Transcript OTA II
Physical Dysfunction and Activities of Daily Living: Assessment, Analysis and Intervention Defining Physical Dysfunction Causes of physical dysfunction Arthritic Diseases Hip/Knee Replacements Cardiopulmonary Diseases Lab Activity What is physical dysfunction? ◦ Related to function of body structures Strength ◦ Muscle strength related to ability to perform Occupations and ADLs Range of Motion ◦ Ability to use all joints, or necessary joints for functional movement Endurance ◦ Ability to sustain movement over time, to enable performance of functional activity Congenital ◦ Present at birth Examples: Cerebral Palsy, Muscular Dystrophy Acquired ◦ Disease Examples: Rheumatoid arthritis, heart disease ◦ Accidental Examples: Hip fracture, spinal cord injury Osteoarthritis ◦ Degenerative Joint Disease ◦ Breakdown of cartilage in the joints Rheumatoid Arthritis ◦ Chronic, systemic autoimmune disorder ◦ Immune system attacks the body ◦ Leads to breakdown of joints and calcification Gout ◦ Metabolic disease marked by urate ◦ Causes acute recurrent episodes of arthritis Crepitation: Grating, crunching or popping sensation/sound in the joints (OA & RA) OsteoArthritis: Osteophyte formation (Bony spur that forms along a joint) ◦ Bouchard’s Nodes (PIP joint) ◦ Heberden’s nodes (DIP joint) Fusiform Swelling Swan Neck Boutonniere Deformity Trigger Finger Ulnar Drift Thumb Deformities (Figure 30-9, pg. 566) ◦ IP hyperextension, MPC flexion (most common) ◦ IP hyperextension, MPC flexion, carpometacarpal subluxation ◦ IP flexion, MPC hyperextention, carpometacarpal subluxation General objectives might include: ◦ Maintain or increase joint mobility and strength ◦ Increase physical endurance ◦ Prevent, correct or minimize the effect of deformities ◦ Maintain or increase ability to perform ADL’s ◦ Increase knowledge about the disease and the best methods of dealing with the physical, psychological and functional effects ◦ Assist with stress management and adjustment to physical disability. Medical Management ◦ Drug Therapy ◦ Surgical Rest Positioning (to prevent contractures) Physical Agent Modalities Therapeutic Activity and Exercise (ROM exercises pg. 579 Splinting – pg. 573 Early ◦ support the joint in an optimal position for function and to reduce inflammation by providing rest and support to the joint Energy Conservation (See principles of energy conservation pg. 575) Assistive Devices (See Assistive Devices Table pg. 577) Joint Protection ◦ Respect pain ◦ Maintain muscle strength and joint ROM ◦ Avoid positions that put stress on involved joints Weight Bearing Restrictions ◦ ◦ ◦ ◦ ◦ NWB (Non-weight bearing) TTWB (Toe-touch weight bearing) PWB (Partial weight bearing) WBAT (Weight bearing as tolerated) FWB (Full weight bearing) Hip Replacement Precautions ◦ See handout Consider activity limitations with hip and knee replacements Don’t forget precautions! Activity Limitations ◦ ◦ ◦ ◦ Dressing Mobility (sit to stand transfers, driving) Bathing and Toileting Meal Prep and Housekeeping Cardio-Obstructive Pulmonary Disease Angina Heart Attack (Myocardial Infarction) Congestive Heart Failure Acute, inpatient rehabilitation consists of: ◦ ◦ ◦ ◦ ◦ ◦ monitored ADL’s instruction in cardiac and postsurgical precautions energy conservation graded activity risk factor management discharge activities Tools for measuring a client’s response to activity are used to evaluate the cardiovascular system’s response to work. Going beyond the physician recommended maximums can put the client at risk. Heart Rate ◦ Measured in Beats per minute ◦ Heart rate should rise in response to activity but moderate activity should not result in maximal heart rate (could indicate need to grade the activity to conserve energy) Blood Pressure ◦ Pressure the blood exerts against the artery walls as the heart beats. Rate Pressure Product ◦ Rise at peak return to baseline in recovery ◦ RPP = HR(beats/min) x SystolicBP 100 Review of Medical Record (Look For): ◦ ◦ ◦ ◦ ◦ ◦ ◦ Diagnosis Severity Associated Conditions Secondary Diagnoses Social History Test Results Precautions Client Interview: ◦ Clients with a history of angina should be asked to describe in terms of intensity of episodes, and if they’ve had a MI can they differentiate between the symptoms ◦ Identify activities that bring shortness of breath ◦ Look For Signs of Anxiety Shortness of Breath Confusion Difficulty comprehending Fatigue Posture Endurance Ability to Move Family Dynamics Clinical Assessment: ◦ Determine client’s present functional ability and limitations ◦ Monitored for heart rate, BP and signs/symptoms of cardiac/respiratory distress during an evaluation of tolerance to postural changes, and a functional task See Early pg. 669 table 35-2 and 673 table 35-3 ◦ Range of Motion, Strength and sensation may be assessed. ◦ Client’s cognitive and psychosocial status will become apparent through interview and observation. Formal assessments only used if concerns arise Guided by present clinical status, recent functional history, response to current activity, and prognosis Energy costs of an activity and the factors that influence them can further guide the OTA in safe progression of activity (Oxygen consumption often used) Resting quietly in a bed requires the least amount of oxygen per kilogram of body weight ◦ 1basal metabolic equivalent (MET) OR ◦ 3.5ml of Oxygen/kilogram body weight As activity increases more oxygen is required to meet the demands of the task See pg. 674 table 35-4 for MET values associated with self-care and homemaking tasks As a general rule, once clients tolerate an activity (ex. Seated sponge bathing) with appropriate responses, they can progress to the next higher MET level activity (ex. Standing sponge bath) Duration of activity must be considered when determining activity guidelines A person with difficulty performing a 2 MET activity must still use a commode (3.5METS) or bedpan (5METS) for their bowel management. A person can perform at a higher than usual MET level for brief periods without adverse effects. Diaphragmatic breathing: ◦ Benefits some clients ◦ Breathing patternt hat calls for increased use of the diaphragm to improve chest volume ◦ Clients can learn this technique by placing a small paperback novel on the abdomen just below the thorax. The client lies supine and is instructed to inhale slowly and make the book rise. Exhalation through pursed lips should cause the book to fall. Relaxation: ◦ Progressive muscle relaxation in conjunction with breathing exercises can be effective in decreasing anxiety and in controlling shortness of breath. ◦ One technique involves tensing the muscle groups while slowly inhaling, followed by relaxation of the muscle groups when exhaling twice as slowly through pursed lips. ◦ It is helpful to teach the client a sequence of muscle groups to tense and relax. One common sequence involves: Tensing and relaxing the face Followed by the face and neck Next the face, neck and shoulders Etc…. Until you reach the toes ◦ A calm, quiet and comfortable environment is important for learning. Energy Conservation: ◦ Can help clients perform at a higher funcitonal level without expending more energy. ◦ Based on knowledge of how specific factors increase the body’s workload ◦ 6 variables that increase oxygen demands: Increased work rate or activity pace Increased resistance Increase use of large muscles Increased involvement of trunk musculature Raising the arms Isometric work (straining) ◦ Arm activity has also been shown to require a greater cardiovascular output than lower extremity activity ◦ Standing activities require more energy then seated activities. Energy Conservation Cont’d: ◦ Extremes of temperature, high humidity, and pollution make the heart work harder ◦ Exhaling with exertion is more energy efficient and helps control the rate of increase of systolic blood pressure with activity. ◦ By applying all this information, suggestions can be made for modifying an activity that will decrease the amount of energy required for the task. ◦ Should be client centred ◦ Use of time management important Must be taught and reinforced to the client and family members by the team: ◦ ◦ ◦ ◦ ◦ ◦ ◦ Pulmonary anatomy Disease process Symptom management Risk factors Diet Exercise Energy conservation Including family members provides support indirectly to the client through the family unit. Such support is critical when a client is dependent on the help of a family member to accomplish everyday tasks. For the following activities think of 3 means of conserving energy, considering that you have a client with cardiac and pulmonary difficulties: ◦ ◦ ◦ ◦ ◦ ◦ Making vegetable soup Planting a flower garden/vegetable garden Washing, drying and styling their hair Starting an independent fitness program Getting groceries Cleaning a bathroom Please explain your choices for each one and hand this in as your lab mark for this week.