Therapeutic Interventions Exam 1

modalities that produce biophysiological response through the use of light, water, temperature, sound, electricity, or mechanical devices

physical agent modalities

list three ways to describe PAMs in your own words

1. procedures or interventions applied to modify specific client factors that limit occupational performance
2. various forms of energy used to modulate pain, modify tissue healing, increase tissue extensibility, and modify skin and scar tissue
3. used as an adjunctive method to prepare for engagement in occupation

what are some uses of physical agent modalities?

1. wound healing
2. cryotherapy
3. thermotherapy: superficial heat agents
4. therapeutic ultrasound and phonophoresis
5. electrotherapy
6. neuromuscular electrical stimulation (NMES)
7. transcutaneous electrical nerve stimulation (TENS)
8. iontophoresis

cold therapy (superficial cooling) is used for? what is the correct terminology for this PAM?

1. acute injuries or trauma
2. producing lower tissue temperature resulting in analgesia
3. decreasing spasticity
4. spasms
5. reducing edema

CRYOTHERAPY

what are some ways to apply cold agents?

1. cold packs
2. ice massage
3. cold/ice water immersion baths and cool whirlpool
4. ice towels
5. vapocoolant sprays

what are the precautions/contraindications of PAMs?

1. NEVER place a cold agent directly on skin
2. NEVER apply longer than 20 minutes
3. NEVER apply to areas of compromised circulation or over an area with impaired circulation
4. do NOT use with specific cold-sensitivity
5. do NOT apply over deep open wound
6. monitor skin condition and response closely

application of thermal agents are used to increase what? what is the correct terminology for this PAM?

1. cell metabolism
2. blood flow
3. soft tissue elasticity
4. extensibility of collagen tissue
5. metabolic rate
6. subjective “comfort”
7. decrease muscle spasms and pain

what are some examples of superficial heating agents?

1. hot packs
2. heating pads
3. paraffin baths
4. fluidotherapy
5. whirlpool

what are some examples of deep heating agents?

diathermy devices and therapeutic ultrasound

the use of electrical or mechanical currents

diathermy devices

use of inaudible acoustic energy

therapeutic ultrasound

what are some precautions/contraindications for the use of thermotherapy

1. proper positioning to reduce/increase in edema
2. monitoring skin for burns and patient’s response
3. heat should NOT be used when there is sensation or appreciable circulatory impairments, undetermined edema, or during acute, inflammatory phase of healing
4. should NOT be used with tumors/cancer, DVT, infection, advanced cardiac disease, RA, semicomatose, or in cases of impaired mental status

use of electric current to stimulate muscle contraction

electrotherapy

what are the 2 types of electrotherapy?

neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS)

what are some reasons we use electrical stimulation?

1. maintain muscle mass
2. maintain or gain range of motion
3. facilitate voluntary motor control
4. promote wound healing
5. decrease edema
6. relax muscle spasms and spasticity
7. control pain

what are some precautions/contraindications for use of electrotherapy?

1. do NOT use on patients with demand type pacemakers, epilepsy, or malignancies, peripheral vascular disease or infection
2. do NOT use over or near superficial metal pins, plates, or hardware
3. do NOT use over carotid sinus
4. use with caution when there is diminished sensation

use of direct electrical current to deliver topical medication or ionized drugs into the epidermis or mucous membranes of selected tissue and is used to treat inflammatory conditions or modify scar tissue and manipulate the healing process

iontophoresis

use of ultrasound to deliver topically applied drugs, mostly corticosteroids, into deep underlying targeted tissues and are used to impact the healing process

phonophoresis

the study of work performance with an emphasis on worker safety and productivity

ergonomics

ergonomics considers human _______ and human ________, and other human ________________________

abilities; limitations; characteristics that are relevant to design

what are the most common methods of data collection therapists use?

observation, interview, and measurement

what are some reasons work-related assessments are important?

1. to determine the need for intervention
2. to assess an individual’s ability to perform the roles, duties, tasks, and physical demands of work
3. to determine effort during work tasks
4. to measure and document outcomes of work-related interventions
5. to evaluate programs and engage In research

conducted when there is no specifically identified job or employer to return to; focuses on an individual performing physical demands related to work in general, rather than to a specific job or duties

functional capacity evaluations (no job)

conducted to determine the worker’s suitability to return too work and develop an appropriate rehabilitation plan; focuses on an individual worker performing specific tasks within a specific workplace with an identified employer

functional capacity evaluations (job)

a functional capacity evaluation usually takes place in the workplace, what is/are additional terms we call this type of intervention?

return-to-work program or clinic-based work conditioning/hardening program

what are the six physical demands that are assessed? give examples of each

1. working positions - sitting, standing
2. manual handling/exertion - lifting, carrying, pushing, pulling
3. mobility - walking, climbing, crawling
4. other work postures and nonmaterial handling - stooping or bending, crouching, kneeling, balancing
5. upper limb and hand function and manipulation - reaching, handling, fingering, feeling
6. other areas commented - seeing, hearing, and speaking

what are some common tests used in assessing upper limb and hand function and manipulation?

1. hand tool dexterity test
2. minnesota rate of manipulation test/minnesota dexterity test
3. o’conner finger dexterity test
4. o’conner tweezer dexterity test
5. purdue pegboard
6. jamar grip strength dynamometer

list some environmental components in ergonomics

1. vibration

2. lighting

3. sound

4. structural features

5. chemicals and toxins

6. allergies

7. air quality

8. water quality

the context in which an individual works

physical environment

due to equipment that a person is handling OR it being translated to the person in a “whole body” sense

vibration

can impede function if it is either too high or too low; can impede performance and damage the worker’s vision

lighting

noise level, duration of exposure, frequency, vulnerability resulting from environmental factors, and vulnerability resulting from biological factors

sound

what are the three structural features?

1. ground characteristics

2. equipment related to posture

3. temperature

soil or ground conditions and other working surfaces; consider worker’s footwear and friction

ground characteristics

workstation height and orientation, workplace layout, etc.

equipment related to posture

can be too high or too low; if it is out of the safe range for the person and the task that he/she is performing, the body will be under stress

temperature

workers may have to handle or come into contact with _______ in their work; this can enter the environment in many ways (inhalation, ingestion, or skin absorption)

chemicals and toxins

this can be in the result of skin irritation, asthma attack, or anaphylaxis

allergies

global environmental concern; can cause adverse health effects (asthma, respiratory difficulties, decreased lung function, reduced immune system, etc.)

air quality

global environmental concern; quality and availability of water may both be an issue

water quality

keep your body in ___________ (as close to ______________ or ________________ positioning as you can)

good alignment; functional; neutral

be sure to use a ______________ base of support

wide enough

the __________ the object the ____________ the base of support needs to be to maintain _________ and get _____________ use from muscles

heavier; wider; balance; optimum

use the stronger and larger muscle of the ________, ___________, ________, ________, _______, _______

shoulders; upper arms; stomach; back; thighs; and hips

keep objects _____________________ when lifting, moving, or carrying them

close to the body

avoid ________________________. if possible, __________ your work area to ______________ level

unnecessary bending and reaching; elevate; waist

face the direction in which you are working to prevent _________________________-

unnecessary twisting

______, _______, _________ heavy objects whenever possible rather than lifting them

push; slide; pull

use __________________ when lifting, moving, or carrying objects

both of your hands and arms

turn _________________________ when you change the direction of your movement

your whole body

work with _______________________ movements; avoid ___________________________ movements

smooth and even; sudden or jerky

T/F: never get help to move heavy objects whenever necessary

FALSE!!! ALWAYS GET HELP

instead of bending from the waist, __________ to lift heavy objects from the floor

squat

what are some stressful positions?

1. reaching above the head
2. bending at the waist to reach to the floor or lower extremities
3. standing for prolonged periods of time
4. unnecessary stair climbing
5. carrying
6. lifting
7. holding

what are some ways to avoid stressful positions?

1. use a long-handled reacher, scrub brush, or tongs
2. using the foot to close a low cabinet door rather than bending over
3. slide a pan along the countertop from sink to stove
4. hold with open hands rather than a cylindrical grip

what are some stressful situations?

1. hot, humid environment
2. quick temperature changes
3. isometric contractions, such as pulling or pushing, which can cause you to hold your breath
4. avoid rushing
5. exertion following meals since the distended stomach places pressure against the diaphragm
6. excessive bilateral extremity use
7. overexertion
8. emotional outbursts

what are some ways to use good body mechanics?

1. good posture
2. comfortable, supportive posture
3. place yourself close to and facing any object you carry
4. avoid twisting of the trunk

give examples of HOW you should use body mechanics

1. work surfaces should allow you to sit or stand with the back straight, to hold the head and neck or wrist in “neutral”
2. when sitting, the hips, knees, ankles, and wrists should be at 90 degrees with feet flat on the floor
3. use the largest joint possible to carry out the task; carry purse on shoulder rather than in the finger hook grip
4. distribute weight evenly; use both hands to carry a box rather than balance it in one

any activity which is painful and remains so ______________ following the activity is damaging the joint; these activities must be done in another way, following the suggestions given above, or another activity must substitute for them, or the activity must be done by someone else

2 hours

sit if a job takes more than _____________________

10 minutes

after sitting for 10 minutes; stand up after sitting for ____________________

20-30 minutes

when lying down, use a flat, hard bed; do not put a pillow under your knees; lie flat on your back (completely straight) for ______________ before and after each rest period

10 minutes

when sitting, be sure the chair fits you; arm rests should be __________ below the elbow when the shoulder is in a relaxed position; support the feet in a flat position; use a footrest if necessary that is adjusted to your height

2 inches

following a heavy task, take _________________ to rest

10-15 minutes

take time out at least once every __________________

60-90 minutes

what are the joint protection principles?

1. try to use each joint through its full range of motion each day
2. avoid positions which encourage deformity in your hands
3. turn fingers toward the thumb side of your hand as often as possible
4. avoid bending your fingers during activity
5. use each joint in its most stable and aligned position
6. use the strongest joint available for the job
7. avoid muscle imbalance
8. avoid activities which require joints or muscle to be held in one position for a long period of time
9. never attempt any activity when cannot be stopped immediately if it proves to be beyond your power to complete
10. respect pain

what are some examples of using each joint through its full range of motion each day?

reaching for an object on the highest shelf (shoulder flexion) & coloring (wrist extension)

what are some examples in order to avoid positions that cause deformities in hands?

opening a jar with the right hand, and closing it with the left & using a built up eating utensil

what are examples in which you turn your fingers toward the thumb (radial) side of the hand?

turning a doorknob counterclockwise & and stirring a pot of noodles counterclockwise

what are some examples to avoid bending your fingers during activities?

do not support your body weight on your knuckles & when lifting, hold fingers straight with palm up; place hands under the object with the thumbs left free

what are some examples to keep each joint in its most stable and aligned position?

not flopping into chairs & distributing body weight evenly on both knees when rising

what are some examples of using the strongest joint available for the job?

lift objects from the floor with your knees rather than your back & slide objects instead of lifting or carrying them

what are some examples to avoid muscle imbalance

support a book on a bookrest to avoid fatiguing the neck, shoulder, and finger muscles & when standing try to keep the spine straight - adjust worktable if necessary

what are some examples in which to avoid holding one position for a long period of time?

using a vegetable holding board when peeling vegetables & stabilizing bowls with suction cups

what are some examples for never attempting any activity when it cannot be stopped immediately if it proves to be beyond your power to complete

using a sliding board for transfers & moving hot and/or heavy objects using a cart on wheels/ or slide them across the countertop

what are the energy conservation techniques?

1. plan ahead
2. sit while working, when possible
3. avoid unnecessary tasks
4. eliminate unnecessary trips
5. frequently used items should be lightweight and kept within easy reach
6. use power tools to do the work when possible
7. allow gravity to assist rather than oppose it
8. schedule rest breaks before becoming fatigued
9. avoid stressful positions
10. avoid stressful situations
11. do not start tasks which do not allow you to stop and rest
12. maintain normal body weight
13. use good body mechanics during activities

what are some examples to plan ahead

alternate between heavy and light tasks & spread tasks out over the day or week

what are some examples of sitting while working, when possible

using a stool at the stove or sink & folding laundry at a table

what are some examples to avoid unnecessary tasks

soak dirty dishes before washing them & pre-sliced fruits/vegetables

what are some examples to eliminate unnecessary trips

during a task, gather all the necessary tools prior to starting & complete all tasks in one room before going to another room

what are some examples of frequently used items should be lightweight and kept within easy reach?

tv remote should be left on the table near the couch & windex should be left on the counter

what are some power tools?

1. electric knife
2. electric can opener
3. electric mixer
4. electric scissors

what are some examples of allowing gravity to assist rather than oppose it

slide rather than carry & using a fitted sheet

what are some examples of avoiding stressful positions?

using a reacher to grab things too far out of reach & using the foot to close a low cabinet door rather than bending over

what are some examples of using good body mechanics during activities?

place yourself close to and facing any object you carry & avoid twisting of the trunk

a feature of a support surface that provides pressure redistribution via a fluid-like medium created by forcing air through beads as characterized by immersion and envelopment

air-fluidized

a feature of a support surface that provides pressure redistribution via cyclic changes in loading and unloading as characterized by frequency, duration, amplitude, and rate of change parameters

alternating pressure

a feature of a support surface that provides rotation about a longitudinal axis as characterized by degree of patient turn, duration, and frequency

lateral rotation

a feature of a support surface that provices a flow of air to assist in managing the heat and humidity (microclimate) of the skin

low air loss

a segment with a single pressure redistribution capability

zone

a surface in which different segments can have different pressure redistribution capabilities

multi-zoned surface

what are strategies followed by occupational therapists in wound care

1. management of client’s health status
2. prevention of pressure/friction wounds
3. bowel and bladder incontinence maintenance
4. mobility status
5. environmental modification
6. mental status evaluations
7. activities of daily living
8. provide references to other ancillary services

in 2000, the US department of health and human services in its Healthy People 2010 initiative called for a _________ reduction in pressure ulcer incidence by 2010

50%

wounds, or impaired skin integrities, include what?

abrasion, punctures, bites, surgical wounds, diabetic ulcers, pressure ulcers, traumatic wounds, venous stasis ulcers, and arterial ulcers

what populations are more at risk for wounds?

SCI, cerebral palsy, hand injuries, diabetes, breast cancer, burns, and those with sensory or mobility impairments

management of the wound site may be __________, including applying ________________________________ to promote healing as well as managing __________________. clothing or footwear adaptations may be needed to avoid contact with the wound or wound dressings. _________________________ for scar management may be used

demanding; wound care treatments and products; drainage or order; pressure garments

what does an initial skin assessment typically cover?

assessing a wound in any area of the person’s body that is affecting self care

what is one frequently used skin assessment?

the Braden scale

remediation, restoration of wound care includes what factors? (hint: there are 5)

debridement, splinting, AROM, PROM, and wound care

what can the use of debridement, splinting, AROM and PROM prevent?

adhesions and provide proper positioning for a client during wound healing