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111 Cards in this Set
- Front
- Back
What is the biomechanical approach? |
-focuses on ROM, strength, and endurance required to perform and occupation
-most commonly used to treat patients with lower motor neuron deficits and orthopedic problems -approach should not be used in isolation: most effective when used in combination with other approaches that focus on engagement in meaningful and purposeful activity |
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Settings that most commonly use the biomechanical approach
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-hand clinics
-work programs -physical medicine and rehab departments -ergonomic programs |
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Finger ROM p.248
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Total AROM and total PROM
(TAM) + (TPM) -measures tendon excursion -add extension deficits and subtract from flexion measurement, ex: Digit #2 MCP 10-50 PIP 15-75 DIP 0-10 TAM=110 |
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Recording measurements for ROM
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-starting position/ending position (eg 0-150) - Within Functional Limits (WFL) = ROM is fxn -Within Normal Limits (WNL) = ROM achieves normal ranges |
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Average ROM for cervical spine (table p. 248)
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flexion: 0-45 |
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Avg ROM for thoracic and lumbar spine
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flexion: 0-80 |
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ROM for shoulder
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flexion: 0-170 |
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Associated girdle movements for shoulder ROM
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-flexion: abduction, lateral tilt, elevation, slight upward rotation |
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Elbow ROM
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flexion: 0- 135-150
extension: 0 |
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Forearm ROM
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pronation: 0- 80-90
supination: 0- 80-90 |
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Wrist ROM
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Flexion: 0-80
Extension: 0-70 ulnar deviation: 0-30 radial deviation: 0-20 |
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Thumb ROM
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DIP flex: 0-90
MP flex: 0-50 Adduction: 0 Palmar abd: 0-50 Radial abd: 0-50 |
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Finger ROM
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MP flex: 0-90
MP hyperext: 0- 15-45 PIP flex: 0-110 DIP flex: 0-80 abd: 0-25 |
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Hip ROM
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flex: 0-120 (bent knee) |
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Knee ROM
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flex: 0-145
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Ankle and foot ROM
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plantar flex: 0-50 |
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Types of MMT |
Break test = most common MMT Test position: gravity eliminated (lessened) or against gravity. Stabilization: usually proximal to the joint the muscle crosses over. DO not hold over the muscle being tested. Resistance: applied in opposite direction of movement; should be gradual.
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Types of MMT |
Resistance Test Resistance is applied throughout the range. Individual can compensate easily Requires experienced therapist |
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mm grade 5 |
normal |
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mm grade 4
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Good |
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mm grade 4-
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good minus
-full ROM against gravity, less than mod resistance |
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mm grade 3+
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fair plus
-full ROM against gravity, min resistance |
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mm grade 3
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fair
-full ROM against gravity, no resistance |
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mm grade 3-
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fair minus
-less than full ROM against gravity |
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mm grade 2+
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poor
-full ROM in gravity eliminated w/ no resistance |
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mm grade 2-
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poor minus
-less than full ROM in gravity eliminated |
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mm grade 1
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trace |
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mm grade 0 |
zero |
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Types of grip strength tests
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1. Position of UE: shoulder adducted, elbow 90, forearm neutral- mean of 3 trials w/ dynamometer |
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Pinch Strength entails... |
1. Use of Pinchmeter 2. Position of UE: Shoulder adducted to side, elbow flexed 90 and forearm in neutral 3. Type of pinch strength test - Key or later pinch: thumb pulp to lateral aspect of index middle phalanx. - three jaw chuck (palmar pinch): pulp of thumb -pulp of index and middle fingers - tip to tip thumb pulp to pulp of index fingers. 4. trials on each hand are obtained for all pinch strengths |
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Types of edema
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pitting-acute |
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How to measure edema in hand with tape measure
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figure 8 method
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What is significant edema change in volumeter?
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10 ml; only true objective tool |
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What are the steps to measuring sensation? |
1. Demonstrate sensory test w/ vision; then occlude vision for actual test. 2. Test uninvolved side first. Apply stimular to volar and dorsal surfaces |
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Sensory testing in SCI and peripheral nerve injuries |
SCI tested proximal to distal.
Peripheral injuries tested distal to proximal using dermatomes. |
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What is the order of return for peripheral nerve injuries? |
pain, moving touch, static light touch, then touch localization |
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Types of sensory testing
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1. light touch: cotton swab; +(intact), -(impaired), or 0(absent) |
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Type of sensory testing Moving 2 pt discrimination |
-begin with points 5-8 mm apart |
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Type of sensory testing Static 2 pt discrimination |
-test begins at 5mm |
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Testing proprioception
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*position sense |
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testing kinesthesia
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*movement sense
-therapist moves segment -person responds up or down |
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dermatome anterior facial region (p.250)
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1. spinal segment: CN V
2. mm facilitated: mm of masication 3. function- ingestion |
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dermatome neck region
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1. C3 |
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dermatome upper shoulder region |
1. C4
2. trapezius (diaphragm) 3. head control |
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dermatome lateral aspects of shoulder
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1. C5 |
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dermatome thumb and radial forearm
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1. C6
2. extensor carpi radialis, biceps 3. shoulder abduction, wrist extension |
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dermatome middle finger
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1. C7
2. triceps, wrist and finger extensors 3. wrist flexion, finger extension |
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dermatome little finger, ulnar forearm
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1. C8
2. flexors of wrist and fingers 3. wrist flexion, finger extension |
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dermatome axilla and proximal medial arm
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1. T1
2. hand intrinsics 3. abd, add of fingers |
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dermatome thorax
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1. T2-T12
2. intercostals 3. respiration |
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dermatome nipple line
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1. T4-T6
2. intercostals 3. respiration |
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dermatome midchest and lower rib
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1. T11
2. abdominal wall, abd muscles 3. T5-T7 superficial abdominal reflex |
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dermatome umbilicus
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1. T10
2. psoas, iliacus 3. leg flexion |
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dermatome inside of thigh
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1. L1-L2
2. cremasteric reflex, accessory mm 3. elevation of scrotum |
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dermatome proximal anterior thigh
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1. L2
2. iliopsoas, adductors of thigh 3. reflex voiding |
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dermatome anterior knee
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1. L3-L4
2. quads, tibialis anterior, detrusor urinae 3. hip flexion, knee ext, thigh abduction |
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dermatome big toe
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1. L5
2. lateral hamstrings 3. knee flexion, toe extension |
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dermatome foot region
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1. L5-S1
2. gastroc, soleus, ext digitorum longus 3. flexor withdrawal, urinary retention |
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dermatome small band of post thigh
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1. S2
2. small mm of foot 3. bladder retention |
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Purdue pegboard
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-test of fingertip dexterity and assembly job simulation |
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minnesota manual dexterity test
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-test of gross hand and arm movements
-Subtests: 1. placing test-measures rate of hand movement(one hand only) 2. turning test- measures bilateral rate of finger manipulation -scoring: time to complete board. one practice and 4 scored trials |
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O'Connor tweezer test
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-test of eye-hand coordination using tweezers
-scoring: # of seconds to place all pins in board using tweezers |
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Crawford Small Parts Dexterity Test
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-test of fine motor dexterity using small tools
-scoring: time to complete assembly |
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Nine hole Peg Test
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-measures finger dexterity
-scoring: time for each hand to place nine pegs in the board and remove them -Purdue pegboard is preferred over 9 hole b/c it is unilateral and bilateral, and is more reliable |
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Jebsen hand function test
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-test of hand function
-7 subsets: writing, simulated page turning, picking up common objects, simulated feeding, stacking, picking up large heavy objects, picking up large light objects -scoring: time to complete each subject |
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Informal assessment of coordination should include
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1. fine motor: observation of routine task performance |
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Passive ROM and Passive stretching to increase ROM |
PROM = moving joint to desired range using an external force. Therapy gently moving extremity to desired range or when resistance is felt.
Passive stretching is PROM w/ overpressure. * heat prior to stretching increases extensibility |
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Codman's exercise
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common form of PROM use for post-surgical shoulder patients (letting arm dangle and circular motion) p.252 |
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Active ROM |
-should be performed when PROM is greater than AROM |
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ROM precautions
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myositis ossificans may result from overstretching (especially noted in elbow flexors)
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Isometrics used to increase strength entail... |
Isometric = contraction w/o movement
-Sometimes can produce more forceful contraction
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who are isometric exercises contraindicated for?
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people with hypertension and cardiovascular problems. |
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isotonic strengthening
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contraction with movement
1. eccentric- lengthening 2. concentric- shortening |
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Increasing endurance
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-work at 50% of max resistance or less
-increase repetitions and duration, not resistance -energy conservation methods |
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Edema Reduction techniques |
1. elevation: above the heart, unless circulation problems |
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Scar management
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1. ROM |
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In sensory training: Desensitization for hypersensitivity involve...? |
If post surgery, being in periphery of the scar and as tolerated work over the scar. Massage textures vibrations three phase desensitization kit fluidotherapy |
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Sensory re-education involve? |
Massage textures vibrations three phase desensitization kit
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Improving coordination |
1. Begin w/ gross motor activities and grade up to fine motor activities 2. Select appropriate activities which ROM is required w/in the person's reach and yet challenging 3. Focus on accuracy and speed. Being w/ slow gross movements and gradually progress to faster precise movements. |
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Energy Conservation (econs) & work simplification principles and methods |
1. Planned short rests (5-10min) during daily routine 2. Schedule task to alternate btwn heavy/light work tasks to achieve balance 3. Organize tasks; gather all items/equip before task 4. Avoid multiple trips to obtain items 5. Eliminate tasks that are non-essential 6. Delegate tasks 7. Combine tasks 8. Sit to work 9. Organize cabinets for easy reach/convenient 11. Use electrical appliances 12. Slide rather than lift heavy items 13. Use light weight equipment, tools, utensils 14. Rest before fatigue sets in. |
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Joint protection principles
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-maintain joint ROM by using maximal ROM during activity |
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Types of splints |
1. Static splints = has no resilient components and immobilizes a joint or part 2. Dynamic: includes a resilient component (elastic, rubber band, or spring) which the individual moves. Designed to increase PROM or to augment AROM. |
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Purpose of Splinting |
Rest Prevent deformities & contractures Increase joint ROM Protect bone, joint and soft tissue Increase functional use |
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Hand splinting design standards
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1. Maintain arches of the hand |
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Mechanical principles of splinting
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1. decrease pressure |
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Resting position for splinting
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wrist 10-20 ext,
MCPs 30-45 flex, IPs 0-20 flex, thumb abducted |
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Safe position for splinting
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wrist 20-30 ext, |
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splint for brachial plexus injury
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flail arm splint
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splint for radial nerve palsy
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dynamic wrist, finger and thumb extension splint |
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splint for median nerve injury
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opponens splint, C-bar, or thumb post splint
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splint for ulnar nerve injury
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dynamic/static splint to position MPs in flexion |
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splint for combined median ulnar nerve injury
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figure of eight or dynamic MCP flexion splint |
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splint for spinal cord injury (c6-c7)
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tenodesis splint
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splint for carpal tunnel syndrome
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wrist splint positioned in neutral |
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splint for cubital tunnel syndrome
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elbow splint positioned at 30 deg flexion
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splint for DeQuervain's
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thumb splint, includes wrist, IP joint free
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splint for Skier's thumb
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UCL hand based splint
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splint for CMC arthritis
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hand based thumb splint
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splint for ulnar drift
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ulnar drift splint
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splint for flexor tendon injury
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dorsal protection splint |
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splint for swan neck deformity
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silver rings or buttonhole splint
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splint for Boutonniere deformity
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silver rings or PIP extension splint
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splint for arthritis
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functional or safe splint, depending on stage
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splint for flaccidity
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resting splint
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splint for spasticity
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spasticity splint or cone splint
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splint for mm weakness (ALS, SCI, Guillan-Barre)
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balanced forearm orthosis (BFO), deltoid sling/suspension sling
-mounts to wheelchair -individuals must have shoulder or trunk movement |
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splint for hand burns
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wrist 15-3o ext, |
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Important note of physical agent modalities
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should NEVER be used alone
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benefits of e-stim |
relieves pain, dec swelling, stimulate and strenghen, stimulated denervated mm
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benefits of ultrasound
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relieves pain, dec inflammation, dec tissue extensability (inc ROM), decrease adhesions
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general contraindications for PAMs |
cancer, pacemaker, pregnancy, cognitive impairment, sensory impairment, vascular impairment |