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Musculoskeletal
| Question | Answer |
|---|---|
| Prosthesis control training | operate each component |
| Prosthesis use training | integration of components for efficient assist in functional tasks |
| Prepositioning training | identify optimal position of each positioning unit (joint) |
| Prehension training | TD control during grasp activities |
| Contractures | fixed posture because of shorterning of skin, ligaments, joint capsule, tendon, and muscle could be from burns, wound healing, muscle imbalance because of PNI, SCI, increased muscle tone from stroke, head injury, and CP |
| Soft tissue contractures vs bony block contractures | respond to therapy vs requires surgery to release |
| Treatment of contractures | 1. superficial and deep heat to increase tissue extensibility 2. slow stretch 3. static splinting |
| Antideformity (safe position) burn splint | wrist 20 deg extension MCP 90 deg flexion PIP and IP extension |
| Wrist extension splint | prevent wrist drop, functional splint with 45 deg of wrist extension worn during the day |
| thumb abduction splint | prevent thumb adduction contracture C-bar in web space |
| lumbrical bar splints | reduce MCP hyperextension and IP flexion contractures |
| resting hand, ball, and cone antispasticity splint | decrease tone in hand and UE |
| soft neoprene splints | position thumb and forearm used with RA or CP |
| serial casting | fiberglass or plaster to position clients iwth increased tone and over time stretch out soft tissue contractures |
| dynamic splinting | angle of pull at 90 deg for most effective outcome |
| fibromyalgia | widespread soft tissue pain, nonrestorative sleep, fatigue, inability to think clearly, paresthesia, joint swelling, depression, anxiety excessive tenderness in 11 of 18 trigger points |
| fibromyalgia intervention | daily activity log education to avoid triggers gentle aerobic exercise myofascial release sleep hygiene techniques fatigue management, energy conservation, work simplification activity/environment modification |
| Toe touch weight bearing | toe touch for balance, 90% weight on unaffected leg |
| partial weight bearing | 50% WB |
| Posterolateral hip precautions | no hip flexion >90 deg no internal rotation no adduction |
| anterolateral hip precautions | no external rotation no extension no adduction |
| sciatic pain | nerve is trapped by a herniated disc |
| spinal stenosis | narrowing of the intervertebral foramen |
| facet joint pain | inflammation or changes of spinal joints |
| spondylosis | stress fracture of the dorsal to transverse process |
| spondylolisthesis | slippage of a vertebra out of position |
| herniated nucleus pulposus | stress tearing of the fibers of a disc, causing an outward bulge pressing on spinal nerves |
| Body mechanics(9) | straight back-minimize lumbar lordosis bend from hip avoid twisting maintain good posture carry loads close to body lift with legs, wide BOS, in sagittal plane, and slowly |
| semisquat vs squat vs stoop lift | safest for the back, ideal for heavy loads/preferred by people with LBP/used for light loads |
| Bathing for LBP | shower better than bath handheld shower head bathmat items within reach |
| Dressing for LBP | minimize bending sit while dressing, lie down to pull pants up socks by bringing foot to knee slip on shoes belts through pants prior to donning |
| functional mobility for LBP | logrolling firm armed chairs not sit for more than 20 minutes at a time |
| sleep positioning for LBP | pillow support neck and head without causing flexion sleeping on back: pillow under knees sleeping on side: pillow between knees sleeping on stomach: pillow under feet |
| chemotherapy | use of toxic chemicals to kill cancer cells |
| radiation | use of radioactive material to kill cancer cells precatuions: maintain joint ROM while avoiding pulling burned skin |
| hormone therapy | use of hormones to decrease estrogen which can increase spread of some cancers preacution: monitor room temperature and client mood |
| immunotherapy | use of medicine to block or heighten immune response preacutions: avoidance of scratching skin |
| osteoarthritis | noninflammatory condition that causes a breakdown in articular hyaline cartilage common in PIP, DIP, CMC, MTP, hip, knee, cervical and lumbar |
| osteophytes or bone spurs- bouchards--OA | PIP joint |
| osteophytes or bone spurs-heberdens--OA | DIP joint |
| TKR precautions | no pillow under knee while in bed rest feet on floor while seated avoid kneeling, squatting, twisting the knee |
| Contraindications for OA | pinching exercises with CMC joint instability spica splint can help improve joint stability |
| Joint protection and fatigue management (9) | respect pain, maintain strength/ROM, use each joint in most stable plane avoid positions of deformity use strongest joint and correct patterns of movement avoid staying in 1 position for long avoid starting activities that cant be stopped balance res |
| rheumatoid arthritis | chronic, systemic, inflammatory condition progressive synovitis symmetric polyarticular presentation: PIP, MCP, MTP, hip, knee, shoulder, cervical spine |
| 7 diagnostic criteria for RA | need 4 morning stiffness 3+ swollen joints in 14 possible areas swollen joints of the hands symmetric swollen joints rheumatoid nodules serum rheumatoid factor radiographic changes on posterior hand |
| boutonniere | PIP flexion, hyperextension of DIP |
| swan neck | hyperextension of PIP, DIP flexion |
| mallet finger | flexion of DIP |
| ulnar drift | radial deviation of wrist and ulnar deviation of MCP joint (zigzag deformity) |
| mutilans deformity | floppy joints with shortened bones and redundant skin most common in MCP, PIP, radiocarpal, or radioulnar joints |
| Type 1 pattern of thumb deformity | MCP Flexion and IP joint hyperextension , similar to boutonniere |
| Type 2 pattern of thumb deformity | CMC flexion/adduction, MCP flexion, and IP joint hyperextension, similar to boutonniere |
| Type 3 pattern of thumb deformity | CMC subluxation, MCP hyperextension, and IP flexion (smilar to swan neck) |
| Type 4 pattern of thumb deformity | MCP hyperextension and instability of MCP UCL (similar to gamekeepers thumb) |
| Type 5 pattern of thumb deformity | MCP hyperextension because of a lax volar plate |
| Type 6 pattern of thumb deformity | thumb collapse because of arthritis mutilans |
| Four stages of RA | Might overlap acute, subacute, chronic active, chronic inactive |
| acute stage of RA | pain and tenderness at rest that increases with movement limited ROM, stiffness, gel phenomenon (inability to move joints after rest), weakness, tingling or numbness, hot red joints, cold sweaty hands, low endurance, weight loss, dec appetite, fever |
| subacute stage of RA | acute symptoms with reduced pain and tenderness |
| chronic active stage of RA | low grade inflammation, decreased ROM, less tingling, pain and tenderness primarily with movement, low endurance |
| chronic inactive stage of RA | No inflammation, pain from stiffness and weakened joints, morning stiffness related to disuse, limited ROM, weakness and muscle atrophy, contractures |
| Progression of RA: stage 1, early | no destructive changes on x ray, possible presence of OP |
| progression of RA: stage 2, moderate | radiographic evidence of OP, possible slight bone destruction and presence of slight cartilage destruction, no joint deformity, muscle atrophy, possible presence of lesions |
| progression of RA stage 3 severe | radiographic evidence of OP, cartilage and bone destruction, joint deformity, muscle atrophy, soft tissue lesions |
| progression of RA stage 4 terminal | fibrous or bony ankylosis in addition to stage 3 |
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