NBCOT II
Terms
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- Group Development
- The stages groups typically go through from their initial beginnings to their imaginations
- Origin phase
- Involves the leader composing the group protocol and planning for the group
- Orientation phase
- Involved members learning what the group is about, making a prelim commitment to the group, and developing initial connections with other members
- Intermediate phase
- Involves members developing interpersonal bonds, group norms, and specialized member roles through involvement in goal-directed activities and clarification of group's purpose
- Conflict phase
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Involves members challenging the groups structure, purpose, and/or processes, and is characterized by dissension and disagreement among members
- Unsuccessful resolution = dissolution of group
- Successful resolution = modification to the group that are acceptable to all members, enabling it to proceed to next phase - Cohesion phase
- Involves members regrouping after the conflict with a clearer sense of purpose and a reaffirmation of group norms and values, leading to group stability
- Maturation phase
- Involves members using their energies and skills to be productive and to achieve groups goals
- Termination phase
- Involves dissolution of the group due to lack of engagement by members, inability to resolve conflict, administrative constraints, goal attainment, and task completion
- Group roles
- Describe pattern of behavior that are typical in groups
- Instrumental roles
- Functional and assumed to help the group select, plan, and complete the group's task
- Expressive roles
- Functional and are assumed to support and maintain the overall group and to meet members needs
- Individual roles
- Dysfunctional and contrary to group roles, for the serve and individual purpose and interfere with successful group functioning
- Group norms
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Standards of behavior and attitudes that are considered appropriate and acceptable to the group
- Explicit and clearly verbalized or non-explicit and not verbalized
- Vary in groups and can change as group develops - Therapeutic norms
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- Encourage self-reflection, disclosure, and interaction among members
- Reinforce the value and importance of the group by being on time and well-presented
- Establish atmosphere of support and safety
- Maintain confidentiality and respect
- Regard group members as effective agents of change by not placing the group leader in expert role - Group goals
- Desired outcomes of the group that are shared by sufficient number of groups members
- Group communication
- The process of giving, receiving, and interpreting information through verbal and non-verbal expression
- Group cohesiveness
- Degree to which members are committed to a group and the extent of members liking for the group
- Factors that contribute to group cohesiveness
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- Extensive interaction between members
- Similarity or complementariness in members characteristics
- Perception of relevance of group to individual needs
- Members expectation of goal attainment and successful group outcome
- Democratic leadership and member cooperation - Group decision making
- Process of agreeing on a resolution to a problem through unanimous decision, consensus, majority rule, and compromise
- Directive leadership
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OT is responsible for planning and structuring much of what takes place in the group
- When members cognitive, social, and verbal skills and limited engagement
- Select activities
- Group maintenance roles and feedback by leader
- Goal is task accomplishment - Facilitative leadership
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OT shares responsibility for group and group process with members
- Skill level and engagement are moderate
- Collaborate with group members to select activities to be used
- Share instructions
- Roles and feedback provided by members with OT facilitating
- Goal is to have members acquire skill through experience - Advisory leadership
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OT practitioner functions as the resource to members, who set the agenda and structure the groups functioning
- Members skill and engagement are high
- Members select and complete activities
- Feedback is a natural part of the group process
- Members understand and self-direct the process - Co-leadership
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Occurs when there is sharing of group leadership between two or more therapists
Advantage: share knowledge and skills, model effective behaviors, observation and objectivity can increase, provide and obtain mutual support, and assume different roles, tasks, styles
Disadvantage: splitting by group members, competition among members, and unequal responsibilities resulting in unbalanced work load among co-leaders - Altruism
- Giving of oneself to help others
- Catharsis
- Relieving of emotions by expressing one's feelings
- Universality
- Recognizing shared feelings and that one's problems are not unique
- Existential factors
- Accepting the fact that the responsibility for change comes from within oneself
- Self-understanding
- Discovering and accepting the unknown parts of oneself
- Family reenactment
- Understanding what it was like growing up in one's family through the group experience
- Guidance
- Comes from accepting advice from other group members
- Identification
- Benefiting from imitation of the positive behaviors of the other group members
- Instillation of hope
- Experiencing optimism through observing the improvement of others in the group
- Interpersonal learning
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Receiving feedback from group members regarding ones behavior (input)
Learning successful ways of relating to group members (output) - ASIA A
- Complete: No sensory or motor function is preserved in sacral segments S4-S5
- ASIA B
- Incomplete: Sensory, but not motor, function is preserved below the neurologic level and extends through sacral segments S4-S5
- ASIA C
- Incomplete: Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have muscle grade less than 3
- ASIA D
- Incomplete: Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have muscle grade greater than or equal to 3
- ASIA E
- Normal: Sensory and motor functions are normal
- Central Cord Syndrome
- Associated with a cervical region injury and leads to greater weakness in the upper limbs than in the lower limbs, with sacral sensory sparing
- Brown-Séquard Syndrome
- Associated with a hemisection lesion of the cord, causes a relatively greater ipsilateral proprioceptive and motor loss, with contralateral loss of sensitivity to pain and temperature
- Anterior Cord Syndrome
- Associated with a lesion causing variable loss of motor function and sensitivity to pain and temperature; proprioception is preserved
- Conus Medullaris Syndrome
- Associated with injury to the sacral cord and lumbar nerve roots leading to areflexic bladder, bowel, and lower limbs, while the sacral segments occasionally may show preserved reflexes
- Cauda Equina Syndrome
- Due to injury to the lumbosacral nerve roots in the spinal canal, leading to areflexic bladder, bowel, and lower limbs.
- ACL 1
- Automatic actions - automatic motor reactions and changes in the autonomic nervous system, conscious response to external environment is minimal
- ACL 2
- Postural actions - movement associated with comfort, some awareness of large objects in environment and the individual may assist the caregivers with simple tasks
- ACL 3
- Manual Actions - begins with the use of hands to manipulate objects, the individual ay be able to perform a limited number of tasks with long term repetitive training
- ACL 4
- Goal directed actions - characterized by the ability to carry simple tasks through completion, the individual relies heavily on visual cues, he or she may by able to perform established routines but cannot cope with unexpected events
- ACL 5
- Exploratory Actions - characterized by overt trial and error problem solving, new learning occurs, may be the usual level of functioning for 20% of the population
- ACL 6
- Planned actions - characterized by the absence of disability, can think of hypothetical situations and do mental trial-and-error problem solving
- Intradisciplinary
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- One or more members of one discipline evaluate, plan and implement treatment of individual
- Other disciplines not involved, communication is limited
- "Team" is at risk due to potential narrowness of perspective
- Comprehensive, holistic care questionable - Multidisciplinary
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- Number of professionals from different disciplines conduct assessments/interventions independent from each other
- Member's primary allegiance is to discipline, some formal communications between members
- Limited comm. may result in lack of understanding of different perspectives
- Resources/responsibilities individually allocated between disciplines, competition may develop - Interdisciplinary
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- All disciplines relevant to the case at hand agree to collaborate for decision making
- Eval/intervention conducted independently within defined areas of each profession's expertise, however, greater understanding of each discipline's perspective exists
- Members directed toward a common goal and not bound by discipline line-specific roles and functions
- Members tend to use group process skills effectively
- Exchange of info, prioritization of needs and allocation of resources and responsibilities are based on members expertise and skills, not on 'turf' issues - Transdisciplinary
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- Maintained and expanded roles of interdisc team
- Members support and enhance activities/programs of other disciplines to provide quality, efficient, cost-effective services
- Committed to ongoing communication, collaboration, shard decision making for the pts benefit
- Eval/intervention planned cooperatively, yet one member may take on multiple responsibilities, role blurring
- Ongoing training, support, supervision, cooperation, and consultation among disciplines are important to this model, ensuring that professional integrity and quality of care is maintained - Managing manic or monopolizing behavior
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- Select or design highly structured activities that hold the individual's attention and require a shift of focus from patient to patient
- Thank the individual for their participation and redirect attention to another group member
- Refer to limit-setting - Managing escalating behavior
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- Avoid what can be perceived as challenging behavior
- Maintain comfortable distance
- Actively listen
- Use cal, but not patronizing tone
- Speak simply, clearly and directly, avoid miscommunication
- Clearly present what you would like the person to do
- Avoid positions where either you or the patient feels trapped
- If pt continues to escalate, remove other patients from area, get or send for other staff - Managing the lack of initiation/participation in a group
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- With the individual, identify the reasons for lack of participation
- Motivational hints: more likely to participate when of interest or concern to them, the more ownership the pt has of the activity the more they will participate, success and fun are motivating, positive feedback and rewards, everyone has motivators, it is important to ID them, curiosity, and food - Managing offensive behavior
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- Set limits and immediately address the behaviors during session
- Reasons that the behavior is not acceptable should be clearly presented in a manner that is not confrontational or judgmental
- The consequences of continued offensive behavior should be clearly communicated
- Required for all staff to protect patients from the threat for harm or abuse by another patient, needs of the entire unit/group must be kept in mind - Akathisia
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- Allow the person to move around as needed if it can be done without causing disruption to the goals of the group
- Keep in mind that participation on many levels and in many forms can be beneficial to the individual
- Whenever possible, select gross motor activities over fine motor or sedentary ones - Managing delusions
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- Redirect the individuals thoughts to reality-based thinking and actions
- Avoid discussions and other experiences that focus on and validate or reinforce delusional material - Managing hallucinations
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- Create an environment free of distractions that trigger hallucinatory thoughts and interfere with reality-based activity
- Use highly structured, simple, concrete activities that hold the individuals attention
- When the person appears to be focusing in on a hallucinatory experience, attempt to redirect him/her to reality-based thinking and actions - Managing the effects of Alzheimer's
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- Make eye contact and show you are interested in the person - value and validate what is said
- Maintain a positive and friendly facial expression and tone of voice during all communications - do not give orders, use short simple words/sentences, do not argue/criticize
- Use non-verbal communication
- Create a routine that uses familiar and enjoyable activities
- Activities that demonstrate and promote personal interests and independence
- Analyze and grade carefully
- Do not rush - process is important
- Note effects of time of day and attend to safety issues - Intervention for suicide risk
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- ID the motivation behind the suicidal intention and ID of alternatives
- Development of problem solving skills and stress management techniques to increase the individuals ability to manage life stressors
- ID of positive goals and interests to increase motivation for recovery
- ID of positive personal attributes and support systems to increase hopefullness
- Activities that produce successful outcomes especially with an end-product promote positive thinking
- Activities designed for the expressing and validation of feelings
- Moderate physical activity elevates mood
- Development of skills that increase functional performance - Factors to consider when recommended adaptive strategies
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- What is important to the individual about the task
- Is strategy compatible with particular social context
- Does strategy enhance the individuals sense of personal control
- Does strategy minimize effort
- Does strategy interfere with social opportunities/diminish presentation of self
- Is the recommended strategy temporarily realistic given the context
- Does strategy provide for safety - Top down
- Considering a person's areas of occupations first
- Bottom up
- Focuses initially and/or solely on performance skills and client factors
- Katz Index of ADL - A
- Independent in all 6 activities
- Katz Index of ADL - B
- Independent in any 5 activities
- Katz Index of ADL - C
- Independent in all but bathing and one other activity
- Katz Index of ADL - D
- Independent in all but bathing, dressing, and one other activity
- Katz Index of ADL - E
- Independent in all but bathing, dressing, toileting, and one other activity
- Katz Index of ADL - F
- Independent in all but bathing, dressing, toileting, transfers, and one other activity
- Katz Index of ADL - G
- Dependent in all activities
- FIM Score of 1
- Person could not be evaluated performing the task of he/she required total assistance in task performance
- FIM Score of 2-5
- Increasing levels of assistance required from a helper for the individual to do the task
- FIM Score of 6-7
- Person is independent in task performance and does not require a helper
- AE for self-care activity performance
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- Grab bars and toilet safety frame
- Bedside (3-1) commode or raised toilet seat
- Bowel training and bladder control device
- Skin inspection mirror
- Toilet paper holder - AE for grooming/oral hygiene
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- U-cuff to hold toothbrush, razor, comb, brush
- Built-up, angled, or long-handled brushes/razors
- Blow-dryer, nail clippers, nail polish holders
- Faucet turners
- Electric toothbrush, floss holders, water pik - AE for bathing/showering
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- Grab bars, non skid mat
- Tub and shower bench
- Shower commode
- Handheld shower
- Anti-scald valves/faucets
- Built up, angled, long-handled bath sponge or bath matt
- Soap on a rope, soap dish
- Storage units - AE for dressing
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- Reachers, dressing sticks, pants dressing poles
- Built-up, angled, or long-handled shoe horn
- Pull-on clothing, Velcro type closures, front opening closures for clothing
- Elastic shoelaces, slip on shoes
- Button hook, zipper pull, zipper loop
- Sock/stocking aid - AE for feeding/eating
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- Adapted nipples/bottles for infants
- Scoop dish or plate guards
- Non-slip placemat or dycem
- Built up, angled, weighted, long handled, swivel utensils
- Rocker knife, spork
- Adapted cups or long/angled straws - AE for med management
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- Easy open, non-child-proof bottles
- Pill organizers, medication minders - AE for cleaning
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- Suction bottom bottle and glass brushes
- Reacher
- Aerosol can holders
- Built up, angled, long-handled sponges, dusters, brooms, mops, dustpans
- Front-loading washer/dryer
- Electronic dishwasher, self-cleaning oven, automatic defrosting fridge - AE for cooking
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- Faucet and knob turners
- Anti-scale faucets/valves
- Jar openers, bowl holders, saucepan stabilizers
- Nonskip pad, placemat, dycem
- Cutting board with stabilizing nail, built up edges
- Built up angled utensils, rocker knives
- Adapted timers
- Electric can opener
- Lightweight pots, pans, dishware
- Auto hot water dispenser/hot pots
- Strap loops to open doors
- Reacher, step stools
- Utility cart
- High kitchen stool - Boutonniere deformities
- Lengthening or rupture of the extensor digitorum communis tendons and is expressed by DIP hyperextension and PIP flexion
- Swan-neck deformity
- Results from rupture of the lateral slips of the extensor digitorum communis or flexor digitorum superficialis tendon and results in DIP flexion and PIP hyperextension
- Trigger finger deformity
- Results from thickening of the flexor digitorum superficialis tendon at the flexor tunnel (tendon sheath), affected joint tends to say open upon attempt to close or fist the hand
- Synovitis of the MP joints
- Can cause damage to the MP ligaments with palmar disclocation in conjunction with, or indpendent of, ulnar drift
- Risk management
- Process that identifies, evaluates, and takes corrective action against risk
- Charcot-Marie-Tooth disease
- Neuropathic muscular atrophy characterized by progressive weakness of the distal muscles of the arms and feet
- Froment's sign
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Assesses the motor function of the adductor pollicis with is innervated by the ulnar nerve
Attempt to pinch an object firmly with the thumb which results in flexion of the distal joint of the thumb - Direct therapy involves techniques that utilize a bolus
- Modification of consistency, amount, and pacing of solids and liquids
- Utilizing postural interventions to increase swallowing efficiency during meals
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- Chin tuck
- Head tilt
- Head turn - Specific swallowing adaptations
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- Supraglottic swallow technique to voluntarily close/protect airway during food intake
- Mendlesohn's maneuver (voluntarily prolonging the rise of the larynx by prolonging tongue contractions) - Indirect therapy involves procedures that do not include use of a bolus
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- Thermal (cold) stimulation provides sensory input to the inferior faucial arches via the chilled dental exam mirror to elicit swallow reflex
- Reflex facilitation
- Strengthening, facilitation, and coordination of oral movements
- Airway adduction procedures
- Positioning to maintain the trunk/head/neck in correct postures - Overhead suspension splint
- Best suited for individuals presenting with proximal weakness with muscle grades in the 1/5 to 3/5 range
- Radial nerve laceration
- Weakness or paralysis of the extensors of wrist, MCPs, and thumb with characteristic wrist drop
- Median nerve palsy
- Presents of flattening of the thenar eminence and "Ape hand"
- Ulnar nerve palsy
- Claw hand
- Radial nerve palsy
- Saturday night palsy resulting from a position that compresses the radial nerve
- Splint for low level radial nerve injury
- Dynamic extension splint that provides wrist, MP, thumb extension to prevent over stretching of the extensor tendons during healing phase
- Blocked practice
- Picking up items that are of the same shape, size, and weight involving repeated performance of the same motor skill
- Random practice
- Involves the performance of several motor tasks in random order to encourage the re-formulation of the solution to the presented motor problem (ie. different grasp patterns)
- Max height for countertops
- 31 inches
- Minimum doorway widths for wheelchair accessibility
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32"
Ideal is 36" - Max and min height for reaching forward in wheelchair
- 48" and 15" to prevent tipping
- Hemi-height wheelchair
- 17.5"
- Dynamic interactional approach
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Utilizes awareness questioning to help the individual detect errors, estimate task difficulty, and predict outcomes
Level of auditory processing skills must be considered to determine if adaptations/modifications are needed with implementing approach - Dysmetria
- Over or undershooting of target
- Neurofunctional approach
- Emphasizes functional activity performance in the actual environment
- Categorization
- Separating items into two groups and placing them into a category
- Sequencing
- Planning, organization, implementation of the steps of a task in an appropriate order
- Problem solving
- Recognition and definition of a problem and the selection and implementation of a plan
- Memory
- Registration, integration, recall, and retrieval of information
- Rood patterns in sequence
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1. Supine withdrawl
2. Rollover
3. Prone extension
4. Neck co-contraction
5. Prone on elbows
6. Quadruped
7. Standing
8. Walking - Peripheral neuropathy
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Syndrome of sensory, motor, reflex, and vasomotor symptoms, with symptoms exhibited according to the distribution of the affected nerve; slow and progressive onset and course
Etiology diabetes, Lyme disease, MS, alcoholism, metabolic, infectious diseases - Utilization review
- Analysis of the use of the resources within a facility; examines medical necessity and cost efficiency of these resources
- Sequence of self feeding with a spoon
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- 6.5-7 self-feeding with a cracker
- 9 holding and banging a spoon
- 9.5 stirring with a spoon
- 12-14 bringing a filled spoon to mouth - Secondary prevention
- Early detection of problems in a population that have diagnoses that place them at risk for development of complicating or 2ndary conditions
- Direct service
- Implementation of intervention with clients and therapist
- Primary prevention
- Targets individuals with no pre-existing condition
- Needs assessment
- Done to determine programming needs
- **Contraindication for Cardiac Rehab**
- Isometric exercises
- Visual imagery
- Process of making a mental picture of information so that it can be remembered
- Visual cognition
- Ability to mentally manipulate visual information and integrate it with other sensory information
- Visual memory
- Retrieval and recall of info that has been stored and encoded
- Release of toys
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- 3-4 bang on table but not voluntarily release
- 7-8 able to give up objects with an assisted release
- 9-10 months more efficient release
- 12 months voluntary release - Cubital tunnel syndrome
- Ulnar nerve compression at the elbow - numbness, tingling along ulnar aspect of forearm/hand, pain at elbow with extreme flexion, weakness of power grip, and positive Tinel's sign at elbow
- Erb's palsy
- Injury to the 5th and 6th brachial plexus roots - arm hangs limp with shoulder rotated inward due to atrophy and paralysis in the biceps, deltoid, brachialis, and brachioradialis
- Transference
- person relates, often unconsciously, to another person as if that person were someone else, usually someone significant
- Idealization
- Someone believes a person or an event to be perfect
- Rationalization
- Blaming someone else for one's difficulties
- Countertransference
- Person unconsciously falls into the role to which the other person has transferred him
- Wheelchair seat belts
- Extend across the hips and into the lap at a 45 degree angle
- Anti-psychotic medications
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Side effects - dry mouth, blurry vision, photosensitivity, constipation, orthostatic hypotension, Parkinsonism, dystonias, akathisias, tardive dyskinesia, and cardiovascular disorders
Complications - Neuroleptic Malignant Syndrome - increased BP, tachycardia, sweating, convulsions, coma - Mood stabilizing medications
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Side effects - excessive thirst, tremors, excessive urination, weight gain, nausea, diarrhea, cognitive impairment
Precautions - high levels cause nerve damage/death, toxicity symptoms include motoric disturbance - Anti-convulsants medications
- Side effects - dizziness, drowsiness, ataxia, weight gain, sedation
- SSRI medications
- Side effects - nausea, headache, sexual dysfunction, insomnia
- Tricyclics
- Side effects - dry mouth, blurred vision, sedation, postural hypotension
- MAOI medications
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Side effects - weight gain, hypotension, insomnia, liver damage
Headache is first side of increased tyramine - Anxiolytic medication
- Side effects - drowsiness, ataxia, headache, nausea, depression, dependence
- Anti-obsessional medications
- Side effects - nausea, headache, sexual dysfunction, insomnia
- Brunstromm's Stage 1
- flaccidity, no voluntary or reflexive activity
- Brunstromm's Stage 2
- Minimal voluntary movement, components of the synergies are elicited as reflex reactions, spasticity develops
- Brunstromm's Stage 3
- Marked spasticity, synergies are performed voluntarily
- Brunstromm's Stage 4
- Movements that begin to deviate from synergy can be accomplished on a volitional basis
- Brunstromm's Stage 5
- Movements which differ greatly from the basic synergies are utilized
- Brunstromm's Stage 6
- Spasticity is essentially absent; isolated muscle actions are freely performed
- Brunstromm's Stage 7
- Normal motor function
- Functional splinting position
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20-30 wrist extension
45 MCP flexion
20-30 IP flexion
thumb abducted - Safe splinting position
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0-20 wrist extension
70-90 MCP flexion
IP extension
thumb abducted and extended