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W.G.A.N.K.UDUGAMA
Higher Dip. In ENG., BSc. in OT, BSc. Psychology (Undergrad), MPhil in OT(reading)
CONTENT
• What is arthritis?
• Types of arthritis
1. Osteoarthritis
2. Rheumatoid arthritis
3. Gouty arthritis
4. Psoriatic arthritis
5. Septic arthritis
6. Spinal arthritis
• Medical approach to arthritis
• Occupational therapy for arthritis
• OT evaluation
• General objectives
• Treatment precautions
• OT intervention
• Ergonomic principals
• Fatigue management principals
• Assistive devices for arthritis
• Aging and Arthritis
• Falls prevention
What is ARTHRITIS?
• Group of disorders that affect joints
• Include both inflammatory and degenerative lesions
• Generally characterized by pain and restriction of movements arising
spontaneously accompanied by a swelling or thickening
Types of arthritis
1. Osteoarthritis - OA
• Non inflammatory degenerative disease of wear and tear process in
joints
• Most common in weight bearing joints
• Strongly co-relate with the age
• Basically there are two types as;
I. Primary osteoarthritis
II. Secondary osteoarthritis
Primary
osteoarthritis
Secondary
osteoarthritis
Pathophysiology
Articular cartilage soften and loss
elasticity
Hard and glossy subchondral bone
eburnation
Hypertrophy of joint margins
Osteophytes
Recurrent strains leads to synovitis
and degeneration of capsule
Radiographic features
Clinical features
• Onset is gradual with increasing pain
• Restricted movements
• Crepitation
• Joint enlargement due to osteophytes
• Muscle weakness and wasting
• Deformities in hands
• PIP joints - bouchard’s nodes
• DIP joints – Heber den's nodes
2. Rheumatoid arthritis - RA
• Rheumatoid arthritis is,
Non- suppurative
Systemic
Chronic inflammatory disease of
Unknown cause
Characterized by symmetrical polyarthritis
Affecting peripheral joints and
Extra articular structures with
Exacerbations and remissions
Pathophysiology
Inflammatory process of RA have 04 stages:
1. Acute stage 2. Sub acute stage
3. Chronic active stage / severe RA 4. Chronic inactive stage / End stage
Articular manifestations
• Swelling
• Pain – aggravated with mvts
• Stiffness- in morning
• Warmth over affected joints
• Tenderness
• Muscle weakness and wastage
• Prominent deformities in
hand ( buttonire, swan neck, Z
thumb, ulnar deviation of MCP)
toes ( bunion, hammer toe, claw
toe)
knees ( valgus deformity)
Extra articular manifestations
• Malaise/ fatigue
• Weight loss
• Low grade pyrexia
• Skin –thinning , rheumatoid nodules
• Eyes- episcleritis
• Heart- pericarditis, atherosclerosis
• Lung-chest infections
• Musculoskeletal- osteoporotic
changes, tendon and ligament
rupture
• Hematological- anemia,
thrombocytosis
Radiographic features
OA
• Degenerative disease that
causes articular cartilage loss
and joint space narrowing
• Develops slowly over years
• Typically asymmetrical
• Nodes are present ( heberden’s
& bouchard’s )
• Morning stiffness more than 30
min.
• Negative on blood tests
• Radiograph: subchondral
sclerosis, osteophytes, joint
space narrowing
RA
• Autoimmune disease that causes
inflammatory synovitis
• Sudden onset
• Symmetrical and polyarthritis
• Nodules are present
• Morning stiffness less than 30
min.
• Positive rheumatoid factor,
elevated ESR & CRP
• Radiograph: diffuse rarefaction,
joint malalignment/dislocation/
ankyloses
3. Gouty Arthritis
• It is a clinical manifestation of disturbed purine metabolism
• Characterized by deposition of uric acid in connective tissues,
• Cartilage
• Ligaments
• Walls of bursa
• Cause is unknown
Pathophysiology
Radiographic features
4. Psoriatic Arthritis
• A chronic inflammation of the skin (psoriasis) and joints
(inflammatory arthritis).
• It usually causes the joints to become swollen, stiff and painful
Clinical manifestations
• Swollen, painful,hot,red joints
• Swollen fingers and toes
• Joint stiffness worse in mornings
• Pitted nails
• Lower back pain
5. Septic Arthritis
• When bacteria it can lead to septic/ pyogenic or infective arthritis
• Common pyogenic bacteria's are,
Staphylococcus
Streptococcus
Pneumococcus
• As pus is formed with in the joint this is
also called suppurative arthritis
Pathophysiology
A) In the early stage, there is an acute synovitis with purulent joint effusion
B) Soon the articular cartilage is attacked by bacterial and cellular enzymes
C) If infection is not arrested, the cartilage may be completely destroyed
D) Sequel includes necrosis, subluxation, dislocation and ankyloses
6. Spinal Arthritis
• Though we think of arthritis as affecting hands and legs, the truth is
that it can affect any joints in the body including spine
• 95% of people over age 50 will have degenerative osteoarthritis in
their spines ( cervical and lumbar regions)
• In the spine, arthritis usually affects:
• The small facet joints found between the backbones, causing soreness and
stiffness in the neck and back that increases with inactivity.
• The large sacroiliac joints that connect the spine to the pelvis, causing a dull
ache in the buttocks, groin, or the back of the thigh.
• The sites where ligaments and tendons attach to the backbones, leading
to painful bone spurs. Bone spurs can put pressure on a nerve (pinching the
nerve) and create shock-like pain or numbness
Signs and symptoms
• Low back pain
• Neck pain
• Loss of flexibility of the spine
• Joint stiffness
• Swelling of the spine
• Tenderness along the spine
• A grating sensation when moving
• Fatigue or weakness
• Pain or numbness that travels down the arms or legs (an indication of nerve
problems)
• One of the first indications that you may be suffering from spine arthritis is that
these symptoms are worse first thing in the morning. Often, your symptoms will
dissipate as the day goes on, only to come back in the evening
Radiographic features
• Despite the fact there is no ‘cure’ for spinal arthritis, symptoms can
be relived with medical intervention as well as life style changes
through therapy
• In severe cases, doctors will recommend a laminectomy surgery or
spinal fusion to help relieve the pain
• Although most common type of spinal arthritis is osteoarthritis, There
are following less common types of arthritis as well,
• Rheumatoid arthritis
• Psoriatic arthritis
• Reactive arthritis
• Ankylosing spondylitis
Medical approach to arthritis
• Medical approaches are followed after proper diagnosis conformation
through client’s medical history, laboratory investigations,
radiographic features and physical examinations
• Differs from condition, stage as well as co morbidities from person to
person
 Pharmacological management
Conservative management with physiotherapy and occupational therapy
Operative treatments
(joint debridement/ arthrodesis/ joint replacement
• Arthritis medical approach is consist of a MDT (Multi Disciplinary Team)
• The MDT consists of,
client
Medical
officer
surgeon
Nursing
officer
physiotherapist
Occupational
therapist
• Physical therapy will help the clients to persist with the condition with
minimum restrictions to day to day activities
• If the joints have totally degraded beyond the repair, surgeons decide
synthetic replacements
Pharmacological
management
(commonly using
drugs)
Analgesics
Ex:
Acetaminophen NSAID’s
Ex: Naproxen
Ibuprofen
Indomethacin
celecoxib
DMARDs
Ex:
Methotrexate
Antibiotics
Ex: doxycycline
Vancomycin
Intra
articular
injections
Corticostero
ids
Ex:
dexamethasone
Local
application
s
Biological and
cytokine
treatments
Ex: infliximab
Rituximab
OCCUPATIONAL THERAPY FOR ARTHRITIS
Occupational Therapy Evaluation
• Each client is unique in clinical presentation as well as in functional
impairments
• Client centered approach
• Problems of a same person can also be fluctuate
• Evaluation process consist of,
1. Client history
2. Occupational profile
3. Occupational performance status
4. Cognitive, psychological and social status
5. Clinical status
CLIENT HISTORY
Diagnosis
Date of onset
Other medical conditions
Medications’
surgical history
OCCUPATIONAL PROFILE
Roles
Occupations
Activity level
Ability to participate in
meaningful activities
OCCUPATIONAL PERFORMANCE
STATUS
Self-care (ADL/IADL)
Productivity (education/ work)
Leisure (rest/sleep/play/social
participation)
COGNITIVE PSYCHOLOGICAL AND
SOCIAL STATUS
Appearance and behavior
Mood
Speech
Thought
Perception
Cognition (memory/ attention/
concentration)
CLINICAL STATUS
Posture ROM
Strength stiffness
Pain swelling
Sensation endurance
Hand functions
deformities
General objectives of Occupational Therapy
• Maintain or increase the ability to engage in meaningful occupation
• Maintain or increase joint mobility and strength
• Maximize physical endurance
• Minimize effects of deformity
• Increase understanding of the disease
• Assist with adjustment to disability
Treatment precautions related to arthritis
• Respect pain
• Avoid fatigue
• Avoid stresses on inflamed / unstable joints
• Be aware of sensory impairments
• Cautious with pharmacological side effects
Occupational Therapy intervention in Arthritis
01. Rest
• An active way of reducing inflammation and pain
• Can be either general or local
Rest
General rest
Bed rest
Rest in
between works
Localized rest
Wearing a
splint
positioning
Modified
activities
02. physical agent modalities
• Helpful in relieving pain or improving ROM
ex: hot and cold therapy
paraffin
hydrotherapy
• Careful monitoring of client response is crucial here
03. Therapeutic exercises
Purposes:
• maintain or improve ROM
• maintain or increase muscle strength
• prevent disuse atrophy
•
General guidelines for exercises in Arthritis
• Avoid undue joint stress
• Avoid pain and joint swelling
• Work with the client’s comfortable ROM
• Client should taught to perform exercises slowly, smoothly in proper
techniques
• Typically preferred – assistive exercises
• If pain persist – passive exercises
• Should balance rest and exercises
• Should be done when client feels more fit and having least pain
• Exercise regimes differ:
Good days : 10 repetitions - 3 times per day
Bad days : 3-4 repetitions – At least one time per day
04. Therapeutic activities
• Offers many benefits both physically and psychologically
• Graded activities
• Should be non resistive, avoid patterns of deformity and not over
stress joints
05. Splinting
• Through splinting we can only reduce the progression of the deformity
but cannot be corrected
• Indications for splinting in arthritis:
1. Reduce inflammation
2. Reduce pain
3. Support unstable joints
4. Proper positioning of joints
5. Limit undesired motions
6. Improve ROM
7. Improve functions
Commonly using splints for arthritis
1. Resting splints – for acute synovitis
• Resting position:
Slightly wrist extension (0-20’)
Ulnar deviation (10-20)
MCP joint flexed (20’-30’)
PIP & DIP slightly flexed (10’-30’)
Thumb slightly extended and abducted
from CMC joint
MCP and IP joints of thumb slightly flexed
2. Wrist splint
3.metacarpo- ulnar deviation
splint
4. Thumb Spica
5. Swan – neck splint 6. Buttonire splint
Ergonomic (joint protection) principals
1) Respect pain
2) Maintain muscle strength
3) Distribute pain over several joints
4) Reduce force and effort required in activities
5) Use correct patterns of movements
6) Use good body positioning, posture, moving and handling
techniques – avoid position of deformity
Ex: squeezing, pinching , twisting motions are stressful and promote
ulnar deviation instead:
Opening jar lid opening door knob coconut squeezing
7) Use strongest and largest joint available for the job
8) Avoid staying one position for too long
9) Use as much as ergonomic equipment's or assistive devices
10) Pace activities
11) Work simplification
12) Modify the environment
Fatigue management principals
1. Attitudes and emotions
2. Body mechanics
3. Work pace
4. Leisure time
5. Work methods
6. Organization
7. Plan ahead
Commonly used assistive devices for Arthritis
Activity Assistive devices
dressing Dressing stick, shoe horn, sock aid, button hook, zipper pull, elastic shoelaces
bathing Bath bench, grab bars, long handled sponge
toileting Raised toilet seat, grab bars
Hygiene and
grooming
Extended handles in tooth brush, comb
feeding Extended handle utensils
Meal preparation Adapted knives, adapted openers,
miscellaneous Door knob levers, speaker phones, walking aids
Aging and Arthritis
• According to records almost half of adults 65 and older are present
with arthritic conditions
• Osteoarthritis - most common
Causes leads to arthritis in older adults
• Mechanical stress
• Genetics
• Musculoskeletal degeneration
• Traumatic injuries
• Infections
• Hormonal changes (ex: menopause in women)
Fall Prevention
• World Health Organisation defines a fall as:
“An event which results in a person coming to rest inadvertently on
the ground or floor or other lower level”.
• Excluded:
- major internal event e.g. stroke
- being hit by an external force e.g. knocked over
• Ultimate result of a fall is decreasing the quality of life
Risk factors for falls
Medical
 Polypharmacy
 Postural hypotension
 Medical conditions e.g. PD
 Poor hydration
 Anaemia
Physical
 Reduced balance
 Walking problems
 Reduced muscle strength in legs and
arms
 Poor vision
 Poor hearing
 Loss of sensation in feet
Psychological
• Reduced motivation/ depression
• Memory problems/ confusion e.g.
dementia
Environmental
 Unsafe walking aids
 Inappropriate footwear
 Home hazards- lighting, dogs, loose mats,
grandchildren, wires, hosepipes
 Transfers- bath, stairs, bed, chair
References:
• 1. Hamblen D.,Simpsons A.H.R.W.(2010),Adam’s Outline of
Orthopedics (14th ed.), Elsevier(133-154)
• 2.Radomski M.V.,Latham C.A.T., Occupational Therapy for Physical
Dysfunction(7th ed),Wolters Kluwer /Lippincott Williams & Wilkins
• 3.Pendleton H.M,Winifred Schultz-Krohn,Pedretti’s Occupational
Therapy (practice skills for physical dysfunction)(8th ed), elsevier
THANK YOU

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client care for arthritis.pptx

  • 1. W.G.A.N.K.UDUGAMA Higher Dip. In ENG., BSc. in OT, BSc. Psychology (Undergrad), MPhil in OT(reading)
  • 2. CONTENT • What is arthritis? • Types of arthritis 1. Osteoarthritis 2. Rheumatoid arthritis 3. Gouty arthritis 4. Psoriatic arthritis 5. Septic arthritis 6. Spinal arthritis • Medical approach to arthritis
  • 3. • Occupational therapy for arthritis • OT evaluation • General objectives • Treatment precautions • OT intervention • Ergonomic principals • Fatigue management principals • Assistive devices for arthritis • Aging and Arthritis • Falls prevention
  • 4. What is ARTHRITIS? • Group of disorders that affect joints • Include both inflammatory and degenerative lesions • Generally characterized by pain and restriction of movements arising spontaneously accompanied by a swelling or thickening
  • 6. 1. Osteoarthritis - OA • Non inflammatory degenerative disease of wear and tear process in joints • Most common in weight bearing joints • Strongly co-relate with the age • Basically there are two types as; I. Primary osteoarthritis II. Secondary osteoarthritis Primary osteoarthritis Secondary osteoarthritis
  • 7. Pathophysiology Articular cartilage soften and loss elasticity Hard and glossy subchondral bone eburnation Hypertrophy of joint margins Osteophytes Recurrent strains leads to synovitis and degeneration of capsule
  • 8.
  • 10. Clinical features • Onset is gradual with increasing pain • Restricted movements • Crepitation • Joint enlargement due to osteophytes • Muscle weakness and wasting • Deformities in hands • PIP joints - bouchard’s nodes • DIP joints – Heber den's nodes
  • 11. 2. Rheumatoid arthritis - RA • Rheumatoid arthritis is, Non- suppurative Systemic Chronic inflammatory disease of Unknown cause Characterized by symmetrical polyarthritis Affecting peripheral joints and Extra articular structures with Exacerbations and remissions
  • 13. Inflammatory process of RA have 04 stages: 1. Acute stage 2. Sub acute stage 3. Chronic active stage / severe RA 4. Chronic inactive stage / End stage
  • 14. Articular manifestations • Swelling • Pain – aggravated with mvts • Stiffness- in morning • Warmth over affected joints • Tenderness • Muscle weakness and wastage • Prominent deformities in hand ( buttonire, swan neck, Z thumb, ulnar deviation of MCP) toes ( bunion, hammer toe, claw toe) knees ( valgus deformity) Extra articular manifestations • Malaise/ fatigue • Weight loss • Low grade pyrexia • Skin –thinning , rheumatoid nodules • Eyes- episcleritis • Heart- pericarditis, atherosclerosis • Lung-chest infections • Musculoskeletal- osteoporotic changes, tendon and ligament rupture • Hematological- anemia, thrombocytosis
  • 15.
  • 17. OA • Degenerative disease that causes articular cartilage loss and joint space narrowing • Develops slowly over years • Typically asymmetrical • Nodes are present ( heberden’s & bouchard’s ) • Morning stiffness more than 30 min. • Negative on blood tests • Radiograph: subchondral sclerosis, osteophytes, joint space narrowing RA • Autoimmune disease that causes inflammatory synovitis • Sudden onset • Symmetrical and polyarthritis • Nodules are present • Morning stiffness less than 30 min. • Positive rheumatoid factor, elevated ESR & CRP • Radiograph: diffuse rarefaction, joint malalignment/dislocation/ ankyloses
  • 18.
  • 19. 3. Gouty Arthritis • It is a clinical manifestation of disturbed purine metabolism • Characterized by deposition of uric acid in connective tissues, • Cartilage • Ligaments • Walls of bursa • Cause is unknown
  • 20.
  • 23. 4. Psoriatic Arthritis • A chronic inflammation of the skin (psoriasis) and joints (inflammatory arthritis). • It usually causes the joints to become swollen, stiff and painful
  • 24. Clinical manifestations • Swollen, painful,hot,red joints • Swollen fingers and toes • Joint stiffness worse in mornings • Pitted nails • Lower back pain
  • 25. 5. Septic Arthritis • When bacteria it can lead to septic/ pyogenic or infective arthritis • Common pyogenic bacteria's are, Staphylococcus Streptococcus Pneumococcus • As pus is formed with in the joint this is also called suppurative arthritis
  • 26.
  • 27. Pathophysiology A) In the early stage, there is an acute synovitis with purulent joint effusion B) Soon the articular cartilage is attacked by bacterial and cellular enzymes C) If infection is not arrested, the cartilage may be completely destroyed D) Sequel includes necrosis, subluxation, dislocation and ankyloses
  • 28. 6. Spinal Arthritis • Though we think of arthritis as affecting hands and legs, the truth is that it can affect any joints in the body including spine • 95% of people over age 50 will have degenerative osteoarthritis in their spines ( cervical and lumbar regions) • In the spine, arthritis usually affects: • The small facet joints found between the backbones, causing soreness and stiffness in the neck and back that increases with inactivity. • The large sacroiliac joints that connect the spine to the pelvis, causing a dull ache in the buttocks, groin, or the back of the thigh. • The sites where ligaments and tendons attach to the backbones, leading to painful bone spurs. Bone spurs can put pressure on a nerve (pinching the nerve) and create shock-like pain or numbness
  • 29. Signs and symptoms • Low back pain • Neck pain • Loss of flexibility of the spine • Joint stiffness • Swelling of the spine • Tenderness along the spine • A grating sensation when moving • Fatigue or weakness • Pain or numbness that travels down the arms or legs (an indication of nerve problems) • One of the first indications that you may be suffering from spine arthritis is that these symptoms are worse first thing in the morning. Often, your symptoms will dissipate as the day goes on, only to come back in the evening
  • 31. • Despite the fact there is no ‘cure’ for spinal arthritis, symptoms can be relived with medical intervention as well as life style changes through therapy • In severe cases, doctors will recommend a laminectomy surgery or spinal fusion to help relieve the pain • Although most common type of spinal arthritis is osteoarthritis, There are following less common types of arthritis as well, • Rheumatoid arthritis • Psoriatic arthritis • Reactive arthritis • Ankylosing spondylitis
  • 32. Medical approach to arthritis • Medical approaches are followed after proper diagnosis conformation through client’s medical history, laboratory investigations, radiographic features and physical examinations • Differs from condition, stage as well as co morbidities from person to person  Pharmacological management Conservative management with physiotherapy and occupational therapy Operative treatments (joint debridement/ arthrodesis/ joint replacement
  • 33. • Arthritis medical approach is consist of a MDT (Multi Disciplinary Team) • The MDT consists of, client Medical officer surgeon Nursing officer physiotherapist Occupational therapist
  • 34. • Physical therapy will help the clients to persist with the condition with minimum restrictions to day to day activities • If the joints have totally degraded beyond the repair, surgeons decide synthetic replacements
  • 35. Pharmacological management (commonly using drugs) Analgesics Ex: Acetaminophen NSAID’s Ex: Naproxen Ibuprofen Indomethacin celecoxib DMARDs Ex: Methotrexate Antibiotics Ex: doxycycline Vancomycin Intra articular injections Corticostero ids Ex: dexamethasone Local application s Biological and cytokine treatments Ex: infliximab Rituximab
  • 37. Occupational Therapy Evaluation • Each client is unique in clinical presentation as well as in functional impairments • Client centered approach • Problems of a same person can also be fluctuate • Evaluation process consist of, 1. Client history 2. Occupational profile 3. Occupational performance status 4. Cognitive, psychological and social status 5. Clinical status
  • 38. CLIENT HISTORY Diagnosis Date of onset Other medical conditions Medications’ surgical history OCCUPATIONAL PROFILE Roles Occupations Activity level Ability to participate in meaningful activities OCCUPATIONAL PERFORMANCE STATUS Self-care (ADL/IADL) Productivity (education/ work) Leisure (rest/sleep/play/social participation) COGNITIVE PSYCHOLOGICAL AND SOCIAL STATUS Appearance and behavior Mood Speech Thought Perception Cognition (memory/ attention/ concentration) CLINICAL STATUS Posture ROM Strength stiffness Pain swelling Sensation endurance Hand functions deformities
  • 39. General objectives of Occupational Therapy • Maintain or increase the ability to engage in meaningful occupation • Maintain or increase joint mobility and strength • Maximize physical endurance • Minimize effects of deformity • Increase understanding of the disease • Assist with adjustment to disability
  • 40. Treatment precautions related to arthritis • Respect pain • Avoid fatigue • Avoid stresses on inflamed / unstable joints • Be aware of sensory impairments • Cautious with pharmacological side effects
  • 41. Occupational Therapy intervention in Arthritis 01. Rest • An active way of reducing inflammation and pain • Can be either general or local Rest General rest Bed rest Rest in between works Localized rest Wearing a splint positioning Modified activities
  • 42. 02. physical agent modalities • Helpful in relieving pain or improving ROM ex: hot and cold therapy paraffin hydrotherapy • Careful monitoring of client response is crucial here
  • 43. 03. Therapeutic exercises Purposes: • maintain or improve ROM • maintain or increase muscle strength • prevent disuse atrophy •
  • 44. General guidelines for exercises in Arthritis • Avoid undue joint stress • Avoid pain and joint swelling • Work with the client’s comfortable ROM • Client should taught to perform exercises slowly, smoothly in proper techniques • Typically preferred – assistive exercises • If pain persist – passive exercises • Should balance rest and exercises • Should be done when client feels more fit and having least pain • Exercise regimes differ: Good days : 10 repetitions - 3 times per day Bad days : 3-4 repetitions – At least one time per day
  • 45. 04. Therapeutic activities • Offers many benefits both physically and psychologically • Graded activities • Should be non resistive, avoid patterns of deformity and not over stress joints
  • 46. 05. Splinting • Through splinting we can only reduce the progression of the deformity but cannot be corrected • Indications for splinting in arthritis: 1. Reduce inflammation 2. Reduce pain 3. Support unstable joints 4. Proper positioning of joints 5. Limit undesired motions 6. Improve ROM 7. Improve functions
  • 47. Commonly using splints for arthritis 1. Resting splints – for acute synovitis • Resting position: Slightly wrist extension (0-20’) Ulnar deviation (10-20) MCP joint flexed (20’-30’) PIP & DIP slightly flexed (10’-30’) Thumb slightly extended and abducted from CMC joint MCP and IP joints of thumb slightly flexed 2. Wrist splint
  • 49. 5. Swan – neck splint 6. Buttonire splint
  • 50. Ergonomic (joint protection) principals 1) Respect pain 2) Maintain muscle strength 3) Distribute pain over several joints 4) Reduce force and effort required in activities 5) Use correct patterns of movements
  • 51. 6) Use good body positioning, posture, moving and handling techniques – avoid position of deformity Ex: squeezing, pinching , twisting motions are stressful and promote ulnar deviation instead: Opening jar lid opening door knob coconut squeezing
  • 52. 7) Use strongest and largest joint available for the job 8) Avoid staying one position for too long 9) Use as much as ergonomic equipment's or assistive devices 10) Pace activities 11) Work simplification 12) Modify the environment
  • 53.
  • 54.
  • 55. Fatigue management principals 1. Attitudes and emotions 2. Body mechanics 3. Work pace 4. Leisure time 5. Work methods 6. Organization 7. Plan ahead
  • 56. Commonly used assistive devices for Arthritis Activity Assistive devices dressing Dressing stick, shoe horn, sock aid, button hook, zipper pull, elastic shoelaces bathing Bath bench, grab bars, long handled sponge toileting Raised toilet seat, grab bars Hygiene and grooming Extended handles in tooth brush, comb feeding Extended handle utensils Meal preparation Adapted knives, adapted openers, miscellaneous Door knob levers, speaker phones, walking aids
  • 57.
  • 58.
  • 59. Aging and Arthritis • According to records almost half of adults 65 and older are present with arthritic conditions • Osteoarthritis - most common
  • 60. Causes leads to arthritis in older adults • Mechanical stress • Genetics • Musculoskeletal degeneration • Traumatic injuries • Infections • Hormonal changes (ex: menopause in women)
  • 61. Fall Prevention • World Health Organisation defines a fall as: “An event which results in a person coming to rest inadvertently on the ground or floor or other lower level”. • Excluded: - major internal event e.g. stroke - being hit by an external force e.g. knocked over • Ultimate result of a fall is decreasing the quality of life
  • 62. Risk factors for falls Medical  Polypharmacy  Postural hypotension  Medical conditions e.g. PD  Poor hydration  Anaemia Physical  Reduced balance  Walking problems  Reduced muscle strength in legs and arms  Poor vision  Poor hearing  Loss of sensation in feet Psychological • Reduced motivation/ depression • Memory problems/ confusion e.g. dementia Environmental  Unsafe walking aids  Inappropriate footwear  Home hazards- lighting, dogs, loose mats, grandchildren, wires, hosepipes  Transfers- bath, stairs, bed, chair
  • 63.
  • 64. References: • 1. Hamblen D.,Simpsons A.H.R.W.(2010),Adam’s Outline of Orthopedics (14th ed.), Elsevier(133-154) • 2.Radomski M.V.,Latham C.A.T., Occupational Therapy for Physical Dysfunction(7th ed),Wolters Kluwer /Lippincott Williams & Wilkins • 3.Pendleton H.M,Winifred Schultz-Krohn,Pedretti’s Occupational Therapy (practice skills for physical dysfunction)(8th ed), elsevier