Physical Dysfunction and Activities of Daily
Living: Assessment, Analysis and Intervention
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Defining Physical Dysfunction
Causes of physical dysfunction
Arthritic Diseases
Hip/Knee Replacements
Cardiopulmonary Diseases
Lab Activity
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What is physical dysfunction?
◦ Related to function of body structures
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Strength
◦ Muscle strength related to ability to perform
Occupations and ADLs
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Range of Motion
◦ Ability to use all joints, or necessary joints for
functional movement
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Endurance
◦ Ability to sustain movement over time, to enable
performance of functional activity
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Congenital
◦ Present at birth
 Examples: Cerebral Palsy, Muscular Dystrophy
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Acquired
◦ Disease
 Examples: Rheumatoid arthritis, heart disease
◦ Accidental
 Examples: Hip fracture, spinal cord injury
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Osteoarthritis
◦ Degenerative Joint Disease
◦ Breakdown of cartilage in the joints
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Rheumatoid Arthritis
◦ Chronic, systemic autoimmune disorder
◦ Immune system attacks the body
◦ Leads to breakdown of joints and calcification
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Gout
◦ Metabolic disease marked by urate
◦ Causes acute recurrent episodes of arthritis
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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)
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Fusiform Swelling
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Swan Neck
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Boutonniere Deformity
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Trigger Finger
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Ulnar Drift
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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
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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.
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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
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Weight Bearing Restrictions
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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
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Consider activity limitations with hip and
knee replacements
Don’t forget precautions!
Activity Limitations
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Dressing
Mobility (sit to stand transfers, driving)
Bathing and Toileting
Meal Prep and Housekeeping
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Cardio-Obstructive Pulmonary Disease
Angina
Heart Attack (Myocardial Infarction)
Congestive Heart Failure
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Acute, inpatient rehabilitation consists of:
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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.
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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)
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Blood Pressure
◦ Pressure the blood exerts against the artery walls as the
heart beats.
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Rate Pressure Product
◦ Rise at peak return to baseline in recovery
◦ RPP = HR(beats/min) x SystolicBP
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100
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Review of Medical Record (Look For):
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Diagnosis
Severity
Associated Conditions
Secondary Diagnoses
Social History
Test Results
Precautions
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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
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Signs of Anxiety
Shortness of Breath
Confusion
Difficulty comprehending
Fatigue
Posture
Endurance
Ability to Move
Family Dynamics
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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
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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
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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
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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.
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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.
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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:
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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.
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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:
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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.
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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
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Must be taught and reinforced to the client and
family members by the team:
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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.
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For the following activities think of 3 means of
conserving energy, considering that you have a
client with cardiac and pulmonary difficulties:
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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.