A. Personal adaptive equipment usage (such as a bathtub bench)
B. Nerve gliding exercises done twice daily
C. Physical agent modality usage
D. Splinting fabrication
3. Because there is a strong psychological component to the pain experience, which OT strategy is least likely to be effective for this component?
B. Home safety modification
C. Relaxation training
4. Chris, a 48-year-old truck driver, has a history of ulnar neuropathy and generalized wrist pain. He is now presenting with Carpal Tunnel Syndrome symptoms. You determine the need for Occupational Therapy (OT) evaluation and intervention (see Occupational Therapy Referral form - Fig. 15.2). In addition to referring to OT for wrist cock-up splints bilaterally, iontophoresis, and therapeutic exercise, it would be appropriate to request
A. Home safety evaluation
B. Relaxation education
C. An ergonomic evaluation
D. Myofascial release
1. The answer is D. Occupational therapists are qualified to treat a wide variety of clients including those with autoimmune, orthopedic, and neurological disorders. Appropriate client referrals include those who are experiencing acute or chronic pain, especially if there is a limitation in functional ability.
2. The answer is A. The other answers pertain to the physical management of pain; all strategies can be effective for healing of soft tissues and fall under physical interventions used by occupational therapists. Personal adaptive equipment usage (whether for dressing, bathing, grooming, or toileting) falls under the category of "environmental/contextual" adaptations for pain management. Occupational therapists are adept at analyzing people engaging in occupations within various contexts, so they can be counted on to quickly evaluate and address any such patient needs.
3. The answer is B. Stress management, relaxation training, and cognitive-behavioral approaches have all been demonstrated to promote positive psychological coping strategies for acute or chronic pain management. Thus, home safety modification, although helpful for environmental/contextual intervention, will be less likely to have an impact on a client's immediate need for positive coping strategies to address managing or lessening the impact of pain on their daily living.
4. The answer is C. Due to the symptoms of ulnar neuropathy and now carpal tunnel syndrome, it is expected that splints, iontophoresis, and therapeutic exercise will be beneficial to the client. Beyond this, the benefits ofmyofascial release have not been demonstrated to be effective. Relaxation may be beneficial, but the intervention most likely to bring about the needed work and lifestyle modifications would be an ergonomic evaluation. Through an ergonomic evaluation, Chris' sitting and reach in the semi-truck, along with his daily routine and tasks can be analyzed by the occupational therapist. Together with Chris, they can develop an adaptation plan for driving, rest, self-exercise, and sleep breaks that will promote the best positions of his upper extremity joints to decrease inflammation and allow healing of the soft tissues.
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