NSG 552 Exam 2 Study Guide 2023 Graded A

*Orthotics* - - Know the general categories to describe orthotics and the purpose of each type - Recommend orthotics for painful joints, tissue protection and immobilize for healing - Understand principle of splinting fewest joints possible - Describe appropriate angle of pull (90 degree) and rationale - Understand principles related to materials, fit, and safety What is the purpose for splinting? - 1. Support a painful joint 2. Immobilize 3. Protect healing or damaged tissue 4. Provide stability 5. Restrict unwanted motion 6. Substitute for weak/absent muscles 7. Prevent contractures 8. Correct contractures 9. Increase passive motion 10. Modify tone Primary Purpose: Immobilization (static) orthosis - Primary Purpose: provide support, stabilization, protection or immobilization -Communicate purpose to patient -can be for fractures -serial static orthosis/casting Ex: hand based thumb spica, short opponents, short thumb (HFO) Primary Purpose: Serial static orthosis/casting - "Low load", prolonged duration stretch, remolding or refabricaiton of orthosis/cast as ROM increases -communicate purpose to patient 10 to 15 minutes four times a day 10 to 15 degree at a time -If wear longer than 10 to 15 it can become more painful Primary Purpose: Mobilization static orthosis - *-Anything used to stretch/facilitate motion -Purpose is to promote ROM using screws, velcro, hinges* -includes nonelastic components such as screws, Velcro, turnbuckles, or hinges used to promote ROM -adjustments can be made easy by the user typically Primary Purpose: Mobilization elastic orthosis - *-Use moving parts to permit, control, or restore movement with components such as rubber bands, elastic or springs * Ex: dynamic dorsal block, Kleinert (WHFO) -Radial nerve palsy orthotics (WHFO) Primary Purpose: Peripheral nerve injuries orthotics - 1. Keep denervated muscles from remaining in an overstretched position Ex: prevent wrist drop 2. Prevent joint contractures (Nerve damage, so muscles cant fire like they are supposed to) 3. Prevent development of substitution patterns 4. Maximize function Primary Purpose: Status post burn orthotic fabrication - -based on direction and line of pull of scar -where is the scar? -dorsal hand burns have specific protocols due to close proximity to extensor tendons -can use scar inserts to elongate tissue -may begin using 5 days (7-10 is recommended) post grafting Recommend orthotics for painful joints, tissue protection and immobilize for healing - - Immobilizer orthotic is best for pain especially CMC thumb arthritis (thumb spica) - Resting hand orthotic: burns for skin protection and maintenance and pain - See notes for list of orthotics and specific associated conditions Understand principle of splinting fewest joints possible - - You do not want to immobilize joints unless absolutely necessary. It can cause more harm that good in terms of decreasing joint mobility, increasing stiffness and potential contractures Persevering: muscle strength muscle integrity bone intensity Describe appropriate angle of pull (90 degree) and rationale - - The direction and magnitude of the forces applied to a joint or finger are important when applying force to increase passive ROM. The direction of pull must be at a 90-degree angle to the axis of the joint and perpendicular to the axis of rotation. -As ROM increases adjustments can be made to the outrigger to maintain the 90-degree angle. You don't want the line of pull to be in a medial or lateral direction and disturb the mobilization of the joint Understand principles related to materials, fit, and safety: *Materials* - 1. low temperature thermoplastic -width preference -perforated vs non perforated -highly elastic vs stiff 2. Hybrids (orficast) 3. Plaster of Paris 4. Taping: kinesiotape 5. Neoprene Understand principles related to materials, fit, and safety: *Fit* - -molding contours: use of skin creases as guidelines for boundaries -ID bony prominence and take care to dome out or avoid these areas -reduce pressure to skin through long lever (long splint) -support arches both longitudinal and transverse with proper alignment -if using forces, ensure bone being mobilized is perpendicular to the outrigger -should rise 2/3 up limb supported Understand principles related to materials, fit, and safety: *Safety* - -check for latex free materials -skin precautions -pressure precautions -nerve irritation -blood vessel irritation -perfusion: capillary refill -cognitive status influence compliance -sensory status -ability to don/doff *Neurodegenerative Conditions: GB, MS, ALS, PD* - - Describe priorities and role of OT - Apply precautions for treatment based on disease condition - Apply specific strategies to enhance performance - Know guidelines for exercise and strengthening - Understand patient education needs Guillian Barre Syndrome: What is it? - -Everyone has weakness -It's attack on the bodies nerves -Quadraplegia (LE & UE weakness) -Areflexia -Parasthasia -Sensory loss -Sphincter involvement -Oropharyngeal weakness -Pain (neurogenic & neuropathic) -Respiratory failure -Oculomotor weakness -Ataxia -speech & swallowing -Usually are continent in bowel and bladder -weakness proximal more than distal -quadraparesis -respiratory failure