Transcript Frame of Reference

Jamie
By: Missy Dappen, Stephanie Hayes,
Anna Long, Trish Ruby and Kristen
Thompson
P factors
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23-year old female
Complete C6; quadriplegia
Complete trunk and LE paralysis; partial UE paralysis
Sitting tolerance = 4 hr
Good shoulder strength
Minimal wrist strength
No hand function
Difficulty grasping utensils (eating and writing)
Difficulty dressing lower extremity
Difficulty transferring into and out of wheelchair
Using facility’s wheelchair
E factors
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Lives independently in a one-bedroom
apartment
 Drives a sports car
 Has supportive parents and a steady
boyfriend
O factors
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Occupational roles: daughter and girlfriend
 Assistant to an accountant
 Recent graduate, hoping to continue her
education
 Enjoys: dancing, playing softball, movies,
theater and driving her sports car
Frame of Reference
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Biomechanical
– Goal: To remediate loss of range of motion,
strength and endurance
– Purpose: If range of motion, strength, and
endurance are regained the patient will use
these skills to gain functional skills
– Appropriate for Jamie: Remediate muscle
strength in wrist extensors to help increase her
grasp for ADL and leisure activities
Assessments
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Range of Motion (functionally and using
goniometer) (P)
 Manual Muscle Testing (P)
 Endurance testing (P)
 Functional Tests
– SAFER (E)
– COPM (O)
– Kitchen task assessment (E & O)
Strength in Shoulder
Supraspinatus
Teres Minor
Deltoid
Subscapularis
Infraspinatus
Rhomboids
Levator Scapulae
5
5
5
5
5
5
4
Strength in Forearm and Wrist
Brachialis
Brachioradialis
Biceps
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris
Extensor digitorum
Extensor pollicus longus
Extensor pollicus brevis
4
33+
222222-
OP Limitations and Goals
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Limitation: Grasping utensils
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Solution: Strengthen wrist extensors to 3+
so she can use a tenodesis splint
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Goal: Jamie can increase wrist extensors to
a 3+ for use of a tenodesis splint to facilitate
grasp by 1 month
OP Limitations and Goals
(cont.)
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Limitation: Difficulty with transfers
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Solution: Teach biomechanics principals of
transfers to assist when transferring
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Goal: Jamie will be able to transfer from
bed to wheelchair with contact guard assist
by 6 weeks
OP Limitations and Goals
(cont.)
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Limitation: Difficulty dressing especially
lower extremity
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Solution: Strengthen biceps and provide and
train on use of adaptive equipment
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Goal: Jamie will be able to dress using
adaptive equipment and techniques by
discharge
Role Play
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Begin with passive stretching of wrist and
then fingers
 Kitchen stirring activity will strengthen
Jamie’s wrist extensor in a horizontal plane
remediating her extensors to at least a 3+
resulting in the ability for Jamie to
independently return to cooking and have
the strength to use a tenodesis splint for
grasp
 Introduce and educate about splint
Efficacy article
Long-term exercise training in persons with spinal cord injury: effects on
strength, arm ergometry performance and psychological well-being
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Population: Men & Women: Age 19-65 with SCI
(C4 or below)
 Training Intervention: UE stretching;
cardiovascular exercise, and resistance training for
major muscle groups
 Exercise group had significant increases in
strength, arm ergometry performance, as well as
several components reflecting QOL &
psychological well-being
Why Pertinent to Jamie
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Jamie needs to improve her strength in the
muscles that were covered in the article
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By improving Jamie’s strength in affected
muscles, her abilities could generalize to
help with functional activities
Tenodesis Splint
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Purpose: To create functional grasp by facilitating joint
movement and making use of passive tension
properties of muscle
Use: In therapy program when the wrist extensors are a
3+ or better
Indications: C-5 (incomplete); C6 or C7 (complete)
Position: Index and Middle Finger- MP: free, PIP:
flexion 30-45o, DIP: flexion 10-25o; Thumb- CMC:
abduction 50o, MP and IP: 0o
Precautions: Risk of Skin Breakdown
References
Frames of Reference and Models of Intervention at Washington
University in St. Louis School of Occupational Therapy on
September 19, 2005, Dr. Patti LaVesser describing the
Biomechanical Model.
Coppared, B.M., & Lohman, H. (2001). Introduction to splinting:
A critical-reasoning and problem solving approach (2nd ed). St.
Louis, MO: Mosby.
Holm, M. (1986). Frames of reference: Guides for action. In, H.
Schmidt Powell (Ed.) PILOT: Project for independent living in
occupational therapy, pp 69-78. Rockville, MD: AOTA.
Hicks, A. L., Martin, K. A., Ditor, D. S., Latimer, A. E., Cravin, C.,
Bugaresti, J., & McCartney, N. (2003). Long-term exercise
training in persons with spinal cord injury: effects on strength,
arm ergometry performance and psychological well-being.
Spinal Cord, 41, 34-43
References (cont.)
Pedretti, L.W. & Early, M.B. (Eds.) (2001). Occupational
Therapy: Practice Skills for Physical Dysfunction (5th ed). St.
Louis, MO: Mosby, Inc.
Tenney, C. G. & Lisak, J. M. (1986). Atlas of hand splinting.
Boston / Toronto: Little Brown & Co.
Trombly, C.A. & Radomski, M.V. (2002). Occupational
therapy for physical dysfunction (5th ed.). Philadelphia, PA:
Lippincott Williams & Wilkins.