Biomechanics Exam 3 Review

What is ergonomics?

Fitting workplace conditions and job demands to capabilities of the working population

Design jobs, tools, Equipment, facilities and environments to:

- Prevent injury

- Ensure comfort

- Improve effectiveness

What are the most significant risk factors associated with cumulative trauma disorders?

1) Repetition

2) High force

3) Awkward joint posture

An individual complaints of bilateral hand pain. The OT observes that they rest their forearms on a sharp desk edge while they are typing. Which MSKD risk factor will the OT address?

a) Contact stress

b) Duration

c) Vibration

d) Awkward postures

a) Contact stress

Prevention of cumulative trauma disorders in the workplace is the primary focus of an OTR working as an industry consultant. The OT suggests that the most appropriate way to reduce the risk of cumulative trauma in the workplace where there is heavy keyboard use is to do what?

Educate employers about ergonomic adaptations including correct typing techniques, posture, hand positioning, and equipment modifications.

What are examples of engineering controls?

-the way material parts and products are transported.

-workstation layout

-the way tools or parts are manipulated

-tool design

-the materials and fasteners

-the processes or sequence

tool design is an

a) engineer control

b) administrative control

a) engineer control

the processes or sequence is an

a) engineer control

b) administrative control

a) engineer control

What are examples of administrative controls?

- changes in procedure (i.e. more breaks)

- reducing shift length or curtailing overtime

- job rotation through one or two positions

- broadening the job tasks to offset risks (job expansion)

- adjusting the work pace

- educating employees on risk reduction

reducing shift length or curtailing overtime

a) engineer control

b) administrative control

b) administrative control

adjusting the work pace

a) engineer control

b) administrative control

b) administrative control

broadening the job tasks to offset risks (job expansion)

a) engineer control

b) administrative control

b) administrative control

A solution for heavy lifting is:

Using a suspension device

All of the following are principles of body mechanics except:

a) Maintaining your COG close to the COG of the object you are holding

b) Use a wide BOS to stabilize yourself

c) Twist and turn your body to reach for items

d) push/pull/slide an object rather than lift it

c) Twist and turn your body to reach for items

When working for long periods of time, how often should you change positions to prevent injury?

Change positions every half hour

What is the difference between a job demand analysis and an ergonomic evaluation/hazard assessment?

Job demand analysis: you are seeking what the actual demands of the jobs are - what are they making you do and how are they making you do it?

Ergonomic evaluation and a hazard assessment: focus is more on the actual work practice and the risk for injury - taking preventative measure

What is the outcome of a worksite evaluation?

To determine whether an individual can safely and adequately carry out the essential function of the job with or without any reasonable accommodations.

True or false: in a job demand analysis you are looking at the demands of a job to see if someone is fit for it, while in an ergonomic evaluation you are focusing on the actual job and risks for injury in the workplace.

True

Which environmental adaptation will enable the patient with lower back pain to participate in meal prep with less risk of injury?

Place your common items close to you and at waist level

An individual is employed as a stock clerk in the pharmacy. Which is the best activity to perform as work conditioning targeting endurance?

a) Carrying boxes that weigh 10 lbs for 20 feet. Increase the distance.

b) Carrying boxes that weigh 10 lbs for 20 feet. Increase the weight of the boxes.

a) Carrying boxes that weigh 10 lbs for 20 feet. Increase the distance.

What is the definition of work hardening?

Formal multidisciplinary program for rehabilitating an injured worker

Formal multidisciplinary program for rehabilitating an injured worker

a) work hardening

b) ergonomics

c) job demand analysis

d) outpatient rehabilitation

work hardening

If you are an OT working on a work hardening program, which of the following would be best represented as far as the goal for you to document regarding this type of program?

Work simulation to increase strength and endurance that is necessary for the related work tasks. Target specific areas to decrease future injury.

An OT is developing a factory onsite work hardening protocol for someone returning to work under light duties following a musculoskeletal work related injury. Which of the following will be most relevant to include in the design of the program as the top option?

a) increasing endurance

b) decreasing pain

c) decreasing hypersensitivity

d) increasing ROM

Pain management

What is FCE?

Functional capacity evaluation

Objective assessment of an individual's ability to perform work related activities

The most important aspects of an FCE are? why?

Its reliability and validity of the testing protocol

because its an objective assessment

What are the two types of reliabilities deemed important for FCE?

Interrater reliability → 2 people rating

test retake reliability → 2 test days, same scores

An individual was previously working as a cashier in a clothing store. She was referred to a work hardening program following knee surgery. Limitations are present in standing tolerance and balance. The activity that will best prepare the individual to return to work is?

a) Counting money while sitting down on a bench

b) Counting money standing while reaching for receipts

c) Standing in line at the movie theater

d) Cooking a meal in her kitchen while seated

b) Counting money standing while reaching for receipts

How do you treat red wounds?

-No debridement! Avoid any tissue trauma or stipping of new cells

-Clean using sterile saline, sterile water, ringers lactate

-Don't use antiseptics

-No topical treatment

-Protect the wound using dressings if necessary

Goals of red wound tx:

-Protect new cells

-Keep the wound moist and clean to speed up healing

-Promote epithelialization by keeping fluids inside

-Angiogenesis (development of new blood vessels)

-Wound contraction

How do you treat yellow wounds?

Debridement:

-Separate wound debris with aggressive scrubs

-Irrigation or whirlpool

Cleansing:

-No antiseptics

-Use soap and water

-Polaxmer 188, Pluronic F-68

Topical Tx for bacteria:

-Silver sulfadiazine

-Bactroban

-Neosporin

Dressing:

-Wet to dry

Goal of yellow wound tx:

Light debridement without disrupting new cells

Absorption

Bacterial control

Evolve to red wound

How do you treat black wounds?

Debridement

- Surgical preferred

- Mechanical

- Whirlpool

- Dressings

Cleansing:

- Whirlpool

- Irrigation

- Soap and water scrubs (harsh)

Topica Tx:

- Topical antimicrobials with low WBC

Dressing:

- Wet to dry to soften eschar

Goal of black wound tx:

Remove debris and mechanical obstruction to allow epithelialization

Allow collage deposition to proceed

Evolve to clean, red wound

what does a red wound look like?

- uninfected

-properly healing with definite borders

- may be pink or beefy red

- granulated tissue and neovascularization (new vessel formation)

what does a yellow wound look like?

- generating exudate

- looks creamy

- contains pus, debris, and viscous surface exudate

- immune response, defense

what does a black wound look like?

- covered with thick necrotic tissue or eschar

- autolysis, defense

What happens in the first stage of burn healing?

Inflammatory stage:

- The neutrophils and macrophages are responsible for clearing the wound of debris to set the stage for subsequent repair.

Epithelization

- Migration of epithelial cells

- Initiated within hours of injury, sealing the cleanly incised and sutured wound within 6 to 48 hours

What happens in the second stage of burn healing?

Fibroblastic or reparative stage

- The fibroblast will begin the process of collagen synthesis (contract)

Endothelial cells

- Form the new blood vessels in granulation tissue, which provides oxygen and nutrients to the wound site

What happens in the third stage of burn healing?

Maturation and remodelling of scar tissue

What cell is responsible for clearing the wound of debris to set the stage for subsequent repair?

a) Neutrophils and macrophages

b) Epithelial cells

c) Myofibroblasts

d) Endothelial cells

a) Neutrophils and macrophages

What cell seals the cleanly incised and sutured wound within 6 to 48 hours?

a) Neutrophils and macrophages

b) Epithelial cells

c) Myofibroblasts

d) Endothelial cells

b) Epithelial cells

What cell begins the process of collagen synthesis?

a) Neutrophils and macrophages

b) Epithelial cells

c) Fibroblasts

d) Endothelial cells

c) Fibroblasts

What cell is responsible for the phenomenon of wound contraction?

a) Neutrophils and macrophages

b) Epithelial cells

c) Myofibroblasts

d) Endothelial cells

c) Myofibroblasts

What cells form the new blood vessels in granulation tissue, which provides oxygen and nutrients to the wound site?

a) Neutrophils and macrophages

b) Epithelial cells

c) Myofibroblasts

d) Endothelial cells

d) Endothelial cells

T/F Wounds are evaluated in terms of risk factors for healing, presence or absence of infections, physical location or appearance

True

T/F Hematoma and edema are main precursor of deep scars

true

T/F red wounds require mechanical surgical debridement

False

All of the following are indicative of a red wound except:

a) color is pink or beefy red

b) granulated tissue and neovascularization

c) has definite borders and is uninfected

d) generates creamy exudate

d) generates creamy exudate

During the ... phase, medical management is of utmost importance for survival of the patient, and the goal of occupational therapy is primarily preventive.

a) Acute Care Phase

b) Surgical and Postoperative Phase

c) Rehabilitation Phase

d) Reconstructive Phase

a) Acute Care Phase

Rehabilitation goals during the ... are focused on preserving or enhancing performance skills and patterns while supporting surgical objectives.

a) Acute Care Phase

b) Surgical and Postoperative Phase

c) Rehabilitation Phase

d) Reconstructive Phase

b) Surgical and Postoperative Phase

The focus intervention during this phase is on maximizing function and participation in occupations, promoting physical and emotional independence, and managing scar formation to prevent or correct deformity and contracture formation.

a) Acute Care Phase

b) Surgical and Postoperative Phase

c) Rehabilitation Phase

d) Reconstructive Phase

c) Rehabilitation Phase

Compression garments and scar management begins in what phase?

a) Acute Care Phase

b) Surgical and Postoperative Phase

c) Rehabilitation Phase

d) Reconstructive Phase

d) Reconstructive Phase -- outpatient

What is the goal of the acute care phase after a burn injury?

-Provide cognitive reorientation and psychological support.

-Reduce edema.

-Prevent loss of joint and skin mobility.

-Prevent loss of strength and activity tolerance.

-Promote occupational performance, such as independence in self-care skills.

-Provide patient and caregiver education.

Burn shock is treated in what phase?

a) Acute Care Phase

b) Surgical and Postoperative Phase

c) Rehabilitation Phase

d) Reconstructive Phase

a) Acute Care Phase

During the Surgical and Postoperative Phase, the goals of therapy include the following:

1) Promote cognitive awareness by providing orientation activities when necessary, and continue psychological support.

2) Protect and preserve graft and donor sites by fabricating splints and establishing positioning techniques that support the surgeon's postoperative care orders.

3) Prevent muscular atrophy and loss of activity tolerance, and reduce the risk for thrombophlebitis by providing exercise for areas that are not immobilized.

4) Increase independence in self-care by teaching alternative techniques and providing adaptive equipment as needed.

5) Educate and reassure the patient and family members regarding this phase of recovery.

When does the rehabilitation phase of wound healing occur?

Begins as the wound begins to close

Inpatient rehabilitation phase for wounds includes what activities?

ADL

ROM

Strengthening

Endurance

Cardiopulmonary endurance

Splinting

Positioning

Outpatient rehabilitation phase for wounds includes what tx?

Pressure garments

Splinting

Upgrade exercise programs

Scar management

ADL

Focus on return to work/leisure/school

Compartment syndrome can be a complication of burn injuries. Why does this complication occur? What does the client complain of?

Increased amount of eschar!! makes everything supper tight and reduces the area

Tingling

Numbness

Burning

Stabbing pain

Temperature

Jeff has partial-thickness burns to his left thigh, knee, dorsum or left arm and hand, and left side of face and neck. To prevent contracture of the left knee, how would you position Jeff's leg?

Knee extension with slight flexion

Hips and thighs should be positioned in neutral with hips slightly abducted

Elevate his leg just adobe his heart to decrease edema

Jeff has partial-thickness burns to his left thigh, knee, dorsum or left arm and hand, and left side of face and neck. How would the left wrist and hand be positioned to prevent deformity?

Intrinsic plus position to prevent deformity with the use of a volar resting hand splint

What are the angles and positions of a volar resting hand splint?

Wrist extension → 30 degrees

MP flexion → 50-70 degrees

IP → full extension

Thumb → abduction and extension

Jeff has partial-thickness burns to his left thigh, knee, dorsum or left arm and hand, and left side of face and neck. What is the antideformity position for the head and the neck?

Should not use any pillow or headgear

Maintain his neck in neutral to slight extension

Use a towel roll or a neck collar

Jeff has partial-thickness burns to his left thigh, knee, dorsum or left arm and hand, and left side of face and neck. What methods would you employ to preserve ROM and strength of the affected side?

PROM - even though you are not strengthening

AROM

AAROM as tolerated by patient

Jeff has partial-thickness burns to his left thigh, knee, dorsum or left arm and hand, and left side of face and neck. For the unaffected right arm, what would you do to maintain strength and endurance?

Theraband

Resistive activities

Transfers

ADL

Functional activities

Jeff has partial-thickness burns to his left thigh, knee, dorsum or left arm and hand, and left side of face and neck. What ADL can Jeff be extended to perform independently with the unaffected right arm during the acute phase?

hygiene/self-care/grooming using one handed techniques

Feeding

UE/LE dressing

What is the antideformity position for the neck?

Neutral to slight extension

No pillow; soft collar, neck conformer, or triple-component neck splint

Towel roll

What is the antideformity position for the chest and abdomen?

Trunk extension

Shoulder retraction

Lower the top of the bed, towel roll beneath the thoracic spine, clavicle straps

What is the antideformity position for the axilla?

Shoulder abduction of 90 to 100 degrees

Arm boards, airplane splint, modified hip abduction pillow, clavicle straps, overhead traction

What is the antideformity position for the elbow and the forearm?

Elbow extension

Forearm neutral

Pillows, conformer splints, dynamic splints (when wounds healed/closed)

What is the antideformity position for the wrist and the hand?

Wrist extension to 30 degrees, thumb radial abducted and extended, MP flexion of 50 to 70 degrees, IP extension

Elevate with pillows, volar burn hand splint

What is the antideformity position for the hip and the thigh?

Neutral extension

Hips 10 to 15 degrees of abduction

Trochanter rolls, pillow between the knees, wedges

What is the antideformity position for the knee and lower leg?

Knee extension

Anterior burn: slight flexion

Knee conformer, casts, elevation when sitting, dynamic splints

What is the antideformity position for the ankle and the foot?

Neutral to 0 degrees of dorsiflexion

Custom splint, cast, AFO

What is the antideformity position for the ears, face, mouth and eyes?

Prevent pressure

Maintaining mouth opening

Ability to close eyelids

No pillows; headgear, mouth splint

What is the purpose of the foot drop splint?

To prevent plantar flexion

Promotes dorsiflexion

What do we treat during the surgical/post operative phase of burn injuries?

Immobilization of skin grafts

Assist in wound healing

Prevent edema

Exercise uninvolved extremities

ADL, adaptive equipment

Gentle ROM to involved extremities once cleared by MD

Burns that involve the upper layer of the epidermis

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

a) Superficial

Burns that involve the epidermis and the papillary dermis

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

b) Superficial partial thickness

Extremely painful burns

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

b) Superficial partial thickness

Burns that involve the epidermis and the dermis

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

c) Deep partial thickness

Mottled areas of red and white eschar

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

c) Deep partial thickness

Capillary refill is sluggish

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

c) Deep partial thickness

Prone to hypertrophic scarring and contracture

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

c) Deep partial thickness

May need skin grafting

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

c) Deep partial thickness

Adipose tissue may be exposed

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

d) Full thickness

Non-blanching

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

d) Full thickness

No pain is felt

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

d) Full thickness

High risk for hypertrophic scarring

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

d) Full thickness

Skin grafting and debridement necessary

a) Superficial

b) Superficial partial thickness

c) Deep partial thickness

d) Full thickness

d) Full thickness

All of the following statements describe full thickness burns except?

a) capillary refill is sluggish

b) skin grafting and debreidment is necessary

c) high risk for hypertrophic scarring

d) dry and leathery

a) capillary refill is sluggish

burns from cleaning agents, acids od from a combo of agents

a) electrical

b) thermal

c) chemical

d) radiation

c) chemical

burn that results from flame, steam, hot liquids or metals

a) electrical

b) thermal

c) chemical

d) radiation

b) thermal

burn that results from any type of voltage (pruning a tree, electrical plugs)

a) electrical

b) thermal

c) chemical

d) radiation

a) electrical

You see blanching after stretching the patient post burn injury. What is this a sign of?

That the stretch is doing what is is supposed to be doing

How do I know my client is ready to move on to tactile gnosis or stereognosis?

a) when the client can detect 30 cps of vibration

b) when the client can detect 256 cps of vibration

when the client can detect 256 cps of vibration or moving/constant touch

now move on to discrimination of objects (tactile gnosis)

then work to stereognosis (vision occluded)

How do I know when my client is ready to initiate sensory education?

a) when the client can detect 30 cps of vibration

b) when the client can detect 256 cps of vibration

When they can detect 30 cps vibration or moving touch

work on re-educating the sensations

movement vs touch

All of the following are symptoms associated with CRPS except?

a) hyperesthesia

b) allodynia

c) hyposensation

d) hyperalgesia

c) hyposensation

CRPS symptoms:

Sensory symptoms and signs of CRPS:

- hyperesthesia (abnormal sensation)

- allodynia (painful sensation)

- hyperalgesia (pin prick)

Vasomotor symptoms and signs of CRPS:

- temperature changes

- skin asymmetry

- redness

- shinny

Sudomotor symptoms and signs of CRPS:

- edema

- shinny

- hyperhidrosis (sweaty)

Motor/trophic symptoms and signs of CRPS:

- motor dysfunction (stiffness, claw hand)

- decreased ROM

- trophic changes (muscle weakness. thin bones. thin hair)

Client sustained X. Client's affected hand appears to have edema, hypersensitive to touch and extreme temperature. Client complains of radiating pain going down. What diagnosis?

a. CRPS

b. elbow fracture

c. dupuytren's

d. carpal tunnel

a. CRPS