

Back 27

high resistance, low reps increases strengthisometrics can produce more powerful contractions

Front 28

When strengthening, what type of contraction may be contraindicated? With what populations?

Back 28

Isometrics are contraindicated with cardiovascular conditions and HTN because they increase HR & BP

Front 29

What are the 3 types of muscle contractions

Back 29

-isometrics = contract without movement2 types of isotonics:-eccentric = muscle lengthens -concentric = muscle shortens

Front 30

How do you increase endurance?

Back 30

Work at 50% of max resistance or less-increase reps and duration, but not resistance-use energy cons methods

Front 31

What do you increase in order to improve endurance

Back 31

increase number of reps, and duration of activitydo not increase resistance

Front 32

What are 5 methods of reducing edema?

Back 32

1. Elevate above heart2.Retrograde massage3. compression garments4. cold packs5. contrast bath

Front 33

You patient has poor circulation and an edematous UE. What should you NOT do?

Back 33

you should not use elevation to reduce edema if a patient has poor circulation

Front 34

principles of retrograde massage

Back 34

stroke distal to proximalstroke in centripetal directionperform with extremity elevated

Front 35

when is it appropriate to use a compression garment?

Back 35

to prevent re-accumulation of edema following retrograde massage

Front 36

Examples of compression garments

Back 36

isotoner glove for handtubigrip for UE (elastic stockinet)ace wrapscoban wrap (for digits)(can exercise and use hand for ADL while wearing coban)

Front 37

What should be done when a cold pack is applied to manage edema?

Back 37

cold packs are most effective with elevationmonitor vascular status (vasoconstriction)

Front 38

What is a contrast bath?

Back 38

method of reducing edemathere is conflicting evidence regarding effectiveness for hand edemaemerse hand in warm water then cold water

Front 39

What are the contraindications for managing edema?

Back 39

-avoid heatdo not use edema management techniques if: infections, grafts, wounds, vascular damage, unstable fractures, CHF

Front 40

When is it appropriate to use heat if there is edema

Back 40

may be used in cases of mild edema when application of heat is necessary, but must be closely monitored

Front 41

6 principles of scar management

Back 41

1. ROM - early mobilization is most effective2. massage (circular and friction)3. compression garments (coban, isotoner glove, tubigrip)4. Scar pads with compression5. splinting to prevent contractures6. edema control (particularly in acute phase)

Front 42

What are 3 interventions for sensory training

Back 42

1. desensitization for hypersensitivity2. sensory re-education3. compensation

Front 43

Types of desensitization interventions

Back 43

-if s/p surgery, begin in periphery of scar and work over as tolerated1. massage2. textures3. vibration4. 3 phase desensitization kit5. fluidotherapy

Front 44

Types of sensory re-education interventions

Back 44

1. massage2. textures3. vibration4. 3-phase desensitization kit

Front 45

compensatory strategies for sensory re-training

Back 45

avoid using hands with vision occludedobserve safety precautions

Front 46

principles of improving coordination

Back 46

1. begin with slow gross movements, gradually progress to fast percise movements2. focus on accuracy and speed

Front 47

what are the 2 main types of splints?

Back 47

static (immobilizes)dynamic (increases PROM or augments AROM)

Front 48

5 purposes of splinting

Back 48

1. rest2. prevent deformities/contractures3. increase joint ROM4. protect bone, joint, and soft tissue5. increase functional use

Front 49

2 main principles of designing splints

Back 49

maintain arches of the hand(proximal and distal transverse arches, longitudinal arches)Don't impinge on creases(distal and proximal palmar creases, distal and proximal wrist creases, thenar crease)

Front 50

4 Mechanical principles of splinting

Back 50

1. decrease pressure with a long wide base and round edges2. slings should be positioned at 90* angle of pull3. use low load to increase duration4. maintain 3 points of pressure v. circumference

Front 51

What is the position of deformity?

Back 51

avoid in splintingwrist flexionMCP hyperextensionIPs flexedthumbs adducted

Front 52

what is the safe splinting position?

Back 52

wrist = 20-30* extensionMCP = 50-70* flexionIP extensionthumb abducted and extended

Front 53

Resting splinting position

Back 53

wrist = 10-20* extensionMCP = 30-45* flexionIP = 0-20* flexionthumbs abducted

Front 54

What is an important precaution for splinting

Back 54

check skin before and after weareducate patient to check skin

Front 55

what patient education should be completed for splinting?

Back 55

-skin inspection-splint care-provide wear and care form-teach to don/doff-make sure they understand purpose, functions, and limitations-teach use during role activities

Front 56

What can a COTA do in terms of splinting?

Back 56

help determine splint typeexperienced COTAs can make static splints and help with dynamic splints

Front 57

what splint is used for brachial plexus injury?

Back 57

flail arm splint

Front 58

What splint is used for radial nerve palsy?

Back 58

dynamic wrist, finger, thumb extension splint(lose extensors)

Front 59

What splint is used for median nerve injury?

Back 59

opponens splint, c-bar or thumb post splint(lose opposition)

Front 60

What splint is used for ulnar nerve injury?

Back 60

dynamic or static MP flexion splint(lose intrinsics-- lumbricals 4 & 5 and interossei)

Front 61

what splint is used for combined median-ulnar nerve injury

Back 61

figure of 8 or dynamic MCP flexion splint

Front 62

when is a tenodesis splint used?

Back 62

C6-C7 SCI(C6 has wrist extension and use of bicepsC7 has wrist/finger extensors and use of triceps)C8 does not need this splint because they have wrist/finger flexors

Front 63

what splint is used for carpal tunnel

Back 63

wrist splint in neutral

Front 64

what splint is used for cubital tunnel

Back 64

elbow splint in 30* flexion

Front 65

what splint is used for DeQuervains?

Back 65

forearm based thumb splint (includes wrist) with IP free

Front 66

What splint is used for skier's thumb?

Back 66

Ruptured ulnar collateral ligament Hand based thumb splint (thumb spica)

Front 67

What splint is used for CMC arthritis

Back 67

hand based thumb splint(thumb spica)

Front 68

What splint is used for ulnar drift?

Back 68

ulnar drift splint

Front 69

What splint is used for flexor tendon injury?

Back 69

dorsal block (protection) splint

Front 70

what splints are used for swan neck deformity?

Back 70

silver ring splint or buttonhole splint

Front 71

what splints are used for boutonniere deformity?

Back 71

silver ring splint or PIP extension splint

Front 72

what splints are used for arthritis?

Back 72

functional splint or safe splint depending on the stage

Front 73

what splint is used for flaccidity

Back 73

resting hand splint

Front 74

what splint is used for spasticity

Back 74

spasticity splint or cone splint

Front 75

What splints are used for muscle weakness?

Back 75

For ALS, SCI, Guillan Barre-balanced forearm orthosis-deltoid sling-suspension sling

Front 76

How are balanced forearm orthoses, deltoid slings, and suspension slings used?What movement is needed?

Back 76

mount to wheelchairneed shoulder or trunk movement to use

Front 77

splinting for hand burns

Back 77

wrist = 15-30* extensionMCP = 50-70* flexionIPs = full extension

Front 78

When is it appropriate to use PAMs?

Back 78

PAMs can only be used if they precede, support, or enable engagement in occupation.-a PREPARATORY method

Front 79

What are 8 types of PAMs?

Back 79

1. paraffin baths2. hot packs3. cold packs4. fluidotherapy5. whirlpool6. contrast baths7.ultra sound8. electrical stimulation units

Front 80

what are 3 types of Estim?

Back 80

1. functional electrical stim (FES)2. Neuromuscular electrical stim (NMES)3. trancutaneous electrical nerve stimulator (TENS)

Front 81

Benefits of superficial heat

Back 81

1. relieves pain2. increases tissue extensibility (for increasing range of motion)3. assists with wound healing

Front 82

benefits of cryotherapy

Back 82

1. relieves pain2. controls edema3. decreases abnormal tone4. facilitates muscle tone

Front 83

benefits of whirlpool

Back 83

1. cleans and debrides an open infected woundcannot be used as a heat modality--it is not hot enough

Front 84

benefits of electrical stimulation

Back 84

1. relieves pain2. decreases swelling3. stimulates and strengthens muscles4. stimulates denervated muscle

Front 85

benefits of ultrasound

Back 85

1. relieves pain2. decreases inflammation3. increases tissue extensibility4. decreases adhesions

Front 86

benefits of contrast baths

Back 86

reduces edema

Front 87

6 general contraindications for PAMs

Back 87

1. cancer2. pacemaker3. pregnancy4. cognitive impairment5. sensory impairment6. vascular impairmentalways consider age and diagnosis (ex. ultrasound cant be used over a growth plate)