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occupational therapy intervention for spinal cord injury

question

What interventions are done in Acute Care OT and in what order of priority do we do them?
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Skin Integrity, know your bony prominences, range of motion, UE splinting, edema managment, swallowing assessment, positioning and seating, BADL’s, client and family education
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what all do OTs do in acute care for skin integrity?
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Educate the client and family on the importance of vigilance in preventing pressure sores. Reposition to provide pressure relief or turn at least every 2 hours while maintaining spinal precautions. Keep the area under the patient clean and dry and avoid temperature elevation. Inspect the skin under pressure garments and splints.
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what are the areas of greatest risk for skin breakdownin acute care?
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Occiput Scapulae Sacrum Trochanters Ankles Heels
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what all do OT’s do in acute care for ROM?
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PROM AROM Stretching Strengthening
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what all do OT’s do in acute care for UE splinting?
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Resting hand splints Anti-spasticity splints Tenodesis splints Elbow casting or splinting to address spasticity
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what all do OT’s do in acute care for edema management?
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Manual edema reduction Assessment and fitting for edema reduction garments.
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what all do OT’s do in acute care for swalling assessments?
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Depending on your setting this could be a part of speech-pathology or the two disciplines may jointly assess the client.
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what all do OT’s do in acute care for positioning and seating?
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Position tolerance: Tilt table, Cardiac chair, EOB, Wheelchair Seating: Basic wheelchair and cushion assessment. More complex assessment to be done in inpatient rehabilitation.
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what all do OTs do in acute care for BADL’s?
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Not always possible in acute care, but if client is able begin BADL retraining: Grooming and Hygiene Upper body bathing Upper body dressing
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what all do OTs do in acute care for client and family education?
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This is essential in every phase of treatment. In acute care you have to be mindful that both client and family are still in shock. Provide only small amounts of information at any one time. Explain to the client and family the rehabilitation process so they are aware of what will be coming next.
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What interventions are done in Inpatient Rehabilitation OT and in what order of priority do we do them?
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Prevention of pressure sores, teach pressure relief routine, prevent “bottoming out”, wheelchair assessment, power chair control terminology, Bladder managment, bowel managment, program for reflexive bowel, program for flaccid bowel, functional outcome basis, specific functional outcomes.
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what are the areas of risk for pressure sores in inpatient rehabilitation?
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Supine: occupital, shoulder, elbow, sacrum, heel side-lying: ear, shoulder, trochanter, knee, ankle sitting: scapula, sacrum, ischium, heel, ball of foot
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what are the prevention steps for pressure sores in inpatient rehabilitation?
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Conduct daily visual and tactile skin inspection. Reposition every 2 hours. Eliminate stretching and folding of soft tissues and prevent shearing when individuals are repositioned. Avoid positioning individuals who are side-lying in bed directly on their trochanter. Apply pressure-reducing support surfaces preventively to protect soft tissues from bruise and injury. Prevent moisture accumulation and temperature elevation at the support surface-skin interface. Apply pillows and cushions to bridge contacting tissues and unload bony prominences; do not use donut-type devices.
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client must conduct pressure relief every _____ minutes?
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15
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how do we prevent “bottoming out?
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hand check for bottoming out
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C5 or above will most likely require a ______ chair.
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power
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_______ can use manual depending on injury and clients endurance.
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C6-C8
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_____ will most likely use a manual chair
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T1-S5
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what are some power chair control terminology?
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interface, proportional interface, non-proportional interface, switch, latched switch, momentary switch
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what is interface?
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Describes the mechanism for controlling the movement of a power wheelchair. Examples of interfaces include, but are not limited to, joystick, sip and puff, chin control, head control, etc.
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what is proportional interface?
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One in which the direction and amount of movement by the patient controls the direction and speed of the wheelchair. One example of a proportional interface is a standard joystick.
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what is non-proportional interface?
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One, which involves a number of switches. Selecting a particular switch determines the direction of the wheelchair, but the speed is pre-programmed. One example of a non-proportional interface is a sip-and-puff mechanism.
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what is the different types of switches?
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A switch is an electronic device, which turns power to a particular function either “on” or “off”. The external component of a switch may be either mechanical or non-mechanical. Mechanical switches involve physical contact in order to be activated. Examples of the external components of mechanical switches include, but are not limited to, toggle, button, ribbon, etc. Examples of the external components of non-mechanical switches include, but are not limited to, proximity, infrared, etc.
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what is a latched switch?
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Works like a light switch. When you press “on” it stays on. When you press “off” the power is off.
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what is a momentary switch?
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Like an accelerator in a car. As long as you push it the car will go. As soon as you take your foot off the car stops.
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Must know the parts of a wheelchair.
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See handout on Moodle.
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the type of manual wheelchair must coincide with the clients ________.
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lifestyle For example, if the client works and is frequently out in the community, then a lightweight wheelchair is appropriate.
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what are the basic measurements for wheelchair fitting?
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seat width, seat depth, seat height, seat to floor height
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what all is done when measuring for seat width?
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Measure the widest point of the body, An easy way to do this is to place a book on each side of the hips while seated then measure the distance between the books. Add one inch to allow for bulky clothing such as a winter coat.
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what all is done when measuring for seat depth?
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Measure from the back of the buttocks to the inside of the knee, minus at least two inches. Some client’s prefer more leg overhang to make room for their hand when lifting their leg.
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what all is done when measuring for seat height?
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Sitting on a hard surface, measure from the sitting surface to the top of the shoulders. If you prefer a high back seat or a seat With headrest, also measure from the chair seat to the top of the head.
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what all is done when measuring for seat to floor height?
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Measure the leg from the back of the knee to the heel of the foot. Next, add a minimum of two inches for footrest clearance. Do not add the footrest clearance if the wheelchair will be foot propelled. Electric power wheelchairs are almost never foot-propelled by the user- so excluding the additional two inch footrest height for propelling is very rare.
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what are the types of wheelchair cushions.
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Air, gel, foam, honeycomb
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describe a air cushion
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Air floatation cushions support the body entirely on air. Pressure is balanced by air shifting out to surrounding balloons, spreading pressure evenly against your skin. The whole system is closed so air floatation cushions can’t bottom out the way gel cushions can. Biggest drawback is that air cushions require more maintenance.
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describe a gel cushion
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Gel fluids are placed in pouches and usually attached to a foam base, so that the cushion conforms to the pressures placed on it. As a result, gel cushions provide excellent pressure distribution and are very comfortable. Unfortunately, gel cushions are much heavier than other types, which can cancel out some of the benefits of your lightweight wheelchair. Another drawback to gel cushions is the possibility of them “bottoming-out” as the gel is pushed aside by your weight.
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describe a foam cushion
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Foam comes in a range of densities and with varying degrees of “memory,” holding its shape as you sit, contributing to stability. Different foams are often used in combination, layered for their various properties of softness, even support, and memory. Foam is relatively inexpensive. On the downside, foam wears out faster than other materials and loses its shape
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describe a honeycomb cushion
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Thermoplastic urethane honeycomb cushions are made of many individual cells–like a beehive–these cushions are able to distribute weight evenly, but there is no risk of leaking gel or of an air bladder being punctured. The many open spaces in the beehive structure of the cushion allow air to travel more effectively. The honeycomb design helps to protect against skin breakdown because the skin is kept cooler and moisture is prevented from collecting.
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describe what is needed for a letter of medical necessity?
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Wheelchairs and cushions are very expensive and you often have to write long and detailed reports called “letters of medical necessity” to justify to the insurance companies why your client needs particular equipment. Being an expert at wheelchair assessments takes years and many advanced classes to master complicated fittings.
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what are the 2 things that happens to the bladder?
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Spastic – which means the bladder fills with urine and then reflexively empties. Flaccid – the bladder will fill but never empty on its own. If not properly catheterized, the bladder will become overstretched and the urine will back up into the kidneys.
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what are the 2 types of catheterization processess?
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Spastic Indwelling (semi-permanent) ICP – intermittent catheterization program (self-catheterization) Condom or external catheter for men Flaccid ICP Bladder tapping
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what happens to the bowel?
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The nerves that go to your brain to tell you that your bowel is full are impaired. Difficult or lack of movement of the rectal muscle that allows stool to pass to the outside.
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what are 2 types of bowel problems?
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Reflexive bowel – happens to clients whose injury is T12 and above (upper motor neuron). The anal muscle stays tight and the bowel reflexively empties when the full. Flaccid bowel – happens to clients whose injury is below T12 (lower motor neuron). The anal muscle stays relaxed and if the bowel program is not followed accidents will happen.
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what are 3 programs for reflexive bowel?
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Daily stool softeners Laxatives when needed Digital stimulation
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what is a program for flaccid bowel?
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Manual stool removal (disimpaction). Usually done every other day but may need to be adjusted to avoid accidents.
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what is the functional outcome basics for C1-C4?
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Dependent in all areas of care. Treatment should focus on client being able to verbalize needs.
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what is the functional outcome basics for C5-C6?
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Will need some assistance with ADL’s but can achieve modified independence in some areas.
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what is the functional outcome basics for C7-C8?
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Should be able to achieve modified independence in most areas.
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what is the functional outcome basics for T1-S5?
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Modified independence in all areas.
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what is the specific functional outcomes?
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Both of your textbooks have charts that list the specific outcomes. Also, you have a practice guide on Moodle that you can use. Treatment planning should follow the guidelines listed. Remember: Every client is different and some client’ may have surprising function due to the incomplete nature of their injury.
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Clients with tetraplegia will have to use their ______ to compensate for the loss of fingers.
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wrists
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Clients with paraplegia will be independent with all of these areas if they have good_____.
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trunk balance
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What interventions are done in Outpatient Rehabilitation OT and in what order of priority do we do them?
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IADL’s, community mobility, work and/or school, leisure, complex adaptive equipment and technology training, additional issues
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what all is done in Outpatient rehabilitation for iADL’s?
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Depending on what your client’s life was like prior to the injury and what they choose to do once they get home will determine which IADL’s will be your focus.
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what all is done in Outpatient rehabilitation for community mobility?
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Car transfers and adaptations for driving are very important for regaining independence and seeking gainful employment.
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what all is done in Outpatient rehabilitation for work and/or school?
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Occupational treatment intervention for work or school requires an on site evaluation of the environment to find out what is causing your client difficulty and how the environment needs to be modified to accommodate your client’ disabilities.
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what all is done in outpatient rehabilitation for leisure?
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Get clients out and doing something. Anything is better than nothing. Introduce your client to someone who is ahead of them in therapy so they can see progress. Introduce clients to wheelchair athletes and other wheelchair adventurers so they can see the possibilities.
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what all is done in outpatient rehabilitation for complex adaptive equipment and technology training?
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Find someone who is certified in rehabilitation technology and co-treat together to solve your clients environmental access issues.
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what all is done in outpatient rehabilitation for adiitional issues?
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Male sexuality Female sexuality Pregnancy Client education sheets on these topics are on Moodle.