The document discusses various types of orthotic devices and their purposes, including arm slings to prevent shoulder subluxation, arm troughs to support painful shoulders, wrist and hand splints to reduce stress on joints and decrease pain from conditions like rheumatoid arthritis, and finger splints to immobilize injuries. It also covers devices to restore mobility like elbow hinges and hand gauntlets, and devices that substitute for or modify muscle tone like wrist-hand orthoses.
The document outlines topics related to pain management including definitions of pain, types of pain, definitions of pain management, the pain management team, clinical conditions commonly treated, assessment of pain, and interventions for pain management. Pain is defined as an unpleasant sensory and emotional experience associated with tissue damage. Types of pain include acute and chronic. Pain management involves assessment and treatment to reduce pain and improve function using methods such as medication, exercise prescription, bracing, relaxation techniques, and modalities.
Occupational Therapy Practice Framework :Domain & process 3rd EditionMohsen Eslampanah
油
The Occupational Therapy Practice Framework: Domain and Process describes the central concepts that ground occupational therapy practice and builds a common understanding of the basic tenets and vision of the profession.
Occupational Therapy Practice Framework :Domain & process 2nd EditionMohsen Eslampanah
油
The document discusses the Occupational Therapy Practice Framework which outlines the domain and process of occupational therapy. It describes occupational therapy as focusing on supporting health and participation through engagement in occupations. The framework includes sections on persons, organizations, populations, areas of occupation, performance skills, performance patterns, context/environments, and the process of evaluating, intervening, and measuring outcomes.
This document outlines a tendon rehabilitation pyramid consisting of various exercises organized into levels of increasing intensity. The levels include passive protected extension, place and hold, active composite fist, hook and straight fist, isolated joint motion, resistive composite fist, resisted hook and straight fist, and resisted isolated joint motion. The goal is to provide progressive motion stress and resistance to adhesions while monitoring the patient's response and tailoring the rehabilitation program accordingly. Exercises are prescribed based on the patient's stage of recovery and response to the previous level.
Therapeutic Use of Technology: Case-based Clinical Reasoning with Everyday Te...umrobot
油
This document provides an overview of using technology therapeutically in occupational therapy. It begins with learning objectives around describing, relating, analyzing, and integrating the therapeutic use of technology. It then discusses using both traditional and innovative technology-based interventions. The rest of the document discusses various technologies like virtual reality and their effectiveness for stroke rehabilitation. It also discusses limitations, considerations for clinical practice, and case studies applying a clinical reasoning process to select appropriate technologies.
Psychology plays a major role in pain management through techniques like cognitive behavioral therapy, relaxation therapy, and guided imagery. Cognitive behavioral therapy uses treatment rationales, coping skills like relaxation, activity pacing, and cognitive restructuring to help patients manage pain. Relaxation therapy creates measurable physiological changes that lead to feelings of calmness. Guided imagery involves imagining relaxing scenarios to lower pain and suffering. The overall goal of pain psychology is to help patients feel better, conquer pain, and lead a quality life.
This document outlines an activity for occupational therapy students to conceptualize a case study of a client named Mrs. Rita Phillip using one of four occupational therapy models: MOHO, PEOM, Kawa, or CMOP-E. Students will work in small groups to analyze Mrs. Rita's medical and family background, personal interests, and current physical and mental status using the chosen model. The groups will then present their analysis in a poster or short discussion. Feedback will be provided to help students learn how to apply theoretical models to understand clients and their occupational challenges.
OT 425 Intro to clinical documentation in occupational therapyStephanie Lancaster
油
This document provides an introduction to clinical documentation for occupational therapy. It defines clinical documentation as a record of information collected about the client, including assessments, interventions, and observations. Common types of documentation include evaluation reports, intervention plans, progress notes, and discharge summaries. The document emphasizes that documentation must include the client's name, date, practitioner information, and use professional terminology. It also introduces the SOAP note format and provides an example. Finally, it discusses setting-specific documentation forms like the IFSP, IEP, narrative notes, and OT evaluation.
Online technology for Occupational Therapy: Presentation for studentsAnita Hamilton PhD
油
This is similar to the presentation given at the WFOT congress. I used this presentation with my students who were learning about online technology with me in my 13 hour intensive "module".
Designing Systems: An Approach to Responsive Web Design (Portuguese)Pedro Moreira da Silva
油
Este documento discute os princ鱈pios do design responsivo e sistemas flex鱈veis na web. Ele descreve como grids fluidas, imagens flex鱈veis e media queries permitem que sites se adaptem a diferentes dispositivos. Tamb辿m discute a import但ncia de criar sistemas de componentes reutiliz叩veis ao inv辿s de p叩ginas individuais.
Antonio has had a passion for filmmaking since high school when he took a television production class and fell in love with the process of producing and anchoring the news. This led him to study media communications at Full Sail University and he hopes to graduate in early 2016, then find a job in a newsroom and become a renowned broadcast journalist reporting stories from around the world. His goals also include directing and producing for his church, using his platform to tell real stories, hosting and producing for MTV, caring for his mother, traveling, preaching the gospel, and cherishing every moment.
El documento habla sobre la belleza y la paz que se encuentra en la naturaleza y entre los seres humanos. Celebra la vida y la luz de un nuevo amanecer en la Tierra lleno de comprensi坦n mutua. Alienta a las personas a ser responsables de sus pensamientos y a dejar atr叩s creencias que no sirven al bien mayor de la humanidad.
From completing the preliminary task and question 7, the author has learned several skills related to radio broadcasting and journalism. They have learned how to engage audiences through their voice, the importance of preparation and practice, and how to use various tools like blogs, slideshare, and audacity. The author has also gained a better understanding of key media concepts like news values, hard news vs. soft news, and journalism ethics. Through outside broadcasts, they have increased their confidence in interviewing people. Overall, the progression of assignments has helped the author improve various broadcasting and reporting abilities.
Este documento presenta una gu鱈a sobre las funciones b叩sicas de Microsoft Word. Incluye secciones sobre la pantalla principal de Word, las partes del teclado y combinaciones de teclas, la creaci坦n de gr叩ficos Smart Art y gr叩ficos de comparaci坦n de datos, las tablas y sus propiedades, y el formato de texto en dos columnas. El documento proporciona informaci坦n sobre estas herramientas de Word para ayudar a los usuarios a aprovechar al m叩ximo el programa.
Este documento presenta una gu鱈a sobre las funciones b叩sicas de Microsoft Word. Incluye secciones sobre la pantalla principal de Word, las partes del teclado y combinaciones de teclas, la creaci坦n de gr叩ficos Smart Art y gr叩ficos de comparaci坦n de datos, las tablas y sus propiedades, y el formato de texto en dos columnas. El documento proporciona informaci坦n sobre estas herramientas de Word para ayudar a los usuarios a aprovechar al m叩ximo el programa.
The document summarizes the targeting of specific social and psychographic groups for a marketing campaign. It aimed to target demographic groups classified as C1-E and the psychographic groups of "Reformers" and "Explorers". The design of the masthead used a graffiti-like font to portray a rebellious attitude aligned with the Reformers category of valuing independence and freedom from restrictions. However, the overall style was similar to existing products in the genre, which somewhat went against Explorers who prefer new things.
The document provides guidance on formatting magazine columns and layout. It recommends using different column widths and numbers of columns for different stories to avoid rigidity and encourage creativity. While columns can provide order, the document advises mixing up the formatting to make the magazine more visually interesting and engaging for readers. It also emphasizes treating each story as a separate unit and focusing on readability.
LOST IN THE MIX: A CASE FOR INCLUSIVE AND PARTICIPATORY APPROACHES TO DISAST...Mohsen Eslampanah
油
Occupational therapy
Disaster and development: an occupational perspective
chapter 5: LOST IN THE MIX: A CASE FOR INCLUSIVE AND PARTICIPATORY APPROACHES TO DISASTER AND DEVELOPMENT
This document discusses multiple sclerosis (MS), including its incidence being highest between ages 20-45 and more prevalent in women. MS damages the myelin sheath in the central nervous system, causing intermittent symptoms like sensory issues, incoordination, and weakness. An occupational therapist's role includes evaluating a patient's occupational performance, sensory-motor skills, and environment to establish compensatory strategies and goals addressing deficits from MS.
Stroke is the third leading cause of death worldwide. It is defined as acute neurologic dysfunction of vascular origin affecting focal areas of the brain. Common effects of stroke include motor paralysis, sensory disturbances, cognitive impairments, and speech or language disorders. Occupational therapists play an important role in evaluating clients after a stroke and providing intervention to improve functional limitations in areas like mobility, self-care, and upper extremity function. Treatment focuses on retraining skills and compensating for deficits through task-oriented and occupation-based approaches.
Dr. Vincenzo Giordano began his medical career 2011 at Aberdeen Royal Infirmary in the Department of Cardiothoracic Surgery. Here, he performed complex adult cardiothoracic surgical procedures, significantly enhancing his proficiency in patient critical care, as evidenced by his FCCS certification.
Solubilization in Pharmaceutical Sciences: Concepts, Mechanisms & Enhancement...KHUSHAL CHAVAN
油
This presentation provides an in-depth understanding of solubilization and its critical role in pharmaceutical formulations. It covers:
Definition & Mechanisms of Solubilization
Role of surfactants, micelles, and bile salts in drug solubility
Factors affecting solubilization (pH, polarity, particle size, temperature, etc.)
Methods to enhance drug solubility (Buffers, Co-solvents, Surfactants, Complexation, Solid Dispersions)
Advanced approaches (Polymorphism, Salt Formation, Co-crystallization, Prodrugs)
This resource is valuable for pharmaceutical scientists, formulation experts, regulatory professionals, and students interested in improving drug solubility and bioavailability.
OT 425 Intro to clinical documentation in occupational therapyStephanie Lancaster
油
This document provides an introduction to clinical documentation for occupational therapy. It defines clinical documentation as a record of information collected about the client, including assessments, interventions, and observations. Common types of documentation include evaluation reports, intervention plans, progress notes, and discharge summaries. The document emphasizes that documentation must include the client's name, date, practitioner information, and use professional terminology. It also introduces the SOAP note format and provides an example. Finally, it discusses setting-specific documentation forms like the IFSP, IEP, narrative notes, and OT evaluation.
Online technology for Occupational Therapy: Presentation for studentsAnita Hamilton PhD
油
This is similar to the presentation given at the WFOT congress. I used this presentation with my students who were learning about online technology with me in my 13 hour intensive "module".
Designing Systems: An Approach to Responsive Web Design (Portuguese)Pedro Moreira da Silva
油
Este documento discute os princ鱈pios do design responsivo e sistemas flex鱈veis na web. Ele descreve como grids fluidas, imagens flex鱈veis e media queries permitem que sites se adaptem a diferentes dispositivos. Tamb辿m discute a import但ncia de criar sistemas de componentes reutiliz叩veis ao inv辿s de p叩ginas individuais.
Antonio has had a passion for filmmaking since high school when he took a television production class and fell in love with the process of producing and anchoring the news. This led him to study media communications at Full Sail University and he hopes to graduate in early 2016, then find a job in a newsroom and become a renowned broadcast journalist reporting stories from around the world. His goals also include directing and producing for his church, using his platform to tell real stories, hosting and producing for MTV, caring for his mother, traveling, preaching the gospel, and cherishing every moment.
El documento habla sobre la belleza y la paz que se encuentra en la naturaleza y entre los seres humanos. Celebra la vida y la luz de un nuevo amanecer en la Tierra lleno de comprensi坦n mutua. Alienta a las personas a ser responsables de sus pensamientos y a dejar atr叩s creencias que no sirven al bien mayor de la humanidad.
From completing the preliminary task and question 7, the author has learned several skills related to radio broadcasting and journalism. They have learned how to engage audiences through their voice, the importance of preparation and practice, and how to use various tools like blogs, slideshare, and audacity. The author has also gained a better understanding of key media concepts like news values, hard news vs. soft news, and journalism ethics. Through outside broadcasts, they have increased their confidence in interviewing people. Overall, the progression of assignments has helped the author improve various broadcasting and reporting abilities.
Este documento presenta una gu鱈a sobre las funciones b叩sicas de Microsoft Word. Incluye secciones sobre la pantalla principal de Word, las partes del teclado y combinaciones de teclas, la creaci坦n de gr叩ficos Smart Art y gr叩ficos de comparaci坦n de datos, las tablas y sus propiedades, y el formato de texto en dos columnas. El documento proporciona informaci坦n sobre estas herramientas de Word para ayudar a los usuarios a aprovechar al m叩ximo el programa.
Este documento presenta una gu鱈a sobre las funciones b叩sicas de Microsoft Word. Incluye secciones sobre la pantalla principal de Word, las partes del teclado y combinaciones de teclas, la creaci坦n de gr叩ficos Smart Art y gr叩ficos de comparaci坦n de datos, las tablas y sus propiedades, y el formato de texto en dos columnas. El documento proporciona informaci坦n sobre estas herramientas de Word para ayudar a los usuarios a aprovechar al m叩ximo el programa.
The document summarizes the targeting of specific social and psychographic groups for a marketing campaign. It aimed to target demographic groups classified as C1-E and the psychographic groups of "Reformers" and "Explorers". The design of the masthead used a graffiti-like font to portray a rebellious attitude aligned with the Reformers category of valuing independence and freedom from restrictions. However, the overall style was similar to existing products in the genre, which somewhat went against Explorers who prefer new things.
The document provides guidance on formatting magazine columns and layout. It recommends using different column widths and numbers of columns for different stories to avoid rigidity and encourage creativity. While columns can provide order, the document advises mixing up the formatting to make the magazine more visually interesting and engaging for readers. It also emphasizes treating each story as a separate unit and focusing on readability.
LOST IN THE MIX: A CASE FOR INCLUSIVE AND PARTICIPATORY APPROACHES TO DISAST...Mohsen Eslampanah
油
Occupational therapy
Disaster and development: an occupational perspective
chapter 5: LOST IN THE MIX: A CASE FOR INCLUSIVE AND PARTICIPATORY APPROACHES TO DISASTER AND DEVELOPMENT
This document discusses multiple sclerosis (MS), including its incidence being highest between ages 20-45 and more prevalent in women. MS damages the myelin sheath in the central nervous system, causing intermittent symptoms like sensory issues, incoordination, and weakness. An occupational therapist's role includes evaluating a patient's occupational performance, sensory-motor skills, and environment to establish compensatory strategies and goals addressing deficits from MS.
Stroke is the third leading cause of death worldwide. It is defined as acute neurologic dysfunction of vascular origin affecting focal areas of the brain. Common effects of stroke include motor paralysis, sensory disturbances, cognitive impairments, and speech or language disorders. Occupational therapists play an important role in evaluating clients after a stroke and providing intervention to improve functional limitations in areas like mobility, self-care, and upper extremity function. Treatment focuses on retraining skills and compensating for deficits through task-oriented and occupation-based approaches.
Dr. Vincenzo Giordano began his medical career 2011 at Aberdeen Royal Infirmary in the Department of Cardiothoracic Surgery. Here, he performed complex adult cardiothoracic surgical procedures, significantly enhancing his proficiency in patient critical care, as evidenced by his FCCS certification.
Solubilization in Pharmaceutical Sciences: Concepts, Mechanisms & Enhancement...KHUSHAL CHAVAN
油
This presentation provides an in-depth understanding of solubilization and its critical role in pharmaceutical formulations. It covers:
Definition & Mechanisms of Solubilization
Role of surfactants, micelles, and bile salts in drug solubility
Factors affecting solubilization (pH, polarity, particle size, temperature, etc.)
Methods to enhance drug solubility (Buffers, Co-solvents, Surfactants, Complexation, Solid Dispersions)
Advanced approaches (Polymorphism, Salt Formation, Co-crystallization, Prodrugs)
This resource is valuable for pharmaceutical scientists, formulation experts, regulatory professionals, and students interested in improving drug solubility and bioavailability.
ECZEMA 3rd year notes with images .pptxAyesha Fatima
油
If its not Itch Its not Eczema
Eczema is a group of medical conditions which causes inflammation and irritation to skin.
It is also called as Dermatitis
Eczema is an itchy consisting of ill defined erythremotous patches. The skin surface is usually scaly and As time progress, constant scratching leads to thickened lichenified skin.
Several classifications of eczemas are available based on Etiology, Pattern and chronicity.
According to aetiology Eczema are classified as:
Endogenous eczema: Where constitutional factors predispose the patient to developing an eczema.
Family history (maternal h/o eczema) is often present
Strong genetic predisposition (Filaggrin gene mutations are often present).
Filaggrin is responsible for maintaining moisture in skin (hence all AD patients have dry skin.
Immunilogical factor-Th-2 disease, Type I hypersensitivity (hence serum IgE high)
e.g., Seborrheic dermatitis, Statis dermatitis, Nummular dermatitis, Dyshidrotic Eczema
Exogenous eczema: Where external stimuli trigger development of eczema,
e.g., Irritant dermatitis, Allergic Dermatitis, Neurodermatitis,
Combined eczema: When a combination of constitutional factors and extrinsic triggers are responsible for the development of eczema
e.g., Atopic dermatitis
Extremes of Temperature
Irritants : Soaps, Detergents, Shower gels, Bubble baths and water
Stress
Infection either bacterial or viral,
Bacterial infections caused by Staphylococcus aureus and Streptococcus species.
Viral infections such as Herpes Simplex, Molluscum Contagiosum
Contact allergens
Inhaled allergens
Airborne allergens
Allergens include
Metals eg. Nickle, Cobalt
Neomycin, Topical ointment
Fragrance ingredients such as Balsam of Peru
Rubber compounds
Hair dyes for example p-Phenylediamine
Plants eg. Poison ivy .
Atopic Dermatitis : AD is a chronic, pruritic inflammatory skin disease characterized by itchy inflamed skin.
Allergic Dermatitis: A red itchy weepy reaction where the skin has come in contact with a substance That immune system recognizes as foreign substances.
Ex: Poison envy, Preservatives from creams and lotions.
Contact Irritant Dermatitis: A Localized reaction that include redness, itching and burning where the skin has come In contact with an allergen or with irritant such as acid, cleaning agent or chemical.
Dyshidrotic Eczema: Irritation of skin on the palms and soles by
clear deep blisters that itch and burn.
Clinical Features; Acute Eczema:- Acute eczema is characterized by an erythematous and edematous plaque, which is ill-defined and is surmounted by papules, vesicles, pustules and exudate that dries to form crusts. A subsiding eczematous plaque may be covered with scales.
Chronic Eczema:- Chronic eczema is characterized by lichenification, which is a triad of hyperpigmentation, thickening markings. The lesions are less exudative and more scaly. Flexural lesions may develop fissures.
Pruritus
Characteristic Rash
Chronic or repeatedly occurring symptoms.
Best Sampling Practices Webinar USP <797> Compliance & Environmental Monito...NuAire
油
Best Sampling Practices Webinar USP <797> Compliance & Environmental Monitoring
Are your cleanroom sampling practices USP <797> compliant? This webinar, hosted by Pharmacy Purchasing & Products (PP&P Magazine) and sponsored by NuAire, features microbiology expert Abby Roth discussing best practices for surface & air sampling, data analysis, and compliance.
Key Topics Covered:
鏝 Viable air & surface sampling best practices
鏝 USP <797> requirements & compliance strategies
鏝 How to analyze & trend viable sample data
鏝 Improving environmental monitoring in cleanrooms
・ Watch Now: https://www.nuaire.com/resources/best-sampling-practices-cleanroom-usp-797
Stay informedfollow Abby Roth on LinkedIn for more cleanroom insights!
Cardiac Arrhythmia definition, classification, normal sinus rhythm, characteristics , types and management with medical ,surgical & nursing, health education and nursing diagnosis for paramedical students.
At Macafem, we provide 100% natural support for women navigating menopause. For over 20 years, we've helped women manage symptoms, and in 2024, we're proud to share their heartfelt experiences.
Presentaci坦 que va acompanyar la demostraci坦 prctica de metge d'Innovaci坦 Jos辿 Ferrer sobre el projecte Benestar de BSA, nom d'IDIAP Pere Gol, el 5 de mar巽 de 2025 a l'estand de XarSMART al Mobible Word Congress.
Chair and Presenters Sara A. Hurvitz, MD, FACP, Carey K. Anders, MD, FASCO, and Vyshak Venur, MD, discuss metastatic HER2-positive breast cancer in this CME/NCPD/CPE/AAPA/IPCE activity titled Fine-Tuning the Selection and Sequencing of HER2-Targeting Therapies in HER2-Positive MBC With and Without CNS Metastases: Expert Guidance on How to Individualize Therapy Based on Latest Evidence, Disease Features, Treatment Characteristics, and Patient Needs and Preferences. For the full presentation, downloadable Practice Aids, and complete CME/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4f8sUs7. CME/NCPD/CPE/AAPA/IPCE credit will be available until March 2, 2026.
Non-Invasive ICP Monitoring for NeurosurgeonsDhaval Shukla
油
This presentation delves into the latest advancements in non-invasive intracranial pressure (ICP) monitoring techniques, specifically tailored for neurosurgeons. It covers the importance of ICP monitoring in clinical practice, explores various non-invasive methods, and discusses their accuracy, reliability, and clinical applications. Attendees will gain insights into the benefits of non-invasive approaches over traditional invasive methods, including reduced risk of complications and improved patient outcomes. This comprehensive overview is designed to enhance the knowledge and skills of neurosurgeons in managing patients with neurological conditions.
Invasive systems are commonly used for monitoring intracranial pressure (ICP) in traumatic brain injury (TBI) and are considered the gold standard. The availability of invasive ICP monitoring is heterogeneous, and in low- and middle-income settings, these systems are not routinely employed due to high cost or limited accessibility. The aim of this presentation is to develop recommendations to guide monitoring and ICP-driven therapies in TBI using non-invasive ICP (nICP) systems.
BIOMECHANICS OF THE MOVEMENT OF THE SHOULDER COMPLEX.pptxdrnidhimnd
油
The shoulder complex acts as in coordinated fashion to provide the smoothest and greatest range of motion possible of the upper limb.
Combined motion of GH and ST joint of shoulder complex helps in:
Distribution of motion between other two joints.
Maintenance of glenoid fossa in optimal position.
Maintenance of good length tension
Although some amount of glenohumeral motion may occur while the other shoulder articulations remain stabilized, movement of the humerus more commonly involves some movement at all three shoulder joints.
Local Anesthetic Use in the Vulnerable PatientsReza Aminnejad
油
Local anesthetics are a cornerstone of pain management, but their use requires special consideration in vulnerable groups such as pediatric, elderly, diabetic, or obese patients. In this presentation, well explore how factors like age and physiology influence local anesthetics' selection, dosing, and safety. By understanding these differences, we can optimize patient care and minimize risks.
Local Anesthetic Use in the Vulnerable PatientsReza Aminnejad
油
Upper exrtremity orthoses
2.
Support a painful joint
Immobilize for healing or to protect tissues
Provide stability or restrict unwanted motion
Restore mobility
Subsitute for weak or absent
Prevent contructure of modify tone
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2
3.
Arm sling
Prevent or correct shoulder subluxation
Reduce pain in patients who have subluxation
caused by brachial plexus injury, hemiplegia
and central cord syndrom injury
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3
16. Resting hand splint
RA
Reduce stress on joint capsules,synovial
lining and periarticular structures,thereby
decreasing pain
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21.
Sprain, strain, tendonitis, arthritis, CTS, wrist
fracture following cast removal, and other
condition that cause pain
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26.
Relive pain from wrist and thumb arthritis or
from DeQuervains tendonitis of the abductor
policis longus and extensor pollicis brevis.
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63.
Treatment of flexion or extension
contractures related to increased muscle
tone.
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64.
Limitation in wrist extension or flexion
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65.
Lack of MCP flexion
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66.
Gain composite flexion of all joints, must effect on MCP
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67.
Gain flex or ext ROM
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68.
Gain flex or ext ROM
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69.
Provide circumfrencial pressure and a dynamic force
into extension via an angled seam on its volar
surface
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71.
Substitute for weak or absent shoulder or
elbow muscle
Substitute for weak or absent wrist or hand
muscle
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72.
Bunnell thomas suspention splint:
Radial nerve palsy
Dynamicaly extend the wrist MCP and thumb
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74.
Treatment of combined median and ulnar nerve
injuries which result in the clawing of all for fingers
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75.
This splint can provide minimal hand grasp while harnessing
the power of the wrist extensor to bring the thumb, index
finger and long finger into the functional pinch
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76.
Allow passive holding of functional implement such as utensile or pen
may also used in the presence of wrist or hand weakness
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77. Commercial inflatable pressure splint:
emergency immobilizer for the limbs in patient with
abnormal tone
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80.
Decrease tone and position the thumb out of the
palm for function
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81.
Treatment of the children with increased flexor tone can also
be used with adult patient having hypertonisity
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82.
Occupational Therapy for Physical
Dysfunction, trombly, 6th Edition, chapter
16
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