Ot in Rehab PPT 2
Ot in Rehab PPT 2
Ot in Rehab PPT 2
TOPIC: OT MANAGEMENT
FOR PAIN
-AARTHI A
BOT(FINAL YEAR)
SRIHER
INTRODUCTION
• Pain is defined as an unpleasant sensory and emotional experience associated with actual or
potential tissue damage
• The perception of pain may depend on the situation or the mental state
PA I N T E R M I N O L O G Y
• Acute pain: Pain associated with tissue damage and typically resolves once the tissue heals.
• Chronic pain: Pain that persists past the healing phase following an injury; impairment is greater than anticipated based on the physical
findings or injury and it occurs in the absence of observed tissue injury or damage.
• Allodynia: Pain due to a stimulus that does not normally provoke pain.
• Causalgia: A syndrome of sustained burning pain, allodynia, and hyperpathia after a traumatic nerve lesion, often combined with
vasomotor and sudomotor dysfunction (such as diabetic autonomic neuropathy) and later trophic changes.
• Central pain: Pain initiated or caused by a primary lesion or dysfunction in the central nervous system.
• Chronic pain syndrome: Pain that exists when individuals have developed extensive pain behaviours such as preoccupation with pain,
passive approach to health care, significant life disruption, feelings of isolation, demanding, angry, or doctor-shopping.
PAIN
PAIN
BEHAVIORS
PA I N S Y N D RO M E S
• Headache Pain
• Low Back Pain
• Arthritis (OA and RA)
• Complex Regional Pain Syndrome
• Myofascial Pain Syndrome
• Phantom Pain
• Chronic Pain and Depression
• Fibromyalgia
• Cancer Pain
• Central Pain Syndrome
E X A M I N AT I O N O F PA I N
Pain is a purely subjective phenomenon. Unlike range of motion (ROM), strength, or tissue extensibility, pain
has no objective or specific measurement tool.
Effective examination of chronic pain is more complex than the visual analogue or numeric rating scales
typically used for acute pain. The psychosocial aspects of chronic pain should be examined and evaluated to
better identify psychosocial factors and guide intervention within a biopsychosocial model of care.
• Onset: When and how did it start? Sudden or gradual? Trauma, illness, or
O other possible cause?
• Character: How does the pain feel? Sharp? Stabbing? Burning? Aching?
C Other?
• Time course: How does the pain vary over the day?
T
• Factors that may contribute to pain perception, occupational role disruption, decreased occupational
performance, and diminished quality of life should be identified.
• Non steroidal anti-inflammatory agents have been used in the treatment of arthritis and inflammation of a musculo-
skeletal origin.
• Codeine is often used for moderate intensity pain that has not responded adequately to aspirin or acetaminophen.
• Occupational therapy interventions focus on increasing physical capacities, productive and satisfying
performance of life tasks and roles, mastery of self and the environment through activities, and education
ACTIVITY TOLERANCE-GRADING
• Activity levels are increased on a gradual basis, with the client working to “tolerance” (i.e., gradual increase in
task demands such as mobility, strength, and endurance), as opposed to “pain,” before a scheduled rest period.
• The client should not initiate rest at the time of the pain onset or exacerbation because this may reinforce pain
behaviour's.
• Task selection based on occupational roles, interests, and abilities is a unique contribution of occupational
therapy in pain management.
BODY MECHANICS AND POSTURE TRAINING
• Instruction in and rehearsal of proper body mechanics and postures that will not increase the risk of low back injury
or strain are essential for clients experiencing both acute and chronic LBP.
• Practice in using the body safely and to maximum performance during routine tasks in natural (i.e., home, work, or
leisure) environments is particularly important
• The client should be taught to avoid tasks or positions that do not allow balanced posture.
The patient is taught to do the following:
PRINCIPLES OF ● Incorporate a pelvic tilt during static sitting or standing to unload the facet joints, aid in
pelvic awareness, and decrease muscular tension in the low back.
BODY ● Position the body close to and facing the task. This aids in balance by getting the objects
MECHANICS as close to the centre of gravity as possible.
● Avoid twisting. Twisting causes stress on the ligaments and small muscles of the spine.
Instead, turn the body by stepping with both legs to face the activity.
● Use the hip flexors and extensors to lower and raise the body. These are large muscles
with leverage and power to handle heavy loads.
● Avoid prolonged repetitive activity or static positions. Take microbreaks and walk briefly
or stretch every hour.
● Use a wide base of support. Stability while lifting is increased when the feet are at least
hip distance apart. One foot slightly in front of the other provides additional support.
● Keep the back in proper alignment, ear over shoulder, shoulder over hips, and hips over
knees and feet to maintain the natural curves of the back. Practice in front of a mirror.
● Test a load before lifting to decide whether the lift should be modified. Describe how to
modify the lift: get help, split the load into more than one lift, or put the object on wheels.
● Stay physically fit. Strong muscles and flexible joints are the best defence against injury
or recurrence of an injury.
PRIORITIZE
PLAN
ENERGY
C O N S E RVAT I O N PACE
TECHNIQUES
POSITION
POSITIVE ATTITUDE
JOINT PROTECTION PRINCIPLES
● Respect Pain
● Distribute load over several joints
● Reduce the force and effort required in activities
● Use correct patterns of movement
● Use good body positioning, posture and moving and handling techniques
● Use the strongest, largest joint available for the job
● Avoid staying in one position for too long
● Use ergonomic equipment, assistive devices, and labour-saving gadgets
● Pace activities: balance rest and activity, alternate heavy and light tasks, take microbreaks
● Use work simplification: plan, prioritise, and problem solve
● Modify the environment and equipment location to be ergonomically efficient
● Maintain muscle strength and range of movement
SPLINTING
• Patients with persistent activity limitations due to defined physical impairments may benefit from
assistive devices to improve function.
• Many techniques are available for inducing relaxation. Abdominal breathing is the simplest
way to encourage relaxation. The learning sequence involves (1) awareness of breathing
pattern, (2) inhalation, and (3) slow exhalation
(2) systematic tensing and relaxing of major musculoskeletal groups for several seconds
• AT includes
• AT has proven effective in treating persons with tension headaches, substance abuse, and musculoskeletal
disorders, in addition to promoting wellness
• Guided imagery is the purposeful use of images to reduce stress and distract attention away from intrusive
thoughts. In this technique, the participant focuses on a relaxing environment (e.g., a peaceful garden) of his or
her choice. Meditation, massage, yoga and physical exercise may also be used as relaxation approaches.
• Visualization – Imagining a safe and relaxing environment, including sounds, smell and eel
NEUROMUSCULAR RE-
E D U C AT I O N
PHYSICAL AGENT Both heat and ice are useful in reducing pain and
M O DA L I T I E S muscle spasm of musculoskeletal and neurologic
pathologies.
INDICATION CONTRA-INDICATION
• Subacute and chronic traumatic and inflammatory • Acute inflammatory conditions, cardiac
conditions such as muscle spasms, arthritis of the insufficiency, malignancies, or peripheral vascular
small joints of the hands and feet, tendonitis, and disease.
bursitis. • Pre-existing oedema
• Insensate clients
Cold Therapy
• Cold can improve pain control by elevating the pain threshold. Local
vasoconstriction occurs in direct response to cold therapy (cryotherapy).
• When the area is subsequently exposed to air, vasodilatation occurs.
• Cold applications also result in decreased local metabolism, slowing of nerve
conduction velocity, diminished muscle spasm and spasticity, decreased edema, and
lessened tissue damage.
• Cold can be applied via commercial packs, sprays, ice cups, or a massage stick.
• There are several contraindications in the use of cryotherapy.
• Movement therapies such as yoga, tai chi, and qigong will improve flexibility, strength, balance, proprioception
and decreasing kinesiophobia
• REHABILITATIVE FOR
• COGNITIVE BEHAVIORAL THERAPY
• BIOMECHANICAL FOR
• MOHO
COMMONLY ASKED MGR UNIVERSITY QUESTIONS
VIII. Biofeedback
BIOFEEDBACK
• Biofeedback—which means biological feedback—refers to the process of using instrumentation to feed back to the patient
immediate sensory information about what the body is doing.
• This allows the patient to make small alterations in body functions during performance in order to improve the actual
functional outcome.
• Types of biofeedback
EMG biofeedback - This type of biofeedback helps make the patient more aware of muscle activation
Electro goniometric biofeedback - It allows the patient to learn the correct movement patterns
• And is used for muscle re-education and training.
HOW DOES IT WORKS?
• In biofeedback, small electrodes are attached to the patient’s skin to detect the tiny electrical signals that are generated
when skeletal muscle contracts. When the onset of a muscle contraction is detected, the biofeedback unit will alert the patient
with, typically, an auditory or visual stimulus.
• As the muscle contraction progresses and strengthens, the auditory tone will become louder, and the visual display will
become larger.
INDICATIONS
o Urinary incontinence
o Motor dysfunction and spasticity following stroke
o Muscle dysfunction and myoclonus following spinal cord injury
o Focal hand dystonia
o Cerebral palsy
BIOFEEDBACK EQUIPMENT
• Biofeedback units have three major components to detect, measure, and report activity in the body:
o Transducer - detects the target activity in the body
o Processing unit – It contains electrical circuits that amplify, integrate, or prepare the messages from
the electrodes for an output signal
o The output mechanism - Provide visual and auditory feedback
Electromyography Biofeedback Session for Muscle Re-education
• Begin with large, widely spaced electrodes over the muscle belly.
• Initially set the threshold at an attainable level.
• During a 10- to 15-minute treatment session, the patient voluntarily contracts the muscle to reach
the threshold level.
• When possible, incorporate purposeful activities to facilitate the muscle activity desired.
• Gradually raise the threshold during the treatment session to challenge the patient to contract the
muscle more strongly.
T R E AT M E N T O F T H E PAT I E N T W I T H LOW BAC K
PA I N
• The occupational therapist facilitates the patient’s active participation in tasks and activities by teaching body
mechanics and how to perform activities safely.
• PAM such as hot packs
• Transcutaneous electrical nerve stimulation (TENS)
• Stretching exercises
• Relaxation techniques for stress reduction
• Biofeedback for muscle control
• Group educational sessions
• Therapeutic activity, including games, crafts, ADL, and work tasks
Application of principles of body mechanics in various postures are as follows:
• While standing, the patient places one foot on the shelf under the sink or on a low stool to achieve posterior pelvic tilt.
• To sit, the patient lowers the body by flexing the knees and hips without bending the spine by placing the hands on the
chair’s armrest
• When lying in bed, the ideal posture to decrease pressure on the spine is supine with the knees flexed. A pillow should
be placed under the knees to maintain the flexed posture.
• To pick up a large or heavy object - the patient adds more central support by lowering one knee to the floor (half-
kneeling) so that the body is close to and facing the object.
REFERENCE
THANK YOU