old OT reminders

I spend a lot of time while working trying to make sure I get the lingo down and know what I am talking about. I write myself a lot of cheat sheets with things I observe/read that I want to use in the future. I don't do a great job of organizing it though. But here is an example cheat sheet from when I worked in adult physical dysfunction last year. Now it's all alien to me since school OT is a whole other area! But when I read some of this stuff it reminds me how complex OT can be. :0

PS: None of this should be taken as advice down below – it could be wrong for all I know, and it's certainly all out of context. Just showing all the complex terminology and thought processes etc. I do notice when I read through this the lack of occupation-based terminology. Oops. 😉

PS2: I am down to under 100 new mails. That's why so many new OT blog posts lately, I'm getting close to everything being cleaned out. 🙂

Stroke:

PROM/AROM

Isometrics

Cocontractions

Rhythmic stabilizations

Scapular muscles

Weight bearing

PNF patterns

Abduction on sidelying

Regressive resistance

Short arc

 

Actaboski?

 

“composite digit flexion”

 

“Pt also demo intact LUE sensation to SWM 5.07 for protective sensation, however absent 2 point 1.0cm discrimination along L median nerve distribution/medial cutaneous nerve”

 

OT then applied gentle PROM to L digit flex/extend with differential FDP/FDS tendon gliding and pt instructed in joint blocking.

 

Increase facilitation of normal tone, neuro-re ed out of flexor synergy, activation of paraspinals and abdominals, long duration stretch with ext/sup patterning using deep tendon inhibition techniques, RUE through PNF D2 flexion patterns, OT maintaining flexor synergy inhibition points of contact for increased AROM while pt moved through PNF patterns

 

Ironing board/incline

Sliding board with wedges

Partial stands

Straight cane to activate external rotation with ace bandaged hand

Scapular mobilizatios – elevate, me do it, then u try to help

Supine uphill, cocontractions

Do some oscillations on shld while supine, quick approximations as well, externally rotate thumb while trying to do elbow ext

Prone on elbows or table top

Arm skate

Soques

Remiste

Concentric/eccentric

Closed chain/open chain

 

Lumbricals – tend to get clawed?

Intrinsic plus/minus positioning

Transfers to graded height surfaces

Recripocal patterning

 

No proximal activation palpated

Performed closed chain task

Dynamic reaching over weak limbs?

To improve postural stability, stand on variety of unstable surfaces

Try to self-correct and improve postural integrity, perturbations –v estibular

Change velocity, angle, distance

Unilateral UE release to challenge dynamic sitting balance

Air splint for neutral warmth to decrease tone

Max A to find initial placement on L

 

Unilateral UE downward reach and hip flexion needed for LE clothing management

Intermittent hands on assistance to maximize full elbow extension, keep postural integrity

Lowered concentrically with control

Paresthesias

Cross friction massage

Excursion

FPL – same, only move IP of thumb

FDS – same, to move PIP

Isolated FDS, FDP, FPL tendon     FDP – hol down palm up so can only move DIP

Scapulohumeral rythym discoordinated

 

Ulnar nerve paresthesias, 2/7 for 0.5 2 point discrimination

Stereognosis – no vision tactile search

Intrinsic: digit abd/add, interosseous lumbricals, so do pull apart fingers with resistance. Strengthen intrinsic plus position

Straighten elbow, FDP flatter stretch at IPS????????

 

Follow ulnar nerve tract up C8/T1 (brachial plexus)

 

Scaption to decrease impingement

 

Thumb up: coracobrachialis

Supination: biceps bracchi

 

Ulnar nerve glide ex: elbow extend etc

With OT correcting techniquers

CMC joint tightness

 

Resistive L digit extension

Difficulty with voluntary movement of thumb and digit opposite and lumbrical grip

 

Contract – isotonic

Hold – isometric

Agonist – pattern with limited motion

Antagonist – muscle shortened that limits range of agonist

D2 ext: ext add, int rot, flex abd ext rot, seatbelt  side on top, cross on bottom

D1: flex/add/ext, ext/abd/int, cross on top, side on bottom

PNF – proprioceptive neuromuscular facilitation, increase response of nm mechanism by stimulating prioprioceptors, fl/ext, abd/add, int/ext R, rotary component, balance of antagonists, sag, front, horiz

Trophic changes – ie swollen shiny skin and nails with ridges, sign of CRPS

TENS : transcutaneous, sensory to decrease pain, no visible contractions, bipolar 2, quad 4, crisscross pattern, black delivers shock, red grand/receiving. Further apart pads, shallow, close together deep. IFC – inferential current,

 

Ligaments – frozen shoulder, distraction, rythymic stabilization

Facilitate motor return

Respiratory rate – count number of times chest raises

BP manual, valve tight, pump up past 180, slowly release, listen to brachial artery, first and last heartbeat

 

Try to normalize movement patterns

Media positioned to facilitate BUE

For improved proximal stability for ADL tasks

Performed to improve BUE extensor strength

QD – once a day

BID – 2x a day

Cross tendon massage, subscapularis massage from axillary angle

UE assisted pelvic elevation

Shoulder capsular massage

Interosseous mobilization – supination and pronation, go up and down, radius and ulna

 

Neuro – don’t go past pain, ortho- go past pain

Pain increases tone so only go to tolerance

Ribcage elongation

Don’t stretch hypotonic

Manual protraction/retraction

 

Performed eval and pt has potential to increase functional skills, need to redo home program with 2 visits.

 

“composite flexure contracture”

 

Viscolas Flexigrip Hand exerciser

 

Vision: contrast, geographical vs spatial, inattention, poor vision, eyes jump/nystagmus, boundaries ie red tape to red tape

 

0—- bp, then 0 seated, standing etc

 

Dissociation of body and limbs

Active assist bow activity, bow positioned to inhibit compensatory R shld abduction and facilitate flexion in slight scaption. Occasional manual assist to inhibit compensatory R trunk lateral flexion.

Media positioned to promote RUE AROM in diagonal patterns and improve standing balance. Min A to maintain dynamic balance during task, ball placed to provide proprioceptive input to RUE and resisted trunk flexion, to improve postural integrity, decrease compensatory movements, improve tone for increased efficiency with ADL and mobility tasks.

 

Stickler’s syndrome: decreased visual acuity, nystagmus, increased risk of retinal detachment and amblyopia

 

Swivel spoon/wrist splint, steering wheel covers, HEP tendon glide, nerve glide, gentle strength, rubber band extension, towel crumble

 

Jul 20, 2011 | Category: Occupational Therapy | Comments: none

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