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RA is a chronic destructive inflammatory disease of the synovium with a course Characterised by exacerbation and remission. It is a systematic disease and may involve the lungs, blood vessels, heart or eyes in some cases. Roll of OT: The following is an outline of basic treatment for both isolated and multiple joint involvement. 1. Acute Phase A) Reduce pain and inflammation a) Splinting or positioning to rest specific joints Joint Position of Splinting Neck Extension of cervical spine, Chin forward Dorsal spine Full extension Shoulder 90 degree abduction, neutral rotation Elbow 90 flexion, 10 supination Wrist 30 dorsiflexion Thumb Extension opposition Finger Extension, no lateral deviation Hips Extensions - in line with body foot pointing upward Knee Extension Ankle Neutral position Foot No varus or valgus, upward pressure beneath second, Third or fourth metatarsal Toe In line with plantar surface or foot. b) Elimination of unnecessary joint stress by adequate systemic rest during the day. General principles of joint protection include the following: i) Respect for pain ii) Balance between rest and work iii) Maintenance of muscles strength and JROM iv) Reduction of effort needed to do a job. v) Avoidance of positions of deformity. vi) Use of the strongest/ largest joints available for the job. vii) Avoidance of holding or staying in one position for prolonged period of time. viii) Avoidance of activities which are too useful. ix) Use of assistive equipment and splinting to protect joints. c) Application of ice compresses, heating pads, or hot packs to relieve pain secondary to both joint inflammation and protective muscles spasm. B) Maintain ROM and joint integrity a) Generate passive or active ROM to the point of pain (without stretch) two times per day. b) Proper positioning for lying or sitting. This includes a firm mattress, small head pillow and no knee pillows. c) Use of resting hand, ankle or foot splints. d) Deep breathing and postural exercises to maintain thoracic and scapular joint mobility. e) Exercise to maintain jaw mobility. C) Maintain strength and endurance a) Performance of ADL to tolerance b) Isometric exercise- one to three full contraction per muscles group once a day. 2. Subacute Phase A) Reduce inflammation and pain. B) Maintain ROM and joint integrity C) Improve endurance for clients with systemic disease -require at least 10-12 hour of adequate rest and work simplification and energy conservation methods. D) Maintain muscles strength. 3. Chronic - active Phase Emphasis is different because patients are able to perform more activities than in the acute or substances phases. In this phase joint protection techniques, assistive devices and splinting are most important treatment. In addition, exercise to improve muscle strength and ROM can be started vigorously. Common Functional limitation and possible solution: Joint protection for hands - Shoulder strap for handbags, suitcase. Adaptive built up hands - Shopping bags Non-slip pads or plastic - Electric blankets Faucets turners - Sheet tuckers House or car key adaptations - Universal cuff to hold brushes, silverware, pencils Light weight kitchen utensils - Book racks Jar opener - Writing devices Tea kettle tipper - Electric shaver or cup holders Bowl holders - Button hooks Electric scissors - Soap on a rope( for shower or tub) Strap loops for forearm - Car door openers Shoulder involvement: Extended handles with enlarged grip on hairbrushes, combs, toothbrushes, silverware, backbrushes Long cloth back scrubbers Extended drinking straws Coat holders Reachers, dressing sticks, front opening clothes Sponges and dustpans with extended handles for floor care. Neck involvement: Typing draft holder, adjustable book holders Cervical contour pillows, telephone receiver holders. Knee involvement: Elevated chairs in the living room, kitchen, at work, high kitchen stool, raised toilet seat, arm bars for toilet, shower, bench, tub grab bars, walking aids, half steps or short steps. Hip, Back, or Elbow involvement: (which limits hand to foot or floor range) Reachers, sock dressers, dressing sticks, pant dressing poles, extended shoe Lack of hip flexion (extension contractures): Specially adapted chairs and toilet seats allow the patients to sit upright with the hip in less than 90 degree flexion. |
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