This week focuses on: Musculoskeletal Conditions & Interventions, Physical agent modalities (PAM’S), Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF)/Met Levels, and Functional Independence Measure (FIM)
This week focuses on: Musculoskeletal Conditions & Interventions, Physical agent modalities (PAM’S), Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF)/Met Levels, and Functional Independence Measure (FIM)
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Hands and Upper Extremities Powerpoint with Cory
– Hands and Upper Extremities Powerpoint with Cory, with answers
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Thoracic Outlet Syndrome:view
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An OTR® in a hand therapy clinic receives a referral to evaluate and treat a woman with a diagnosis of right hand carpal tunnel syndrome. The hand surgeon wants to try a conservative approach to managing the woman’s symptoms, as the woman has a history of adverse reactions to anesthesia. During the initial evaluation with the woman, the OTR® finds out that the woman does data entry for a bank. She is married, has two very young children, and lives in a rented townhouse. The woman reports that her symptoms began about one month prior to the evaluation.
Section A: Based on the diagnosis and initial evaluation, what clinical tests should the OTR® complete? Select the best 3 choices.
As the patient has been already been diagnosed with Carpal Tunnel Syndrome by the physician, tests to diagnose the condition, such as the Tinel sign and Phalen’s test are not indicated in this scenario. Numbness, tingling, burning, pain, weakness, a tendency to drop things and poor fine motor co-ordination are common symptoms in cases of carpal tunnel syndrome, so the tests that address these areas should be administered. In particular, the Semmes-Weinstein monofilaments test will be useful as it will help to determine the extent of the woman’s loss of sensation resulting from the nerve compression. Limitations in ROM do not always occur unless the symptoms have been present for a long time, so a functional ROM screening would be more appropriate than detailed goniometer measurements. The woman’s ADLs and IADLs may be compromised, but the woman should be able to accurately report her own ADL status, so a KELS is not necessary.. There is no indication that the woman has cognitive limitations, so an Allen Cognitive Levels test would not be necessary.
As the patient has been already been diagnosed with Carpal Tunnel Syndrome by the physician, tests to diagnose the condition, such as the Tinel sign and Phalen’s test are not indicated in this scenario. Numbness, tingling, burning, pain, weakness, a tendency to drop things and poor fine motor co-ordination are common symptoms in cases of carpal tunnel syndrome, so the tests that address these areas should be administered. In particular, the Semmes-Weinstein monofilaments test will be useful as it will help to determine the extent of the woman’s loss of sensation resulting from the nerve compression. Limitations in ROM do not always occur unless the symptoms have been present for a long time, so a functional ROM screening would be more appropriate than detailed goniometer measurements. The woman’s ADLs and IADLs may be compromised, but the woman should be able to accurately report her own ADL status, so a KELS is not necessary.. There is no indication that the woman has cognitive limitations, so an Allen Cognitive Levels test would not be necessary.
Clinical Simulation, setting 1: An OTR® in a hand therapy clinic receives a referral to evaluate and treat a woman with a diagnosis of right hand carpal tunnel syndrome. The hand surgeon wants to try a conservative approach to managing the woman’s symptoms, as the woman has a history of adverse reactions to anesthesia. During the initial interview with the woman, the OTR® finds out that the woman does data entry for a bank. She is married, has two very young children, and lives in a rented townhouse. The woman reports that her symptoms began about one month prior to the evaluation.
Section B: The woman reports significant pain in her right wrist and hand. What modalities should the OTR® consider when deciding what to use to help reduce pain? Select the best 3 choices.
Iontophoresis and TENS can reduce pain and inflammation in the carpal tunnel area. Iontophoresis will also safely inject medication into the affected area and may be more effective than TENS. Fluidotherapy is a safe heat modality that can be used to improve circulation and address loss of tactile sensation. Contrast baths may provide temporary relief of symptoms but are not as effective as the modalities mentioned previously.. Paraffin bath is not a safe modality to use with carpal tunnel as the patient may not feel when the paraffin is too hot and may be at risk for burns. Even though therapeutic ultrasound is used to relieve the symptoms of carpal tunnel syndrome, there is minimal evidence in the research to support its effectiveness.
Iontophoresis and TENS can reduce pain and inflammation in the carpal tunnel area. Iontophoresis will also safely inject medication into the affected area and may be more effective than TENS. Fluidotherapy is a safe heat modality that can be used to improve circulation and address loss of tactile sensation. Contrast baths may provide temporary relief of symptoms but are not as effective as the modalities mentioned previously.. Paraffin bath is not a safe modality to use with carpal tunnel as the patient may not feel when the paraffin is too hot and may be at risk for burns. Even though therapeutic ultrasound is used to relieve the symptoms of carpal tunnel syndrome, there is minimal evidence in the research to support its effectiveness.
Clinical Simulation, setting 1: An OTR® in a hand therapy clinic receives a referral to evaluate and treat a woman with a diagnosis of right hand carpal tunnel syndrome. The hand surgeon wants to try a conservative approach to managing the woman’s symptoms, as the woman has a history of adverse reactions to anesthesia. During the initial interview with the woman, the OTR® finds out that the woman does data entry for a bank. She is married, has two very young children, and lives in a rented townhouse. The woman reports that her symptoms began about one month prior to the evaluation.
Section C:The physician’s order includes splinting the patient’s right wrist, with no specifications. How should the OTR® proceed with the splinting? Select the best 3 choices.
Rationale: Splints for carpal tunnel syndrome should position the wrist in neutral or slight extension. Splinting is especially important at night as many carpal tunnel patients report increased pain at night. If the woman purchases a wrist support herself, that support may not position her wrist correctly. Issuing a prefabricated wrist brace for daytime use will give the woman a bit of flexibility while working, but will hold the wrist in place. A thermoplastic splint for night use will hold the wrist firmly in position while the woman sleeps. The prescription should be clarified with the physician, especially if third party insurance will be billed for the service, but the OTR® should make the recommendation regarding the type of splints to be prescribed, rather than asking the physician what he wants. Because the physician did not specify the type of splint on the initial order, he is relying on the OTR® to provide the correct type of splint.
Rationale: Splints for carpal tunnel syndrome should position the wrist in neutral or slight extension. Splinting is especially important at night as many carpal tunnel patients report increased pain at night. If the woman purchases a wrist support herself, that support may not position her wrist correctly. Issuing a prefabricated wrist brace for daytime use will give the woman a bit of flexibility while working, but will hold the wrist in place. A thermoplastic splint for night use will hold the wrist firmly in position while the woman sleeps. The prescription should be clarified with the physician, especially if third party insurance will be billed for the service, but the OTR® should make the recommendation regarding the type of splints to be prescribed, rather than asking the physician what he wants. Because the physician did not specify the type of splint on the initial order, he is relying on the OTR® to provide the correct type of splint.
Clinical Simulation, setting 1: An OTR® in a hand therapy clinic receives a referral to evaluate and treat a woman with a diagnosis of right hand carpal tunnel syndrome. The hand surgeon wants to try a conservative approach to managing the woman’s symptoms, as the woman has a history of adverse reactions to anesthesia. During the initial interview with the woman, the OTR® finds out that the woman does data entry for a bank. She is married, has two very young children, and lives in a rented townhouse. The woman reports that her symptoms began about one month prior to the evaluation.
Section D: The woman’s employer contacts the OTR® and expresses concerns over the woman’s request for adaptations at work. How should the OTR® respond? Select the best 3 choices.
Most employers think that adaptations to compensate for a medical condition or disability will cost a lot of money. Adaptations for carpal tunnel syndrome, however, can often be accomplished by adjusting the height of the work station in relation to the chair the employee uses. Other adaptations, such as a wrist rest or an ergonomic keyboard, are low cost. Since employees of a bank have jobs that place them at risk for developing carpal tunnel syndrome, the woman’s co-workers would benefit from training in how to prevent the condition and the OTR® could offer this to the employer. The OTR® should not make the employer think that she must change every work station or provide expensive adaptations to comply with the Americans with Disabilities Act.
Most employers think that adaptations to compensate for a medical condition or disability will cost a lot of money. Adaptations for carpal tunnel syndrome, however, can often be accomplished by adjusting the height of the work station in relation to the chair the employee uses. Other adaptations, such as a wrist rest or an ergonomic keyboard, are low cost. Since employees of a bank have jobs that place them at risk for developing carpal tunnel syndrome, the woman’s co-workers would benefit from training in how to prevent the condition and the OTR® could offer this to the employer. The OTR® should not make the employer think that she must change every work station or provide expensive adaptations to comply with the Americans with Disabilities Act.
Clinical Simulation, setting 2: An OTR® in an outpatient rehabilitation clinic receives an order to evaluate and treat a woman with right shoulder girdle muscle denervation. Through medical records review, the OTR® learns that the woman has lost nerve function to a portion of her rotator cuff due to a surgeon accidentally severing a nerve during surgery for another condition. The woman is in her 50s and lives alone. Her adult children live nearby. She works as a waitress at a local diner and enjoys babysitting her grandchildren.
Section A: Since the woman’s injury affects specific muscles, how should the OTR® proceed with the initial evaluation? Select the best 3 choices.
Since the woman’s injury is specific to a certain nerve, it is important to complete goniometer measurements and manual muscle testing to identify the upper extremity functions affected by the loss of innervation to specific muscles. Screening is not adequate. Testing sensation in the full upper extremity is not necessary, although screening sensation in the areas innervated by the severed nerve may be helpful. The woman’s ADLs and IADLs should also be assessed. The woman was previously independent in all tasks, so this can be completed through interview.
Since the woman’s injury is specific to a certain nerve, it is important to complete goniometer measurements and manual muscle testing to identify the upper extremity functions affected by the loss of innervation to specific muscles. Screening is not adequate. Testing sensation in the full upper extremity is not necessary, although screening sensation in the areas innervated by the severed nerve may be helpful. The woman’s ADLs and IADLs should also be assessed. The woman was previously independent in all tasks, so this can be completed through interview.
Clinical Simulation, setting 2: An OTR® in an outpatient rehabilitation clinic receives an order to evaluate and treat a woman with right shoulder girdle muscle denervation. Through medical records review, the OTR® learns that the woman has lost nerve function to a portion of her rotator cuff due to a surgeon accidentally severing a nerve during surgery for another condition. The woman is in her 50s and lives alone. Her adult children live nearby. She works as a waitress at a local diner and enjoys babysitting her grandchildren..
Section B: During treatment, the OTR® notices that the woman is having difficulty compensating for the loss of function in her rotator cuff muscles. How can the OTR® help the woman re-learn shoulder movements using different muscles?
While strengthening the shoulder girdle will help the woman overcome the deconditioning that her injury caused, it will not help her learn to compensate for the muscles that no longer function by using other muscles. To do this, she must consciously feel the way each muscle moves when it contracts. Using tactile feedback, such as brushing or vibration, or visual feedback, such as watching movement in a mirror, will help accomplish this. Biofeedback training using a biofeedback machine will help the woman to learn to use alternate muscles through both visual and auditory feedback.
While strengthening the shoulder girdle will help the woman overcome the deconditioning that her injury caused, it will not help her learn to compensate for the muscles that no longer function by using other muscles. To do this, she must consciously feel the way each muscle moves when it contracts. Using tactile feedback, such as brushing or vibration, or visual feedback, such as watching movement in a mirror, will help accomplish this. Biofeedback training using a biofeedback machine will help the woman to learn to use alternate muscles through both visual and auditory feedback.
Clinical Simulation, setting 2: An OTR® in an outpatient rehabilitation clinic receives an order to evaluate and treat a woman with right shoulder girdle muscle denervation. Through medical records review, the OTR® learns that the woman has lost nerve function to a portion of her rotator cuff due to a surgeon accidentally severing a nerve during surgery for another condition. The woman is in her 50s and lives alone. Her adult children live nearby. She works as a waitress at a local diner and enjoys babysitting her grandchildren.
Section C: The woman’s progress in therapy is plateauing and the woman still complains that she cannot complete certain activities, including combing one side of her hair, lifting the coffee pot at work, and picking up her grandson. How should the OTR® address these activities? Select the best 3 choices.
Because the woman is plateauing in therapy, she may not relearn how to complete these specific activities using different muscles. That does not mean she should give them up, but the activities should be adapted instead to allow her to continue to perform them. Since only the right arm was affected by the injury, the woman can adapt some activities by using her other arm. This would be appropriate for lifting her grandson and a special harness would not be necessary. A long-handled comb should help the woman reach the parts of her head that she cannot reach due to her right shoulder limitation. The woman’s ability to lift coffee pots at work could be helped by moving the coffee pots to a lower position, but that might not be possible depending on the coffee station set-up. It would be appropriate to ask the woman if recommendations could be given to her employer regarding the coffee station. The woman should work with her employer to adapt her coffee station, rather than adapting it herself by using smaller coffee pots.
Because the woman is plateauing in therapy, she may not relearn how to complete these specific activities using different muscles. That does not mean she should give them up, but the activities should be adapted instead to allow her to continue to perform them. Since only the right arm was affected by the injury, the woman can adapt some activities by using her other arm. This would be appropriate for lifting her grandson and a special harness would not be necessary. A long-handled comb should help the woman reach the parts of her head that she cannot reach due to her right shoulder limitation. The woman’s ability to lift coffee pots at work could be helped by moving the coffee pots to a lower position, but that might not be possible depending on the coffee station set-up. It would be appropriate to ask the woman if recommendations could be given to her employer regarding the coffee station. The woman should work with her employer to adapt her coffee station, rather than adapting it herself by using smaller coffee pots.
Clinical Simulation, setting 2: An OTR® in an outpatient rehabilitation clinic receives an order to evaluate and treat a woman with right shoulder girdle muscle denervation. Through medical records review, the OTR® learns that the woman has lost nerve function to a portion of her rotator cuff due to a surgeon accidentally severing a nerve during surgery for another condition. The woman is in her 50s and lives alone. Her adult children live nearby. She works as a waitress at a local diner and enjoys babysitting her grandchildren.
Section D: During therapy, the woman has repeatedly stated that she may sue the surgeon who severed her nerve. Realizing that a lawsuit may be involved with this injury, what should the OTR® do? Select the best 3 choices.
Rationale: If an upper extremity injury is the result of an action that could result in a lawsuit, the OTR® should be very careful to remain neutral to the cause of the injury during evaluation and treatment. The OTR® should not document opinion or express opinion to the patient, but should carefully document all evaluation and treatment sessions and the outcomes of those sessions. Regular, detailed reports should also be provided to the woman’s physician. Treatment should continue until treatment goals are reached or until progress plateaus, just as it would with any other patient. If the OTR® is subpoenaed as a witness in a lawsuit, she will be required to testify based on the written documentation, so it is important that the documentation be accurate and thorough.
Rationale: If an upper extremity injury is the result of an action that could result in a lawsuit, the OTR® should be very careful to remain neutral to the cause of the injury during evaluation and treatment. The OTR® should not document opinion or express opinion to the patient, but should carefully document all evaluation and treatment sessions and the outcomes of those sessions. Regular, detailed reports should also be provided to the woman’s physician. Treatment should continue until treatment goals are reached or until progress plateaus, just as it would with any other patient. If the OTR® is subpoenaed as a witness in a lawsuit, she will be required to testify based on the written documentation, so it is important that the documentation be accurate and thorough.
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Module 3 OT Assessment
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An OT is working with a patient who sustained a proximal humerus fracture which required surgical intervention using the surgical approach of open reduction internal fixation (ORIF) to reduce the displaced bone fragments. Post op, when should this patient be able to begin AAROM?
A. 4-6 weeks.
One passive shoulder exercise often prescribed during shoulder rehabilitation is called the pendulum or Codman exercise. It’s used to facilitate passive range of motion of the joint, and doesn’t require a muscle contraction.
REHABILITATION GUIDELINES FOR PROXIMAL HUMERUS FRACTURE – ORIF
PHASE I (1-3 WEEKS) DATES:
Rehabilitation Goals
• Protect repair
• Minimize pain and swelling
• Maintain ROM of surrounding joints
• Prevent adhesive capsulitis
• Minimize cardiovascular deconditioning
Precautions
• Sling at all times or per MD
• No AROM, lifting, pushing, pulling x 6 weeks
• No ER > 40 degrees or excessive shoulder EXT x 6 weeks
• No supporting of body weight
Suggested Therapeutic Exercises
• PROM of shoulder:
– Flexion to 90 degrees
– ER to 30 degrees
– IR to tolerance (no behind back)
• Scapular clocks:
– Elevation, depression, retraction, protraction
• Pendulums (Codman’s)
• Cervical, hand, wrist, elbow AROM – thumb to shoulder, make fist
Progression Criteria
• Per X-ray evidence of healing
• PROM flexion to 90 degrees, ER to 30 degrees
PHASE II (WEEKS 3-6) DATES:
Rehabilitation Goals
• Regain PROM
• Gentle functional use
• No resistance
Precautions
• Sling and ROM limitations per MD
• No IR/ER
• No driving
• No pushing, pulling, lifting
• No cuff strengthening
Suggested Therapeutic Exercises
• PROM in scapular plane (no hand behind back IR)
• AAROM:
– flexion to 90 degrees
– ER to 40 degrees
• Pulleys
• AROM of elbow, wrist and hand
• Continue scapular isometrics and clocks
• UBE no resistance
Progression Criteria
• Per X-ray evidence of healing
• AAROM flexion to 90 degrees, ER to 40 degrees
PHASE III (WEEKS 6-12)
Rehabilitation Goals
• Regain full PROM
Precautions
• Sling use per MD based on x-ray evidence of healing
• May begin driving
• 20 # weight limit
• No pushing or pulling
• No overhead activity
Suggested Therapeutic Exercises
• Continue PROM/AAROM/AROM cervical, shoulder, elbow, wrist and hand
• General UE strengthening at 10 weeks
Progression Criteria
• Advance to work/sport specific conditioning once AROM is = bilateral and strength is 4+/5 in all directions
PHASE IV (WEEKS 12 +)
Rehabilitation Goals
• Full ROM in all planes
• Transition to HEP
Precautions
• Per MD but generally no lifting, pushing or pulling precautions at this point
• No overhead lifting until 4-6 months post op
Suggested Therapeutic Exercises
• AROM of cervical shoulder, elbow, wrist and hand emphasizing end ROM
• GH and scapular joint mobilizations as needed
• General UE strengthening
https://www.mammothortho.com/pdf/proximal-humerus-fracture-orif-crall.pdf
A. 4-6 weeks.
One passive shoulder exercise often prescribed during shoulder rehabilitation is called the pendulum or Codman exercise. It’s used to facilitate passive range of motion of the joint, and doesn’t require a muscle contraction.
REHABILITATION GUIDELINES FOR PROXIMAL HUMERUS FRACTURE – ORIF
PHASE I (1-3 WEEKS) DATES:
Rehabilitation Goals
• Protect repair
• Minimize pain and swelling
• Maintain ROM of surrounding joints
• Prevent adhesive capsulitis
• Minimize cardiovascular deconditioning
Precautions
• Sling at all times or per MD
• No AROM, lifting, pushing, pulling x 6 weeks
• No ER > 40 degrees or excessive shoulder EXT x 6 weeks
• No supporting of body weight
Suggested Therapeutic Exercises
• PROM of shoulder:
– Flexion to 90 degrees
– ER to 30 degrees
– IR to tolerance (no behind back)
• Scapular clocks:
– Elevation, depression, retraction, protraction
• Pendulums (Codman’s)
• Cervical, hand, wrist, elbow AROM – thumb to shoulder, make fist
Progression Criteria
• Per X-ray evidence of healing
• PROM flexion to 90 degrees, ER to 30 degrees
PHASE II (WEEKS 3-6) DATES:
Rehabilitation Goals
• Regain PROM
• Gentle functional use
• No resistance
Precautions
• Sling and ROM limitations per MD
• No IR/ER
• No driving
• No pushing, pulling, lifting
• No cuff strengthening
Suggested Therapeutic Exercises
• PROM in scapular plane (no hand behind back IR)
• AAROM:
– flexion to 90 degrees
– ER to 40 degrees
• Pulleys
• AROM of elbow, wrist and hand
• Continue scapular isometrics and clocks
• UBE no resistance
Progression Criteria
• Per X-ray evidence of healing
• AAROM flexion to 90 degrees, ER to 40 degrees
PHASE III (WEEKS 6-12)
Rehabilitation Goals
• Regain full PROM
Precautions
• Sling use per MD based on x-ray evidence of healing
• May begin driving
• 20 # weight limit
• No pushing or pulling
• No overhead activity
Suggested Therapeutic Exercises
• Continue PROM/AAROM/AROM cervical, shoulder, elbow, wrist and hand
• General UE strengthening at 10 weeks
Progression Criteria
• Advance to work/sport specific conditioning once AROM is = bilateral and strength is 4+/5 in all directions
PHASE IV (WEEKS 12 +)
Rehabilitation Goals
• Full ROM in all planes
• Transition to HEP
Precautions
• Per MD but generally no lifting, pushing or pulling precautions at this point
• No overhead lifting until 4-6 months post op
Suggested Therapeutic Exercises
• AROM of cervical shoulder, elbow, wrist and hand emphasizing end ROM
• GH and scapular joint mobilizations as needed
• General UE strengthening
https://www.mammothortho.com/pdf/proximal-humerus-fracture-orif-crall.pdf
Richard, a 30-year-old college soccer coach, fractured his left wrist after landing on an outstretched arm when he fell off his bike. After 6 weeks of wearing a cast, he has been given a wrist brace to wear for support. Richard reports that his left wrist remains painful, stiff, and the swelling in his hand is limiting his ability to drive to soccer training and matches. Pain and edema are being addressed with the use of PAMs. The main focus of OT is now on improving his wrist and hand strength for grasping. What is the BEST activity that can be used to improve Richard’s grasp on the steering wheel?
A. Collecting glass bottles, pulling the caps off, rinsing them with water, and then placing them in a carton. With these activities, the patient is using the functional use of wrist extension, wrist ulnar deviation, thumb CMC opposition, and flexion of the MCP, PIP, and DIP joints. All these hand wrist and finger movements are required to grasp a steering wheel.
B. Works on lateral pinch and wrist extension with no emphasis on cylindrical grasp.
C. Works on isolated finger movements but does not address grasping.
D. Works on lateral pinch, DIP and PIP flexion as well as thumb opposition but does not rely on cylindrical grasp.
Keogh, J., Sain, S.; and Roller, C. (2012). Kinesiology for the Occupational Therapy Assistant: Essential Components of Function and Movement. Thorofare, NJ: SLACK Incorporated, p 258.
A. Collecting glass bottles, pulling the caps off, rinsing them with water, and then placing them in a carton. With these activities, the patient is using the functional use of wrist extension, wrist ulnar deviation, thumb CMC opposition, and flexion of the MCP, PIP, and DIP joints. All these hand wrist and finger movements are required to grasp a steering wheel.
B. Works on lateral pinch and wrist extension with no emphasis on cylindrical grasp.
C. Works on isolated finger movements but does not address grasping.
D. Works on lateral pinch, DIP and PIP flexion as well as thumb opposition but does not rely on cylindrical grasp.
Keogh, J., Sain, S.; and Roller, C. (2012). Kinesiology for the Occupational Therapy Assistant: Essential Components of Function and Movement. Thorofare, NJ: SLACK Incorporated, p 258.
Dan, a 36-year-old male, is accompanied by his wife to an outpatient hand therapy clinic. Dan who works as a truck driver, recently sustained an injury to his right dominant hand when he fell off a ladder at home. Before fabricating a splint for Dan, the COTA® becomes aware that there is a lot of tension between Dan and his wife. Dan verbalizes that he is extremely concerned about lost time from work as he is the only breadwinner. His wife, however, is reluctant to engage in any part of the conservation and Dan excuses her behavior by saying “she’s very upset with me!” Taking the couple’s emotional state into consideration, what approach should the OTR® use to initiate the discussion about the need for a splint for Dan’s recovery?
D. Clarify concerns and allow them to vent before determining their understanding about the diagnosis and splint order.
It is important to allow the patient and his wife the opportunity to express their emotions and concerns. This helps in establishing rapport in order to develop client-centered goals. The therapist can positively influence the patient’s compliance and motivation and determine the readiness of family members for ensuring carryover and support of the patient’s self-maintenance of the splint, precautions, and home exercise program.
A. This would not be therapeutic and client-centered as the concerns must be addressed first.
B. The emotional state of the patient and his wife need to be addressed first.
C. Although environmental modification for therapeutic rapport may be an effective protocol for addressing anxiety, allowing the patient and his wife to speak first would be priority.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 113.
D. Clarify concerns and allow them to vent before determining their understanding about the diagnosis and splint order.
It is important to allow the patient and his wife the opportunity to express their emotions and concerns. This helps in establishing rapport in order to develop client-centered goals. The therapist can positively influence the patient’s compliance and motivation and determine the readiness of family members for ensuring carryover and support of the patient’s self-maintenance of the splint, precautions, and home exercise program.
A. This would not be therapeutic and client-centered as the concerns must be addressed first.
B. The emotional state of the patient and his wife need to be addressed first.
C. Although environmental modification for therapeutic rapport may be an effective protocol for addressing anxiety, allowing the patient and his wife to speak first would be priority.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 113.
A 64-year-old patient who fractured his left femur when he fell onto a barricade, is currently 4 weeks post-op, and is attending outpatient rehab services. The patient has recently consulted with his orthopedic surgeon for a routine follow-up. At his next OT session, the patient presents the clinician with new orders from the surgeon, stating that the patient can progress from non-weight-bearing (NWB) to toe-touch weight bearing (TTWB) of the affected extremity. With this new change in his weight-bearing status, how would you BEST adapt a dish washing task, to incorporate the patient’s new weight-bearing precautions?
A. Wash dishes in a seated position.
Washing dishes requires the patient to use both their hands for the task and they can therefore not hold onto a walking aid to help them adhere to their weight bearing precautions, when they need to move along the work surface. Therefore, while the patient is only permitted to partially weight-bear, it is advisable that they complete kitchen tasks from a seated position to reduce the likelihood of them unintentionally taking full weight through their operated limb. This includes tasks such as making a hot drink, cooking and washing up. This is because the patient may be tempted to hold onto the work surface and step sideways without their walking aid, which means they will not be partially weight-bearing on their operated limb.
B. Washing dishes typically requires bilateral upper extremity use.
C and D. Weight-bearing 50% -100% of the body onto the operated leg is contraindicated as partial weight bearing is defined as bearing 30% to 50% of your body weight. Toe touch weight bearing is poorly defined in the research literature, however, in clinical practice, it is commonly described as having the ability to touch the foot or toes to the floor without supporting weight from the affected limb.
A. Wash dishes in a seated position.
Washing dishes requires the patient to use both their hands for the task and they can therefore not hold onto a walking aid to help them adhere to their weight bearing precautions, when they need to move along the work surface. Therefore, while the patient is only permitted to partially weight-bear, it is advisable that they complete kitchen tasks from a seated position to reduce the likelihood of them unintentionally taking full weight through their operated limb. This includes tasks such as making a hot drink, cooking and washing up. This is because the patient may be tempted to hold onto the work surface and step sideways without their walking aid, which means they will not be partially weight-bearing on their operated limb.
B. Washing dishes typically requires bilateral upper extremity use.
C and D. Weight-bearing 50% -100% of the body onto the operated leg is contraindicated as partial weight bearing is defined as bearing 30% to 50% of your body weight. Toe touch weight bearing is poorly defined in the research literature, however, in clinical practice, it is commonly described as having the ability to touch the foot or toes to the floor without supporting weight from the affected limb.
What is the benefit of using a physical agent modality such as whirlpool therapy with patients who have multiple sclerosis?
D. Enhances muscle relaxation and flexibility.
The various PAMs can help decrease muscle tone and spasticity and improve circulation prior to active movement in patients with multiple sclerosis. Whirlpool therapy consists of three main healing properties: heat, buoyancy, and massage. Overall, hydrotherapy studies have shown that the health benefits of immersion in warm water with massage jet action include the relaxation of muscles and loosening of joints. The muscle relaxing and joint loosening benefits of whirlpools help patients with MS who suffer from spasticity from muscle spasms and chronic achiness in their joints.
D. Enhances muscle relaxation and flexibility.
The various PAMs can help decrease muscle tone and spasticity and improve circulation prior to active movement in patients with multiple sclerosis. Whirlpool therapy consists of three main healing properties: heat, buoyancy, and massage. Overall, hydrotherapy studies have shown that the health benefits of immersion in warm water with massage jet action include the relaxation of muscles and loosening of joints. The muscle relaxing and joint loosening benefits of whirlpools help patients with MS who suffer from spasticity from muscle spasms and chronic achiness in their joints.
What type of splint is used to inhibit flexor spasticity in the hand and should not apply stretch to the wrist and finger flexor muscles?
A. Cone splint. A cone splint is best for inhibiting tone. Rood first promoted the inhibition of flexor spasticity by using a firm cone to provide constant pressure over the palmar surface. The device should provide skin contact over the entire palmar surface for maximal effect but should not apply stretch to the wrist and finger flexor muscles. The hard cone has an inhibitory effect on flexor muscles because this device places deep tendon pressure on the wrist and finger-flexor insertions at the base of the palm. The total contact from the hard cone provides maintained pressure over the flexor surface of the palm, thus assisting in the desensitization of hypersensitive skin.
A. Cone splint. A cone splint is best for inhibiting tone. Rood first promoted the inhibition of flexor spasticity by using a firm cone to provide constant pressure over the palmar surface. The device should provide skin contact over the entire palmar surface for maximal effect but should not apply stretch to the wrist and finger flexor muscles. The hard cone has an inhibitory effect on flexor muscles because this device places deep tendon pressure on the wrist and finger-flexor insertions at the base of the palm. The total contact from the hard cone provides maintained pressure over the flexor surface of the palm, thus assisting in the desensitization of hypersensitive skin.
What is the purpose of a compression garment?
D. Prevent re-accumulation of fluids post retrograde massage.
Compression Garments:
· Prevent re-accumulation of fluids post retrograde massage
· Types: Isotoner gloves, Tubigrip (elastic stockinette), Ace wraps, Coban (wrapped distal to proximal) for edema in digits while exercising/ADL, but avoid too much tension.
D. Prevent re-accumulation of fluids post retrograde massage.
Compression Garments:
· Prevent re-accumulation of fluids post retrograde massage
· Types: Isotoner gloves, Tubigrip (elastic stockinette), Ace wraps, Coban (wrapped distal to proximal) for edema in digits while exercising/ADL, but avoid too much tension.
What is the name of the hand position which requires the MCP joints to be placed in flexion, and the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in extension?
C. Safe position.
The overall safe position of immobilization for the hand is called the intrinsic plus or clam digger position. In the intrinsic plus position, the MCP joints are positioned in flexion and the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the fingers are positioned in extension.
C. Safe position.
The overall safe position of immobilization for the hand is called the intrinsic plus or clam digger position. In the intrinsic plus position, the MCP joints are positioned in flexion and the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the fingers are positioned in extension.
What is the Kleinert protocol for a flexor tendon injury repair?
D. Active extension of digit with passive flexion using rubber band traction.
Kleinert protocol: Active extension of digit with passive flexion using rubber band traction.
D. Active extension of digit with passive flexion using rubber band traction.
Kleinert protocol: Active extension of digit with passive flexion using rubber band traction.
A 23-year-old student sustained an injury to her left forearm when she fell during a college basketball tournament. She has now developed a flexion contracture of her left elbow as a result of her arm being immobilized in a long-arm cast for the past 6-weeks. Before participating in an upper dressing task, the OTR® decides to apply a warm pack over the patient’s bicep tendon. What is the PRIMARY purpose for using this modality?
A. To facilitate tissue extensibility for increasing elbow extension.
Heat increases muscle extensibility, especially helpful when a patient is experiencing restriction in range of movement. This type of physical agent modality also serves as an adjunctive method in preparation for purposeful, functional activity.
https://www.webmd.com/fitness-exercise/understanding-sprains-strains#1, http://www.fixhands.com/how-to-refer/splintorthotics/, https://livehealthy.chron.com/kinds-long-arm-splints-1112.html
A. To facilitate tissue extensibility for increasing elbow extension.
Heat increases muscle extensibility, especially helpful when a patient is experiencing restriction in range of movement. This type of physical agent modality also serves as an adjunctive method in preparation for purposeful, functional activity.
https://www.webmd.com/fitness-exercise/understanding-sprains-strains#1, http://www.fixhands.com/how-to-refer/splintorthotics/, https://livehealthy.chron.com/kinds-long-arm-splints-1112.html
What is the Duran protocol for a flexor tendon injury repair?
B. Passive flexion and extension of the digits.
Duran protocol: Passive flexion and extension of digit
B. Passive flexion and extension of the digits.
Duran protocol: Passive flexion and extension of digit
A 22-year-old male professional golfer has been diagnosed with medial epicondylitis. What is the most appropriate splint for this patient, when being treated conservatively?
D. Medial epicondylitis brace.
Medial epicondylitis refers to the chronic tendinosis of the wrist flexors and pronators that attach to the medial epicondyle. Medial epicondylitis occurs most commonly through repetitive pronation of the forearm or flexion of the wrist. Also called Golfer’s elbow. The patient usually complains about pain of the elbow distal to the medial epicondyle of the humerus with radiation up and down the arm, most common on the ulnar side of the forearm, the wrist and occasionally in the fingers. Local tenderness over the medial epicondyle and the conjoined tendon of the flexor group, without evidence of swelling or erythema, are also characteristics that can occur. Other symptoms are stiffness of the elbow, weakness in the hand and the wrist and a numb or tingling feeling in the fingers (mostly ring and little finger). The pain is evoked by resisted flexion of the wrist and by pronation. The pain is usually accompanied by a weakness of hand grip. Pain can begin suddenly or can develop gradually over time. The main goal of the conservative treatment is to relieve pain, reduce inflammation and promote healing. The counterforce brace consists of a tight strap which is placed approximately 4 cm distal to the elbow flexion crease and then tightened for comfort. Counterforce braces help reduce tension on the painful tendons.
D. Medial epicondylitis brace.
Medial epicondylitis refers to the chronic tendinosis of the wrist flexors and pronators that attach to the medial epicondyle. Medial epicondylitis occurs most commonly through repetitive pronation of the forearm or flexion of the wrist. Also called Golfer’s elbow. The patient usually complains about pain of the elbow distal to the medial epicondyle of the humerus with radiation up and down the arm, most common on the ulnar side of the forearm, the wrist and occasionally in the fingers. Local tenderness over the medial epicondyle and the conjoined tendon of the flexor group, without evidence of swelling or erythema, are also characteristics that can occur. Other symptoms are stiffness of the elbow, weakness in the hand and the wrist and a numb or tingling feeling in the fingers (mostly ring and little finger). The pain is evoked by resisted flexion of the wrist and by pronation. The pain is usually accompanied by a weakness of hand grip. Pain can begin suddenly or can develop gradually over time. The main goal of the conservative treatment is to relieve pain, reduce inflammation and promote healing. The counterforce brace consists of a tight strap which is placed approximately 4 cm distal to the elbow flexion crease and then tightened for comfort. Counterforce braces help reduce tension on the painful tendons.
An OTR® is working with a patient who has rheumatoid arthritis. The patient works in the kitchen of a local restaurant and he has identified that turning the knobs of the stove and the taps of the sinks, exacerbates his pain. To protect his joints, which type of hand movements should the patient focus on using when manipulating the various objects in the kitchen ?
B. Movements that place the MCP joints in radial deviation.
A characteristic sign of rheumatoid arthritis is ulnar drift which affects the MCP joints of the hands. The ligaments supporting the joints are either destroyed or weakened. Therefore, when turning knobs, the joints should be moving in the direction away from the ulnar side of the hands as the gripping forces will pull the joints toward the 5th digit.
,em>Joint protection
• Respect the pain – Use it as a sign to change the activity
• Distribute the load on more than one joint
• Reduce the strength and the effort required to perform some activity, changing the way to perform it, using assistive devices or reducing the weight of utensils
• Use each joint in its most stable and functional anatomical plane
• Avoid positions or forces in directions that favor deformities
• Always use the stronger and larger joint to work
• Avoid staying in the same position for a prolonged time
• Avoid holding objects with excessive force
• Avoid awkward postures and inappropriate ways to pick up and handle objects
• Maintain muscle strength and range of motion
B. Movements that place the MCP joints in radial deviation.
A characteristic sign of rheumatoid arthritis is ulnar drift which affects the MCP joints of the hands. The ligaments supporting the joints are either destroyed or weakened. Therefore, when turning knobs, the joints should be moving in the direction away from the ulnar side of the hands as the gripping forces will pull the joints toward the 5th digit.
,em>Joint protection
• Respect the pain – Use it as a sign to change the activity
• Distribute the load on more than one joint
• Reduce the strength and the effort required to perform some activity, changing the way to perform it, using assistive devices or reducing the weight of utensils
• Use each joint in its most stable and functional anatomical plane
• Avoid positions or forces in directions that favor deformities
• Always use the stronger and larger joint to work
• Avoid staying in the same position for a prolonged time
• Avoid holding objects with excessive force
• Avoid awkward postures and inappropriate ways to pick up and handle objects
• Maintain muscle strength and range of motion
A patient who has been diagnosed with radial tunnel syndrome is being treated conservatively. The OT practitioner is fabricating a splint for this patient to manage their condition. What type of splint is the MOST appropriate for this patient, at this stage of their intervention?
B. Long arm splint.
Radial tunnel syndrome (RTS): Compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm. With RTS, placing the elbow in extension, forearm in pronation and wrist in flexion along with resisting long finger extension will often provoke symptoms of dull pain or aching and burning in the lateral forearm. Fabricating a long arm orthosis with the wrist in extension, elbow in flexion, and forearm in pronation to neutral rotation is the classic recommended position .
A. Dorsal blocking splint is used to prevent stress to the flexor tendons following injury or repair.
C. Wrist volar splint with wrist in neutral is typically used to treat Carpal tunnel syndrome.
D. Opponens splint typically used for fractures, injuries, and repetitive motion syndromes of the thumb.
B. Long arm splint.
Radial tunnel syndrome (RTS): Compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm. With RTS, placing the elbow in extension, forearm in pronation and wrist in flexion along with resisting long finger extension will often provoke symptoms of dull pain or aching and burning in the lateral forearm. Fabricating a long arm orthosis with the wrist in extension, elbow in flexion, and forearm in pronation to neutral rotation is the classic recommended position .
A. Dorsal blocking splint is used to prevent stress to the flexor tendons following injury or repair.
C. Wrist volar splint with wrist in neutral is typically used to treat Carpal tunnel syndrome.
D. Opponens splint typically used for fractures, injuries, and repetitive motion syndromes of the thumb.
A 78-year-old resident in a skilled nursing facility has been referred for OT intervention following a CVA. As a result of her CVA, she has developed hypertonicity in her left non-dominant upper extremity. The patient has been fitted with an ulnar platform anti-spasticity hard cone splint to reduce the tone in her hand and to prevent palmar skin maceration. Several days later, when you arrive to review the splint, you notice that instead of wearing her cone splint, the nursing staff have taken rolled-up washcloths and placed them in the patient’s palm to keep her hand open. The nursing staff report that they are not confident that the splint is effective, and they therefore decided to use the washcloths as an alternative. What is the MOST IMPORTANT objective of the prescribed splint you should discuss with the nursing staff, to assure them that the splint is a necessary part of the patient’s treatment so that they are aware of the benefits of the splint and are empowered to help the patient with her splint management?
D. The splint will reduce the manual effort required to access the patient’s palm and therefore maintaining adequate hand hygiene will be achievable. By maintaining what passive ROM the patient does have, the splint provides comfort with gentle, soft-tissue stretch, thus reducing contractures. The nursing staff will therefore require less effort to manage the patient’s hand during bathing and hygiene if the ROM is maintained. The soft material of rolled-up washcloths increases finger flexion, and it does not provide sufficient resistance, making it more difficult to manage hygiene.
A. Although increased sensory feedback is beneficial, the value and purpose of the prescribed splint will increase the likelihood of staff buy-in.
B. It is unlikely that the staff will need to provide any support for self-feeding as the patient has use of her dominant hand.
C. Demonstrated outcomes will support the staff’s active engagement in splint management but their understanding of how the splint will assist them in managing the patient’s hand during bathing and hygiene is the MOST IMPORTANT aspect to discuss.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, pp 327-329.
French-Bravo, M., Crow, G., (March 19, 2015) “Shared Governance: The Role of Buy-In In Bringing About Change” OJIN: The Online Journal of Issues in Nursing Vol. 20 No. 2.
D. The splint will reduce the manual effort required to access the patient’s palm and therefore maintaining adequate hand hygiene will be achievable. By maintaining what passive ROM the patient does have, the splint provides comfort with gentle, soft-tissue stretch, thus reducing contractures. The nursing staff will therefore require less effort to manage the patient’s hand during bathing and hygiene if the ROM is maintained. The soft material of rolled-up washcloths increases finger flexion, and it does not provide sufficient resistance, making it more difficult to manage hygiene.
A. Although increased sensory feedback is beneficial, the value and purpose of the prescribed splint will increase the likelihood of staff buy-in.
B. It is unlikely that the staff will need to provide any support for self-feeding as the patient has use of her dominant hand.
C. Demonstrated outcomes will support the staff’s active engagement in splint management but their understanding of how the splint will assist them in managing the patient’s hand during bathing and hygiene is the MOST IMPORTANT aspect to discuss.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, pp 327-329.
French-Bravo, M., Crow, G., (March 19, 2015) “Shared Governance: The Role of Buy-In In Bringing About Change” OJIN: The Online Journal of Issues in Nursing Vol. 20 No. 2.
A patient with COPD who has been educated about her disease and energy conservation complains of shortness of breath while walking upstairs, performing her grooming routine, and cooking. Following the SOAP note formula, which subjective statement is the MOST appropriate to record in this patient’s notes?
D. “I still get so tired when I walk up the stairs, wash myself and cook for my family.”
S: Subjective. What is the patient reporting?
The MOST appropriate statement as reported by the patient will be the statement that relates to her diagnosis and levels of fatigue & energy conservation. Waking up in the morning and attempting to do all those activities will cause the patient to become short of breath and tired. Keeping a stool next to her to sit down when she fatigues is a strategy related to her COPD.
D. “I still get so tired when I walk up the stairs, wash myself and cook for my family.”
S: Subjective. What is the patient reporting?
The MOST appropriate statement as reported by the patient will be the statement that relates to her diagnosis and levels of fatigue & energy conservation. Waking up in the morning and attempting to do all those activities will cause the patient to become short of breath and tired. Keeping a stool next to her to sit down when she fatigues is a strategy related to her COPD.
An OTR® is fabricating a customized resting hand splint for an 80-year-old patient with rheumatoid arthritis. The patient has also been diagnosed with hyperthyroidism and poor circulation. One of the symptoms of hyperthyroidism is the development of a tremor , which usually presents as a fine trembling in the hands and fingers. The patient lives alone in an apartment and his daughter regularly checks up on him and helps him with his meals and light house cleaning. The daughter is concerned that her father will have difficulty removing and re-applying his splint as his tremors interfere with his hand function. How can the OTR® ensure that the patient can independently manage his splint?
B. Attach wide-based stretchy Velcro straps with D-rings. This strapping method ensures a secure fit, reduces constriction for one with poor circulation, and is compatible for a patient with decreased hand function..
A. Would be appropriate for a patient who has short-term memory deficits for sequencing donning and doffing the splint.
C. This patient needs a wider strap to compensate for his poor hand function. The additional bandage would promote constriction and is contraindicated for a patient with poor circulation.
D. Pulling straps with a D-ring component allows for less fine-motor manipulation than a neoprene splint, and a customized splint may be necessary for supporting unstable joints secondary to rheumatoid arthritis.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo.: Elsevier/Mosby, pp 399-400.
B. Attach wide-based stretchy Velcro straps with D-rings. This strapping method ensures a secure fit, reduces constriction for one with poor circulation, and is compatible for a patient with decreased hand function..
A. Would be appropriate for a patient who has short-term memory deficits for sequencing donning and doffing the splint.
C. This patient needs a wider strap to compensate for his poor hand function. The additional bandage would promote constriction and is contraindicated for a patient with poor circulation.
D. Pulling straps with a D-ring component allows for less fine-motor manipulation than a neoprene splint, and a customized splint may be necessary for supporting unstable joints secondary to rheumatoid arthritis.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo.: Elsevier/Mosby, pp 399-400.
2 days ago, a 60-year-old farmer was seen at the local hand therapy clinic where he was issued a neoprene hand-based splint. On the first day he only wore the splint for 2 hours and as advised, he did not wear the splint that evening. On waking in the morning of the second day, he noticed small red welts on the area where the splint had been in contact with his skin. Despite the red marks, he re-applied the splint and after wearing it for 4 hours, he started to complain of swelling and pain from his fingertips to his forearm. The patient’s wife calls the hand clinic to explain his situation to the OTR® and asks the OTR® what she should do. What is the MOST appropriate recommendation the OTR® can give the patient’s wife at this point?
C. Immediately have the patient discontinue use of the orthotic as he may be having an allergic reaction to the neoprene adhesive compounds.
There is a possibility that the patient may have be having allergic reaction to the compounds that make up the neoprene material. The initial hypersensitivity stage is displayed as a localized response which may not manifest itself immediately and is indicated by no apparent reaction. When the patient removed it and wore it again the day after, the body’s immune system recognized the allergen and triggered allergic symptoms. Re-exposure intensifies the reaction. At this time, it would be best to remove the splint and seek medical treatment, before returning to the Hand Therapist for an alternative splint.
Callinan, Nancy, et al. “Neoprene Splinting: Dermalogical Issues”. American Journal of Occupational Therapy, July/August 1998, Vol. 62, 573-575.
C. Immediately have the patient discontinue use of the orthotic as he may be having an allergic reaction to the neoprene adhesive compounds.
There is a possibility that the patient may have be having allergic reaction to the compounds that make up the neoprene material. The initial hypersensitivity stage is displayed as a localized response which may not manifest itself immediately and is indicated by no apparent reaction. When the patient removed it and wore it again the day after, the body’s immune system recognized the allergen and triggered allergic symptoms. Re-exposure intensifies the reaction. At this time, it would be best to remove the splint and seek medical treatment, before returning to the Hand Therapist for an alternative splint.
Callinan, Nancy, et al. “Neoprene Splinting: Dermalogical Issues”. American Journal of Occupational Therapy, July/August 1998, Vol. 62, 573-575.
An entry-level OT is assessing a patient who has ALS. The OT is measuring the patient’s active range of elbow flexion using a standard goniometer. In an attempt to get an accurate measurement, the OT asks the patient to flex his elbow 4 times in succession, and still finds that the measurements vary 2-10 degrees. In this scenario, what should the OT do NEXT?
C. Verify correct placement of the goniometer.
A goniometer is an instrument that either measures an angle or allows an object to be rotated to a precise angular position. If the OT is getting 3 different measurements, then they need to check where they are placing the goniometer.
C. Verify correct placement of the goniometer.
A goniometer is an instrument that either measures an angle or allows an object to be rotated to a precise angular position. If the OT is getting 3 different measurements, then they need to check where they are placing the goniometer.
When evaluating an individual with suspected complex regional pain syndrome, what are the key symptoms you would expect to see?
A. Changes in skin temperature, skin color, or swelling of the affected limb. The injured arm or leg may feel warmer or cooler than the opposite limb. Skin on the affected limb may change color, becoming blotchy, blue, purple, gray, pale, or red. These skin symptoms typically fluctuate as they indicate abnormal blood flow in the area. Opening and closing the small blood vessels under the skin is controlled by the C-nerve fibers that are injured in CRPS.
Complex regional pain syndrome (CRPS) is a broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg. CRPS has acute (recent, short-term) and chronic (lasting greater than six months) forms. CRPS used to be known as reflex sympathetic dystrophy (RSD) and causalgia. Patients with CRPS have changing combinations of spontaneous pain or excess pain that is much greater than normal following something as mild as a touch. Other symptoms include changes in skin color, temperature, and/or swelling on the arm or leg below the site of injury. Although CRPS improves over time, eventually going away in most people, the rare severe or prolonged cases are profoundly disabling.
Other symptoms may include:
A. Stiffness in affected joints. This common problem is that reduced movement leads to reduced flexibility of tendons and ligaments. Tight ligaments or tendons sometimes rub or pinch nerves to provide an internal cause of CRPS in people who do not have external injuries.
B. Excess or prolonged pain after use or contact. There is often increased sensitivity in the affected area, known as allodynia, in which light touch, normal physical contact, and use is felt by the person to be very painful. Some notice severe or prolonged pain after a mildly painful stimulus such as a pin prick, known as hyperalgesia.
C. Impaired muscle strength and movement. Most people with CRPS do not have direct injury to the nerve fibers that control the muscles coordinating muscle movement. However, most report reduced ability to move the affected body part. This is usually due to pain and abnormalities in the sensory input that helps coordinate movements.
A. Changes in skin temperature, skin color, or swelling of the affected limb. The injured arm or leg may feel warmer or cooler than the opposite limb. Skin on the affected limb may change color, becoming blotchy, blue, purple, gray, pale, or red. These skin symptoms typically fluctuate as they indicate abnormal blood flow in the area. Opening and closing the small blood vessels under the skin is controlled by the C-nerve fibers that are injured in CRPS.
Complex regional pain syndrome (CRPS) is a broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg. CRPS has acute (recent, short-term) and chronic (lasting greater than six months) forms. CRPS used to be known as reflex sympathetic dystrophy (RSD) and causalgia. Patients with CRPS have changing combinations of spontaneous pain or excess pain that is much greater than normal following something as mild as a touch. Other symptoms include changes in skin color, temperature, and/or swelling on the arm or leg below the site of injury. Although CRPS improves over time, eventually going away in most people, the rare severe or prolonged cases are profoundly disabling.
Other symptoms may include:
A. Stiffness in affected joints. This common problem is that reduced movement leads to reduced flexibility of tendons and ligaments. Tight ligaments or tendons sometimes rub or pinch nerves to provide an internal cause of CRPS in people who do not have external injuries.
B. Excess or prolonged pain after use or contact. There is often increased sensitivity in the affected area, known as allodynia, in which light touch, normal physical contact, and use is felt by the person to be very painful. Some notice severe or prolonged pain after a mildly painful stimulus such as a pin prick, known as hyperalgesia.
C. Impaired muscle strength and movement. Most people with CRPS do not have direct injury to the nerve fibers that control the muscles coordinating muscle movement. However, most report reduced ability to move the affected body part. This is usually due to pain and abnormalities in the sensory input that helps coordinate movements.
Frederick, a professional guitarist has been diagnosed with Dupuytren’s contracture affecting his left hand. Since developing Dupuytren’s contracture, playing his guitar has become increasingly difficult for him and subsequently he has been unable to perform with his band. What part of Frederick’s left hand is MOST LIKELY impacting on his ability to play his guitar?
B. The proximal interphalangeal joint of his ring finger.
Dupuytren’s contracture is an abnormal thickening of the tissue just beneath the skin. This thickening occurs in the palm and can extend into the fingers. Firm pits, bumps and cords (thick lines) can develop and cause the fingers to bend into the palm. Dupuytren’s contracture is a flexion contracture of the proximal interphalangeal joint. The 4th and 5th digits are usually affected. The thumb and index finger are always spared. The lumps can be uncomfortable in some people, but Dupuytren’s contracture is not typically painful. The contracture makes it difficult to position the finger and release the finger in a timely manner during chord progression on the neck of the guitar because of the snapping effect the finger produces when moved in extension.
A. The proximal interphalangeal joint is affected, not the distal.
C and D. The thumb and web space are not affected.
Walthall J, Rehman UH. Dupuytren’s Contracture. [Updated 2019 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526074/
https://orthoinfo.aaos.org/en/diseases–conditions/dupuytrens-disease/
http://www.assh.org/handcare/hand-arm-conditions/dupuytrens-contracture
B. The proximal interphalangeal joint of his ring finger.
Dupuytren’s contracture is an abnormal thickening of the tissue just beneath the skin. This thickening occurs in the palm and can extend into the fingers. Firm pits, bumps and cords (thick lines) can develop and cause the fingers to bend into the palm. Dupuytren’s contracture is a flexion contracture of the proximal interphalangeal joint. The 4th and 5th digits are usually affected. The thumb and index finger are always spared. The lumps can be uncomfortable in some people, but Dupuytren’s contracture is not typically painful. The contracture makes it difficult to position the finger and release the finger in a timely manner during chord progression on the neck of the guitar because of the snapping effect the finger produces when moved in extension.
A. The proximal interphalangeal joint is affected, not the distal.
C and D. The thumb and web space are not affected.
Walthall J, Rehman UH. Dupuytren’s Contracture. [Updated 2019 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526074/
https://orthoinfo.aaos.org/en/diseases–conditions/dupuytrens-disease/
http://www.assh.org/handcare/hand-arm-conditions/dupuytrens-contracture
A 58-year-old male who is a carpenter by trade, was diagnosed with subluxation of the CMC joint of his right, dominant hand. After conservative treatment failed, surgery was performed. Since the surgery however, contractures of the stabilizers of the CMC joint including the thumb flexors and adductors, have developed resulting in a diminished web space. The patient’s goal is to return to his full-time employment within 2 months, once his course of therapy has been completed. To help this patient achieve his goal, what hand therapy protocol (splint, exercises, hand-function activities) should the OT select as part of the patient’s OT intervention?
A. Thumb spica splinting, edema control, isometric abduction of the thenar eminence, grasp of small tools, and manipulation of nuts and bolts.
The best client-centered intervention is guided by the patient’s perspective and values, meets their needs, and recognizes their experience and knowledge.
B. This protocol prevents or reduces clawing and focuses on finger extension but does not relate to engagement in work-related activities.
C. Works on mobilizing the wrist which is not the focus of this protocol and the activities do not relate to carpentry work.
D. Does not work on thumb opposition, stretching of the web space, nor do the activities relate to carpentry-related work
A. Thumb spica splinting, edema control, isometric abduction of the thenar eminence, grasp of small tools, and manipulation of nuts and bolts.
The best client-centered intervention is guided by the patient’s perspective and values, meets their needs, and recognizes their experience and knowledge.
B. This protocol prevents or reduces clawing and focuses on finger extension but does not relate to engagement in work-related activities.
C. Works on mobilizing the wrist which is not the focus of this protocol and the activities do not relate to carpentry work.
D. Does not work on thumb opposition, stretching of the web space, nor do the activities relate to carpentry-related work
Which splint is specifically designed to protect the stability of the first CMC joint during grasp and to also maintain this digit in a functional position at rest?
B. CMC short opponens orthosis.
The CMC joint of the thumb is also known as the first CMC joint.
The CMC short opponens orthosis maintains approximation of the CMC joint. Unlike other orthoses, this splint does not need to cross the joint to be effective. With simple radial support to the proximal metacarpal head the joint is approximated as the ulnar strap helps maintain contact and stability. The splint also maintains the web space in a functional position with abduction and slight opposition.
B. CMC short opponens orthosis.
The CMC joint of the thumb is also known as the first CMC joint.
The CMC short opponens orthosis maintains approximation of the CMC joint. Unlike other orthoses, this splint does not need to cross the joint to be effective. With simple radial support to the proximal metacarpal head the joint is approximated as the ulnar strap helps maintain contact and stability. The splint also maintains the web space in a functional position with abduction and slight opposition.
A patient recently experienced shoulder trauma and as a result sustained a brachial plexus injury. What single upper limb movement would be the MOST appropriate to ask the patient to perform in order to assess the functioning of their C5 myotome?
A. Shoulder abduction.
Testing Myotomes: SCI vs Brachial Plexus Injury
• With a SCI, the loss of motor and/or sensory function is due to damage to neural elements within the spinal canal.
• With a brachial plexus lesion/injury it is the peripheral nerves outside the spinal cord that are being affected.
When testing for a brachial plexus lesion, you want to test movement(s) which have the strongest association with each myotome.
Most muscles in the limbs receive innervation from more than one spinal nerve root and are hence comprised of multiple myotomes.
The primary muscles involved in the action of arm abduction include the supraspinatus, deltoid, trapezius, and serratus anterior:
• Serratus Anterior, Deltoid- innervated by C5.
• Cranial nerve XI innervates the motor function of the trapezius.
• The supraspinatus muscle is supplied by the suprascapular nerve (C5 and C6)
Technique for assessing C5 myotome with BPL.
C5- Shoulder abduction. Ask the patient to raise both their arms to the side of them simultaneously as strongly as then can while the examiner provides resistance to this movement. Compare the strength of each arm.
The brachial plexus is formed by the anterior primary rami of C5 through T1 and provides sensory and motor innervation of the upper extremity. The brachial plexus is divided, proximally to distally into rami/roots, trunks, divisions, cords, and terminal branches. Most muscles in the upper and lower limbs receive innervation from more than one spinal nerve root. Muscular innervation of the C5 spinal nerve includes arm abduction and external rotation. These 2 arm movements are very important for upper extremity function and are classically lost with upper brachial plexus injuries, including neonatal palsy (i.e., Erb’s palsy). The terminal branches mediating these movements include the axillary nerve to the deltoid muscle, and the suprascapular nerve to the supra- and infraspinatus muscles. A composite movement involving all 3 of these muscles, and therefore predominantly mediated by the C5 nerve root, is abduction of the arm. When assessing a myotome’s functioning, using a single movement, it is important to know which movement is MOST strongly associated with that myotome.
Movements most strongly associated with each myotome for BPI:
C5 – Shoulder abduction
C6 – Elbow flexion Wrist extension
C7 – Elbow extension
C8 – Finger flexion
T1 – Finger abduction
L2 – Hip flexion
L3 – Knee extension
L4 – Ankle dorsiflexion
L5 – Great toe extension
S1 – Ankle plantarflexion
A. Shoulder abduction.
Testing Myotomes: SCI vs Brachial Plexus Injury
• With a SCI, the loss of motor and/or sensory function is due to damage to neural elements within the spinal canal.
• With a brachial plexus lesion/injury it is the peripheral nerves outside the spinal cord that are being affected.
When testing for a brachial plexus lesion, you want to test movement(s) which have the strongest association with each myotome.
Most muscles in the limbs receive innervation from more than one spinal nerve root and are hence comprised of multiple myotomes.
The primary muscles involved in the action of arm abduction include the supraspinatus, deltoid, trapezius, and serratus anterior:
• Serratus Anterior, Deltoid- innervated by C5.
• Cranial nerve XI innervates the motor function of the trapezius.
• The supraspinatus muscle is supplied by the suprascapular nerve (C5 and C6)
Technique for assessing C5 myotome with BPL.
C5- Shoulder abduction. Ask the patient to raise both their arms to the side of them simultaneously as strongly as then can while the examiner provides resistance to this movement. Compare the strength of each arm.
The brachial plexus is formed by the anterior primary rami of C5 through T1 and provides sensory and motor innervation of the upper extremity. The brachial plexus is divided, proximally to distally into rami/roots, trunks, divisions, cords, and terminal branches. Most muscles in the upper and lower limbs receive innervation from more than one spinal nerve root. Muscular innervation of the C5 spinal nerve includes arm abduction and external rotation. These 2 arm movements are very important for upper extremity function and are classically lost with upper brachial plexus injuries, including neonatal palsy (i.e., Erb’s palsy). The terminal branches mediating these movements include the axillary nerve to the deltoid muscle, and the suprascapular nerve to the supra- and infraspinatus muscles. A composite movement involving all 3 of these muscles, and therefore predominantly mediated by the C5 nerve root, is abduction of the arm. When assessing a myotome’s functioning, using a single movement, it is important to know which movement is MOST strongly associated with that myotome.
Movements most strongly associated with each myotome for BPI:
C5 – Shoulder abduction
C6 – Elbow flexion Wrist extension
C7 – Elbow extension
C8 – Finger flexion
T1 – Finger abduction
L2 – Hip flexion
L3 – Knee extension
L4 – Ankle dorsiflexion
L5 – Great toe extension
S1 – Ankle plantarflexion
A 28-year-old student who is studying computer science is being treated at an outpatient hand clinic for carpal tunnel syndrome. The nature of her studies requires her to spend many hours working on the desktop computers at the computer lab which is based on the college campus. The student has been assessed by the OT, and a dorsal wrist splint was provided. During a follow-up appointment, the student reports that she is finding it difficult to hold the mouse while wearing the splint as the splint covers the proximal portion of her palm and the palmar transverse bar tends to get in the way. In order to recommend a suitable ergonomic mouse which would preserve the student’s cutaneous feedback and thereby increase her task efficiency, what characteristics should the OT consider in terms of the features of the mouse and the anthropometric measurements of the hand (width of hand and length of hand, palm, and index finger)?
C. Index finger length, the height and position of the hump of the mouse, and hand size.
The index finger length determines optimal reach of the mouse clicker. The length of the index finger is typically considered to be the prime anthropometric measurement related to computer task performance when wearing a splint. A mouse that promotes less pronation posture while holding it lowers the risk of repetitive motion injuries. Therefore, a rear-hump mouse would be the best design. A rear-hump mouse also preserves cutaneous feedback.
A. Thumb opposition is not relevant when considering preservation of cutaneous feedback.
B.The length of the index finger and not the middle finger is typically considered to be the key measurement related to using a mouse when wearing a splint.
D. This is a compensatory strategy. As the entire lab uses desktop computers, the environmental modification would not be reasonable or practical for the school to pursue.
Chien-Hsiou, Liu; Shih-Chen Fan. “Ergonomic Design of a Computer Mouse for Clients with Wrist Splints”. American Journal of Occupational Therapy, May/June 2014, Vol. 68, 317-324. doi:10.5014/ajot.2014.009928
C. Index finger length, the height and position of the hump of the mouse, and hand size.
The index finger length determines optimal reach of the mouse clicker. The length of the index finger is typically considered to be the prime anthropometric measurement related to computer task performance when wearing a splint. A mouse that promotes less pronation posture while holding it lowers the risk of repetitive motion injuries. Therefore, a rear-hump mouse would be the best design. A rear-hump mouse also preserves cutaneous feedback.
A. Thumb opposition is not relevant when considering preservation of cutaneous feedback.
B.The length of the index finger and not the middle finger is typically considered to be the key measurement related to using a mouse when wearing a splint.
D. This is a compensatory strategy. As the entire lab uses desktop computers, the environmental modification would not be reasonable or practical for the school to pursue.
Chien-Hsiou, Liu; Shih-Chen Fan. “Ergonomic Design of a Computer Mouse for Clients with Wrist Splints”. American Journal of Occupational Therapy, May/June 2014, Vol. 68, 317-324. doi:10.5014/ajot.2014.009928
An OT is working on energy conservation with a 73-year-old male patient who has COPD. Which strategy would be the MOST effective in helping this patient conserve the most amount of energy when he washes and dries dishes at the sink?
C. Suggest he uses a dish rack to allow the dishes to drip dry.
Letting dishes drip dry and soaking them before washing them to eliminate the need to scrub them are examples of energy conservation techniques.
C. Suggest he uses a dish rack to allow the dishes to drip dry.
Letting dishes drip dry and soaking them before washing them to eliminate the need to scrub them are examples of energy conservation techniques.
Which branch of the radial nerve if entrapped, results in sensory manifestations and no motor deficits?
B. Superficial branch.
Wartenberg’s Syndrome is described as the entrapment of the superficial branch of the radial nerve with only sensory manifestations and no motor deficits. In this condition, the patient reports pain over the distal radial forearm associated with paresthesia over the dorsal radial hand. This should not be confused with Wartenberg’s Sign which refers to the slightly greater abduction of the fifth digit, due to paralysis of the abducting palmar interosseous muscle and unopposed action of the radial innervated extensor muscles.
A. The posterior interosseous nerve (deep branch) is entirely motor. Patients with posterior interosseous nerve syndrome do not present with a sensory deficit.
C. The anterior interosseous nerve (volar interosseous nerve) is a branch of the median nerve that supplies the deep muscles on the anterior of the forearm, except the ulnar (medial) half of the flexor digitorum profundus.
D. The peroneal nerve is a branch of the sciatic nerve, which supplies movement and sensation to the lower leg, foot and toes.
B. Superficial branch.
Wartenberg’s Syndrome is described as the entrapment of the superficial branch of the radial nerve with only sensory manifestations and no motor deficits. In this condition, the patient reports pain over the distal radial forearm associated with paresthesia over the dorsal radial hand. This should not be confused with Wartenberg’s Sign which refers to the slightly greater abduction of the fifth digit, due to paralysis of the abducting palmar interosseous muscle and unopposed action of the radial innervated extensor muscles.
A. The posterior interosseous nerve (deep branch) is entirely motor. Patients with posterior interosseous nerve syndrome do not present with a sensory deficit.
C. The anterior interosseous nerve (volar interosseous nerve) is a branch of the median nerve that supplies the deep muscles on the anterior of the forearm, except the ulnar (medial) half of the flexor digitorum profundus.
D. The peroneal nerve is a branch of the sciatic nerve, which supplies movement and sensation to the lower leg, foot and toes.
A patient who recently sustained a distal radius fracture has been fitted with a splint, as prescribed by the physician. Which type of movement of the non-immobilized joints of the affected upper limb is MOST likely to assist with edema reduction in the acute phase of healing?
B. Active range of motion (AROM).
AROM of all available joints while in the cast, orthosis, or external fixator is vital to edema control and to maintaining tissue length. AROM acts as a pump mobilizing edema through the lymphatic system.
Edema is a natural by-product of trauma, and the development of some edema following injury and surgery is normal and expected. However, moderate to severe swelling that persists is the silent enemy, as it will infiltrate every tissue and alter the normal gliding of joints and tendons. Over time, there can be increased collagen formation and progression from moveable edema to more fibrous protein-rich edema that ultimately turns to scar tissue.
Cooper’s Fundamentals of Hand Therapy Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity By: Christine M. Wietlisbach.
B. Active range of motion (AROM).
AROM of all available joints while in the cast, orthosis, or external fixator is vital to edema control and to maintaining tissue length. AROM acts as a pump mobilizing edema through the lymphatic system.
Edema is a natural by-product of trauma, and the development of some edema following injury and surgery is normal and expected. However, moderate to severe swelling that persists is the silent enemy, as it will infiltrate every tissue and alter the normal gliding of joints and tendons. Over time, there can be increased collagen formation and progression from moveable edema to more fibrous protein-rich edema that ultimately turns to scar tissue.
Cooper’s Fundamentals of Hand Therapy Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity By: Christine M. Wietlisbach.
An 85-year-old man who has been diagnosed with Type 2 Diabetes Mellitus and osteoarthritis is experiencing chronic pain in both his wrists and CMC joints. Symptomatically, his right dominant hand has been more affected by the arthritis and this has resulted in the patient having difficulty maintaining his grasp on objects and tools which in turn has compromised his level of hygiene and ability to participate in his woodworking hobbies. It has been determined that the patient would benefit from wearing a resting hand splint with D-ring straps at night to support his wrist and CMC joint, for pain management. What is the purpose of the D-ring straps in this scenario?
C. To improve ease of application and provide mechanical leverage.
Given pain symptoms, the patient can more easily tighten the straps by holding onto the end piece between 2 fingers (other than the thumb and index finger) and rotating the forearm to tighten the D-ring strap.
A. Cognitive function was not mentioned.
B. There are other options of straps that could decrease the weight of the splint.
D. Although edema was not a concern, it may not be expected in this case. Any strap is moveable and can accommodate fluctuating edema.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 381.
C. To improve ease of application and provide mechanical leverage.
Given pain symptoms, the patient can more easily tighten the straps by holding onto the end piece between 2 fingers (other than the thumb and index finger) and rotating the forearm to tighten the D-ring strap.
A. Cognitive function was not mentioned.
B. There are other options of straps that could decrease the weight of the splint.
D. Although edema was not a concern, it may not be expected in this case. Any strap is moveable and can accommodate fluctuating edema.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 381.
An OT is working with a 70-year-old patient who presents with right-sided weakness secondary to a CVA. The patient has intact procedural memory despite demonstrating minor cognitive deficits. The focus of the session is on encouraging active movement of the patient’s affected upper limb which currently scores at a grade 3+ (Fair plus) on the MMT, for both shoulder and elbow movements. Using a task-oriented approach, which meaningful activity would achieve the patient’s goal of increasing their affected limb’s function?
B. Brushing the fur of a large therapy dog (Greyhound) in the rehabilitation gym while seated.
Grade 3+ (Fair plus) – complete ROM against gravity and slight resistance.The goal of a task-oriented approach is to improve motor function by performing a task in an environment that utilizes common everyday objects and tools, provides opportunities to practice functional tasks, and uses the principles of training or retraining skills. Brushing the hair of the Greyhound requires full active elbow and shoulder ROM against gravity, as the patient is sitting and the dog is a large breed. Brushing the fur offers slight resistance as this breed has short hair. The task incorporates retraining motor performance with repetitive action.
A. Demands working memory with little challenge for motor performance for the upper extremity in this case. Moving the mouse is a gravity eliminated task.
C. It requires the person to lift, hold and carry a load which is more than slight resistance. Transferring a hot liquid is dangerous.
D. Does not offer any resistance to movement as the seeds are very light
Katharine Preissner; Use of the Occupational Therapy Task-Oriented Approach to Optimize the Motor Performance of a Client With Cognitive Limitations. Am J Occup Ther 2010;64(5):727-734. doi: 10.5014/ajot.2010.08026.
Israely, S., Leisman, G., & Carmeli, E. (2017). Improvement in arm and hand function after a stroke with task-oriented training. BMJ case reports, 2017, bcr2017219250. doi:10.1136/bcr-2017-219250
B. Brushing the fur of a large therapy dog (Greyhound) in the rehabilitation gym while seated.
Grade 3+ (Fair plus) – complete ROM against gravity and slight resistance.The goal of a task-oriented approach is to improve motor function by performing a task in an environment that utilizes common everyday objects and tools, provides opportunities to practice functional tasks, and uses the principles of training or retraining skills. Brushing the hair of the Greyhound requires full active elbow and shoulder ROM against gravity, as the patient is sitting and the dog is a large breed. Brushing the fur offers slight resistance as this breed has short hair. The task incorporates retraining motor performance with repetitive action.
A. Demands working memory with little challenge for motor performance for the upper extremity in this case. Moving the mouse is a gravity eliminated task.
C. It requires the person to lift, hold and carry a load which is more than slight resistance. Transferring a hot liquid is dangerous.
D. Does not offer any resistance to movement as the seeds are very light
Katharine Preissner; Use of the Occupational Therapy Task-Oriented Approach to Optimize the Motor Performance of a Client With Cognitive Limitations. Am J Occup Ther 2010;64(5):727-734. doi: 10.5014/ajot.2010.08026.
Israely, S., Leisman, G., & Carmeli, E. (2017). Improvement in arm and hand function after a stroke with task-oriented training. BMJ case reports, 2017, bcr2017219250. doi:10.1136/bcr-2017-219250
Due to structural changes in the arm muscles, an elderly patient has lost range of motion in their upper limbs. What should the goal of OT intervention be at this stage?
D. Coach on compensatory methods.In this scenario, the patient has developed restricted joint movement due to the normal aging process and the goal should therefore, be to teach the patient compensatory methods.
No matter how healthy an individual is, as they age their joints will show some changes in mobility, due in part to changes in the connective tissues. As joint range of movement has a direct effect on movement, this can result in marked alteration of function. With ageing, joint movements becomes stiffer and less flexible because the amount of synovial fluid inside the synovial joints decreases and the cartilage becomes thinner. Ligaments also tend to shorten and lose some flexibility, making joints feel stiff.
D. Coach on compensatory methods.In this scenario, the patient has developed restricted joint movement due to the normal aging process and the goal should therefore, be to teach the patient compensatory methods.
No matter how healthy an individual is, as they age their joints will show some changes in mobility, due in part to changes in the connective tissues. As joint range of movement has a direct effect on movement, this can result in marked alteration of function. With ageing, joint movements becomes stiffer and less flexible because the amount of synovial fluid inside the synovial joints decreases and the cartilage becomes thinner. Ligaments also tend to shorten and lose some flexibility, making joints feel stiff.
Jeff, a 23-year-old college athlete, recently sustained an injury to his right dominant upper limb during football practice. He was diagnosed with a brachial plexus injury, which required surgical intervention. 2 weeks post-surgery, Jeff continues to experience weakness in his right upper limb and his shoulder movements are limited, with both flexion and abduction measuring at 120º. One of Jeff’s main goals, at this stage of his recovery is to use his affected upper limb for function and to continue doing his own laundry without enlisting the help of his roommate. Which of the following tasks would be the MOST CHALLENGING for Jeff to perform?
C. Hanging his clothes in the closet.
In order to hang clothes in the closet, Jeff would be required to flex and abduct his shoulder beyond 120º.
A, B and D. These actions require movements that are within the patient’s functional capabilities.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo.: Elsevier/Mosby, pp 562-564.
C. Hanging his clothes in the closet.
In order to hang clothes in the closet, Jeff would be required to flex and abduct his shoulder beyond 120º.
A, B and D. These actions require movements that are within the patient’s functional capabilities.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo.: Elsevier/Mosby, pp 562-564.
A mother of twins appears to have developed De Quervain’s syndrome due to repeatedly lifting her children up. Which test is used to confirm this diagnosis?
A. Positive Finkelstein.
Chronic overuse of the wrist is commonly associated with de Quervain’s tenosynovitis. Although the exact cause of de Quervain’s tenosynovitis isn’t known, any activity that relies on repetitive hand or wrist movement, such as working in the garden, playing golf or racket sports, or lifting your baby, can make it worse.
Finkelstein’s test is the classic provocative test for diagnosis of De Quervain’s syndrome and is used in the diagnosis of De Quervain’s syndrome. The patient actively (or active assistive) flexes their thumb maximally and wraps their fingers over the thumb, making a fist. The patient then ulnarly deviates his/her wrist to stretch the muscles of the 1st extensor compartment. The test is positive if the patient complains of pain over the 1st extensor compartment of the wrist.
Positive result: Ask the patient if he or she feels pain radiating up the inside of his or her arm from the thumb. If the patient reports noticeable pain then, the Finkelstein’s test is positive, what indicates De Quervain’s syndrome.
Symptoms of de Quervain’s tenosynovitis include:
– Pain near the base of your thumb
– Swelling near the base of your thumb
– Difficulty moving your thumb and wrist when you’re doing something that involves grasping or pinching
– A “sticking” or “stop-and-go” sensation in your thumb when moving it
– If the condition goes too long without treatment, the pain may spread further into your thumb, back into your forearm or both. – Pinching, grasping and other movements of your thumb and wrist aggravate the pain.
A. Positive Finkelstein.
Chronic overuse of the wrist is commonly associated with de Quervain’s tenosynovitis. Although the exact cause of de Quervain’s tenosynovitis isn’t known, any activity that relies on repetitive hand or wrist movement, such as working in the garden, playing golf or racket sports, or lifting your baby, can make it worse.
Finkelstein’s test is the classic provocative test for diagnosis of De Quervain’s syndrome and is used in the diagnosis of De Quervain’s syndrome. The patient actively (or active assistive) flexes their thumb maximally and wraps their fingers over the thumb, making a fist. The patient then ulnarly deviates his/her wrist to stretch the muscles of the 1st extensor compartment. The test is positive if the patient complains of pain over the 1st extensor compartment of the wrist.
Positive result: Ask the patient if he or she feels pain radiating up the inside of his or her arm from the thumb. If the patient reports noticeable pain then, the Finkelstein’s test is positive, what indicates De Quervain’s syndrome.
Symptoms of de Quervain’s tenosynovitis include:
– Pain near the base of your thumb
– Swelling near the base of your thumb
– Difficulty moving your thumb and wrist when you’re doing something that involves grasping or pinching
– A “sticking” or “stop-and-go” sensation in your thumb when moving it
– If the condition goes too long without treatment, the pain may spread further into your thumb, back into your forearm or both. – Pinching, grasping and other movements of your thumb and wrist aggravate the pain.
Matilda, a woman in her late 70s who has RA, lives on her own in a ground-floor apartment, and has enlisted the help of a part-time caregiver. Matilda arrives for her weekly water aerobics class, which is run at the local community center, with a visible first degree burn on her non-dominant hand. When questioned about this burn, Matilda reports that she is having difficulty opening and closing her sink taps and she cannot always get the temperature right. What recommendations would be the MOST beneficial for Matilda so that washing her hands can become a safe and efficient task for her?
C. Install levered handles and a water temperature control device to prevent scalding in order to maintain constant water temperature.
Levered handles are easier to use, especially for individuals with RA, and a water temperature control device is essential to prevent and further injuries from hot water.
Rheumatoid arthritis is an autoimmune disorder that is characterized by inflammation, pain, and loss of function in the joints. It most often affects the wrist and hand, but it sometimes affects the elbows, shoulders, neck, knees, hips or ankles. Rheumatoid vasculitis is a condition which is associated with rheumatoid arthritis in which blood vessels become inflamed. Vasculitis is a serious complication of rheumatoid arthritis. Vasculitis that injures the nerves can cause loss of sensation, numbness and tingling, or potentially weakness or loss of function of the hands and/or feet.
C. Install levered handles and a water temperature control device to prevent scalding in order to maintain constant water temperature.
Levered handles are easier to use, especially for individuals with RA, and a water temperature control device is essential to prevent and further injuries from hot water.
Rheumatoid arthritis is an autoimmune disorder that is characterized by inflammation, pain, and loss of function in the joints. It most often affects the wrist and hand, but it sometimes affects the elbows, shoulders, neck, knees, hips or ankles. Rheumatoid vasculitis is a condition which is associated with rheumatoid arthritis in which blood vessels become inflamed. Vasculitis is a serious complication of rheumatoid arthritis. Vasculitis that injures the nerves can cause loss of sensation, numbness and tingling, or potentially weakness or loss of function of the hands and/or feet.
A 12-year-old boy sustained an injury to his right distal radial epiphysis from falling off a tree. The boy’s doctor has ordered physical agent modalities as a part of his occupational therapy treatment. Which modality is contraindicated for this type of injury?
A. Ultrasound. The bones of children and adults share many of the same risks for injury. But because they are still growing, a child’s bones are also subject to a unique injury called a growth plate fracture. Growth plates are areas of cartilage located near the ends of bones. Because they are the last portion of a child’s bones to harden (ossify), growth plates are particularly vulnerable to fracture. An epiphyseal injury therefore affects the growth plate of the bone. Since the patient is 12 years old, his growth plates are active and any treatments that could affect that growth should be avoided. Ultrasound which is a deep heat modality has been shown to interfere with active growth plates and the use of ultrasound over growth plates is therefore contraindicated.
A. Ultrasound. The bones of children and adults share many of the same risks for injury. But because they are still growing, a child’s bones are also subject to a unique injury called a growth plate fracture. Growth plates are areas of cartilage located near the ends of bones. Because they are the last portion of a child’s bones to harden (ossify), growth plates are particularly vulnerable to fracture. An epiphyseal injury therefore affects the growth plate of the bone. Since the patient is 12 years old, his growth plates are active and any treatments that could affect that growth should be avoided. Ultrasound which is a deep heat modality has been shown to interfere with active growth plates and the use of ultrasound over growth plates is therefore contraindicated.
What is the MOST objective tool that can be used to measure a patient’s edema?
C. Volumeter.
A volumeter uses water displacement to measure edema in an extremity. To measure, the volumeter is filled up to a predetermined level and the patient immerses the affected extremity to the level directed by the OT practitioner. The amount of water displaced is recorded. The process is repeated as the patient’s edema decreases to record progress. Volumeter measurement is more objective than measuring edema with a tape measure because the procedures for volumeter measurement are more standardized and there is less chance for error than tape measurements.
C. Volumeter.
A volumeter uses water displacement to measure edema in an extremity. To measure, the volumeter is filled up to a predetermined level and the patient immerses the affected extremity to the level directed by the OT practitioner. The amount of water displaced is recorded. The process is repeated as the patient’s edema decreases to record progress. Volumeter measurement is more objective than measuring edema with a tape measure because the procedures for volumeter measurement are more standardized and there is less chance for error than tape measurements.
Karen, a 70-year-old woman who is a retired secretary, recently sprained her left (non-dominant) wrist while lifting a heavy object. As a result, she requires an immobilization splint to support her wrist to promote healing and for pain management. Karen is an avid gardener who has expressed her desire to continue working in her garden. She has agreed to learn 1-handed techniques with her dominant hand, while her wrist heals, and will only use her left hand for light stabilization, for bilateral activities. What type of splint is the MOST appropriate to address Karen’s needs during the acute stage of healing?
B. A volar wrist immobilization splint with forearm trough and an MP and hypothenar bar with the wrist positioned in neutral. A wrist sprain is caused by a tear in a ligament which requires the wrist to remain in a static position for healing. It is important to avoid extreme wrist extension or flexion as it will interfere with the normal functional position of the hand. This splint will enhance digital function and minimize tension on involved structures while the hand rests and heals.
A. This is more appropriate for a peripheral radial nerve lesion to facilitate mobilization of wrist extension in 30 degrees and MCPs in dynamic extension.
C. Although a wrist cock-up splint provides the greatest functional wrist position, it is more appropriate to maximize passive extension which the patient can tolerate in conditions such as wrist fractures, radial nerve palsy, tendinitis, median nerve compression and CRPS. However, in acute stage where pain and inflammation is present, a neutral position is advised.
D. This is more appropriate for a median peripheral nerve lesion.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, pp 145-188.
B. A volar wrist immobilization splint with forearm trough and an MP and hypothenar bar with the wrist positioned in neutral. A wrist sprain is caused by a tear in a ligament which requires the wrist to remain in a static position for healing. It is important to avoid extreme wrist extension or flexion as it will interfere with the normal functional position of the hand. This splint will enhance digital function and minimize tension on involved structures while the hand rests and heals.
A. This is more appropriate for a peripheral radial nerve lesion to facilitate mobilization of wrist extension in 30 degrees and MCPs in dynamic extension.
C. Although a wrist cock-up splint provides the greatest functional wrist position, it is more appropriate to maximize passive extension which the patient can tolerate in conditions such as wrist fractures, radial nerve palsy, tendinitis, median nerve compression and CRPS. However, in acute stage where pain and inflammation is present, a neutral position is advised.
D. This is more appropriate for a median peripheral nerve lesion.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, pp 145-188.
A 32-year-old ballet instructor who recently sustained a left proximal humeral fracture which required surgical intervention, has been referred to OT. The surgeon’s orders for treating the patient’s left upper limb include no weight bearing on that arm, maintaining full AROM of the wrist and fingers and extension/flexion of the elbow as tolerated, with supervision from the therapist. The OTR® is currently working with the patient on dressing and is instructing her on how to correctly don her elastic waist pants. The OTR® has already established that the patient has good trunk control and normal upper extremity strength of her unaffected arm. After carefully assisting the patient with doffing her sling, what sequence of dressing would be the MOST effective for the patient to follow, to help her learn to dress independently while adhering to the doctor’s instructions?
B. With right hand, open waist cuff, thread over feet in figure-4, pull to thighs, stand and manage pants over hips while left hand stabilizes waist band.
Proximal humeral fracture most likely occurred at the surgical neck of the upper arm limiting shoulder movements during the initial healing phase. The patient has good trunk control and is able to use her left hand with supervised movement of her left elbow as long as the patient supports her forearm against her body. This would allow her to stabilize the pants with her left hand while she pushes to stand with her right hand and complete dressing. Given her profession, it is likely her balance is within functional range.
A. Bending over would increase the chance of weight-bearing with her LUE which is contraindicated at this time.
C. Managing the reacher with her operated upper extremity would increase the chance of shoulder movement which is contraindicated at this stage of rehabilitation for a proximal humeral fracture.
D. The patient has optimal trunk control with no indication of balance deficits and is able to perform lower body dressing in a seated, unsupported position.
https://passtheot.com/hand-upper-extremity-worksheet/
http://bostonshoulderinstitute.com/wp-content/uploads/2017/03/Post-Fracture-Proximal-Humerus-Rehab-Guidelines.pdf
B. With right hand, open waist cuff, thread over feet in figure-4, pull to thighs, stand and manage pants over hips while left hand stabilizes waist band.
Proximal humeral fracture most likely occurred at the surgical neck of the upper arm limiting shoulder movements during the initial healing phase. The patient has good trunk control and is able to use her left hand with supervised movement of her left elbow as long as the patient supports her forearm against her body. This would allow her to stabilize the pants with her left hand while she pushes to stand with her right hand and complete dressing. Given her profession, it is likely her balance is within functional range.
A. Bending over would increase the chance of weight-bearing with her LUE which is contraindicated at this time.
C. Managing the reacher with her operated upper extremity would increase the chance of shoulder movement which is contraindicated at this stage of rehabilitation for a proximal humeral fracture.
D. The patient has optimal trunk control with no indication of balance deficits and is able to perform lower body dressing in a seated, unsupported position.
https://passtheot.com/hand-upper-extremity-worksheet/
http://bostonshoulderinstitute.com/wp-content/uploads/2017/03/Post-Fracture-Proximal-Humerus-Rehab-Guidelines.pdf
When treating a patient who recently suffered a CVA, which physical agent modality (PAM) would cause the patient’s muscles to contract, thus strengthening the muscles which have become flaccid due to the CVA?
C. NMES.
NMES is a safe, low-frequency current that excites the nerves that innervate desired muscles, causing contractions, blocks pain pathways & reduces swelling and edema. NMES strengthens muscles in a different way than active muscle movements. Often NMES is positioned based on the angle of pull, from the origin to the insertion along the bulk of the muscle fibres.
A. TENS is typically applied over a surrounding area of pain (i.e., more client-specific).
C. NMES.
NMES is a safe, low-frequency current that excites the nerves that innervate desired muscles, causing contractions, blocks pain pathways & reduces swelling and edema. NMES strengthens muscles in a different way than active muscle movements. Often NMES is positioned based on the angle of pull, from the origin to the insertion along the bulk of the muscle fibres.
A. TENS is typically applied over a surrounding area of pain (i.e., more client-specific).
Barbara is a 68-year old retired professional baker who has been diagnosed with RA. Recently, Barbara has started to develop severe anxiety associated with her having to deal with her progressive RA symptoms. To help her cope with her diagnosis and limitations, Barbara recently joined a support group. During a group session, the OTR® observes Barbara becoming increasingly anxious and distracted by her thoughts. How should the OTR® react in this scenario?
B. Acknowledge her concerns and redirect her onto a neutral topic.
It is important for a patient with anxiety to express her concerns, confront her fears, and release stress. The clinician’s role in maintaining a therapeutic relationship is by allowing patients to come to terms with their conditions, manage their symptoms, and carry on with their meaningful tasks by gradually turning their attention to a more constructive topic.
A. The problem which is related to her anxiety is occurring at this time and should be addressed straight away.
C. The focus of action should be on gradual redirection, not encouraging discussion regarding physical symptoms.
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, pp 290-291.
B. Acknowledge her concerns and redirect her onto a neutral topic.
It is important for a patient with anxiety to express her concerns, confront her fears, and release stress. The clinician’s role in maintaining a therapeutic relationship is by allowing patients to come to terms with their conditions, manage their symptoms, and carry on with their meaningful tasks by gradually turning their attention to a more constructive topic.
A. The problem which is related to her anxiety is occurring at this time and should be addressed straight away.
C. The focus of action should be on gradual redirection, not encouraging discussion regarding physical symptoms.
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, pp 290-291.
An inpatient with COPD has been referred to OT for intervention. The patient is currently on supplemental oxygen and their vitals are being monitored. During an OT session, while working on upper body dressing, the OT practitioner notices that the patient’s oxygen saturation levels are dropping. What is the BEST method the OT practitioner can use at this time to help the patient improve their oxygen saturation levels?
D. Instruct the patient to inhale deeply through their nose and to slowly exhale through pursed lips.
Pursed-lip breathing (PLB) is thought to prevent tightness in the airway by providing resistance to expiration. This technique has been shown to increase use of the diaphragm and decrease accessory muscle recruitment.
1. Purse the lips as if to whistle.
2. Slowly exhale through pursed lips. Some resistance should be felt.
3. Inhale deeply through the nose.
4. It should take twice as long to exhale as it does to inhale.
A. Patients in respiratory distress typically need to sit up or lean over by resting their arms on their legs to enhance lung expansion. Patients who have dyspnea will not tolerate lying flat in bed.
B. An order to use oxygen therapy or to increase the oxygen dose during exertion should only be requested by the physician.
D. Instruct the patient to inhale deeply through their nose and to slowly exhale through pursed lips.
Pursed-lip breathing (PLB) is thought to prevent tightness in the airway by providing resistance to expiration. This technique has been shown to increase use of the diaphragm and decrease accessory muscle recruitment.
1. Purse the lips as if to whistle.
2. Slowly exhale through pursed lips. Some resistance should be felt.
3. Inhale deeply through the nose.
4. It should take twice as long to exhale as it does to inhale.
A. Patients in respiratory distress typically need to sit up or lean over by resting their arms on their legs to enhance lung expansion. Patients who have dyspnea will not tolerate lying flat in bed.
B. An order to use oxygen therapy or to increase the oxygen dose during exertion should only be requested by the physician.
During an assessment a patient with heart disease states that he is under an extreme amount of pressure since he lost his job and the bank is about to take away his home. Which would be the most important aspect to assess in regards to controllable risk factors?
C. Types of activities used to reduce stress. Controllable risk factors include lifestyle influences such as foods, exercise, stress level and methods used to control stress. Medications and prior medical history are non-controllable risk factors. Since this patient’s primary problem appears to be stress, it would be most important to find out what the patient already does to control stress, if anything. Although types of exercises could be relevant in reducing stress, it is not immediately assumed in this case and thus is not the best answer.
C. Types of activities used to reduce stress. Controllable risk factors include lifestyle influences such as foods, exercise, stress level and methods used to control stress. Medications and prior medical history are non-controllable risk factors. Since this patient’s primary problem appears to be stress, it would be most important to find out what the patient already does to control stress, if anything. Although types of exercises could be relevant in reducing stress, it is not immediately assumed in this case and thus is not the best answer.
An OTR® is working with Emily, a 65-year-old woman with COPD, in an outpatient setting. The focus of the session is on teaching Emily how to manage her disease, including adopting appropriate coping strategies. Emily identifies that shopping for groceries typically causes her to experience dyspnea. What is the BEST strategy for Emily to use in this type of situation?
D. To prevent the trolley from rolling forward, push it against a wall. Remain standing, lean forward from your hips and rest your forearms on the supermarket trolley.
Dyspnea Control Postures:
Adopting certain postures can reduce breathlessness. In a seated position, the patient bends forward slightly at the waist while supporting the upper part of the body by leaning the forearms on a table or the thighs. In a standing position, relief may be obtained by leaning forward and propping oneself on a counter or shopping cart.
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 1207).
D. To prevent the trolley from rolling forward, push it against a wall. Remain standing, lean forward from your hips and rest your forearms on the supermarket trolley.
Dyspnea Control Postures:
Adopting certain postures can reduce breathlessness. In a seated position, the patient bends forward slightly at the waist while supporting the upper part of the body by leaning the forearms on a table or the thighs. In a standing position, relief may be obtained by leaning forward and propping oneself on a counter or shopping cart.
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 1207).
A 55-year old housewife and mother of 4 adolescent children has COPD. She reports fatigue and a Borg rating of 3/10 (on the modified Borg Scale) for moderate breathlessness which interferes with her ability to complete morning routines. She has a goal for improving endurance to make breakfast for her children before they leave for school. Which techniques would be beneficial to teach the client to use for supporting this goal? Choose the best 3 answer choices
A, B and D are the best techniques.
A. Pursed lip breathing decreases hyperinflation of the lungs which enables the patient to breathe in more oxygen and reduces dyspnea on exertion.
B. Positioning techniques such as leaning slightly forwards, elevating the head of the bed, and sleeping propped up on pillows reduces dyspnea with rest.
D. Diaphragmatic breathing incorporates inhaling with pushing or contracting the abdomen while keeping the shoulders relaxed.
C) Myofascial release is a manual therapy technique to improve muscle mobility and reduce pain. E) is a method of measuring a person’s perception of pain. F) Accessory muscle use is indicated when a person has trouble moving air out of their lungs normally; this is a compensatory method for poor respiratory function.
Causey, R. (2013). Breathing Easier: Pulmonary Rehabilitation in Skilled Nursing Facilities. OT Practice 18(21), 13–17. http://dx.doi.org/10.7138/otp.2013.1821f2
A, B and D are the best techniques.
A. Pursed lip breathing decreases hyperinflation of the lungs which enables the patient to breathe in more oxygen and reduces dyspnea on exertion.
B. Positioning techniques such as leaning slightly forwards, elevating the head of the bed, and sleeping propped up on pillows reduces dyspnea with rest.
D. Diaphragmatic breathing incorporates inhaling with pushing or contracting the abdomen while keeping the shoulders relaxed.
C) Myofascial release is a manual therapy technique to improve muscle mobility and reduce pain. E) is a method of measuring a person’s perception of pain. F) Accessory muscle use is indicated when a person has trouble moving air out of their lungs normally; this is a compensatory method for poor respiratory function.
Causey, R. (2013). Breathing Easier: Pulmonary Rehabilitation in Skilled Nursing Facilities. OT Practice 18(21), 13–17. http://dx.doi.org/10.7138/otp.2013.1821f2
Andy is a 34-year-old man who recently sustained a laceration across the palm of his hand which required surgical intervention. The surgeon has referred Andy to OT to initiate active finger exercises to maintain his ROM. Which tendon gliding exercise would be the BEST to use at this stage of his recovery to ensure Andy’s AROM is maintained while his hand heals?
C. Start with the fingers straight, keep the PIP joints straight while flexing the MCP joints, then flex the PIP joints. This exercise is an example of a tendon gliding exercise. It is designed to keep the tendons from adhering to the scar tissue that forms around the laceration site, ensuring that the tendons glide smoothly during motion and maintaining Andy’s ability to move his fingers.
C. Start with the fingers straight, keep the PIP joints straight while flexing the MCP joints, then flex the PIP joints. This exercise is an example of a tendon gliding exercise. It is designed to keep the tendons from adhering to the scar tissue that forms around the laceration site, ensuring that the tendons glide smoothly during motion and maintaining Andy’s ability to move his fingers.
A patient who has been diagnosed with muscular dystrophy exhibits a trace contraction on the manual muscle test (MMT). What type of active range of motion (AROM) can you expect this patient to demonstrate based on their muscle strength?
A. No active range of motion.
Trace contraction can be observed or felt, but there is no motion. Trace is defined as a visible or palpable contraction. This contraction is not strong enough to move a limb, therefore no AROM is present.
A. No active range of motion.
Trace contraction can be observed or felt, but there is no motion. Trace is defined as a visible or palpable contraction. This contraction is not strong enough to move a limb, therefore no AROM is present.
When are cardiac patients usually ready to be discharged to phase 2 of their cardiac rehab?
C. When the patient is able to tolerate an activity level of 3.5 MET.
Phase 2 for cardiac patients is in outpatient rehab and begins 12 weeks post cardiac event. This phase begins when a patient is able to tolerate an activity level at 3.5 MET. It is completed through outpatient rehabilitation and can last up to 12 to 18 weeks after the patient’s initial cardiac event.
C. When the patient is able to tolerate an activity level of 3.5 MET.
Phase 2 for cardiac patients is in outpatient rehab and begins 12 weeks post cardiac event. This phase begins when a patient is able to tolerate an activity level at 3.5 MET. It is completed through outpatient rehabilitation and can last up to 12 to 18 weeks after the patient’s initial cardiac event.
A 67-year-old male was recently admitted to the hospital for coronary artery disease. What are the most important factors to assess when working with this patient?
A. Assess the individual’s lifestyle and dietary habits
Controllable risk factors of heart disease include smoking, high lipids, high cholesterol, hypertension, obesity, diabetes, mental stress, and lack of exercise.
A. Assess the individual’s lifestyle and dietary habits
Controllable risk factors of heart disease include smoking, high lipids, high cholesterol, hypertension, obesity, diabetes, mental stress, and lack of exercise.
An 82-year-old male patient who has been diagnosed with CHF, is consulting with an OT as he is having difficulty retrieving his wallet from the back pocket of his jeans, using his right dominant hand. As part of his evaluation, the OT asks the patient to perform the movement, which he does but with great effort. The OT then uses a goniometer to measure the patient’s shoulder movements. The OT reads a measurement of 68 degrees for internal rotation. How should the OT document this findings?
D. Normal range is 70-90 degrees, and his ROM is slightly below the limits but expected for his age and remains a functional movement.
This question is specifically asking about interpreting the results of the goniometer measurement. As the reading is within the functional range for the patient’s age, further investigation needs to be done as to why the patient is having difficulty retrieving his wallet from the back pocket of his jeans. Further assessments could include: Assessing muscle strength, looking at the quality of the movement to see if the patient is using any compensatory movements, knowing if the patient experiences pain when performing this movement, knowing if there are any underlying arthritic factors.
Internal rotation of shoulder:
Normal ROM: 70-90 degrees
Testing position: Patient supine with the shoulder abducted to 90 degrees and the forearm is in neutral position
Axis: Olecranon process of the ulna
Fixed Arm: Perpendicular to the floor (vertical)
Movable Arm: Along shaft of ulna
No matter how healthy an individual is, as they age their joints will show some changes in mobility, due in part to changes in the connective tissues. As joint range of movement has a direct effect on posture and movement, this can result in marked alteration of function. Joint range of movement (ROM) decreases with increasing age; passive and active ROM both decrease, but often within a single joint the active ROM reduces more than the passive ROM.
https://www.healthline.com/health/shoulder-range-of-motion#3
https://www.physio-pedia.com/Effects_of_Aging_on_Joints
D. Normal range is 70-90 degrees, and his ROM is slightly below the limits but expected for his age and remains a functional movement.
This question is specifically asking about interpreting the results of the goniometer measurement. As the reading is within the functional range for the patient’s age, further investigation needs to be done as to why the patient is having difficulty retrieving his wallet from the back pocket of his jeans. Further assessments could include: Assessing muscle strength, looking at the quality of the movement to see if the patient is using any compensatory movements, knowing if the patient experiences pain when performing this movement, knowing if there are any underlying arthritic factors.
Internal rotation of shoulder:
Normal ROM: 70-90 degrees
Testing position: Patient supine with the shoulder abducted to 90 degrees and the forearm is in neutral position
Axis: Olecranon process of the ulna
Fixed Arm: Perpendicular to the floor (vertical)
Movable Arm: Along shaft of ulna
No matter how healthy an individual is, as they age their joints will show some changes in mobility, due in part to changes in the connective tissues. As joint range of movement has a direct effect on posture and movement, this can result in marked alteration of function. Joint range of movement (ROM) decreases with increasing age; passive and active ROM both decrease, but often within a single joint the active ROM reduces more than the passive ROM.
https://www.healthline.com/health/shoulder-range-of-motion#3
https://www.physio-pedia.com/Effects_of_Aging_on_Joints
What is the typical presentation of a Boutonniere deformity?
A. PIP joint appears flexed and the DIP joint appears hyperextended.
A Boutonniere deformity describes a medical condition in which the finger is flexed at the proximal interphalangeal joint (PIP) and hyperextended at the distal interphalangeal joint (DIP). This is usually a result of trauma and is caused by a rupture of the PIP central slip. This results in damage to the extensor function of the affected digit.
A. PIP joint appears flexed and the DIP joint appears hyperextended.
A Boutonniere deformity describes a medical condition in which the finger is flexed at the proximal interphalangeal joint (PIP) and hyperextended at the distal interphalangeal joint (DIP). This is usually a result of trauma and is caused by a rupture of the PIP central slip. This results in damage to the extensor function of the affected digit.
Jim, a 57-year-old landscape architect who sustained a distal radius wrist fracture 3-weeks ago, is reporting feeling pain in his hand that is burning and stinging, and his hand is becoming warm, red, and swollen. He has also started to notice that he has an increased sensitivity to painful stimuli and moving his wrist is becoming limited as it feels stiff. What is the MOST likely reason Jim is experiencing these symptoms?
A. Complex regional pain syndrome.
Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, fracture or surgery. The most common and prominent symptom of CRPS is the pain that affected individuals will feel. The pain is often deep inside the limbs with a burning, stinging, or tearing sensation. Sensory changes are also common, and may include increased sensitivity to painful stimuli, feeling pain from stimuli that are usually non-painful, and in some instances, sensory loss (e.g., numbness). In addition to pain, patients commonly experience an affected extremity that is warm, red, and swollen, at least initially. In many patients, as CRPS continues, the affected extremity may more often feel cool with dark or bluish skin. Swelling, resulting from fluid build-up in the limb (edema), can be present regardless of the color and temperature of the skin, but is typically more prominent with the early clinical picture (red and warm skin). Skin color and temperature may sometimes change even over short periods of time inconsistently. In addition to the changes above, CRPS patients may experience skin that becomes thin and shiny, and may experience either increased or decreased hair and nail growth in the affected extremity. Most patients will experience motor impairment, which is the decrease in the ability to use the limbs for movement, with weakness or limited range of motion being the most common impairments. Some patients may develop spasms or even uncontrollable muscle contractions (dystonia).
https://rarediseases.org/rare-diseases/reflex-sympathetic-dystrophy-syndrome/
A. Complex regional pain syndrome.
Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, fracture or surgery. The most common and prominent symptom of CRPS is the pain that affected individuals will feel. The pain is often deep inside the limbs with a burning, stinging, or tearing sensation. Sensory changes are also common, and may include increased sensitivity to painful stimuli, feeling pain from stimuli that are usually non-painful, and in some instances, sensory loss (e.g., numbness). In addition to pain, patients commonly experience an affected extremity that is warm, red, and swollen, at least initially. In many patients, as CRPS continues, the affected extremity may more often feel cool with dark or bluish skin. Swelling, resulting from fluid build-up in the limb (edema), can be present regardless of the color and temperature of the skin, but is typically more prominent with the early clinical picture (red and warm skin). Skin color and temperature may sometimes change even over short periods of time inconsistently. In addition to the changes above, CRPS patients may experience skin that becomes thin and shiny, and may experience either increased or decreased hair and nail growth in the affected extremity. Most patients will experience motor impairment, which is the decrease in the ability to use the limbs for movement, with weakness or limited range of motion being the most common impairments. Some patients may develop spasms or even uncontrollable muscle contractions (dystonia).
https://rarediseases.org/rare-diseases/reflex-sympathetic-dystrophy-syndrome/
When a patient who has been diagnosed with RA, is experiencing a flare-up, what aspect of OT intervention is contraindicated?
C. Active stretching.
Rheumatoid arthritis is a chronic disease characterized by periods of disease flares and remissions.
Rest and energy conservation can be helpful for locally inflamed joints but should be avoided long-term due to the potential side effects. A structured exercise program can be greatly beneficial to the overall well-being and functioning of the individual with rheumatoid arthritis. Such a program should focus on stretching, strengthening and aerobic conditioning while conserving energy. Acutely, inflamed joints should be rested to prevent exacerbation of symptoms. For non-inflamed joints, active or active-assisted stretching of all major joints is essential to prevent contracture formation and maintain the current range of motion to perform most activities of daily living.
C. Active stretching.
Rheumatoid arthritis is a chronic disease characterized by periods of disease flares and remissions.
Rest and energy conservation can be helpful for locally inflamed joints but should be avoided long-term due to the potential side effects. A structured exercise program can be greatly beneficial to the overall well-being and functioning of the individual with rheumatoid arthritis. Such a program should focus on stretching, strengthening and aerobic conditioning while conserving energy. Acutely, inflamed joints should be rested to prevent exacerbation of symptoms. For non-inflamed joints, active or active-assisted stretching of all major joints is essential to prevent contracture formation and maintain the current range of motion to perform most activities of daily living.
When working with a patient who has been diagnosed with complex regional pain syndrome, what aspect of OT intervention should the therapist focus on initially?
C. Pain.
Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) usually after an injury. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord; the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body. CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and/or swelling in the affected area. As the key symptom is prolonged severe pain that may be constant, it is important to address pain and pain management first with the patient.
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet
C. Pain.
Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) usually after an injury. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord; the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body. CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and/or swelling in the affected area. As the key symptom is prolonged severe pain that may be constant, it is important to address pain and pain management first with the patient.
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet
A 45-year-old patient who has a history of breast cancer has been referred for OT intervention. The OT who is performing the initial evaluation observes that the patient has significant lymphedema in her left upper extremity. The OT would like to accurately measure the patient’s lymphedema in order to form a baseline and monitor progress in response to a newly developed lymphedema program. Which method would be the most objective to attain precise measurements?
C. Using a Volumeter
Cancer and its treatment are risk factors for lymphedema.
Lymphedema can occur after any cancer or treatment that affects the flow of lymph through the lymph nodes, such as removal of lymph nodes. It may develop within days or many years after treatment. Most lymphedema develops within three years of surgery.
The accurate evaluation of upper limb volume is crucial for an early diagnosis of lymphedema and also for monitoring treatment. Water displacement methods are commonly used to measure upper limb swelling and is considered the gold standard for evaluating limb lymphedema.
C. Using a Volumeter
Cancer and its treatment are risk factors for lymphedema.
Lymphedema can occur after any cancer or treatment that affects the flow of lymph through the lymph nodes, such as removal of lymph nodes. It may develop within days or many years after treatment. Most lymphedema develops within three years of surgery.
The accurate evaluation of upper limb volume is crucial for an early diagnosis of lymphedema and also for monitoring treatment. Water displacement methods are commonly used to measure upper limb swelling and is considered the gold standard for evaluating limb lymphedema.
Name the type of exercise that uses the force generated by the contraction in which there is no joint movement and minimal change in its muscle length.
B. Isometric.
During isometric exercises, the muscle doesn’t noticeably change length and the affected joint doesn’t move.
Isometric contractions are contractions that generate force without altering the length of the muscle. These muscles are common in body parts that are responsible for grips, such as your hands and forearms. These muscles are also prominent in maintaining posture. You experience isometric contractions when you are trying to lift items that are too heavy for you, leading to the object not being lifted. In this case, the maximum force a muscle can generate has been reached. In contrast, isotonic contractions do involve shortening. Force is generated by isotonic contractions by the change of length of muscles. These isotonic contractions can either be eccentric (the muscle lengthens) or concentric (the muscle shortens). With isotonic contractions, you are able to lift the object that you are attempting to lift, unlike isometric contractions.
1. Isometric: A muscular contraction in which the length of the muscle does not change.
2. Isotonic: A muscular contraction in which the length of the muscle changes.
• Eccentric: An isotonic contraction where the muscle lengthens.
• Concentric: An isotonic contraction where the muscle shortens.
B. Isometric.
During isometric exercises, the muscle doesn’t noticeably change length and the affected joint doesn’t move.
Isometric contractions are contractions that generate force without altering the length of the muscle. These muscles are common in body parts that are responsible for grips, such as your hands and forearms. These muscles are also prominent in maintaining posture. You experience isometric contractions when you are trying to lift items that are too heavy for you, leading to the object not being lifted. In this case, the maximum force a muscle can generate has been reached. In contrast, isotonic contractions do involve shortening. Force is generated by isotonic contractions by the change of length of muscles. These isotonic contractions can either be eccentric (the muscle lengthens) or concentric (the muscle shortens). With isotonic contractions, you are able to lift the object that you are attempting to lift, unlike isometric contractions.
1. Isometric: A muscular contraction in which the length of the muscle does not change.
2. Isotonic: A muscular contraction in which the length of the muscle changes.
• Eccentric: An isotonic contraction where the muscle lengthens.
• Concentric: An isotonic contraction where the muscle shortens.
A patient recovering from a MI in the cardiac unit is eager to start an exercise program. He is currently only permitted to participate in exercises which expend 1.0 to 1.4 MET. What would you advise this patient in terms of what exercise is safe for him to perform?
D. Active exercise to all extremities in supine.
Stage. Exercise 1-1.4 MET
Supine: Active exercise to all extremities (10-15 x/extremity)
Sitting: AROM to only neck and LE
A. Active exercise to all extremities in sitting position.
This is relevant for stage 2 (1.4 – 2.0 MET)
In sitting – May exercise all extremities but NO ISOMETRICS or strengthening exercises are allowed. AROM to all extremities, progressively increasing number of repetitions.
B. Active exercise to all extremities in standing position.
At stage 3 ( 2.0 – 3.0 MET) – Standing: AROM exercises to all extremities, progressively increasing number of reps.
C. Balance and mat activities with mild resistance.
At stage 3 ( 2.0 – 3.0 MET) – May include: balance exercises, light mat work with no resistance
D. Active exercise to all extremities in supine.
Stage. Exercise 1-1.4 MET
Supine: Active exercise to all extremities (10-15 x/extremity)
Sitting: AROM to only neck and LE
A. Active exercise to all extremities in sitting position.
This is relevant for stage 2 (1.4 – 2.0 MET)
In sitting – May exercise all extremities but NO ISOMETRICS or strengthening exercises are allowed. AROM to all extremities, progressively increasing number of repetitions.
B. Active exercise to all extremities in standing position.
At stage 3 ( 2.0 – 3.0 MET) – Standing: AROM exercises to all extremities, progressively increasing number of reps.
C. Balance and mat activities with mild resistance.
At stage 3 ( 2.0 – 3.0 MET) – May include: balance exercises, light mat work with no resistance
A patient has advanced to the second stage (1.4 to 2.0 MET) of her cardiac rehab and she is very keen to participate in a leisure activity. What activity can the OT recommend to this patient while she is at this stage of her recovery?
B. Knitting.
Stage 2 (1.4 – 2.0 MET)
For Recreational activities, patient permitted to:
In sitting: crafts (painting, knitting, sewing, mosaics, embroidery)
NO ISOMETRICS
A. Golf – Leisure activity appropriate at stage 4 (3.0 – 3.5 MET)
C. Driving – Leisure activity appropriate at stage 4 (3.0 – 3.5 MET)
D. Dancing – Slow dancing appropriate at stage 6 (4.0 and above MET)
B. Knitting.
Stage 2 (1.4 – 2.0 MET)
For Recreational activities, patient permitted to:
In sitting: crafts (painting, knitting, sewing, mosaics, embroidery)
NO ISOMETRICS
A. Golf – Leisure activity appropriate at stage 4 (3.0 – 3.5 MET)
C. Driving – Leisure activity appropriate at stage 4 (3.0 – 3.5 MET)
D. Dancing – Slow dancing appropriate at stage 6 (4.0 and above MET)
What is the BEST recommendation an OT practitioner can make to a patient who has COPD and needs to conserve their energy when performing a bathing ADL?
A. Recommend a shower chair and a terry bath robe.
Showering expends less energy, especially if seated. Bathing is strenuous because the hot, humid air makes breaking difficult.
B. This would be recommended for a patient who is at risk for falling.
C. A reacher is usually recommended for a patient who has limited reach.
D. Proper body mechanics is typically for back injuries
A. Recommend a shower chair and a terry bath robe.
Showering expends less energy, especially if seated. Bathing is strenuous because the hot, humid air makes breaking difficult.
B. This would be recommended for a patient who is at risk for falling.
C. A reacher is usually recommended for a patient who has limited reach.
D. Proper body mechanics is typically for back injuries
If a patient tests positive for Froment’s sign, what nerve injury might they have?
C. Ulnar nerve palsy.
Positive Froment’s sign: Froment’s sign tests for the action of adductor pollicis, which is weak with ulnar nerve palsy. With ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure, causing a pinching effect.
C. Ulnar nerve palsy.
Positive Froment’s sign: Froment’s sign tests for the action of adductor pollicis, which is weak with ulnar nerve palsy. With ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure, causing a pinching effect.
What type of shoulder range of motion is being demonstrated when an OT asks the patient to place their hand behind their back and instructs them to reach as high up their spine as possible, and observes the extent of their reach in relation to the scapula and/or thoracic spine?
A. Adduction and internal rotation.
The patient should be able to reach the lower border of the scapula (~ T 7 level). This combination of movement is important for independence in ADL. It allows one to tuck in the back of their shirt, wash their mid-back and fasten/undo a bra strap etc.
A. Adduction and internal rotation.
The patient should be able to reach the lower border of the scapula (~ T 7 level). This combination of movement is important for independence in ADL. It allows one to tuck in the back of their shirt, wash their mid-back and fasten/undo a bra strap etc.
An OT is treating a patient who recently fractured his humerus while playing football. The patient is being treated conservatively and is currently wearing a cast. In this scenario, what is the BEST treatment intervention for this patient at this stage of the healing process?
B. AROM of uninvolved joints.
Immobilization such as wearing a cast can result in tissue shortening. Stretching the tissue around the immobilized joint helps to maintain ROM which will help the patient regain function.
C. The restorative approach forms part of the biomechanical frame of reference which places emphasis on restoring previous function via participation in activity. The restorative approach can only be initiated once the cast has been removed.
B. AROM of uninvolved joints.
Immobilization such as wearing a cast can result in tissue shortening. Stretching the tissue around the immobilized joint helps to maintain ROM which will help the patient regain function.
C. The restorative approach forms part of the biomechanical frame of reference which places emphasis on restoring previous function via participation in activity. The restorative approach can only be initiated once the cast has been removed.
Asking a patient with a suspected peripheral neuropathy to make an “O.K.” sign is used as a quick screening to assess which nerve?
C. Median.
There are three entrapment syndromes involving the median nerve or its branches:
1. Carpal Tunnel Syndrome
2. Anterior Interosseous Syndrome
3. Pronator Teres Syndrome
Anterior Interosseous Syndrome (AINS) is a pure motor neuropathy, as the anterior interosseous nerve contains no sensory fibers; dull forearm pain is however sometimes mentioned by patients. Typically, patients fail to make an “O.K.”-sign, as flexion of the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger, is impaired. Another sensitive test is the pinch test: a patient with AINS will also not be able to pinch a sheet of paper between his thumb and index finger, instead of clamping the sheet between his extended thumb and index fingers.
A. Ulnar nerve use the “peace sign”.
B. Radial nerve use “thumbs up”/”hitchhiker”.
D. The peroneal nerve is a branch of the sciatic nerve, which supplies movement and sensation to the lower leg, foot and toes.
Module 3. NEUROPATHIES. https://passtheot.com/neuropathies/
C. Median.
There are three entrapment syndromes involving the median nerve or its branches:
1. Carpal Tunnel Syndrome
2. Anterior Interosseous Syndrome
3. Pronator Teres Syndrome
Anterior Interosseous Syndrome (AINS) is a pure motor neuropathy, as the anterior interosseous nerve contains no sensory fibers; dull forearm pain is however sometimes mentioned by patients. Typically, patients fail to make an “O.K.”-sign, as flexion of the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger, is impaired. Another sensitive test is the pinch test: a patient with AINS will also not be able to pinch a sheet of paper between his thumb and index finger, instead of clamping the sheet between his extended thumb and index fingers.
A. Ulnar nerve use the “peace sign”.
B. Radial nerve use “thumbs up”/”hitchhiker”.
D. The peroneal nerve is a branch of the sciatic nerve, which supplies movement and sensation to the lower leg, foot and toes.
Module 3. NEUROPATHIES. https://passtheot.com/neuropathies/
A patient has flaccidity in the right upper extremity and the OT would like to use a physical agent modality to activate the patient’s muscles. Which physical agent modality would be best to use?
A. NMES. NMES is used to contract muscles and also help with pain relief.Neuromuscular Electrical Stimulation or NMES uses a device that sends electrical impulses to nerves. This input causes muscles to contract. The electrical stimulation can increase strength and range of motion and offset the effects of disuse. It is often used to “re-train” or “re-educate” a muscle to function and to build strength.
A. NMES. NMES is used to contract muscles and also help with pain relief.Neuromuscular Electrical Stimulation or NMES uses a device that sends electrical impulses to nerves. This input causes muscles to contract. The electrical stimulation can increase strength and range of motion and offset the effects of disuse. It is often used to “re-train” or “re-educate” a muscle to function and to build strength.
A patient comes into a hand clinic for an initial evaluation. The patient complains of tingling on the medial side of her right forearm and reports that gripping objects with her right hand is becoming progressively weaker. What should the OT do NEXT as a part of the evaluation?
C. Tap along the medial epicondyle of the humerus.
Cubital tunnel syndrome (CBTS) is a peripheral nerve compression syndrome. It is a progressive entrapment neuropathy of the ulnar nerve at the medial aspect of the elbow (irritation or injury of the ulnar nerve in the cubital tunnel at the elbow). It is also known as ulnar nerve entrapment and is the second most common compression neuropathy in the upper extremity after carpal tunnel syndrome.
Tinel’s Sign is the general term for a test in which the therapist identifies an irritated nerve trough a percussive or tapping technique. At the elbow, Tinel’s sign indicates an irritated Ulnar nerve. The therapist should locate the Ulnar nerve that is seated in the groove between the olecranon process and the medial epicondyle, the Ulnar nerve is then tapped on repeatedly by the index finger of the therapist. A positive sign is indicated by a tingling sensation in the ulnar distribution of the forearm and hand distal to the tapping point.
C. Tap along the medial epicondyle of the humerus.
Cubital tunnel syndrome (CBTS) is a peripheral nerve compression syndrome. It is a progressive entrapment neuropathy of the ulnar nerve at the medial aspect of the elbow (irritation or injury of the ulnar nerve in the cubital tunnel at the elbow). It is also known as ulnar nerve entrapment and is the second most common compression neuropathy in the upper extremity after carpal tunnel syndrome.
Tinel’s Sign is the general term for a test in which the therapist identifies an irritated nerve trough a percussive or tapping technique. At the elbow, Tinel’s sign indicates an irritated Ulnar nerve. The therapist should locate the Ulnar nerve that is seated in the groove between the olecranon process and the medial epicondyle, the Ulnar nerve is then tapped on repeatedly by the index finger of the therapist. A positive sign is indicated by a tingling sensation in the ulnar distribution of the forearm and hand distal to the tapping point.
A patient who works as a custodian for a local high school reports having difficulty lifting chairs, mopping, and performing other janitorial duties due to tightness in his right wrist and fingers. The physician diagnosed the patient with having a non-displaced distal radius fracture to his right-dominant upper extremity. How should the OT incorporate the biomechanical approach in the first intervention to help the patient with his job tasks?
D. Incorporate gentle range of motion exercises.
The biomechanical approach using range of motion will help loosen the patient’s joints. In the first session the OT can use gentle range of motion exercises to mobilize the patient’s joints.
D. Incorporate gentle range of motion exercises.
The biomechanical approach using range of motion will help loosen the patient’s joints. In the first session the OT can use gentle range of motion exercises to mobilize the patient’s joints.
Janet is a 53-year-old patient recovering from a left CVA. The OT completes a MMT on Janet’s right upper extremity and finds that her shoulder, elbow and forearm musculature consistently rate grade 2 (poor) and her wrist and hand rate grade 2+. Based on these results, which activity will Janet be able to complete with her right upper extremity?
B. Wipe off the kitchen table with a dishcloth.
If Janet’s right upper extremity strength rates a grade 2 to 2+, she will have difficulty completing any activities against gravity. She will be able to complete tasks with her right UE that have gravity eliminated. Wiping off the kitchen table meets this requirement because Janet can slide her hand and forearm along the table rather than actively lifting it.
B. Wipe off the kitchen table with a dishcloth.
If Janet’s right upper extremity strength rates a grade 2 to 2+, she will have difficulty completing any activities against gravity. She will be able to complete tasks with her right UE that have gravity eliminated. Wiping off the kitchen table meets this requirement because Janet can slide her hand and forearm along the table rather than actively lifting it.
A patient recently experienced shoulder trauma and as a result has a brachial plexus injury. What would be the most appropriate movement to assess when testing the myotome to C4?
A myotome is the group of muscles that a single spinal nerve innervates
C4-shoulder elevation
C5-shoulder abduction
C6-wrist extension/elbow flexion
C7-wrist flexion/elbow extension
C8-thumb extension/finger flexion
T1-finger adduction/abduction
A myotome is the group of muscles that a single spinal nerve innervates
C4-shoulder elevation
C5-shoulder abduction
C6-wrist extension/elbow flexion
C7-wrist flexion/elbow extension
C8-thumb extension/finger flexion
T1-finger adduction/abduction
What is the most appropriate muscle grade when a patient can raise and lower his arms to the ceiling without resistance?
C. Grade 3 (fair). Raising and lowering his arms to the ceiling without resistance is a movement against gravity, without any resistance. The motion of moving up towards the ceiling indicates that this is a full ROM of the upper extremity. When a patient can perform full range of motion without any resistance it is a grade 3.
The most commonly accepted method of evaluating muscle strength is the Oxford Scale (AKA Medical Research Council Manual Muscle Testing scale). This method involves testing key muscles from the upper and lower extremities and grading the patient’s strength on a 0 to 5 scale accordingly:
Flicker of movement
Through full range actively with gravity counterbalanced
Through full range actively against gravity
Through full range actively against some resistance
Through full range actively against strong resistance
C. Grade 3 (fair). Raising and lowering his arms to the ceiling without resistance is a movement against gravity, without any resistance. The motion of moving up towards the ceiling indicates that this is a full ROM of the upper extremity. When a patient can perform full range of motion without any resistance it is a grade 3.
The most commonly accepted method of evaluating muscle strength is the Oxford Scale (AKA Medical Research Council Manual Muscle Testing scale). This method involves testing key muscles from the upper and lower extremities and grading the patient’s strength on a 0 to 5 scale accordingly:
Flicker of movement
Through full range actively with gravity counterbalanced
Through full range actively against gravity
Through full range actively against some resistance
Through full range actively against strong resistance
What is the condition called which causes pain, stiffness, and a sensation of locking or catching when an individual actively bends and straightens their finger?
B. Trigger finger. Trigger finger is a condition that causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger. The condition is also known as “stenosing tenosynovitis.” The ring finger and thumb are most often affected by trigger finger, but it can occur in the other fingers, as well.
A. Results in ulnar claw deformity and numbness of the ulnar side of the hand and the fifth and half of the fourth digits, with generalized weakness of the ulnar side of the hand and pain.
C. Swan-Neck Deformity is a deformity of the finger, in which the DIP and MCP is in flexion, and PIP is in hyperextension.
D. A Smith’s fracture, also known as a reverse Colles’ fracture or Goyrand-Smith’s, is a fracture of the distal radius. It is caused by a direct blow to the dorsal forearm or falling onto flexed wrists, as opposed to a Colles’ fracture which occurs as a result of falling onto an extended wrist.
B. Trigger finger. Trigger finger is a condition that causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger. The condition is also known as “stenosing tenosynovitis.” The ring finger and thumb are most often affected by trigger finger, but it can occur in the other fingers, as well.
A. Results in ulnar claw deformity and numbness of the ulnar side of the hand and the fifth and half of the fourth digits, with generalized weakness of the ulnar side of the hand and pain.
C. Swan-Neck Deformity is a deformity of the finger, in which the DIP and MCP is in flexion, and