Term
| What is the leading cause of disability in adults? |
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Definition
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Term
| What are the goals of therapy for someone with arthritis? |
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Definition
| to reduce inflammation, decrease trauma to the joints, decrease pain, facilitate proper joint alignment, and improve function in activities of daily living. |
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Term
| does OsteoArthritis happen quickly or over time? |
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Definition
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Term
| Does OsteoArthritis impact all joints or just individual joints? |
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Definition
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Term
| Morning stiffness with OsteoArthritis is less or greater than 30 mins? |
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Definition
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Term
| Joints commonly affected with OsteoArthritis... |
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Definition
| Neck, spine, hips, knees, MTPs, DIPs, PIPs, CMC |
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Term
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Definition
Use related pain- pain w/ activity
Stiffness after inactivity
Loss of cartilage – bone enlargement
Commonly seen in the DIPs/PIPs |
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Term
| Herbenden’s node occurs where? |
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Definition
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Term
| Bouchard’s node occurs on... |
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Definition
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Term
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Definition
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Term
| will you see RA systematicly and bilaterally? |
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Definition
| Systemic inflammation. Will see bilaterally. Symetrical |
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Term
| Joints commonly affected with RA |
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Definition
| Neck, jaw, knees, ankles, MTPs, shoulders, elbows, wrists, PIPs, MCPs and thumb joints |
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Term
| Morning stiffness with RA is how long? |
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Definition
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Term
| With RA you will usually see what joints that are swollen in the fingers? |
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Definition
| MCP, But in OA the distal joints. |
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Term
| Stage 1 Early acute inflammation of RA |
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Definition
| Swelling, redness, pain. No destructive changes. Resting orthoses as needed. |
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Term
| Stage 2 RA Moderat Acute Proliferative |
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Definition
Synovium begins to invade the soft tissues, causing decreased mobility
Tenosynovitis
Less Pain
Decreased Mobility
May have slight bone and cartilage destruction No obvious deformity
Night orthoses in an attempt to prevent potential deformity and to decrease pain |
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Term
| Stage 3 RA Severe Destructive chronic Active |
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Definition
Joint deformity and soft tissue involvement
Bone, joint, and cartilage destruction, with osteoporosis
Night orthoses and functional day orthoses |
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Term
Stage 4 RA
Skeletal Collapse and deformity
Chronic |
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Definition
Joint disorganization and severe deformities
Severe bone, joint, and cartilage destruction with joint instability, dislocation, and/or fusion
Orthoses at this stage cannot reverse deformities, but may provide joint stability during activities and comfort at night |
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Term
| Common Arthritic Hand Deformities |
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Definition
Swan Neck
Boutonniere Deformity
Thumb Deformities
Ulnar Drift and Volar Subluxation of MPs
Heberden’s nodes (common with OA)
Bouchard’s nodes (common with OA) |
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Term
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Definition
Dorsal displacement of the lateral bands
Decrease tension to extend DIP
PIP: synovitis stretches volar plate, PIP hyperextends, lateral bands displace dorsally relaxing the pull on the terminal tendon which leads to flexion of DIP
Tight Intrinsics |
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Term
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Definition
Bunnel test
Intrinsic Tightness is demonstrated by comparing passive PIP joint flexion w/ MP joint held in extension and then flexion; Intrinsics are put on stretch with MCP extension |
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Term
| OT Intervention-Swan Neck? |
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Definition
A/PROM exercises If red and swollen just rest.
Joint protection/adaptive equipment
Intrinsic stretch exercises: Passive IP flexion stretch with MP extended
Tri-point splint- good w/swan neck deformaties
Dorsal pressure on proximal and middle phalanx
Volar pressure at the PIP joint
Allow full flexion |
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Term
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Definition
Deformity of a digit in which it assumes a posture of conjoint PIP flexion and DIP hyperextension
Proximal pull of extensor mechanism may also lead to MP extension
Loss of the central slip results in unopposed PIP flexion by the FDS tendon
Volar migration of the lateral bands secondary to transverse retinacular ligament and triangular ligament laxity
Intrinsic tendon pulls directly on the DIP joint which results in hyperextension
laceration in the hand, sports
Usually those with boutoinnere only get surgery if gets in the way but tends not to hurt. |
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Term
| OT Intervention Boutinner |
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Definition
Reduce edema/pain
Maintain biomechanics of the digit
Prevent complete rupture of extensor tendon
Prevent Lateral band subluxation
Prevent PIP joint contracture
Prevent DIP contracture (ORL tightness)
Acute
Modalities to decrease pain/edema
PIP splinted in 0 degrees extension – DIP/MP free
Exercises to increase PIP extension and DIP active flexion
Chronic deformity
Primary Goals: Increase PIP ROM, decrease pain/edema
A/PROM and resistive exercises – 3-5x’s/day
Active DIP exercises (Burton)
Splinting program to gain ROM
Static, dynamic, serial
If PIP contracture persists: surgical intervention may be considered |
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Term
| what conditions would you do a MP Arthroplasty? |
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Definition
Severe Arthritis
Ulnar drift and volar subluxation and/or intrinsic tightness
Appropriate amount of bone stock required
If not: salvage procedure: fusion
More difficult surgies |
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Term
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Definition
Synovial inflammation
Destroy articular cartilage
Stretch collateral ligaments
Decrease in joint support/stability
CMC Inflammation |
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Term
| OT Intervention for thumb RA |
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Definition
Initially when joint are supple/correctable:
-Maintain ROM
-Joint protection
-Splinting
When CMC becomes involved:
-Long Opponens CMC splint
-Prevent adduction of 1st metacarpal
-Maintain Functional ROM
CMC involvement- protect CMC, Prevent 1st Metacarpal subluxation
Long Opponens splint – night wear and as much as possible during the day
Remove for gentle ROM exersises 3x’s /day
Short opponens to wear during daily functional activies
Many times those that have issues at the CMC, have problems with wrist- long wrist |
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Term
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Definition
ADL/Functional training
Patient Education
Energy Conservation/Joint Protection
Pain/edema management
General conditioning- get them up & moving
Strengthening / ROM- don’t make them flare, within pain tollerance
Contracture prevention/management
Hand function and dexterity
Pinch (5-7 lbs required for most ADLs)
Grip (at least 20 lbs required for ADLs)
NOTE: Do not test Grip/Pinch if patient is having an Active Flare |
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Term
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Definition
Nonsteroidal Anti-inflammatory (NSAIDs)- helps w/pain
-Cortiocosteroids
-Disease Modifying Antirheumatic Drugs (DMARDs)- don’t help with pain but will slow down on progression. |
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Term
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Definition
Use the strongest, largest joint possible
Use two hands
Push instead of lift or pull
Reduce effort & force
Lightweight tools and utensils
Add levers
Smaller size containers
Use good posture
Use good body mechanics
Adequate rest and nutrition
Delegate or eliminate tasks |
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Term
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Definition
Control body center of gravity (COG) over base of support(BOS)
COG normally just anterior to spine at S2
BOS depends on points of support—includes area covered by points of support |
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Term
| Systems involved with balance |
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Definition
Involves organization of sensory input with planning & execution of motor output
Inputs: visual, proprioception, vestibular
Outputs: muscle tone, reflexes, movement |
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Term
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Definition
Parts of the body that experience pressure due to weight & gravity (parts that are “touched down”)
Can have multiple BOS
Larger BOS more stable |
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Term
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Definition
| Limit to where can maintain balance (edge of BOS) |
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Term
| Body Influences on Balance |
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Definition
Reflexes
Joint condition
Muscle strength & endurance
Reaction time
PNS & CNS condition
Other illnesses
Pain
Multiple demands |
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Term
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Definition
Interaction between
Individual
Task
Environment
Uses both feed forward (adjusting to the ground that you know about) and feed back (predict and then make adjustments when your body is off)
Constant cyclical nature |
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Term
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Definition
| allows visual tracking with either fixed or moving head |
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Term
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Definition
| allows stable body when head moved |
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Term
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Definition
| when you step on something sharp, that side will pull back and the other side will pull all the weight) |
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Term
Automatic Postural Responses
4 common strategies |
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Definition
Ankle-first
Hip-second
Suspensory-third
Stepping-fourth |
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Term
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Definition
| sit on chair, get up walk to end of tape and then back to chair. |
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Term
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Definition
| Client does task and then gets a score. All scores added together to determine fall risk. Lower score=bigger fall risk |
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Term
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Definition
| The ability to produce accurate, controlled movement. Such movement is characterized by smoothness, rhythm, appropriate speed, refinement to the minimum number of muscle groups necessary to produce the desired movement, and appropriate muscle tension, postural tone, and equilibrium |
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Term
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Definition
| When used in reference to the upper extremities it usually refers to coordination of the whole upper limb. |
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Term
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Definition
| Finger manipulation, dexterity. |
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Term
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Definition
| the ability to manipulate objects with the hands rapidly and skillfully |
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Term
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Definition
| consists of errors in rate, rhythm, range, direction and force of movement |
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Term
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Definition
| failure of muscular coordination; irregularity of muscular action. |
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Term
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Definition
| Inability to perform rapid alternating movements Palms up and down quickly. |
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Term
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Definition
| An inability or impaired ability to accurately control the range of movement in muscular acts, typically characterized by overestimating or underestimating the range of motion needed to place the limbs correctly during voluntary movement They reach and overshoot or undershoot |
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Term
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Definition
| rapid, jerky, involuntary movements of the limbs or face that characterize several different disorders of the nervous system Start off rapidly and then die off. |
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Term
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Definition
| involuntary, purposeless writhing motions of the body or its extremities do funny movements with upper body movements |
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Term
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Definition
| sustained muscle contractions that result in writhing or twisting movements and unusual body postures. |
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Term
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Definition
| rhythmic, oscillatory, involuntary movements of the outstretched upper limb |
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Term
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Definition
●stabilizing as many joints as possible
● addition of small amount of weight at distal end of lever
● holding devices and other adaptive equipment
● swivel utensils
Smaller movements and last longer than choreas. |
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Term
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Definition
| absence of tone; Absent deep tendon reflex, no resistance to passive movement; can result from UMN (spinal cord and superior structures) and LMN |
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Term
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Definition
| low tone; Absent or diminished deep tendon reflexes; may lead to hypermobility of joints |
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Term
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Definition
increased or high tone, difficulty initiating movement, may lead to a decrease in range of motion, affected by - noxious stimuli (UTI, Pressure sore, fear, anxiety), often occurs in synergistic patterns
Cerebral Hypertonia (CVA, TBI, CP, Brain Tumors)
Spinal Hypertonia (SCI, spinal tumors etc.) |
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Term
| UE Flexor synergy pattern |
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Definition
| scapular retraction and/or elevation, shoulder internal rotation, elbow flexion, forearm pronation, wrist and fingers flexed. |
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Term
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Definition
| scapula depression and protraction, shoulder adduction and internal rotation, elbow extension, forearm pronation, wrist flexion, finger flexion. |
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Term
| LE Flexor synergy pattern |
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Definition
| Hip flexion, Abduction and External Rotation, inversion and dorsiflexion of ankle, dorsiflexion of toes |
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Term
| LE Extensor synergy pattern- |
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Definition
Hip extension, Adduction and Internal roatation, Knee extension, plantar flexion and inversion of ankle, plantar flexion of toes
Most common to see UE flexor synergy and LE extensor synergy with Cerebral Hypertonia |
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Term
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Definition
Velocity dependent- stretch reflex is only increased by the rapid passive stretch It will catch when you take it through passive rotation
Hyperactive stretch reflex (phasic stretch reflex)
Clasp knife phenomenon-
when moving through a quick passive stretch a sudden catch and then release |
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Term
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Definition
Hypertonicity is not typically velocity dependent
Hypertonus continues as long as the stretch is being applied (tonic stretch reflex)
Hypertonicity- no catch felt with passive movement |
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Term
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Definition
Present in clients w/moderate to severe spasticity
repetitive contractions of antagonistic muscles in response to a quick stretch
Commonly seen in finger flexors and ankle plantar flexors
Weight bearing will typically stop clonus |
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Term
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Definition
Increased tone of agonist and antagonist
Increased resistance to passive ROM in any direction
usually seen with Parkinson’s, TBI, degenerative diseases, poisoning such as carbon monoxide
Tight on both sides. |
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Term
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Definition
| constant resistance throughout ROM when part moved in any direction (parkinson’s) |
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Term
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Definition
| resistance through ROM w/rhythmic give (parkinson’s) go downn in small incriments |
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Term
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Definition
| hypertonic flexion of arms and extension of legs (TBI) Toes even straight. Want the feet so they can put them on the ground |
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Term
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Definition
| extensor posturing all 4 limbs and neck; usually worse than decorticate (TBI) Everything in extension |
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Term
| Treatment for flaccidity and hypotonicity |
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Definition
Tapping
Vibration
FES
Splinting and positioning
Weight bearing
Muscle strengthening |
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Term
| Treatment for hypertonicity and spasticity |
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Definition
Positioning
Splinting
Serial casting
Slow range of motion
Modalities |
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Term
| Mild-Moderate-Severe Spasticity Scale |
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Definition
Mild: The stretch reflex (palpable catch) occurs at the muscle’s end-range (i.e. lengthened position) Typically have full range of motion
Moderate: The stretch reflex occurs in midrange
Severe: The stretch reflex occurs in a shortened range Very limited ROM |
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