April 01, 2012

Toolkit of All Toolkits

OCCUPATIONAL THERAPY FIELDWORK TOOLKIT

A list of important items for all your fieldwork and professional needs. 

1. Range of Motion and Degrees (MUST HAVE!)



 2.  Range of Motion (Angles)




3. Manual Muscle Testing Grading


5
Normal
subject completes ROM against gravity with maximal resistance
4+
Good Plus
completes ROM against gravity with moderate-maximal resistance
4
Good
completes ROM against gravity with moderate resistance
4-
Good Minus
completes ROM against gravity with minimal-moderate resistance
3+
Fair Plus
completes ROM against gravity with only minimal resistance
3
Fair
completes ROM against gravity without manual resistance
3-
Fair Minus
does not complete the range of motion against gravity, but does complete more than half of the range
2+
Poor Plus
is able to initiate movement against gravity
2
Poor
completes range of motion with gravity eliminated
2-
Poor Minus
does not complete ROM in a gravity eliminated position
1
Trace
muscle contraction can be palpated, but there is no joint movement
               0
Zero
patient demonstrates no palpable muscle contraction


4. Levels of Principal Dermatomes


5. Brachial Plexus

6. Spinal Segments


7. Spinal and Autonomic Nerves


8. Peripheral Nervous System


9. Developmental Milestones


10. Understanding EKG


11. Possible Nerve Involvement Weakness with Manual Resistive Test


12. Joints, Associated Motions, Plane of Motion, Axis of Rotation, and Average Range of Motion


13. Arrhythmias 


What are the different types of arrhythmias?
An atrial arrhythmia is an arrhythmia caused by abnormal function of the sinus node, or by the development of another atrial pacemaker within the heart tissue that takes over the function of the sinus node.

A ventricular arrhythmia is an arrhythmia caused by abnormal function of the sinus node, an interruption in the electrical conduction pathways, or the development of another area within the heart tissue that takes over the function of the sinus node.

Arrhythmias can also be classified as slow (bradyarrhythmia) or fast (tachyarrhythmia). "Brady-" means slow, while "tachy-" means fast.

Listed below are some of the more common arrhythmias:
Atrial Arrhythmias
Ventricular Arrhythmias
sinus arrhythmia - a condition in which the heart rate varies with breathing. Sinus arrhythmia is commonly found in children; adults may often have it as well. This is usually a benign condition - there may be no symptoms or problems associated with sinus arrhythmias.
premature ventricular contractions (PVCs) - a condition in which an electrical signal originates in the ventricles and causes the ventricles to contract before receiving the electrical signal from the atria. PVCs are not uncommon and often do not cause symptoms or problems. However, if the frequency of the PVCs increases to several per minute, symptoms such as weakness, fatigue, dizziness, fainting, or palpitations may be experienced.
sinus tachycardia - a condition in which the heart rate is faster than normal for the child's age because the sinus node is sending out electrical impulses at a rate faster than usual. This condition may cause symptoms such as weakness, fatigue, dizziness, or palpitations if the heart rate becomes too fast to pump an adequate supply of blood to the body. Sinus tachycardia is often temporary, occurring when the body is under stress from exercise, strong emotions, fever, or dehydration, to name a few causes. Once the stress is removed, the heart rate will usually return to its usual rate.
ventricular tachycardia (VT) - a condition in which an electrical signal is sent from the ventricles at a very fast but even rate. If the heart rate is sustained at a high rate, symptoms such as weakness, fatigue, dizziness, fainting, or palpitations may be experienced.
sick sinus syndrome - a condition in which the sinus node sends out electrical signals either too slowly or too fast. There may be alternation between too-fast and too-slow rates. This condition may cause symptoms if the rate becomes too slow or too fast for the body to tolerate.
ventricular fibrillation (VF) - a condition in which an electrical signal is sent from the ventricles at a very fast and erratic rate. As a result, the ventricles are unable to fill with blood and pump it out, thus causing a very low blood pressure and symptoms such as weakness, dizziness, fainting, or loss of consciousness.
premature supraventricular contractions or premature atrial contractions (PAC) - a condition in which the sinus node or another pacemaker site above the ventricles sends out an electrical signal early. The ventricles are unable to respond to this signal because they are still in the contraction phase.

supraventricular tachycardia (SVT), paroxysmal atrial tachycardia (PAT) - a condition in which the heart rate speeds up due to a series of early beats from the sinus node or another pacemaker site above the ventricles. PAT usually begins and ends rapidly, occurring in repeated periods. This condition can cause symptoms such as weakness, fatigue, dizziness, fainting, or palpitations if the heart rate becomes too fast.
atrial flutter - a condition in which the electrical signals come from the atria at a fast but even rate, thus causing the ventricles to contract faster and increase the heart rate. The heart rate maintains an even rate as it beats faster. When the signals from the atria are coming at a faster rate than the ventricles can respond to, the EKG pattern develops a signature "sawtooth" pattern, showing two or more P waves between each QRS complex. The number of P waves between each QRS complex is usually a constant number and is expressed as a ratio (i.e., a two-to one atrial flutter means that two P waves are occurring between each QRS).
atrial fibrillation - a condition in which the electrical signals come from the atria at a very fast and erratic rate. The ventricles contract in an erratic manner because of the


*References:
1. Visual Odyssey, 2001
2. Advance OT Practictioners
3. Netters, 2010
4. Pedretti, 2010