OCTA Conditions Test 3 Material

• neuroma

• phantom sensation

• phantom pain

• weakness

• skin breakdown

• knee flexion contractures

What are some post-operative complications for amputations?

neuroma

mass or swelling along the course of a nerve at the end of a divided nerve

phantom sensation

sensation that is missing limb is still there (may involve uncomfortable but not necessarily painful sensations such as burning, tingling, and/or itching)

Phantom pain

painful sensations, usually moderate, that felt in amputated portion of limb (may be burning, stinging, cramping, shooting, or twisting)

• TENS

• ice/heat

• contrast baths

• massage

• functional tasks to encourage normal motor patterns in painful extremity

• desensitization

• mirror box

What are some pain management techniques for phantom pain?

• none

• passive prosthesis

• body-powered

• electric

• hybrid

• task-specific prosthesis

What are different prosthetic options?

passive prosthesis

for cosmetic purposes only

body-powered prosthesis

mvmt and control elicited by power of remaining musculature

electric prosthesis

mvmt and control elicited by electrical impulses from remaining musculature

hybrid prosthesis

combines use of muscle power and muscular electrical impulses

terminal devices

devices attached to wrist unit of an UE prosthesis that provide some aspect of normal hand function usually to grasp and maintain hold on objects

socket

portion of prosthesis that fits around & envelopes that residual limb & to which the prosthetic components are attached

stump sock

tubular accessories with a blind end, worn on residual limb

1. acute phase

2. pre-prosthetic phase

3. basic prosthetic phase

4. advanced prosthetic training

What are the 4 phases of amputation tx?

acute phase of amputation tx

(1-3 wks post injury)—evaluation, wound care, edema control, ROM, desensitization & scar management, pain control, exercise, flexibility, gross motor activity, psychological support

ex. Compression therapy

pre-prosthetic phase of amputation tx

strengthening exercises, postural exercises, ROM of noninvolved jts, ADL, prosthetic fitting= edema control, desensitization, scar management, noninvasive feedback for muscle control, instruct in motions to operate prosthetic

basic prosthetic phase of amputation tx

teach care of prosthetic, donning/doffing, wear schedule, increase wearing tolerance, basic controls, monitor ADLs, practice engagement in occupations, emotional support—unilateral amputations 2-8 wks & bilateral amputation 4-10 wks after receiving prosthesis

advanced prosthetic training phase of amputation tx

integrate use of prosthetic into childcare, home maintenance, work, driving, sports, hobbies

• flexibility

• body symmetry— use visual feedback via mirror, verbal & tactile cues

• incorporation of residual limb into activity to assist with desensitization & increasing residual limb tolerance to pressure

• muscle strengthening

What are different components of an exercise program for amputees?

• pain management

• stump care/ skin hygiene

• stump wrapping

• ROM exercise

• desensitization

• wear & use schedule

• prosthetic skill training

What are areas addressed by OT in UE amputation?

• positioning

• stump hygiene, wrapping, desensitization

• dressing training/bathing, bed mobility

• w/c mobility & mngmt

• transfer training, stand pivot

• balance activities, standing tolerance, UE strengthening

• pain mngmt

• energy conservation & work simplification

• home mngmt/work/leisure

• driving

What are areas addressed by OT in LE amputation?

traumatic fracture

bone break due to injury—leading cause is falls followed by MVA, sports/play injuries, abuse

pathologic fracture

bone break due to increase processes such as tumors, osteoarthritis or osteoporosis which make bones vulnerable

• localized pain at site

• deformity

• edema

• ecchymosis (discoloration)

What are general symptoms of a fracture?

• closed (simple)= skin intact

• open (compound)= skin disrupted

• greenstick= part broken, part bent

What are the types of fractures?

• complete= bone fully broken

• incomplete= bone partially broken

• displaced= segments shifted or misaligned

• comminuted= 2 or more fragments

What are the different fracture descriptions?

• transverse= at right angle to longitudinal axis of bone

• oblique= diagonal/slanted fracture line

• spiral= twisting fracture line

what are the types of fracture lines?

1. hematoma formation

2. soft callus formation

3. hard callus formation (6 wks)

4. bone remodeling (3-4months)

What are the phases of fracture healing?

6-12 wks

How long does normal healing usually take?

• type of fracture

• location

• severity

• premorbid health condition

what are influencing factors of fracture healing?

delayed union

• pain persists 3 months to 1 year post fracture

• caused by infection, poor vascularization, inadequate immobilization

• healing occurs if cause is treated

malunion

• heals in abnormal or deformed position

• caused by muscle imbalance, inadequate protection

• results in limited ROM, strength, & use

nonunion

• not completely healed

• caused by vascular & tissue damage, poor alignment, stress to site, infection

disuse syndrome

dependent, guarded position & lack of use lead to more complicated symptoms

compartment syndrome

potential complication in fractures caused by increased pressure within muscle compartment

• pain

• pallor

• paresthesias (numbness, tingling or burning)

• faint pulse

• weakness

What are some symptoms of compartment syndrome?

complex regional pain syndrome (CRPS)

potential complication in fractures of excessive and prolonged pain and inflammation that follows an injury to an arm or leg

• disproportionate pain

• stiffness

• edema

• loss of ROM

• changes in temp

• edema/sweating asymmetry

• trophic changes ( hair, nail, skin)

what are symptoms of complex regional pain syndrome?

• modalities to decrease pain (TENS and ESTEM work well)

• AROM to involved jts

• ADLs to encourage pain-free active use

• stress loading (weight bearing)

• splinting to prevent contractures and enable ability to engage in leisure/productive pursuits

• modalities to avoid include PROM, jt mobilization, dynamic splinting and casting

What are some interventions for complex regional pain syndrome?

osteoporosis

a medical condition in which bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D

osteopenia

reduced bone mass of lesser severity than osteoporosis

hand fracture

most common phalanx fracture— common complication of phalanx fracture is mallet finger

metacarpal fractures

classified by location—head, neck, shaft, or base

• Colles’ (extension) fracture

• Smith’s (flexion) fracture

• Scaphoid fracture

What are the different wrist fractures?

Colles’ (extension) fracture

fracture of distal radius with dorsal displacement—dinner fork deformity— most common wrist fracture

Smith’s (flexion) fracture

fracture of distal radius with volar displacement (garden spade deformity)

Scaphoid fracture

carpal bone break susceptible to avascular necrosis— usually in young males 15-30 yrs old— 60% of all fractures (hyperextention)

FOOSH

fall on out stretched hand

FOOSA

fall on out stretched arm

• loss of wrist extension '

• impaired sensation on dorsal aspect of wrist

What are signs and symptoms of radial nerve involvement with arm (humeral) fractures?

supracondylar (elbow) fracture

bone break at distal end of humerus above medial & lateral condyles—- can result in nerve, muscle, tissue injury

Volkmann’s Syndrome

a deformity of hand, fingers, and wrist caused by injury to muscles of forearm

Closed reduction

a procedure to set (reduce) a broken bone w/o cutting skin open

ORIF

open reduction internal fixation

intrinsic plus (safe) position

overall safe position of immobilization for hand

• edema management

• pain management

• scar management (post-surgery)/skin care

• AROM of uninvolved jts

• use of involved jt as an ADL assist

• light, purposeful activity progressing to strengthening per protocol

What are general OT tx of wrist/hand fractures?

Total shoulder replacement

a complex procedure that involves replacing shoulder jt with artificial parts

hip fracture

break in proximal femur

• referred pain to knee

• inability to bear weight on involved LE

• leg length discrepancy

What are symptoms of hip fracture?

THR

total hip replacement

• bed mobility & ADLs

• functional ambulation of transfers

• practice role activities

What is OT tx for THR?

• posterolateral approach

• anterolateral approach

• superpath approach

What are hip precautions post-op up to 6-12 wks?

posterolateral approach for hip precautions

• no adduction (crossing legs/feet)

• no internal rotation

• no hip flexion beyond 90 degrees ( no bending forward)

anterolateral approach for hip precautions

• no hip extension

• no external rotation

• no adduction (crossing legs/feet)

SUPERPATH approach for hip precautions

no precautions

• non WB

• toe-touch WB/ touchdown

• partial WB

• WB as tolerated

• Full WB

What are the different weight-bearing statuses?

non WB

0%— dont touch floor— most restrictive

toe-touch WB

10-15%= foot may rest on floor— for balance only

partial WB

30-50%= usually requires crutches, cane or walker

WB as tolerated

as tolerated w/o unnecessary pain or discomfort

full WB

75-100%= no restrictions

relocation trauma

decrease cognition, increase confusion, emotional lability, disorientation due to being out of familiar surroundings

TKR

total knee replacement

• avoid rotation

• avoid kneeling

• avoid sleeping on operated side

• avoid wiggling foot in shoe

What are precautions of TKR?

• out of bed activities

• maintain/regain jt motion

• slowly increase strength of surrounding muscles

• decrease swelling

• increase independence in ADL— teach adaptive techniques

What is OT tx for TKR?

hemovac

wound drainage system

abduction wedge

designed to separate legs on pt

balanced suspension

system of pulleys, ropes and weights used to immobilize femur fractures

reclining w/c

has backrest the transforms user from sitting position to a close to lying down position

commode chairs

portable toilet that can be placed at bedside

sequential compression device

device that applies pressure through inflation and deflation to recirculate blood and allow blood to flow to all vital organs and extremities to prevent blood clots

antiembolus hosiery

place pressure on legs to increase circulation to reduce clot formation

incentive spirometer

handheld device that promotes lung expansion