Oh, the Ailments
John's parents are worried about him. He will be playing in their house and become incredibly focused and fixated on one toy, and lately has been absolutely fighting and resisting the idea of trying a new daycare as well and gets incredibly overwhelmed easily. John's friends at daycare want to play with him, but are discouraged he stares them straight in the eyes and has a hard time respecting their "bubbles". What does it sound like John has? And what are ways that could help him?
Autism is a developmental disability that affects 1 in 88 children and is 5 times more common in boys.
Give him a structured routine, continue to teach about social cues, provide comfort items and ways to express their fascination and focus. Among many others.
When transferring a patient with a non-weight-bearing injury and left hip replacement, for example, the left hip is non-weight bearing, what is important to remember about
a) rolling over in bed
b) placing the wheelchair or cane
c) standing
d) putting on pants
e) sitting back down
Because this is a LEFT hip injury, the following will be true:
a) When rolling, roll to the left side because the left leg CANNOT cross over the right. (Roll or turn to the side the injury is on). EDIT, either side is ok, but must have a pillow in between legs if choosing good side.
b) place the wheelchair and cane on the GOOD, STRONG SIDE. They can pivot on the good side
c) make sure walker is in front of them, adjusted to right height (in line with metacarpals) and they use their hands to push off the bed. Make sure to not let them place weight on the left side if indicated.
d) when putting on pants, start with LEFT BAD LEG. When taking off pants, start with GOOD LEG. DON'T CROSS LEFT LEG.
e) make sure knee-pits are pressing into bed. Reach back with hands to feel chair arm rests or bed.
Jack has had a left hip replacement, with pins supporting the head of the femur, and you are trying to transfer him into a wheelchair alongside of the bed. What important precautions should be kept in mind?
Precautions vary with injury, but remember:
No weight bearing on left leg. No twisting, turning, rotation. Transfer with chair on the RIGHT side, so the weight of moving the left leg does not get in the way. Move with the strong side.
1.This works closely with cognition and is how our brain recognizes and interprets sensory information.
This area of the answer to 1 can come with apraxia, stereognosis, and graphesthesia. Define these.
1. Perception.
Apraxia is the inability to plan or perform the purposeful movement
Stereognosis is identifying objects through touch
Graphesthesia is the ability to recognize things drawn on skin
Amputations are an absolute last resort. Some people are born with them (congenital). But 75% is due to diabetes, or peripheral vascular disease.
1. Fitting of a prosthetic should be within how many days?
2. Prosthetics have benefits, list some.
3. Myoelectric and mechanical have different components, but components to a prosthetic include...?
1. 30
2. Decreased sensation of phantom pain/sensation, accelerate wound healing, decrease edema (swelling), improve psychological adjustment
3.
Rigid Dressing – applied in surgery (changed every 10 days or so), Pylon – temporary leg casted on, Stump shrinker/liner – silicone sleeve, Stump socks – compensate for fluctuation in stump circumference, Socket – fits snugly over residual limb
Pin/leg/joints – attach the prosthetic to residual limb
Common CNS (BRAIN AND SPINAL CORD) diseases include the following. Please read the description and determine the disease being described.
1. Severe demyelination of the CNS. Signs – depends on site of lesion, symptoms exacerbate and remit, fatigue, visual issues, motor/sensory disturbances, cognitive/mood issues.
2. Slow progressive disease process affecting basal ganglia= impaired coordination, procedural movements and habits. Regulation disorder – dopamine. Signs – muscle rigidity, abnormal movements/posture, shuffling gt, swallowing difficulties, resting tremor.
3. Rapid degeneration of motor neurons with a 1-3 year life expectancy. Most common progressive MN. Signs – progressive loss of muscle strength/coordination (distal to proximal) impaired speech, swallowing, respiration, cognition remains intact.
4. Deterioration of brain tissue. Tangles, plaque, degeneration in brain tissue. Signs – gradual memory/mood changes, progress to total functional deterioration
MS 1. Severe demyelination of the CNS. (has 4 kinds, benign, relapsing-remitting, primary progressive, progressive relapsing. )
PARKINSONS 2. Slow progressive disease process affecting basal ganglia= impaired coordination, procedural movements, and habits
ALS (Lou Gehrig's) 3. Rapid degeneration of motor neurons with a 1-3 year life expectancy.
ALZHEIMERS 4. Deterioration of brain tissue.
Mickey has been experiencing symmetrical pain in multiple joints, and much pain and tingling in them even though he has not been incredibly physically active in his life.
Ayra has pain and weakness in both of her knees, too, but has been a runner for 30+ years.
Both have arthritis. But what kind and why?
Mickey has rheumatoid. Higher swelling. It is where the body attacks the joints and swells them with its own immune system not dependent on wear and tear.
Ayra has osteoarthritis. Her own knees have suffered wear and tear for years and they are wearing out and breaking down. Combination of mechanical, metabolic, chemical, and genetics.
Posterior hip precautions include:
Anterior hip precautions include:
No hip flexion above 90 degrees, No internal rotation No adduction Explain in pt terms (cannot put on shoes)
No ext rotation, No adduction, No extension but can put on shoes
Orientation (awareness of current situation), attention (focus), memory (memory and its multiple types), and executive functioning (formulate plan and implement goals) are all areas of what?
Areas tested of the answer to 1, include
Abstract thinking – understanding relationships, recognize absurdities, aware of nuances
Concrete thinking – literal understanding
Problem solving – process of reasoning to come to solution
Convergent – arrive at central idea (point/theme)
Divergent – ability to generate alternatives
Deductive – arrive at conclusions based on data collected
Inductive – generalizations from experiences
What are other areas?
Cognition.
Orientation – awareness of current situation
Time, place, topographical
Attention – focus
Automatic, controlled, sustained, divided
Memory – recall/retain information
Confabulate – fill in gaps with misinformation
Declarative – recite/reproduce information
Episodic- personal history
Semantic – general knowledge, societal norms
Procedural – sequencing, skills
Executive functioning – formulate plan implement goals
Initiation – when/where to begin task
Perseverate – continue/repeat action beyond purpose
Benefits of positioning and handling?
Stability and mobility skills are first developed in what position?
Increases the child’s physical comfort and reduces fatigue
Promotes skeletal alignment
Provides the child with a range of sensory experiences that enhance learning
Assists the child with learning movement
prone
Haylee has a history of high fever, aches, and pains, muscle weakness, numbness, trouble swallowing, as well as slowed speech. Her symptoms are symmetrical, muscle weakness on both sides of the body and she is slowly becoming paralyzed. Recovery can be complete, or it can be fatal. What is most likely her diagnosis?
GUILLAIN-BARRE SYNDROME
fun fact. People diagnosed with this should not have a flu shot. I learned that with my 95-year-old client I care for at her doctor's appointment!
In a sensory testing procedure, there are many tips recommended for OT's. Occlude vision, perform free from distractions, and administer bilaterally include some new ones.
Common areas of sensation tested are
Sensation = outside feelings – from the environment
Perceptions = inside feelings – understanding of what we feel
Cognition = thoughts, ability to put sensations/perceptions into actions
Rheumatoid arthritis: chronic disease, bilaterally (both hands) can cause deformities. Pulls hands outward.
Osteo Arth= single joint at a time, not often both sides
Gout= huge swollen, metabolic disease, uric acid overproduction crystals settle in joint.
What do we do?
I literally don't know where I was going with this.
I guess it was make them comfortable, splinting, use medicine, drain gout, body mechanic training
CP has tonal distributions (quad, di, Hemi, mono, and triplegia, the last two being the rarest).
These can also be specified as spastic (intensely crossed legs) (hypertonic, rapid release in movement) with one of the above. Very HIGH tone and rigidity with above.
or dyskinetic (slow abnormal movements involuntary that can cause jerky unusual movements, usually in UE, WEAK MUSCLES). What are the types of dyskinetic?
All usually having a quadriplegic tone
Atheoid: fluctuate between high tone and low tone. (ataxia is like this but less severe, lack of coordinated muscle movement, tremors)
Choreoatheoid: another form of this, usually in face and head
Dystonic: strong slow movements usually affecting whole body
Best position to neutralize excessive muscle tone
Easiest position in which to align arms, hands, and head in midline, with gravity eliminated
Little use of the ATNR in this position
Good for independent play and development of eye-hand coordination
what is this position?
Side-lying
Martin's face muscles are beginning to lose their tone. His eyelids are starting to droop and hes had trouble keeping his lips completely closed. The family suggested it was a stroke, but it is happening on both sides of his face, along with a feeling of his throat closing. Martin tried working out but panicked and had to stop because he feared he would not be able to breathe. What does it sound like happened to Martin?
MYASTHENIA GRAVIS
TBI (Traumatic brain injury) GREATLY AFFECTS a person's level of functioning. This includes concussions, spinal fractures, whiplash, and spinal cord injury. They are the leading cause of death in the US. When one occurs, what is crucial?
Stages of care are similar despite injury
ABC’s = Establish, protect, maintain airway, breathing, circulation
CPR, Intubation, ventilator support, vitals, provide blood/fluids
Protect/align spine – traction, c-collar, internal fixation, external bracing, spine precautions, splinting
Loss of Consciousness – assess = GCS, CT scan, physical exam
Surgical intervention may be necessary immediately or delayed depending on level of stability
1. Of the types of joints (synovial, cartilaginous, and fibrous) which is the most susceptible to injury?
2. OT considerations for musculoskeletal diseases and injury include what?
1. Synovial. They are fluid and provide tons of movement. Of those, the hip and shoulder are HIGHEST PROBABILITY OF INJURY.
2. Constant movement, turning, and gentle motion (they get hecka stiff and good blood flow), contracture (permanent shortening or deformity) prevention, splint, and work with nurses to understand kind of injury (is it from trauma, constant use, genetics, or immune responses gone bad?)
With CP, there can be:
Visual impairments – 50%
Strabismus: misalignment of the eyes due to muscle imbalances
Exotropia: eye drift outward
Esotropia: eye drift inward
What is Nystagmus?
What are some interventions of CP?
the constant movement of the eyes in a repetitive, uncontrolled way that may reduce acuity, affect balance, decrease reaching accuracy'
Interventions:
Constraint-Induced Movement Therapy
Modalities
Robotics
Kinesiotaping
Orthotics and Casting
Surgical interventions: orthopedic surgery, severing nerves (severe cases)
Hip Precautions?
Anterior: No crossing legs, no stepping backward with bad leg, no turning foot outward
Posterior: no bending forward, no crossing legs, no turning foot inward
Spinal Fractures involve specific spinal precautions. List some.
log roll precautions, 5-7 lb lifting restriction, fall/safety, maintain good body mechanics (no bending, twisting, leaning), change positions frequently (avoid prolonged sitting)
Cerebral Palsy is a disease in which a lesion in a person's brain, not a physical problem with their legs or body, interferes with the ability to perform. It is stopping a signal from working, to allow them to work correctly.
Common complications of CP include trouble coordinating the movement of arms or legs, the persistence of primitive reflexes, and can cause an incredibly rigid tone or not enough tone at all.
SEVERE COMPLICATIONS INCLUDE: can restrict breathing, vision impairments, bladder and bowel control, such compact and tight muscles no allowed movement at all.
How frequent is CP? And what greatly increases the chances of giving it to a developing baby?
For every 1000 live births, there are about 2-3 children born with CP
Brain Injury to fetus is a huge cause (80-90%), maternal health issues, trauma, infection, genetics
1. This is a metabolic disease in which uric acid no longer has a place to go and ends up pooling in a bone or joint causing very painful crystals. It usually appears in the LE first and causes very localized red hot pain.
2. The constant stripping of calcium from bones, the chosen occupation of being a swimmer, not doing much weight bearing or weight lifting, and being female all heavily contribute to which disease?
1. Gout/gouty arthritis
2. Osteoporosis. Huge huge cause of hip fractures, femur fractures, and LE breakage in general.
There are 3 kinds of spina bifida. Name them and list their severity. Higher level of spina bifida, harder it is to deal with. Hydrocephalus may also be a symptom.
1. Occulata= least serious, most common, small bump, discovery by surgery or x-ray. Vertebrae completely fused. May cause bowel problems.
2. Meningocele=second most serious, forms large bump in affected spinal area, but does not involve spinal cord into swelling. Vertebrae are not closed.
3. Myelomeningocele=very serious, spinal cord is enclosed in the large cyst. Spinal nerves in the sac level and downward do not work.
Brian is hypertonic. He has active primitive reflexes, has excessive activity and motion, and excites easily. What techniques can help with him?
Kyla is hypotonic. She has a lack of balance reactions, doesn't appear to have primitive reflexes, appears semiconscious, and doesn't react much to touch. What techniques help with this?
BRIAN=INHIBIT HIGH TONE WITH:
wrapping, neutral warmth
slow stroking
gentle shaking or rocking
trunk and hip rotation
slow rolling
KYLA=FACILITATE LOW TONE
light moving touch
stretch, muscle tapping
battery-operated vibration
fast, irradic vestibular input