Contraindications and Safety
Burns:
 Risk of dehydration (emergent phase 0-72 hrs after injury)
 hypo or hyperthermia, fluid resuscitation, cardiopulmonary stability
 Controlling infections
 Proper nutrition and hydration
 Splinting in antideformity (anti-frog leg and anti foot drop)
 and anticontracture (neck neutral, trunk extension shoulder retraction,
shoulder abduction to 90 degrees, external rotation, elbow extension,
forearm neutral to supination, dorsal wrist 30 degree extension, volar wrist
30-45 degree extension, hand MCP extension, 70 degrees flexion IP
extension, thumb abducted and extended, hip 10-15 degrees of abduction,
neutral extension, knee extension with anterior burn slight flexion, ankle
neutral to 5 degree of dorsiflexion) positions
 Hypertrophic scar, heterotopic ossification
 Heat intolerance
 Pruritis
 Dorsal hand burns-boutonniere precaution
 Sensory impairment
 Volumeter only if wound is closed
Cardiopulmonary:
 Sternal precautions 6 weeks post op
o No lifting, pushing, pulling more than 10lb (a gallon of milk is 8lb)
 Monitor bp, o2 saturation (for ADLs below 90), and heart rate
 Dressing one limb at a time, rest breaks
 Breathing and stress management training
Community Mobility:
 Observing road safety/personal safety/passenger safety
 Safety training
Ethics:
 Principle of Beneficence: OT demonstrating safe practices
Driving and Rehab:
 Attention/cognitive deficits/visual deficits can cause safety issues when
judging distances between cars/people/lanes/traffic
 Pedal guard for covering original manufactures right sided pedal
 Drive in areas familiar to pose less risk (reaction time/visual scanning)
 Client specific risks
Hand and UE:
 Sensory protection (lack of sensation)
 Precautions for PAMS:
o Cryotherapy: impaired circulation, vascular disease, hypersensitivity
to cold, impaired sensation, open wounds, and infections
o Thermotherapy: avoid use with clients with acute inflammation,
edema, sensory impairment, cancer, blood clot, infection, cardiac
problems, and impaired cognition.
o Ultrasound: avoid use with pregnancy, over eyes, pacemaker,
bleeding, infections, cancer, over blood clots, and growth plate of
bones in children. Be cautious when using with inflammation,
fractures, breast implants, and clients with cognitive, language, or
sensory impairments.
o E-stim: do not use over pacemakers, carotid sinus, pregnant uterus,
eyes, and clients with epilepsy, cancer, infection, decreased sensation,
cardiac disease and stroke. With iontophoresis use, be aware of
possible drug allergies.
o Laser and light therapy: wear protective eyewear when using laser, do
not use over vagus nerve, carotid sinus, pregnant uterus, eyes,
infection, endocrine glands, or cancer
 Work related risk factors : repetition, high force, direct pressure, vibration,
cold environment, poor posture, female gender, and prolonged static position
Low Vision:
 Increased fall risk
Mental Health:
 Kawa model emphasizes cultural safety
 Safety contract with those who suffer from suicidal ideation
 Contraindications for MAOI’s no tyramine as in no aged food, pickled veggies,
cured meats (no nitrates/no hot dog/bologna), soy sauce, fish sauce, yeast
extract spread, broad bean pods
Musculoskeletal:
 Antideformity for burns: wrist 20 degree of /, MCP 90 degree of flexion, PIP
and DIP 0 degree /
 Elbow and knee / splint
 Wrist / splint to prevent wrist drop
 Thumb abduction splint for adduction contractures forms a c shape
 Lumbrical bar splint to reduce MCP hyperextension and IP flexion
 Resting hand, ball, cone antispasticity splint to reduce tone
 Soft neoprene splint to position thumb and forearm: commonly used for
people with RA and CP to increase fxal use of the hand
 Splint to prevent foot drop, 0 degrees below the knee
 Serial casting for tone correction and stretching over time
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Dynamic splint-angle of pull should be 90 degrees
HIP precautions no BLT (bending, lifting or twisting), hip flexion/extension,
adduction, internal/external rotation based on approach
Squatting is better for back then bending over
Pinching is contraindicated with CMC joint instability
Oncology
o Chemo: use a mask for their immunity, restricted diet d/t mouth
yeast, screen for anxiety, depression, fatigue, monitor for excessive
bleeding
o Radiation: maintenance of joint ROM, water based ointment, don’t pull
burned skin
o Surgery: no bathing until staples/sutures removed, edema
management
o Hormone: mood and room temp
o Immunotherapy: avoid scratching skin
OA related THR and TKR: know your precautions/safety ed, transferability,
bed mobility, ability to change positions, and LE dressing
TKR: no pillow under the knee while in bed, resting feet on floor when sitting
to increase ROM, wearing an immobilizer as instructed, avoid kneeling,
squatting, twisting the knee
OA and lack of mobility are risk factors for hip fractures
Neurodegenerative diseases:
 Home safety assessment and recommendations to reduce fall risk: removing
clutter, clearing pathways, and using bright or contrasting tape to mark steps
inside and out of the home
 PD safety considerations:
o Sit to stand and bed mobility
o Managing freezing such as counting, singing, avoiding crowds and
tight spaces, turns or corners, reducing distractions and avoid
multitasking, eliminate clutter in pathways and avoid rushing to
answer your phone
o Assistive device instruction
o Use a single auditory cue to help the person with quicker smoother
movements-rhythm helps with movement, music helps with
bradykinesia, emotional health, and ADL performance and WOL
o Feeding and stuff:
 Modify meals with smaller portions, remove distractions, eat
slowly and use adaptive equipment
 Increased time
 Modified clothing w/o fastners and use button hooks
 Distal wrist weight for tremors
 Self care ax as close to the body as possible, support UE on a
table (proximal muscles help stabilize distal-reducing tremors)
DME, raised toilet seat, long handled sponge, soap on a rope,
grab bars, shower bench
o Communication: larger paper and pens, pay bills online, speed dial
and voice control, mirror for awareness of facial expression, phrase ?
to elicit shorter responses
o Sex after the bathroom, screen for depression, lack of interest, and
general apathy
o Bathroom: voiding schedule and diapers/absorbent underwear
o Avoid rigidity and pain, encourage stress reduction, breathing, yoga
ALS: positioning, transfers, skin integrity
Huntingtons dz:
o safety in the kitchen (unbreakable dinnerware, accessibility of
cabinets, kitchen timer for turning off appliances, lowering water
temp to prevent scalding injury, covered mugs for hot liquids, oven
mits not pot holders) during later stages hypertonicity replaces
chorea
o bathroom: nonskid mat in shower, soap on a rope, shower chair, and
safety bars
o stabilize furniture so it doesn’t move, chairs with high backs and arm
rests, clean houses with no clutter, no rugs or thick carpets, keep
tables and lamps away from walkways, and padding doorway and
furniture when in frequent contact with them
o utensils with built up handles-put them down between bites to avoid
fatigue
o rings on zippers/splinting/positioning/contractures etc
AD: safety is a huge issue
o Get lost when engaging in community mobility-early stage
o Wandering, letting in strangers, setting a fire-middle stage
o Ambulation issues regarding safety-late stage
Allen’s cognitive level 3: Cx needs protection against safety hazards and
wandering
Cognitive impairment safety: hid door handles/locks, doors with posters,
door alarm, bed alarms
RA-NO MMT, heat is contraindicated, high resistance exercises are also
contraindicated (gentle stretches are indicated), standard reacher with a
trigger handle may hurt (easy squeeze reachers are recommended),
crouching particularly for hip and knee RA
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Neurological impairments:
 TBI and CVA: contracture management, joint ROM, sensation issues, proper
positioning, splinting, neglect, apraxia’s, visual disturbances
Return to Work/Occupational Rehab:
 Ergonomics
Pediatrics:
 Safety awareness, social skills
 Precautions for atlantoaxial instability AAI: sports, do not hyperflex the neck
and do not do front rolls
Wheelchair positioning:
 2 inches more than the hip width, 2 inches before the knee length
Random:
 Teach spoon usage before fork usage since the unskilled use of a fork can
cause harm/injury to the kiddo
 Percussion to neuromas would hurt and is contraindicated
 Metastatic bone cancer with pathological fractures is contraindicated to do
MMT or resistive exercises
 Psychotrophic meds plus outdoor activity leads to a severe
sunburn/photosensitivity
 EI: frequent and rapid changes in movement are contraindicated to a infant
who has trouble being soothed because it can increase tone and stimulate
arousal
 IADL/home management criteria group would be contraindicated if you have
unstable angina, venous thrombosis, and uncontrolled atrial arrhythmia—if
you have hypotension you can join the group
 E-stim contraindicated for someone with a pacemaker
 PROM contraindicated for those with DJD
 Pacemaker precautions: no shoulder flexion or abd greater than 90 degree,
on the side of the pacemaker for the first 4 wks; lift no more than 10lb
 THA: doing tasks in sitting instead of standing is contraindicated