OTA 125: Exam 2

parkinson’s

• degenerative neurologic disease: because these diseases are progressive

• may have inconsistent performance throughout the day due to fatigue

• may deal with end-of-life issues

symptoms of parkinson’s

• blank facial expressions (flat affect)

• slow, slurred speech

• rigidity and tremor of extremities and head

• forward tilt posture

• reduced arm swinging

• shuffling gait

intention

type of tremor:

• when resting you don’t see tremor, but when they start to do a task tremors appear

risks of parkinson’s

• falls

• orthostatic hypotension

• dysphasia

dysphagia

• a risk of parkinson’s:

• mm are weak and uncoordinated

• may drool a lot, difficulty initiating swallowing

• aspiration

parkinson’s treatment

• big movements

• targets

• inhibition

• facilitation

• mobility

fracture

interruption in the continuity of bone or an epiphyseal plate, usually caused by trauma

transverse

a direct blow to the extremity often causes what kind of fracture?

spiral

a twisting force causes what kind of fracture?

comminuted

a crushing injury often results in what kind of fracture, one with multiple bone fragments?

open fracture

type of fracture where skin and soft tissue wounds are visible?

closed fracture

type of fracture where there is no interruption of the skin present

pathological

type of fracture that occurs spontaneously from some abnormal conditions such as osteoporosis

myositis ossifications

after a cast for a fracture is removed, AROM is recommended to prevent what?

non-operative clavicle fractures

• simple support of the extremity: sling

• reduction and immobilization: typically with figure-of-eight brace

non-operative clavicle fractures

precautions:

• sling immobilized 2 weeks

• lifting restriction 6 weeks

• week 2 pendulum

• progress according to pain: start with isometrics and progress to isotonics

non-surgical proximal humerus fracture

precautions:

• 6-12 week healing

• immobilized with sling

• NWB

• can usually perform distal ROM of elbow, wrist, and hand

don/doff sling, hygiene

OT tx for a non-surgical proximal humerus fracture is to instruct on what two things?

pendulum

in week 6-8 for a non-surgical proximal humerus fracture, what kind of ROM can be performed?

PROM

in week 8 for a non-surgical proximal humerus fracture, what kind of ROM can be performed?

AROM

in week 12 for a non-surgical proximal humerus fracture, what kind of ROM can be performed?

ORIF proximal humeral fracture

precautions:

• 5# lifting restriction

• supine: keep pillow under elbow to prevent extension of the shoulder

• no active IR

• may shower 4 days post-op: no insertion of bath for at least 10 weeks

• sometimes pendulum:

  • passive sh flex to 90, or passive ER to 30

codman

• passive motion

• using body to move (not shoulder mm)

pendulum

• active motion

• using shoulder mm to move

2

what week for ORIF proximal humeral fracture recovery:

• scapular isometrics in protraction/retraction & elevation/depression

• incision mobilization and desensitization

4-6

what week for ORIF proximal humeral fracture recovery:

• pulleys

• self-assisted sh. flex

• assisted ER to 40

• no horizontal abduction

8

what week for ORIF proximal humeral fracture recovery:

• possible sling removal

• AROM

• pec minor stretches

• isometric rotator cuff strengthening

  • advance to isotonic

• emphasize trap, serrates anterior force couple to create stable scap base

• emphasize anterior delt strength and scap stabilization

• emphasize ER stretch

12

what week for ORIF proximal humeral fracture recovery:

• begin strengthening

• WBAT

shrugs

exercise to strengthen upper trap

retraction

action that strengthens middle trap

depress scap

action that strengthens lower trap

distal humeral fracture

precautions:

• NWB

• sling or cast 6-12 weeks

• no elbow ROM often

• may wear a cuff brace

0-7 days

for a shoulder dislocation, how long does it have to be immobilized

2-4

in what weeks for a shoulder dislocation:

• begin mobility with pendulum when pain allows

• avoid abduction and ER

• continue to wear sling when not exercising

4-6

in what weeks for a shoulder dislocation:

• begin isometric if no pain

• do IR pain free

• d/c sling

• scapular stabilizing exercises

  • trap and serrates anterior

6-10

in what weeks for a shoulder dislocation:

• regain strength

SITS mm

since recurrent dislocations are common, what must you strengthen to avoid it?

circumduction, flexion/extension, abduction/adduction

what three distinct mvmt patterns of the shoulder are present in Codman’s or pendulum exercises?

0-2

week for small rotator cuff repair:

• sling/immobilization

• no active ER

• limit ER to neutral for 2 weeks

0-4

week for small rotator cuff repair:

• PROM

3-6

week for small rotator cuff repair:

• AROM

• cane and pulleys, progress to wall climb

4-8

week for small rotator cuff repair:

• AROM

8+

week for small rotator cuff repair:

• strengthening

9-12 months

what is the full recovery time for a total shoulder arthroplasty?

total shoulder arthroplasty

precautions:

• sub scap is detached and then reattached after surgery and must be protected for 6 weeks

• ER to 20 only or as directed by physician

total shoulder arthroplasty

Immobilization: 

• Sling 48-72 hours

• Pendulum only at 3 days (no active for 4 weeks)

• Still wearing sling most of the time

• Can do distal ROM (elbow, wrist and hand)

• To prevent edema

• 5 lb. lifting restriction for 6 weeks

• After 3 days, sling can be removed for light activity as deskwork

• Still protect ER

• Always wear sling at night for 6 weeks

  • Sling d/c after 6 weeks

day 1

reverse shoulder:

• sling 4-6 weeks

• begin pendulum several timer per day

• NWB

• passive abduct to 70

• scap and delt isometrics

day 3

reverse shoulder:

• shower POD 2 weeks

• keep covered with plastic wrap while showering

• don’t submerge for 4 weeks

• to wash: bend at waist and let arm passively swing away from body

2

week for reverse shoulder:

• sleep with sling

• pendulum,

• supine flexion (limited slight above head)

• ER with dowel (limited)

• scapular retraction

3-6

week for reverse shoulder:

• begin supine AAROM exercises to shoulder flex only 120 degrees

6-8

week for reverse shoulder:

• AROm sh flex

• PROM IR to 50

8-10

week for reverse shoulder:

• minimal resistance to elbow, wrist, and hand

10-12

week for reverse shoulder:

• light resistance (5# max)

• never behind the head

• gentle IR/ER resistance

reverse shoulder

precautions:

• no sh ext past neutral (hyperextension)

  • need pillow to prevent hyperextension in supine

• no combined adduction and IR and ext

• AROM at 12 weeks

radius

is the radius or ulna more frequently fractured in a wrist fracture?

wrist fracture

precautions:

• NWB

• at times is casted or a soft removable splint

• immobilized at least 4-6 weeks

• no lifting

ORIF hip fractures

precautions:

• NWB or PWB

• usually femur fractures

• don’t have motion precautions usually, but pain limits motion

  • bending at waist may be painful due to pressure

  • figure 4 for donning/doffing socks and shoes

tibial fractures

precautions:

• often NWB for ~3 months

ankle fractures

precautions:

• may be NWB for up to 3+ months

• may wear a boot

posterior THR

precautions:

• 8-12 weeks

• avoid hip flex beyond 90

• no IR

• no adduction

• often WBAT (limited to pain)

anterior THR

precautions:

• can flex if dr allows

• no hip ext

• no hip ER

• no hip adduction

• sometimes do not have any precautions

arthroplasty

• total joint replacement (bipolar arthroplasty)

• WBAT most of the time

• hip precautions depending on the procedure

• cemented vs not

• different size of the ball of joint

hemiarthroplasty

one surface is replaced for joint replacement

total knee replacement

precautions:

• WBAT

• avoid rotation

• sometime will have a brace

pelvic fractures

precautions:

• rami often breaks

• very painful

• pt can’t roll or sit

• may be NWB

• can start rehab ~6 weeks after

laminectomy

nerves become compressed, lamina is shaved down or removed so there is room for nerves/spinal cord

spinal surgery

precautions:

• BLT:

  • no bending

  • no lifting

  • no twisting

cardiopulmonary system

• constant supply of nutrients and oxygen

• continual removal of carbon dioxide and other waste products

• constant temperature

warning signs for cardiac patients

• Extreme fatigue

• Significant shortness of breath

• Light headedness

• Clammy skin

• Nausea

• Dizziness

• Weakness

• Chest pain   

• Sudden feeling of need to have a bowel movement

• Sudden balance problems

• Sudden cognitive deficits

dyspnea

• Shortness of breath with activity or at rest

• Note the activity that brought on the dyspnea and the amount of time that it takes to resolve

• Often respiratory rate over 30 breaths per minute

orthopnea

• dyspnea brought on by lying supine

• count the number of pillows the patient sleeps on to breathe comfortably

diaphoresis

cold, clammy sweat

cerebral signs

ataxia, dizziness, confusion, fainting (syncope) = brain is mot getting enough oxygen

orthostatic hypotension

drop in systolic blood pressure of greater than 10 mm Hg with change of position from supine to sit to stand

pvd

hardening of the arteries

can cause lack of circulation = slower healing wounds, infection, gangrene

atherosclerosis

narrowing and hardening of the arteries

ischemic heart disease

• not enough oxygen to mm

• heart can not get stronger

myocardial infarction

• heart attack

• women have different symptoms compared to men

• scapular discomfort and up into the neck

• symptoms:

  • SOB

  • fatigue

  • chest pain (angina)

congestive heart failure

• results when the heart can’t pump effectively and fluid back up into lungs or body

• fluid overload puts extra stress on the body

• straining causes further congestion

• L ventricle

• R ventricle (cor pulmonale)

• most common reason people over 65 are hospitalized

2

how many kinds of left-sided heart failure are there?

systolic heart failure

left ventricle doesn’t contract with enough force

diastolic heart failure

left ventricle becomes stiff and can no longer relax, therefore, there heart is unable to fill with blood between beats

50-70%

normal ejection fraction

41-49%

borderline ejection fraction

<40%

reduced ejection fraction

edema management

• movement

• elevation

• retrograde massage

• compression

• protection

• reduce salt intake

CABG

precautions:

• 6-8 weeks for sternum to heal

• no pushing

• no pulling

• no lifting items greater than 5-10 lbs

• no excessive reaching

• no lying on side for prolonged periods of time

• no twisting in thoracic area, can twist in lumbar area

• splint your cough with pillow over chest

stage 1

BP stage:

• monitor BP during session

2

BP stage:

• modify activity

hypertensive crisis

BP stage:

• stop activity and call dr

pulmonary hypertension

• arteries in the lungs have increased pressure on them

• can lead to

  • right sided heart failure (for pulmonale)

  • blood clots

  • arrhythmias

  • bleeding

cardiomyopathy

• Chronic Disease of the heart

• The heart muscle becomes enlarged, thick or rigid and weakens which limits its ability to pump blood

• Disease can lead to heart failure

anticoagulants

type of medication to prevent blood clots, blood thinners

ACE inhibitors

type of medication that expands vessels to make the heart work easier

beta blockers

type of medication that makes the heart beat slower and with less force

calcium channel blockers

type of medication that is used to treat HTN, angina, and some arrhythmias

diuretics

type of medication that lowers blood pressure and decreases edema

vasodilators

type of medication that increases blood supply

statins

type of medication that lowers cholesterol

COPD

• a chronic, progressive disease process of the lungs

• need to be aware of potential CO2 retention