Upper Extremity & Spine Rehabilitation: OT Interventions and Assessments

What is the significance of the hand in daily life?

The hand is vital to function and appearance.

What psychological impacts can upper extremity dysfunction have?

It can affect physical abilities and self-esteem.

What are common causes of upper extremity dysfunction?

Injury or disease, which may be acquired or congenital.

Which demographic is most affected by work-related hand injuries?

Mostly men ages 25 to 44.

What are some common settings where hand injuries occur?

Manufacturing, construction, retail trade, household activities, sports, and motor vehicle accidents.

What is hand therapy also known as?

Upper extremity rehabilitation.

What are the three phases of healing in rehabilitation?

Inflammatory, proliferative, and remodeling.

What occurs during the inflammatory phase of healing?

It is the acute phase that begins at the time of injury.

What happens during the proliferative phase of healing?

Production of new collagen and blood vessels as the body begins to repair.

What is involved in the remodeling phase of healing?

Collagen continues to increase, strength is added to new tissue, and scar tissue begins to form.

What is essential for achieving maximum therapeutic gains in rehabilitation?

Client-centered care.

What is an occupational profile in OT intervention?

Information about how the client's habits, routines, and roles have been affected by the hand injury.

What methods are used to gather information for an occupational profile?

Standardized assessments and informal interviews.

What does the strength assessment involve?

It should be performed after the patient has been cleared for full-resistive activities, usually 8 to 12 weeks post-injury.

What is manual muscle testing (MMT)?

A screening tool that provides resistance to a muscle to assess contraction strength.

How is grip strength assessed?

Using a dynamometer while the patient is seated with specific arm and wrist positions.

What is the purpose of joint assessment in rehabilitation?

To measure range of motion (ROM) and identify joint dysfunction.

What is sensory testing used for?

To assess recovery of a nerve after laceration and repair, and to determine the presence of nerve compression.

What are threshold tests in sensory testing?

Tests for pain, vibration, temperature, and touch pressure.

What is two-point discrimination?

The ability to distinguish between two direct stimuli on the skin.

What is the Jebsen Hand Function Test?

A test that provides objective measurements of standardized tasks for patient comparison.

What is the significance of edema in upper extremity rehabilitation?

It is a normal consequence of trauma that must be treated to prevent permanent stiffness and disability.

What is the role of joint mobilizations in rehabilitation?

To assess or help restore joint play motions necessary for normal ROM.

What does sensory mapping involve?

Assessing the volar surface of the hand and repeating monthly.

What are provocative tests in nerve assessment?

Tests like Tinel's and Phalen's that elicit symptoms of nerve compression.

What is the purpose of functional testing in rehabilitation?

To observe the effect of dysfunction on the use of the hand during activities of daily living (ADLs).

What is the importance of following physician's orders in rehabilitation?

To ensure safe and effective treatment aligned with the healing process.

What are the seven subtests mentioned for evaluating dexterity?

1) Writing a short sentence, 2) Turning over 5-inch cards three times, 3) Picking up small objects and placing them in a container, 4) Stacking checkers, 5) Eating (stimulated), 6) Moving large empty cans, 7) Moving large weighted cans.

What is dexterity?

The ability to manipulate small objects with the fingers with speed and accuracy.

Which test is most commonly used to evaluate dexterity?

Nine Hole Peg Test.

What are the three categories of Patient-Reported Measures?

1) Generic measures, 2) Regional measures, 3) Disease-specific measures.

What is the purpose of elevation in edema management?

To keep the hand above the heart to reduce swelling.

Why should slings be avoided in edema management?

They can reduce blood flow and lead to shoulder stiffness.

What is the purpose of contrast baths in edema management?

To reduce edema and facilitate range of motion by alternating immersion in warm and cold water.

What is retrograde massage?

A massage technique that assists in blood flow and lymph drainage, starting distally and moving proximally.

What is Manual Edema Mobilization (MEM)?

A massage technique used for temporary edema, based on manual lymphatic therapy.

What are pressure wraps used for in edema management?

To apply light compression throughout the day to reduce swelling.

What are PAMs in the context of edema reduction?

Physical agent modalities, such as neuromuscular electrical stimulation (NMES) and high-voltage pulse-current stimulation (HVPC).

What does AROM stand for, and why is it important?

Active Range of Motion; it is important for controlling edema and promoting tendon gliding.

What does PROM indicate about joint function?

Passive Range of Motion gives information about noncontractile structures like ligaments.

What is the purpose of Soft Tissue Mobilization (STM)?

To modify and remodel scar tissue to preserve soft tissue mobility.

How should pressure be applied to a scar for effective treatment?

Pressure should be applied for most of the 24-hour period and removed for bathing and exercise.

What is the role of heat in scar treatment?

Heat helps to stretch scar tissue when followed by stretching exercises.

What types of strength training equipment are mentioned?

Computerized evaluation systems, resistive pulley weights, Theraband, hand grips, and therapy putty.

What is the goal of treatment for amputation?

To ensure good skin coverage, manage wounds, reduce edema, and restore ROM and function.

What are the main goals of prosthetics in rehabilitation?

To improve functional use of the digit and rebuild patient self-confidence.

What challenges are associated with acute tendon injuries?

They are difficult to treat and often require specific surgical and rehabilitation protocols based on the injury level.

What is the significance of active hand use in rehabilitation?

Engaging in occupation-based activities early helps achieve long-term goals in desired performance areas.

What are the three primary states of tendon healing?

Inflammatory (48-72 hours), proliferative (5 days post-surgery until week 4), and remodeling (week 4 until 4-5 months).

What is the purpose of immobilization in flexor tendon injuries?

To completely immobilize the tendon for 3.5 weeks after repair, though it may lead to scar adherence and increased risk of tendon rupture.

What technique is used for early active range of motion in flexor tendon rehabilitation?

The Kleinert technique, which involves rubber band traction.

What is the function of a dorsal blocking splint?

It allows for passive flexion of the digits and full active extension at the PIP and DIP joints.

What are the three positions recommended for differential tendon gliding?

Hook first, straight fist, and composite fist.

What makes extensor tendon injuries more likely to become adherent?

Their broad, thin, and structurally flat nature.

What is the immobilization approach for extensor tendon injuries?

Keeps tendons in a shortened position through splinting or casting for 3 weeks, followed by gentle active motion in week 4.

What is the early passive motion approach for extensor tendons?

Extensor tendons are held in extension while the patient actively flexes the fingers, passively moving the repaired tendons.

What are common causes of peripheral nerve injuries?

Compression from tumors or fractures, lacerations, stretching, and inadvertent injections.

What symptoms indicate a peripheral nerve injury?

Muscle weakness or paralysis and sensory loss in the area innervated by the injured nerve.

What is the role of the radial nerve?

It innervates the extensor and supinator muscles of the forearm.

Why is sensory loss from median nerve injury particularly disabling?

Because it affects sensory innervation in the fingers that perform pinch patterns.

What is the function of splints for ulnar nerve injuries?

To block hyperextension of the MCP joints and protect the anesthetic area.

What is the typical management for nerve repair post-operation?

Correction of contractures may take 4 to 6 weeks, with active exercise preferred for gaining full wrist extension.

What is the most common wrist fracture?

The Colles fracture of the distal radius.

What is CRPS?

Complex regional pain syndrome.

What does CTD stand for?

Cumulative trauma disorder.

What are the signs and symptoms of tendinitis?

Inflammation, heat, redness, edema (swelling), and pain.

What are the stages of adhesive capsulitis?

Freezing (pain and decreased ROM), Frozen (decrease in pain with increased ROM limitations), Thawing (improvement of ROM without pain).

What is a common medical treatment for adhesive capsulitis?

Oral or injection pain medications (NSAIDs or steroids) and progressive stretching of the joint capsule.

What is spinal fusion?

A surgery to join two or more vertebrae to prevent movement between them.

What is a laminectomy?

Decompression surgery that enlarges the spinal canal to relieve pressure on the spinal cord or nerves.

What precautions should be taken after spinal surgery?

Avoid bending, lifting, and twisting (BLTs) as per MD orders.

What is the purpose of OT intervention in spinal rehabilitation?

To educate on precautions, provide ADL/functional training, and recommend adaptive equipment.