2. OBJECTIVES OF INTRODUCTION
• Provide a very brief review of conditions common in older adults that may lead to
orthopedic injury or surgery
• Preview the two upcoming lessons related to OT in orthopedics for the older adult
3. REVIEW
• Orthopedic injury
• An injury involving the skeletal system to include joints and their structures
• Older adult
• Effects of aging
• Comorbid conditions
• OT role
• Global: enable occupation
• Specific: varies with setting, stage of healing
5. PREVIEW
The following slides preview:
The objective of the upcoming orthopedic lectures,
The general outline of class for the lectures, and
Present case studies to guide your reading and promote independent inquiry.
6. OVERALL OBJECTIVE
• Demonstrate entry level ability to evaluate, treat, and establish an OT plan of care for
older adults with common orthopedic injuries
• Total hip and knee replacement (THA, TKA)
• Femur fracture
• Vertebral fractures
• Total shoulder replacement (TSA)
• Humeral fracture
• Rotator cuff injuries
7. OUTLINE OF CLASS
• Day One, lower extremity emphasis:
• 9:30 to 10:00, answer questions, present material related to lower extremity
orthopedic conditions
• 10:00-10:30, practical application based on case examples
• 10:30-10:45, discussion
• 10:45-11:00, break
• 11:00-11:30, practical application based on case examples
• 11:30-12:00, questions, discussion, review, preview Day Two
• **We may change the flow of class as needed, but the above provides a general idea
of what to expect
8. OUTLINE OF CLASS
• Day Two, upper extremity emphasis:
• 9:30 to 10:00, answer questions, present material related to upper extremity
orthopedic conditions
• 10:00-10:30, practical application based on case examples
• 10:30-10:45, discussion
• 10:45-11:00, break
• 11:00-11:30, practical application based on case examples
• 11:30-12:00, questions, discussion, review
**We may change the flow of class as needed, but the above provides a general idea of
what to expect
9. CASE EXAMPLES
• The following case examples are designed to generate questions and critical thinking in preparation for
class. For example:
• Tell yourself, “I could meet a person with this condition in less than three months.”
• Ask yourself, do I know how to assess this, or treat that? Or, do I know what to do about an identified
problem?
• What have I seen in fieldwork or other experiences?
• Please bring the knowledge gained through
your experiences to class
• What more do you want or need to know?
• Please bring your questions to class
• Case examples 1-4 apply to the first day of ortho class
• Case examples 5-7 apply to the second day of ortho class
10. CASE EXAMPLE 1
• 68 year old male 2 nd day post-op for elective R THA
• Prior level of function: independent, avid golfer
• Past medical history: mild COPD, 2 lpm O2 via nasal cannula at night only, HTN, OA
• Initial evaluation: Moderate assistance LB dressing and toileting with adaptive equipment,
activity tolerance limited to 5 minutes sitting, O2 desaturation on room air, requires 2 lpm
O2 at all times, UB strength and cognition WNL.
11. CASE EXAMPLE 2
• 74 year old sedentary male admitted to inpatient rehab following L TKA.
• Precautions: WBAT
• Prior level of function: independent in ADL, functional and community mobility. Spouse
completes IADL.
• Initial evaluation: Significantly greater edema in L LE than anticipated, skin is hot and red,
resident unable to follow commands
12. CASE EXAMPLE 3
• 66 year old male admitted to skilled nursing facility for rehab following ORIF due to R
femur fracture.
• Precautions: NWB R LE
• PMH: Diabetes type 2, TBI with short term memory loss
• Initial evaluation: impulsive, cannot recall NWB status, UE strength: 3+/5, L LE: 4/5
13. CASE EXAMPLE 4
• 90 year old female discharged home from hospital after 1 day stay with L 1-4 vertebral
fractures
• Prior level of function: home alone, modified independent with adaptive equipment, but
struggling
• Home health OT evaluation: Full assist from family caregivers, bed bound
14. CASE EXAMPLE 5
• 74 year old sedentary male s/p revision of L TKA x 4 days now transferred from hospital
back to skilled nursing facility for rehab. Complicated initial L TKA due to infection,
multiple I&D procedures and is now on IV antibiotics
• Prior level of function: independent in ADL, functional and community mobility. Spouse
completes IADL.
• Assessment: Resident with stand by assist for mobility and ADL with adaptive equipment.
However…
• New complaint: R shoulder pain, initial assessment reveals pain with flexion,
abduction, and compensatory motion of shoulder elevation
15. CASE EXAMPLE 6
• 82 year old female s/p 3rd day ORIF (open reduction internal fixation) for L humerus
fracture after a fall at home
• Precautions: NWB L UE, Fall risk
• Prior level of function: modified independent for ADL and mobility; daily assist with IADL
• Assessment: Mod assist x 2 for transfers. Pain 9/10; too fatigued to continue assessment
but appears grossly, cognitively intact
16. CASE EXAMPLE 7
• 70 year old female admitted to skilled nursing facility for rehab following a TSA.
• Prior level of function: independent except driving
• PMH: Parkinson’s disease
• OT evaluation: Mod assist for all ADL, min assist for functional transfers.
