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87 Cards in this Set

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Name 6 assessments of coordination/dexterity
1. Perdue pegboard
2. Minnesota manual dexterity test
3.O'connor tweezer test
4. crawford small parts dexterity test
5. nine hole peg test
6. Jebson hand function test
Why is perdue pegboard preferred over nine-hole peg test?
perdue peg board can be both unilateral and bilateral

it is more reliable
What UE assessment tool includes 7 subtests in various areas of occupation
Jebsen hand Function Test

Includes writing, page turning, picking up common objects, feeding, stacking, picking up large light objects, picking up large heavy objects
what 2 UE assessment tools look at finger dexterity
purdue pegboard

nine hole peg test
what assessment tool looks at eye hand coordination in the context of fine motor?
o'connor tweezer test
what UE assessment tool looks at gross hand and arm movements?
Minnesota Manual Dexterity Test
what are the 2 components of the perdue peg board?
manual dexterity (30 sec)

assembly job simulation (1 min)
What are the 2 components of the Minnesota Manual dexterity test?
placing test (1 hand)
turning test (2 hands)
How do you increase ROM?
1. PROM and passive stretch
used when there is contracture, or PROM = AROM

2. AROM
use when PROM is greater than AROM

3. cannot increase ROM if there is arthrodesis, ankylosis, long-standing contracture, or joint destruction

Incorporate into occupation
How do you know what type of passive exercise is appropriate?
Review MD orders
How do passive stretch and PROM differ?
passive stretch includes over-pressure
how do you apply passive stretch
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
What exercises are often prescribes s/p shoulder surgery
codman's exercises (a type of
PROM)
What are some additional methods of PROM
dynamic and serial splinting

equipment such as continuous passive movement and pulleys
When is it appropriate to use AROM to improve range of motion?
when PROM > AROM
what are some methods to improve ROM via AROM?
differential tendon glides (increase tendon excursion in case of adhesions)

blocking exercises (isolate joint motion)

encourage functional use/occ based activities

preparatory interventions: wall walking, cane exercises, AROM
Precautions when increasing ROM
overstretch can create myositis ossificans
(a type of heterotopic ossification)
How do you increase ROM?
1. PROM and passive stretch
used when there is contracture, or PROM = AROM

2. AROM
use when PROM is greater than AROM

3. cannot increase ROM if there is arthrodesis, ankylosis, long-standing contracture, or joint destruction

Incorporate into occupation
How do you know what type of passive exercise is appropriate?
Review MD orders
How do passive stretch and PROM differ?
passive stretch includes over-pressure
how do you apply passive stretch
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
What exercises are often prescribes s/p shoulder surgery
codman's exercises (a type of
PROM)
What are some additional methods of PROM
dynamic and serial splinting

equipment such as continuous passive movement and pulleys
When is it appropriate to use AROM to improve range of motion?
when PROM > AROM
what are some methods to improve ROM via AROM?
differential tendon glides (increase tendon excursion in case of adhesions)

blocking exercises (isolate joint motion)

encourage functional use/occ based activities

preparatory interventions: wall walking, cane exercises, AROM
Precautions when increasing ROM
overstretch can create myositis ossificans
(a type of heterotopic ossification)
How do you increase strength? what type of contraction is most efficient?
high resistance, low reps increases strength

isometrics can produce more powerful contractions
When strengthening, what type of contraction may be contraindicated? With what populations?
Isometrics are contraindicated with cardiovascular conditions and HTN because they increase HR & BP
What are the 3 types of muscle contractions
-isometrics = contract without movement

2 types of isotonics:
-eccentric = muscle lengthens
-concentric = muscle shortens
How do you increase endurance?
Work at 50% of max resistance or less

-increase reps and duration, but not resistance
-use energy cons methods
What do you increase in order to improve endurance
increase number of reps, and duration of activity
do not increase resistance
What are 5 methods of reducing edema?
1. Elevate above heart
2.Retrograde massage
3. compression garments
4. cold packs
5. contrast bath
You patient has poor circulation and an edematous UE. What should you NOT do?
you should not use elevation to reduce edema if a patient has poor circulation
principles of retrograde massage
stroke distal to proximal

stroke in centripetal direction

perform with extremity elevated
when is it appropriate to use a compression garment?
to prevent re-accumulation of edema following retrograde massage
Examples of compression garments
isotoner glove for hand
tubigrip for UE (elastic stockinet)
ace wraps
coban wrap (for digits)
(can exercise and use hand for ADL while wearing coban)
What should be done when a cold pack is applied to manage edema?
cold packs are most effective with elevation

monitor vascular status (vasoconstriction)
What is a contrast bath?
method of reducing edema

there is conflicting evidence regarding effectiveness for hand edema

emerse hand in warm water then cold water
What are the contraindications for managing edema?
-avoid heat

do not use edema management techniques if: infections, grafts, wounds, vascular damage, unstable fractures, CHF
When is it appropriate to use heat if there is edema
may be used in cases of mild edema when application of heat is necessary, but must be closely monitored
6 principles of scar management
1. ROM - early mobilization is most effective
2. massage (circular and friction)
3. compression garments (coban, isotoner glove, tubigrip)
4. Scar pads with compression
5. splinting to prevent contractures
6. edema control (particularly in acute phase)
What are 3 interventions for sensory training
1. desensitization for hypersensitivity
2. sensory re-education
3. compensation
Types of desensitization interventions
-if s/p surgery, begin in periphery of scar and work over as tolerated

1. massage
2. textures
3. vibration
4. 3 phase desensitization kit
5. fluidotherapy
Types of sensory re-education interventions
1. massage
2. textures
3. vibration
4. 3-phase desensitization kit
compensatory strategies for sensory re-training
avoid using hands with vision occluded

observe safety precautions
principles of improving coordination
1. begin with slow gross movements, gradually progress to fast percise movements

2. focus on accuracy and speed
what are the 2 main types of splints?
static (immobilizes)

dynamic (increases PROM or augments AROM)
5 purposes of splinting
1. rest
2. prevent deformities/contractures
3. increase joint ROM
4. protect bone, joint, and soft tissue
5. increase functional use
2 main principles of designing splints
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)
4 Mechanical principles of splinting
1. decrease pressure with a long wide base and round edges
2. slings should be positioned at 90* angle of pull
3. use low load to increase duration
4. maintain 3 points of pressure v. circumference
What is the position of deformity?
avoid in splinting

wrist flexion
MCP hyperextension
IPs flexed
thumbs adducted
what is the safe splinting position?
wrist = 20-30* extension
MCP = 50-70* flexion
IP extension
thumb abducted and extended
Resting splinting position
wrist = 10-20* extension
MCP = 30-45* flexion
IP = 0-20* flexion
thumbs abducted
What is an important precaution for splinting
check skin before and after wear

educate patient to check skin
what patient education should be completed for splinting?
-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
What can a COTA do in terms of splinting?
help determine splint type

experienced COTAs can make static splints and help with dynamic splints
what splint is used for brachial plexus injury?
flail arm splint
What splint is used for radial nerve palsy?
dynamic wrist, finger, thumb extension splint

(lose extensors)
What splint is used for median nerve injury?
opponens splint, c-bar or thumb post splint

(lose opposition)
What splint is used for ulnar nerve injury?
dynamic or static MP flexion splint

(lose intrinsics-- lumbricals 4 & 5 and interossei)
what splint is used for combined median-ulnar nerve injury
figure of 8 or dynamic MCP flexion splint
when is a tenodesis splint used?
C6-C7 SCI

(C6 has wrist extension and use of biceps
C7 has wrist/finger extensors and use of triceps)
C8 does not need this splint because they have wrist/finger flexors
what splint is used for carpal tunnel
wrist splint in neutral
what splint is used for cubital tunnel
elbow splint in 30* flexion
what splint is used for DeQuervains?
forearm based thumb splint (includes wrist) with IP free
What splint is used for skier's thumb?
Ruptured ulnar collateral ligament

Hand based thumb splint (thumb spica)
What splint is used for CMC arthritis
hand based thumb splint
(thumb spica)
What splint is used for ulnar drift?
ulnar drift splint
What splint is used for flexor tendon injury?
dorsal block (protection) splint
what splints are used for swan neck deformity?
silver ring splint or buttonhole splint
what splints are used for boutonniere deformity?
silver ring splint or PIP extension splint
what splints are used for arthritis?
functional splint or safe splint depending on the stage
what splint is used for flaccidity
resting hand splint
what splint is used for spasticity
spasticity splint or cone splint
What splints are used for muscle weakness?
For ALS, SCI, Guillan Barre

-balanced forearm orthosis
-deltoid sling
-suspension sling
How are balanced forearm orthoses, deltoid slings, and suspension slings used?
What movement is needed?
mount to wheelchair

need shoulder or trunk movement to use
splinting for hand burns
wrist = 15-30* extension
MCP = 50-70* flexion
IPs = full extension
When is it appropriate to use PAMs?
PAMs can only be used if they precede, support, or enable engagement in occupation.

-a PREPARATORY method
What are 8 types of PAMs?
1. paraffin baths
2. hot packs
3. cold packs
4. fluidotherapy
5. whirlpool
6. contrast baths
7.ultra sound
8. electrical stimulation units
what are 3 types of Estim?
1. functional electrical stim (FES)
2. Neuromuscular electrical stim (NMES)
3. trancutaneous electrical nerve stimulator (TENS)
Benefits of superficial heat
1. relieves pain
2. increases tissue extensibility (for increasing range of motion)
3. assists with wound healing
benefits of cryotherapy
1. relieves pain
2. controls edema
3. decreases abnormal tone
4. facilitates muscle tone
benefits of whirlpool
1. cleans and debrides an open infected wound

cannot be used as a heat modality--it is not hot enough
benefits of electrical stimulation
1. relieves pain
2. decreases swelling
3. stimulates and strengthens muscles
4. stimulates denervated muscle
benefits of ultrasound
1. relieves pain
2. decreases inflammation
3. increases tissue extensibility
4. decreases adhesions
benefits of contrast baths
reduces edema
6 general contraindications for PAMs
1. cancer
2. pacemaker
3. pregnancy
4. cognitive impairment
5. sensory impairment
6. vascular impairment

always consider age and diagnosis (ex. ultrasound cant be used over a growth plate)