OT 643 Lecture Exam Study Guide 1- 2022 Ottinger
Topics covered for Exam 1: Models of OT, Health Literacy, EBP, Occupational Screening/Evaluation
processes, Pain, Edema, CRPS, Low Back Pain, Arthritis, UE and Upper Quadrant evaluation, Acute Care/
Trauma, Cardiac & Pulmonary, Hip, Knee and Spine
Models of OT/Health Literacy/EBP
 Compare and contrast models of OT.
 Understand importance of EBP and processes involved in selection of EBP.
CRPS
 Be familiar with the typical signs and symptoms, risk factors, and specific OT interventions
o Complex Regional Pain Syndrome
 Causes: Trauma, post-surgery, infection, or laceration
 Inconsistent with the injury that occurred:
 Causes severe burning pain, shiny skin, and sometimes cool skin
 Interventions include: Stress loading and scrubbing
 3 minutes per day, putting pressure through the joints
Cardiac and Pulmonary
 Review the cardiovascular and pulmonary conditions and be able to define and differentiate
between the conditions
o Cardiovascular conditions
 Ischemic Heart Disease
 Part of the heart is deprived of oxygen
 Often causes CAD
 Coronary artery disease (CAD)
 Atherosclerosis: Plaque such as cholesterol gather and causes clogging
or narrowing
 Angina: Chest pain- squeezing, tightening, fullness, pressure, sharp pain
in the chest
o May occur in the jaw or arm, often confused with indigestion
o Pain not relieved by nitroglycerin or rest is usually a myocardial
infarction (heart attack)
 Can lead to congestive heart failure (CHF)
 Congestive Heart Failure (CHF)
 Develops with the heart weakening and is no longer able to pump
effectively enough to meet demands and fluid backs up into the
lungs/body
o Fluid buildup in the lungs cause SOB (thoracentesis)
o Diet: low sodium and fluid restrictions
 Valvular Disease
 Heart valves are responsible for controlling the direction and flow of
blood through the heart
 Atrial Fibrillation: irregular and ineffective contraction to both atria
o Pulmonary Conditions
 Chronic Lung Disease
 Chronic obstructive pulmonary diagnosis (COPD)
o Emphysema: alveoli are gradually damaged
o Chronic bronchitis: bronchial airway is inflamed causing an
increase in mucus production, cough, and airway obstruction
SOB on exertion and even at rest
o Bronchodilators help open the airway
o Expectorant to clear mucus
o Oxygen and ventilator
 Sarcoidosis
 Asthma
 Idiopathic pulmonary fibrosis
 Cystic fibrosis
 Know the common/typical signs of cardiac distress
o Angina: chest pain or discomfort
o Feeling weak, light-headed, or faint
o Pain/discomfort in jaw, neck, or back
o Pain/discomfort in one or both arms or shoulders
o Shortness of breath
 Be able to describe interventions including but not limited to: dyspnea control postures, pursedlip breathing, energy conservation
o Dyspnea control postures:
 Leaning forward at the waist and supporting arm
 Ex: Runners out of breath after sprints
o Pursed-lip breathing: In 2 through the nose, out 4 through the mouth
 Improves air movement by releasing trapped air in the lungs to keep airways
open
 Smell a rose, blow out a candle
 Use when bending, lifting, stair climbing
o Diaphragmatic breathing: lying supine inhaling slowly abdomen should rise; exhaling
through pursed lips abdomen should fall
o Relaxation: progressive muscle relaxation- tensing muscle groups while inhaling and
relaxing muscle groups while exhaling 2x slower through pursed lips
o Energy Conservation
 Lifestyle modification, home environments, task simplification, etc.
 Be able to develop a basic intervention plan related to a client with a cardiopulmonary condition
o Cardiac Rehabilitation
 Days 1-3: Stabilization then early mobilization
 Phase 1: inpatient cardiac rehab- monitored low-level physical activity
o Determine the appropriate level of activity appropriate for
discharge

Phase 2: Outpatient cardiac rehab- at discharge exercise can be
advanced while the patient is monitored
 Phase 3: community-based exercise
o Home health if no assistance at home; not strong enough to go
to outpatient
o BORG scale (6-19) to measure perceived exertion
 6= none, 19= extremely dangerous
o “A delicate balance of rest and activity must be maintained to allow the damaged area
of the myocardium to heal while also sustaining the strength of the health part of the
heart
o Therapist teaches signs of fatigue, when rest breaks are needed and how to perform
activities safely
 Goals incorporating appropriate precautions/contraindications
o Start slowly and do more as you get stronger. Pain medicine might make it harder for
you to know when to slow down or be careful. Stop immediately if you hear a crunch or
pop in your sternum.
o Protect your sternum. Hug a pillow to your chest or cross your arms over your chest
when you laugh, sneeze, or cough.
o Be careful when you get into or out of a chair or bed. Hug a pillow or cross your arms
when you stand or sit.
o Do not twist as you move.
o Use only your legs to sit and stand.
o You may need to use a raised toilet seat if you have trouble standing up without using
your arms.
o Your healthcare provider may teach you to use your elbow for support as you move
from lying to sitting.
o Ask when you may take a bath or shower. You may need to use a bath chair if you have
trouble getting into or out of the tub. Do not use a grab bar.
o Do not lift or carry anything heavier than 5 pounds. For example, a gallon of milk weighs
8 pounds.
o Do not lift or carry anything heavier than 5 pounds. For example, a gallon of milk weighs
8 pounds.
o Keep your arms down as much as possible. Do not put your arms out to the side, behind
you, or over your head. Do not let anyone pull your arms to help you move or dress. Do
not reach for items.
o Do not push or pull anything. Examples include a car door or a vacuum cleaner.
o Do not drive while you are healing. Your surgeon will tell you when it is safe for you to
start driving again.
o MD specific as always!!!
 Be able to apply MET levels
o Stage 1 and 2: seated activities
o Stage 3: Seated to standing activities
o Stage 4-6: Standing activities
o
o
These can be used to gage what activities they can successfully engage in
Edema
 Management strategies for edema
o Intermittent active-motion: gentle AAROM, AROM
 AROM is best: ankle pumps
o Elevation at the elbow or above level of heart
o Compression: including Coban wrapping and compression garments
o Physical Agent Modalities (PAMs): Cold packs may be used in the acute stage
o Contrast baths (if the wound isn’t open): one bowl with warm water, and one with cool
to promote venous return
o Pneumatic pump: used in subacute and chronic edema
o Chip bags (Schneider Packs): Consist of stockinette bags filled with various densities and
sizes of foam
Pain
 Appropriate interventions, types of pain, etiology, and safety considerations
o Interventions:
 PAMs
 Energy conservation, pacing, joint protection
 Splinting
 Adaptive equipment (compensatory)
 Relaxation: guided meditation
 Support groups
 Medication
 Acetaminophen for mild pain
 Codeine for moderate pain
 Morphine for severe pain, narcotics
o Types of Pain
 Acute Pain: well-defined onset

o
Sympathetic nervous system arousal, increased blood pressure and
heart rate
 Responds to rest, medication, TNS, and therapeutic modalities
 Chronic Pain: long-standing intractable pain, longer than 6 months
Pain Syndromes
 Lower back pain: job, infection, neurological disorder, spinal stenosis, arthritis
 Arthritis
 Myofascial Pain: trigger points- point tenderness in muscles
 Fibromyalgia: widespread musculoskeletal pain
 Cancer pain: progression, chemotherapy, radiation, infection, or muscle aches
 Referred pain: Radiculopathy: pain not at the site of injury
 Safety
o Pain is usually a sign of something bigger going on
o If there is a lack of sensation, pain may not be felt, and therefore injury can occur
Arthritis OA & RA
 Be able to compare and contrast the description, etiology, and pathology of RA vs. OA
o Osteoarthritis
 Alteration of normal wearing down and repair of articular cartilage
 Deterioration of cartilage begins in the superficial layer and gradually progresses
to the development of fissures and lesions
 Cartilage gradually thing, osteophytes, and synovial inflammation (synovitis)
occurs
 OA Goals: relieve symptoms, improve function, limit disability, avoid drug
toxicity
o
o
Rheumatoid Arthritis
 Immune system attacks the joints- breaking down the lining of the joints- bone
erosion
 Joint protection techniques: respect pain, balance rest and activity, exercise in a
pain-free range, reduce the effort, avoid positions of deformity, use a larger
joint, use of adaptive equipment

RA Goals: reduce pain, swelling, and fatigue, improving joint function and
minimize joint damaged/deformity, preventing disability and disease related
mobility, maintain physical, social, and emotional function while minimizing
long-term toxicity from meds
 Know common UE joint deformities
 Swan neck deformities: The base of the finger and the outermost joint bend,
while the middle joint straightens


Boutonniere deformity: Middle finger joint bends toward the palm while the
outer finger joint may bend opposite the palm
MCP ulnar deviation


Volar subluxation of carpus





Distal ulna dorsal subluxation
Carpal translocation and wrist radial deviation
Thumb deformities:
 Hitchhiker’s thumb: the thumb flexes at the MCP joint and
hyperextends at the IP joint below your thumb nail (Z shaped)
 Know areas of evaluation and treatment methods to be emphasized with arthritic patients
o OA Treatment:
 Evaluation and precaution
 General joint protection principles
 PAMs
 Exercise
 Adaptive equipment
 Splinting
 Goals:
o Relieve Symptoms
o Improve Function
o Limit Disability
o Avoid drug toxicity (Voltaren gel, cortisone injections, risk of GI
and renal toxicity)
o RA Treatment:
 Evaluation
 ROM
 Strength
 ADLs
 Pain
 Goals:
o Reduce pain, swelling, and fatigue
o Improving joint function and minimizing joint
damage/deformity
o Preventing disability and disease-related morbidity
o Maintaining physical, social, and emotional function while
minimizing long-term toxicity from meds
 Know treatment precautions
o Avoid static positions and repetitive motions
 Can cause contractures or build up of bone
o Avoid hand twisting motions and push-pull activities
o Avoid overdoing any activity
o Always comply with treatment regimens
Hip fractures vs THA
 Be able to differentiate
o Hip Fractures:
 Causes:
 Trauma
 Osteoporosis
 Pathological fractures (cancer)
 Which came first? Either the fracture or the fall
 Management
 Closed reduction for minimally displaced fracture




 ORIF
 Joint replacement
 Evaluation: chart review!
 Often there are no standard precautions other than being careful about
putting weight on it
 ADLs, ROM, and strength of US’s, other assessments as needed
(Cognitive)
o Total Hip Arthroplasty (THA) = Total Hip Replacement (THR)
 Causes: trauma from hip fracture, wear and tear
 Total = replaces acetabulum and femoral head
 Partial = (Austin Moore) replaces femoral head
Know typical/common complications
o Abnormal healing: malunion, delayed union, and nonunion
 Malunion: Doesn’t align (misalign)
 Delayed union: takes longer to line up
 Non-union: never heals
o Additional complications: infection (osteomyelitis), deep vein thrombosis (DVT),
neurological damage, vascular damage
Know the basic hip precautions (anterior and posterior) and appropriate strategies for adhering
to hip precautions for bed positioning, transfers, mobility, toileting, bathing, dressing for THA
o Posterolateral:
 Do not flex beyond 90
 Do not adduct or cross legs
 Do not internally rotate
 Do not pivot at hip
 Sit only on raised chair & toilet seat
 t/f sit to stand by keeping operated hip in slight abduct & extended
o Anterolateral:
 Do not externally rotate
 Do not extend hip
 * Some surgeons follow a no restrictions protocol- You typically aren’t
going to be externally rotating or extending hip on a daily basis
Be able to develop goals and intervention activities for clinical scenarios
Weightbearing status
o NWB: Nonweight bearing
o TTWB: Toe touch weight bearing
o PWB: Partial weight bearing (50%)
o WABT: Weight-bearing as tolerated
o FWB: Full weight bearing
Post Op Spine:
 Know precautions and contraindications.
o Spinal Fusion Spondylosis: surgical procedure to correct vertebrae problems
 Fuse together two or more vertebrae
o
ACDF: Anterior cervical discectomy and fusion
 Surgery to remove a herniated or degenerative disc in the neck
 An incision is made in the throat area to reach and remove the disc.
 A graft is inserted to fuse together the bones above and below the disc.
 Know appropriate evaluation/treatment considerations
o Cervical Precautions
 Anterior cervical fusion: avoid extension
 Posterior cervical fusion: avoid flexion
 For 4 weeks, no lifting over 5 pounds, then progress slowly
 Do not lift above shoulder level, no overhead lifting or activity
Acute Care/Trauma
 Poly trauma/ understand consultation process of
 Understanding of acute care goals; consideration of D/C on first visit.
 Concept of triage/ stabilization & OT role
Lab Interventions/ Safety
 Know when to refer to MD, or other care professional and importance of working with a
collaborative rehab team.
 Importance of effective communication with caregiver/family etc.
 Understand standard precautions/ isolation levels