1. ORTHOPEDICS, AGING, AND OT Joyce Goff, MS OTR/LOCTH 533 Spring 2013

2. OBJECTIVES OF INTRODUCTION Provide a very brief review of conditions common in older adults that may lead toorthopedic 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 4. REVIEW Osteoarthritis Non-inflammatory joint disease Rheumatoid arthritis Chronic, inflammatory, systemic disease Osteoporosis Decreased bone density Rotator cuff injuries Trauma, decreased joint integrity 5. PREVIEWThe following slides preview:The objective of the upcoming orthopedic lectures,The general outline of class for the lectures, andPresent 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 forolder 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 forclass. 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 throughyour 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 lpmO2 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. Spousecompletes 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 Rfemur 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 vertebralfractures Prior level of function: home alone, modified independent with adaptive equipment, butstruggling 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 hospitalback 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. Spousecompletes 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 humerusfracture 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 assessmentbut 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: Parkinsons disease OT evaluation: Mod assist for all ADL, min assist for functional transfers.