OAS II-midterm 2-OTHER

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  1. Adhesive Capsulitis (Frozen Shoulder)
    Decreased AROM/PROM, esp in external rotation
  2. Subcromial Impingement
    Painful arc of motion between 80-100 degrees in shoulder flexion
  3. Rotator Cuff Tendonitis
    • Tendonitis: from overuse in daily activities = reaching, lifting, pulling, pushing
    • -pain (no inflammation)
  4. Rotator Cuff Tear
    • Tear: from injury (trauma), progressive impingement, degenerative changes in tendon
    • Presentation: difficulty with above shoulder activities (less than 90 degrees flexion), many will hike shoulder up using trapezius to compensate
  5. Treatment for Nonsurgical treatment of rotator cuff tear:
    • Avoid sleeping with arm above shoulder level
    • Avoid sleeping with arm aDDucted and Internally rotated
    • PROM then AROM
    • Strengthen scapula & rotator cuff muscles
    • ISOMETRIC exercises
  6. Immediately following surgical repair of the rotator cuff:
    • PROM & AAROM for 4-6 weeks
    • Pain-free pendulum exercises
    • Passive shoulder flex/ext/aBd
    • Internal/External rotation with shoulder ADDucted, NOT Ab!!
    • Ice-before during after exercises
    • Use one handed techniques
    • Shoulder immobilized between exercises
  7. Sensory Treatment Approaches for:
    • 1. Loss of Protective Sensation
    • 2. Hypersensitivity to touch
    • 3. Diminished sensation with potential for sensory regeneration
  8. Loss of Protective Sensation
    • Results from: Stroke, TBI, Spinal Cord Injury, Peripheral Nerve Injury
    • Treatment goal: teaching precautions to prevent injury!
  9. Hypersensitivity to touch
    • Results from: Nerve trauma, Soft tissue damange, Burns, Amputation (phantom)
    • Treatment:
    • HABITUATION: desensitization treatment that uses repeated stimuli to decrease in hypersensitive response.
  10. Hypersensitivity can lead to:
    • Non-use, or avoiding use
    • Holding affective part protectively (posture)
  11. Discrimination Sensory Reeducation!
    • Results from: Peripheral Nerve Damage, CVA
    • Functional use of a body part with reduced sensation IS POSSIBLE, but spontaneous use is unlikely...therefore:
    • Goal: learn to reinterpret sensation, regian the use of residual sensation = neuroplasticity! Reorganize cortical map!
    • -to use this technique patient must have PROTECTIVE SENSATION INTACT & be able to feel 4.31 MONOFILAMENT (semmes-weinstein)
  12. Localization vs. Graded Discrimination
    • Localization: localization of touch near the light-touch threshold, feel it and accuretly identify where it is.
    • Graded Discrimination: from gross to fine discrimination...feel how they are the same or different, object identification (feather or end of a pencil)
  13. Procedures for Localization & Graded Discrimination
    • Eyes Closed:localized touch or object manipulation
    • Eyes Open:follow touch (localization) or manupulation (graded discrimination)
    • Eyes Closed:reapeat
  14. Sensory Reeducation Techniques
    • In early phase, patient learns to match sensory perception of stimuli with visual perception
    • After time, focus is on functional task, like object identification through only touch
    • Establish achievable STG
    • Daily training is a must!
  15. Sensory Reeducation after CVA
    • Encourage BILATERAL use during tasks
    • CUE patients to attend to tactile aspects of the task including object identification without vision
    • Early incorporation of affected hand into activities to prevent abnormal grasp & movement patterns
  16. In what position can the hand be immobilized in for long periods of time without much stiffness?
    • Intrinsic Plus!
    • -MP joints flexed
    • -DIP & PIP extended
    • -Wrist slightly eextended
    • -Thumb in palmer opposition
  17. Functional (Resting) Hand splint
    • MCP flexed
    • DIP & PIP flexed
  18. Dorsal Splint Length
    2/3 of forearm!
  19. Motor Unit Disorders can be
    • Neurogenic: lower motor neuron (cell body & peripheral nerve)
    • Neuromuscular/Myopathic: neuromuscular junction or muscle itself
  20. Guillain-Barre (neuropathy)
    • autoimmune disease-destroys myelin sheath
    • Neuromuscular paralysis
    • Ascending from feet to trunk
    • Distal to Proximal
    • 3 stages: Early, Plateau, Recovery
    • Early: medical mgmt, OT not so much
    • Plateau: prevent secondary problems, positioning - paralyzed, can't do much
    • Recovery: OT! ROM, strength, energy conservation, safety
  21. Pliomyelitis (neuropathy)
    • viral disease, enters via fecal matter orally
    • Causes: paralysis, weakness, atrophy, esp in the LE!
    • 3 types: Spinal (LE paralysis), Bulbar (facial paralysis), Bulbospinal (both)
    • Post-Polio: symptoms reoccur after 30 years, causing weakness, paralysis, contractures, atrophy, fatigue, pain
  22. Axillary (peripheral nerve damage) c5-6
    • DELTOID muscle: weakness & paralysis
    • OT: arm sling-joint protection, allow to heal, PROM/AROM, retrograde massage, grading, EMG biofeedback
  23. Brachial Plexus (peripheral nerve damage) c5-8, T1
    • Erb-Duchenne: waiter's tip, muscles of shoulder and elbow affected, hand movement retained
    • -internal rotation/adduction, elbow extension, wrist flexion
    • Klumpke's: claw-hand, distal musculature of the wrist, flexors and intrinsic muscles of the hand
    • OT: PROM, tactile stimulation, retrograde massage, resting splint
  24. Long Thoracic Neck (peripheral nerve damage) c5-7
    • scapular winging (serratus anterior)
    • can't flex shoulder more than 90, protract shoulders of Ab/AD scapula
    • screening: wall push-up
    • OT: DME (long handled devices), PROM, glenohumeral rhythm, surgery, retrograde massage
  25. Myasthenia Gravis (neuromuscular disorder)
    • disorder of chemical transmission at the neuromuscular junction
    • autoimmune attacks ACH receptors
    • more men
    • Skeletal Muscles accected in FACE
    • -drooping eye lids, blurred vision, slurred speech, mastication difficulties
    • OT: eating, self-image
  26. Duchenne MD (myopathic disorder)
    • males only
    • degeneration of muscle fibers causing progressive weakness
    • pelvic girdle & legs --> shoulders & trunk
    • proximal to distal
  27. Facioscapulohumeral MD (myopathic disorder)
    • degeneration of muscle fibers causing progressive weakness
    • FACE & SHOULDER GIRDLE (scapula, humerus)
    • slow progression, usually NOT in LE
  28. Myotonic MD (myopathic disorder)
    • degeneration of muscle fibers causing progressive weakness
    • & myotonia: spasm/delayed muscle relaxation after vigorous contration
    • -fingers & face, cranial muscles & distal limb weakness
    • -affects before adolescence or after 60 years!
    • -The earlier the onset, the faster the progression
Card Set
OAS II-midterm 2-OTHER
OAS II-midterm 2-OTHER
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