Common Adult Diagnoses

An above knee amputation (AKA) or below knee amputation (BKA) is the surgical removal of a portion of the lower extremity usually as a result of either a traumatic injury or the progression of a disease such as cancer, diabetes or vascular disease that has resulted in decreased or total loss of limb viability or the necessary removal of the limb.  In many cases, the lost limb is replaced with a prosthesis, though not every patient is a good candidate for a prosthetic limb and the higher the amputation, the heavier and more difficult the prosthetic limb can be to use.  Patients who do plan to use a prosthetic limb generally make that decision prior to surgery and begin working with a medical team that includes a prosthetist to shape the residual limb and allow for the fit of a prosthesis. Occupational therapy intervention following an AKA or BKA generally focuses on physical strengthening and ADL and IADL training both with and without a prosthesis to assist the patient in achieving the maximal level of independence.

References and Further Reading:

Merck Manual.  (2020). The Merck Manual Online.  Retrieved November 07, 2020 from http://www.merckmanuals.com/professional/

Myers, M. (2020, June 24). Above the Knee Amputations. Retrieved November 09, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK544350/

Adhesive capsulitis, commonly referred to as frozen shoulder, occurs in three stages.  The first stage, called the freezing stage, is the most painful stage, and movement is often painful throughout the range of motion.  During this stage, intervention goals are to decrease pain and maintain range of motion and overstretching of the capsule should be avoided.  Once pain is felt only at the end range and resisted motion is pain free, the client has moved to the second stage, called the frozen stage.  At this point, the client will feel stiff and goals should be to increase range of motion and functional use of the shoulder.  Modalities and low load prolonged stretches can be used, as well as joint mobilization and active range of motion.  Learned disuse should be avoided.  The third and final stage is called the thawing phase.  Goals during this phase should focus on increasing range of motion, strengthening the affected muscles, and increasing functional use of the shoulder.  Spontaneous recovery usually occurs within 1 to 3 years, but the process can occur more quickly with therapeutic intervention.

References and Further Reading:

Clark, P. (2015). Upper extremity injuries [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

The symptoms of amyotrophic lateral sclerosis, more commonly referred to as Lou Gherig’s disease, is caused by a progressive destruction of motor neurons in the motor cortex, brainstem, and spinal cord.  Symptoms include upper and lower motor neuron impairments, abnormal muscle tone, balance issues, and weakness.  Cognition may or may not be affected.  There is no known cause of amyotrophic lateral sclerosis but some theories include that it is caused by a metabolic disorder, autoimmune disorder, viral infection, or metal toxicity.  Intervention generally focuses on compensation and education.

References and Further Reading:

Krajnik, S. (2015). Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Commonly referred to as chest pain, angina pectoris is caused by reduced blood flow to the heart muscle. Angina Pectoris is classified as one of three types: stable angina, unstable angina, and variant angina. Patients may experience stable angina with exertion, but a change or new onset in symptoms may indicate unstable angina and require a medical assessment. Therapists should be aware of the medical history of a patient to determine if and when a medical assessment is appropriate for any angina pectoris that might occur during a treatment session.

References and Further Reading:

Angina – Symptoms and causes. (2020, June 12). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373

Merck Manual.  (2020). The Merck Manual Online.  Retrieved November 07, 2020 from http://www.merckmanuals.com/professional/

Aphasia is an impairment in language skills stemming from neurological impairment.  There are multiple types of aphasia including global aphasia, Broca’s aphasia, Wernicke’s aphasia, and anomic aphasia.  Each type presents slightly differently, but all types can affect verbal and written communication and non-verbal expression.  When working with clients who have aphasia, it is often more effective if you talk slowly and at a normal volume, utilize both verbal and non-verbal communication, and allow the client sufficient time to process and respond.

References and Further Reading:

Krajnik, S. (2015). Techniques for working with individuals who have aphasia [Handout].

Merck Manual.  (2020). The Merck Manual Online.  Retrieved November 07, 2020 from http://www.merckmanuals.com/professional/

Acquired brain injuries are non-congenital injuries to the brain that can be caused by vascular injuries, tumors, anoxia or hypoxia, toxicity, or viral encephalitis.  Traumatic brain injuries are a subtype of acquired brain injuries.  Intervention generally focuses on the particular needs and deficits of the client.

References and Further Reading:

Krajnik, S. (2015). Traumatic brain injury (TBI) [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Asthma is an inflammation of the bronchial tubes that, when exacerbated by exercise or other triggers, can result in further constriction of the bronchial tubes and decreased ability for air to move into and out of the lungs, resulting in typical asthma symptoms such as wheezing or coughing. Therapists should be aware of the medical history of a patient to attempt to avoid or appropriately address any asthma symptoms that might be triggered during a treatment session.

References and Further Reading:

Asthma. (n.d.). The American Academy of Allergy, Asthma & Immunology. https://www.aaaai.org/conditions-and-treatments/asthma

Merck Manual.  (2020). The Merck Manual Online.  Retrieved November 07, 2020 from http://www.merckmanuals.com/professional/

Cerebrovascular accidents are more commonly referred to as strokes and are the third leading cause of death in the United States.  They are vascular in origin and are caused by either interrupted blood flow to a part of the brain—ischemic—or rupture of a blood vessel in the brain—hemorrhagic.  The most common type of stroke is ischemic strokes, and they can be caused by an embolism, or a clot that has traveled to the brain from another part of the body, a thrombosis, or a clot that forms within an artery in the brain, stenosis of the carotid arteries, or atherosclerosis.  Hemorrhagic strokes are less common and can be caused by aneurysms, arterial wall breaks, arteriovenous malformation, intracerebral hemorrhage, or subarachnoid hemorrhage.  Transient ischemic attacks are also referred to as mini-strokes, and though they cause relatively little damage, they can indicate the potential for more serious strokes in the future.  Risk factors for strokes include age—most strokes occur in individuals age 65 and older—gender—men are more commonly affected—family history of strokes, race—African Americans are more likely to have strokes—geographic location—the highest incidents of strokes occur in the south eastern United States—and health factors such as hypertension, heart disease, diabetes mellitus, cigarette smoking, high cholesterol, high alcohol consumption, and use of drugs such as marijuana, cocaine, amphetamines, heroin, or anabolic steroids.  Common effects of a stroke include motor paralysis, sensory and perceptual impairment, language impairments, and cognitive and personality changes.  Useful assessment tools include the Canadian Occupational Performance Measure, the Barthel Index, the Kohlman Evaluation of Living Skills, the Functional Independence Measure, the Mini-Mental State Examination, the Glasgow Coma Scale, the Arnadottir Occupational Therapy Neurobehavioral Evaluation, the Fugl-Meyer Test, the Jebsen Test of Hand Function, the Berg Balance Scale, the Tinetti Test, the Functional Reach Test, the Beck Depression Inventory, the Geriatric Depression Scale, and the Action Research Arm Test.

References and Further Reading:

Krajnik, S. (2015). Cerebrovascular accident (CVA/stroke) [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Chronic Obstructive Pulmonary Disease, or COPD, is one of the leading causes of death and a major cause of disability in the United States.  It impairs breathing, causing symptoms that include shortness of breath, coughing which produces mucus, and wheezing.  COPD is caused by smoking or exposure to other lung irritants such as air pollution, and the lung damage resulting from COPD is irreversible. Occupational therapists who work with clients who have COPD should be aware of the breathing difficulties associated with the disease and monitor treatment sessions accordingly to avoid a potentially dangerous drop in oxygen saturation levels. Intervention often includes education in energy conservation strategies and lifestyle changes in order to maximize independence.

References and Further Reading:

Merck Manual.  (2020). The Merck Manual Online.  Retrieved November 10, 2020 from http://www.merckmanuals.com/professional/

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Dementia is an irreversible form of cognitive decline that occurs most often in older adults. There are multiple types of dementia, with Alzheimer’s dementia being one of the more widely known forms. As dementia progresses, it can lead to decreased functional independence and result in an increased reliance on caregivers for assistance with everyday activities. Occupational therapists who work with clients who have dementia should be aware of the strategies recommended to maximize success and minimize frustrations, including the use of errorless learning and the importance of familiar routines.

References and Further Reading:

de Werd, M., Boelen, D., Rikkert, M., & Kessels, R. (2013). Errorless learning of everyday tasks in people with dementia. Clinical Interventions in Aging, 2013(8). 1177-1190. doi:https://doi.org/10.2147/CIA.S46809

Merck Manual.  (2020). The Merck Manual Online.  Retrieved November 10, 2020 from http://www.merckmanuals.com/professional/

Fractures are breaks in bone. They can range in severity depending upon whether the bone breaks completely, how many breaks are present, and whether the broken bone pokes through the skin. In some cases, a fracture may require surgery for either external or internal fixation, but in others a splint or cast may be sufficient to stabilize the bone until it heals. Occupational therapists may assist a patient in recovery from a fracture by fabricating orthoses for stabilization during the healing process or by assisting with restoration of function while the bone heals or after removal of a cast, orthosis, or external fixator.

References and Further Reading:

Fractures (Broken Bones) – OrthoInfo – AAOS. (n.d.). Retrieved November 07, 2020, from https://orthoinfo.aaos.org/en/diseases–conditions/fractures-broken-bones/

Merck Manual.  (2020). The Merck Manual Online.  Retrieved November 07, 2020 from http://www.merckmanuals.com/professional/

Glenohumeral instability, in many ways the opposite of adhesive capsulitis, is a laxity of the shoulder capsule that results in pain, loss of power, and decreased shoulder function.  The stability of the shoulder is ensured by both static and dynamic restraints, and a breakdown in any of these can contribute to instability.  Static restraints include the shape of the joint and the negative intrascapular pressure that suctions the labrum to the humeral head, while dynamic restraints include the rotator cuff muscles and glenohumeral ligaments and the centering of the humeral head.  Tests for glenohumeral instability include the Anterior and Posterior Drawer Test, the Sulcus Sign, Apprehension Test, and Relocation Test.  Surgical intervention includes open inferior capsular shift—or detachment and superior advancement of the inferior glenohumeral ligament—and capsular plication—or the placement of suture folds in the joint capsule.

References and Further Reading:

Clark, P. (2015). Upper extremity injuries [PowerPoint slides].

Moore, K. L., Agur, A. M. R., & Dalley, A. F. (2011). Essential clinical anatomy (4th ed.). Baltimore: Lippincott Williams & Wilkins.

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

The symptoms of Huntington’s disease are caused by deterioration of the corpus striatum.  This is an autosomal dominant genetic disease that is typically diagnosed in the 30s and 40s.  Symptoms include declining movement, behavioral and cognitive changes, and choreiform movements that get progressively worse over time.  Safety is a concern due to risk of falls and deficits in cognitive functioning.  Intervention strategies often focus on addressing deficit areas and educating family members.

References and Further Reading:

Krajnik, S. (2015). Huntington’s disease (HD) [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Median nerve injuries can be classified as either high or low.  Pronator syndrome, a high injury, is often due to hypertrophy of the pronator teres and causes pain in the forearm with pronation, loss of sensation in the thenar eminence, and parathesis in the thumb, index finger, and middle finger, resulting in what is commonly referred to as the Pope sign.  Anterior interosseous syndrome occurs at a site of injury about six inches below the elbow.  Symptoms include pain in the forearm, weakness of the flexor pollicis longus and flexor digitorum profundus, and an inability to form the “OK” sign with the fingers.  The most common low median nerve injury, and the most common nerve compression injury, is carpal tunnel syndrome.  This injury is caused by compression of the median nerve as it passes the carpal tunnel and results in pain and paresthesias of the thumb, index finger, and middle finger.  With progression, atrophy of the thenar eminence can occur as well as decreased strength and sensation.  Special tests for median nerve impairments include Phalen’s Test and Tinel’s Test.  Conservative treatment approaches include splinting, tendon and nerve gliding, and education.  Surgical intervention may be recommended for treatment of carpal tunnel syndrome.

References and Further Reading:

Clark, P. (2015). Nerve compression disorders [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Multiple sclerosis is a progressive disease caused by the demyelination of the nerve axons.  The disease is characterized by periods of exacerbation and remission that generally worsen over time.  There is no known cause of multiple sclerosis, however, some theories are that it is caused by a dormant virus triggered by another virus or that it is an autoimmune disorder.  There are four main types of multiple sclerosis: relapsing—which presents with unpredictable periods of exacerbation and remission—benign—which presents with only one or two exacerbations followed by complete recovery—secondary progressive—which presents with periods of exacerbation and remission that worsen over time—and primary progressive—which presents with a slow but steadily worsening progression.  Females are more likely to be affected than men, and diagnosis is difficult but usually occurs around age 20 to 30.  Complications include debilitating fatigue, reduced mobility, spasticity and fluctuating muscle tone, balance difficulties, cognitive impairments, visual impairments, pain, and bowel and bladder issues.

References and Further Reading:

Krajnik, S. (2015). Multiple sclerosis (MS) [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Osteoarthritis (OA) is a degeneration of the cartilage in the joints, resulting in pain, stiffness, and an overall decrease in mobility. Unlike rheumatoid arthritis, osteoarthritis affects individual joints and may be localized to only a few joints in the body. In addition to medical management, severe osteoarthritis in select joints may warrant surgical intervention that could be as significant as complete replacement of the affected joint.

Occupational therapy intervention for osteoarthritis can range from pain management or lifestyle changes, to patient education and compensatory strategies for living with osteoarthritis or rehabilitation following joint replacement surgery.

References and Further Reading:

Merck Manual.  (2021). The Merck Manual Online.  Retrieved January 18, 2021 from http://www.merckmanuals.com/professional/

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Parkinson’s disease is a degenerative disease distinguished by deterioration of the substantial nigra and the presence of Lewy bodies.  It often presents with tremors, rigidity, bradykinesia, and balance disorders.  As the disease progresses, language issues may arise, as well as cognitive and behavioral changes and difficulties with bowel and bladder management.  Risk factors include a family history of the disease, suggesting a possible genetic link.  Medication is available but is more effective in the early stages of the disease.  Intervention approaches often focus on compensatory strategies for improving independence, improving or maintaining skills, and educating family members.

References and Further Reading:

Krajnik, S. (2015). Parkinson’s disease (PD) [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Pneumocystis pneumonia is a form of fungal pneumonia that is more common in individuals with weakened immune systems. Symptoms may include fever, shortness of breath, cough, and fatigue. Medical intervention is generally required and the mortality rate is high. Occupational therapy intervention often focuses on restoring function lost as a result of deconditioning and often focuses on rehabilitation and compensation.

References and Further Reading:

Merck Manual.  (2021). The Merck Manual Online.  Retrieved January 18, 2021 from http://www.merckmanuals.com/professional/

Centers for Disease Control and Prevention. (2020, November 30). Pneumocystis Pneumonia. Retrieved January 18, 2021 from https://www.cdc.gov/fungal/diseases/pneumocystis-pneumonia/index.html

Pulmonary fibrosis is irreversible scarring of the lungs that causes symptoms such as cough and shortness of breath. Causes of pulmonary fibrosis vary widely and can be caused by environmental exposures–such as exposure to asbestos or coal dust–genetic factors, medical conditions, or adverse reactions to medications used to treat other diseases. Occupational therapy intervention often focuses on maintaining function despite physical limitations and may include education in energy conservation and compensatory strategies.

References and Further Reading:

Merck Manual.  (2021). The Merck Manual Online.  Retrieved January 18, 2021 from http://www.merckmanuals.com/professional/

Pulmonary Fibrosis. (2018, March 6). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/symptoms-causes/syc-20353690

Radial tunnel is one of the common low radial nerve injuries, although it is far less common than ulnar or medial nerve injuries.  It is caused by entrapment of the motor branch of the radial nerve and is often comorbid with lateral epicondylitis, or tennis elbow.  Entrapment of the radial nerve may be caused by compression of the nerve between the two heads of the supinator muscle, radial head fractures or dislocations, tumors, or repetitive pronation and supination.  Common signs are wrist drop, pain in the radial tunnel distal to the lateral epicondyle, and positive results on the Long Finger and Resisted Supination Tests.  Treatment includes splinting—primarily during periods of rest—with the wrist in 15 degrees of extension, ergonomic education, nerve gliding, modalities, and stretching and strengthening.

References and Further Reading:

Clark, P. (2015). Nerve compression disorders [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Radial nerve palsy presents as paralysis of the wrist extensors, metacarpophalangeal extensors, thumb extensors, and radial abductors, resulting in a wrist drop deformity.  This injury to the radial nerve is often caused by humeral fractures or by external compression from crutches, furniture, or someone else laying on the upper arm for extended periods of time.  Radial nerve palsy often resolves on its own but symptoms can be managed through use of splinting, strengthening, and range of motion exercises in order to facilitate participation in daily activities.  Commonly used splints are the wrist cock-up and the dynamic low-profile radial palsy splint.  Surgery may be required for nerve decompression or tendon transfers depending on the cause of the injury.

References and Further Reading:

Clark, P. (2015). Nerve compression disorders [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Rheumatoid arthritis, or RA, is an autoimmune disorder that causes systemic inflammation of the joints, leading to pain and degeneration. In addition, RA may affect a wide range of additional body systems. The disease process differs from person to person, but most individuals with RA will have periods of exacerbation alternating with periods of remission. In addition to focusing on maintaining range of motion and strength and maximizing functional independence, occupational therapy intervention often also includes splinting to reduce the severity of the deformities (particularly ulnar drift of the MCP joints) that are common in RA.

References and Further Reading:

Merck Manual.  (2020). The Merck Manual Online.  Retrieved November 10, 2020 from http://www.merckmanuals.com/professional/

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Of the four muscles that comprise the rotator cuff—supraspinatus, infraspinatus, teres minor, and subscapularis—the supraspinatus is the most commonly torn muscle and the infraspinatus is the second most commonly torn.  Tears can be partial or full thickness, and surgery may or may not be required.  In the event of surgery, post-operative protocol should be observed.  Conservative treatment goals for rotator cuff tears are to decrease pain and inflammation, maximize passive range of motion, and strengthen the shoulder girdle muscles.  Stretching can be used to decrease tightness in the posterior capsule and all muscles surrounding the joint.

References and Further Reading:

Clark, P. (2015). Upper extremity injuries [PowerPoint slides].

Moore, K. L., Agur, A. M. R., & Dalley, A. F. (2011). Essential clinical anatomy (4th ed.). Baltimore: Lippincott Williams & Wilkins.

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Subacromial impingement occurs when the soft tissues in the subacromial space are crowded or impinged, leading to inflammation.  These soft tissues include the rotator cuff tendons, the subacromial bursa, and the long head of the biceps brachialis.  Subacromial impingement can be secondary to osteophytes, overuse, trauma, various anatomical shapes of the acromion, or superior migration of the humeral head.  Symptoms of subacromial impingement include pain during shoulder movement, particularly between 80 and 100 degrees of elevation or at the end range.  Special tests for shoulder impingement include the Neer’s Test, the Hawkins-Kennedy Test, the Empty Can Test, the Infraspinatus and Teres Minor Test, and the Subscapularis (or Gerber’s Lift Off) Test.  Treatment goals include increasing or maintaining range of motion, decreasing pain, and strengthening of the involved muscles.

References and Further Reading:

Clark, P. (2015). Upper extremity injuries [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Thoracic outlet syndrome is rare and difficult to diagnose, and is caused by inadequate space in the thoracic outlet for the brachial plexus and the subclavian artery to pass through.  Contributing risk factors include weight lifting, obesity, tumors, extra ribs, and heavy use of the upper extremities during work.  Possible locations for the compression of thoracic outlet syndrome include the interscalene triangle between the anterior and middle scalenes, the costoclavicular space between the clavicle and the first rib, and the interpectoral space (due to compression by the pectoralis minor).  Symptoms include neck pain, shoulder pain, arm pain, headaches, numbness, flushing of the extremity, decreased circulation, and weakness.  Special tests include Adson’s Test for the scalenes and Wright’s Test for the pectoralis minor—both of which have high frequencies of false positive results—and the EAST (or Roos) Test.  Treatment includes stretching and gliding exercises, diaphragmatic breathing, positioning during work and sleep, strengthening of the scapular stabilizers and elevators, stretches of pectoralis minor, scalenes, and posterior capsule, and avoiding irritation of the injury.

References and Further Reading:

Clark, P. (2015). Thoracic outlet syndrome [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

When the hip joint becomes damaged by arthritis, fractures, or other causes and medication and lifestyle changes are either not an option or are not sufficient to manage pain or other symptoms, a hip replacement is often recommended. When the entire hip joint is replaced–both the ball and socket components–the procedure is referred to as a total hip replacement or total hip arthroplasty. If instead only part of the hip joint is replaced–the ball portion–then the procedure is referred to as a partial hip replacement or hemiarthroplasty. Both surgeries require participation in therapy services during the recovery process in order to regain range of motion and independence and reduce risk of dislocation or the need for additional surgery. Occupational therapy usually involves education in adaptive equipment and compensatory strategies to maintain independence and ensure compliance with post surgical precautions. These services are often provided in the acute hospital immediately following surgery as well as in an inpatient rehab facility or SNF or in the home setting via home health services, depending upon the needs and overall health and independence of the client. It is important to note that post surgical precautions are dependent upon the specific surgery and should always be confirmed with the surgeon before providing occupational therapy services.

References and Further Reading:

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Total Hip Replacement – OrthoInfo – AAOS. (n.d.). Retrieved November 09, 2020, from https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/

Replacement of the knee due to degenerative changes or traumatic injury can take the form of either a partial knee replacement–or unicompartmental knee replacement–or a total knee replacement–or total knee arthroplasty. In both cases, therapy services are required during recovery in order to maximize range of motion and reduce the need for additional surgery. Occupational therapy usually involves education in adaptive equipment and compensatory strategies to maintain independence and ensure compliance with post surgical precautions. These services are often provided in the acute hospital immediately following surgery as well as in an inpatient rehab facility or SNF or in the home setting via home health services, depending upon the needs and overall health and independence of the client. It is important to note that post surgical precautions are dependent upon the specific surgery and should always be confirmed with the surgeon before providing occupational therapy services.

References and Further Reading:

Total Knee Replacement – OrthoInfo – AAOS. (n.d.). Retrieved November 09, 2020, from https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Although less common than hip and knee replacements, shoulder joints may also be surgically replaced when degenerative changes or traumatic injury interfere with use of the shoulder joint and upper extremity. As the shoulder joint is a ball and socket joint, replacement may involve replacing just the ball–hemiarthroplasty–or both the ball and the socket portions–total shoulder arthroplasty–of the joint. Alternatively, a reverse total shoulder replacement involves converting the head of the humerus from a ball to a socket and the former socket on the scapula to a ball, completely reversing the ball and socket joint. In all shoulder replacement surgeries, therapy services are required during recovery in order to maximize range of motion and reduce the need for additional surgery. Occupational therapy usually involves education in adaptive equipment and compensatory strategies to maintain independence and ensure compliance with post surgical precautions as well as range of motion and strengthening of the shoulder joint and surrounding musculature. It is important to note that post surgical precautions are dependent upon the specific surgery and should always be confirmed with the surgeon before providing occupational therapy services.

References and Further Reading:

Shoulder Joint Replacement – OrthoInfo – AAOS. (n.d.). Retrieved November 09, 2020, from https://orthoinfo.aaos.org/en/treatment/shoulder-joint-replacement/

Total Shoulder Replacement: Johns Hopkins Shoulder and Elbow Surgery. (2020, February 24). Retrieved November 09, 2020, from https://www.hopkinsmedicine.org/orthopaedic-surgery/specialty-areas/shoulder/treatments-procedures/total-shoulder-replacements.html

Traumatic brain injuries are insults to the brain that occur as a result of trauma.  These injuries can either be closed head injuries, where the scull is not penetrated, or open head injuries, where the scull is penetrated.  Concussions are a type of traumatic brain injury and are classified as a mild traumatic brain injury.  The leading cause of traumatic brain injuries is falls, followed by motor vehicle accidents, unknown or other, struck by or against, and assault.  Based on the cause of injury and the conditions under which the injury was sustained, damage may be focal, or isolated, or it may be more diffuse.  Coup and contrecoup injuries occur when the brain slams back and forth or around and around inside of the scull causing damage to multiple parts of the brain.  Impairments that can result from a brain injury include abnormal muscle tone, muscle rigidity, balance disorders, sensory and perceptual issues, impaired cognitive functioning, and personality changes.  Intervention for traumatic brain injuries targets the specific deficits identified by the client.

References and Further Reading:

Krajnik, S. (2015). Traumatic brain injury (TBI) [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.

Ulnar nerve injuries vary in name based on the location of the injury or compression.  Cubital tunnel syndrome is caused by compression in the cubital tunnel at the elbow due to trauma, repetitive flexion, or external compression, and risk factors include diabetes mellitus, obesity, and other work-related nerve compression diagnoses.  Cubital tunnel syndrome causes elbow pain and parasthesis of the fourth and fifth digits, and can be evaluated through special tests such as Froment’s Test, Tinel’s Test, Wartenburg’s Test, and the Elbow Flexion Test.  Treatment includes conservative means such as splinting with a long arm resting splint or hand based splint, pain management, activity modification, and education, or surgery.  Guyon’s canal syndrome is a low ulnar nerve compression that also results in parasthesias in the fourth and fifth digits, but is caused by compression of the ulnar nerve at the wrist.  Common causes include trauma, osteoarthritis, repetitive use, or external pressure.  Treatment can again be conservative—such as splinting—or surgical.

References and Further Reading:

Clark, P. (2015). Nerve compression disorders [PowerPoint slides].

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical dysfunction (7th ed.). St. Louis: Mosby Elseiver.