Background

This section provides three videos that discuss arthritis and orthopedic intervention skills for occupational therapy (OT) practitioners who work with these clients.

The first video, “Orthotics for Orthopedic Issues” explains how to don a thumb spica splint, shoulder abduction sling, and a thoracic lumbar sacral orthosis (TLSO) back brace. The second video, “Exercises Post-Shoulder Arthroplasty,” is about three ways to encourage a client to move their shoulder without injuring it more, and it integrates the concept of range of motion (ROM) pendulum exercises. The final video, “Mobility Training,” explains how the OT practitioner can adhere to back precautions by training their client to get out of bed using the log-roll strategy.

These videos also relates to our previously learned shoulder and back precautions coursework. Now, you’ll learn how to implement that information when using various braces.

Orthotics for Orthopedic Issues

In this video, OT practitioners learn about splints for arthritis and orthopedic clients. It explains how to don and use a thumb spica splint, a shoulder abduction sling, and a back brace—a thoracic lumbar sacral orthosis (TLSO).

Video is licensed under CC BY 4.0.

Orthodics for Orthopedic Issues Video Transcript

Thumb Spica Tips

• The purpose of a thumb spica splint is to stabilize the thumb CMC joint.
• The client only wears the spica splint for activities that cause pain.

Shoulder-Abduction Sling Tips

• The purpose of a shoulder-abduction sling is to prevent damage to healing tissues following rotator-cuff surgery.
• The orthopedic surgeon orders the shoulder-abduction sling to be worn 24/7 during the healing immobilization stage.
• The client is generally non-weight bearing and refrains from active movement during this healing immobilization stage. When donning the sling, the OT practitioner must ensure all arm movements are assisted.
• The OT practitioner assists the client to don the abduction sling by doing the following:
• • Stabilize your client’s arm on a pillow, and place the arm in the sling.
  • Bring the shoulder strap over your client’s head, and fasten it to the sling.
  • Bring the belt around your client’s torso, and fasten to the sling.

Back Brace—TLSO Tips

• The purpose of the prescribed back brace—TLSO, is to prevent your client from excessive movement and forces. It is worn following back surgery or with back precautions.
• Back precautions include no bending, lifting, or twisting.
• Client’s will often have surgeons’ orders to wear the brace anytime they are sitting up.
• The OT practitioner assists the client to don the back brace—TLSO while supine by doing the following:
• • Log roll your client to their side, and place the back brace underneath them.
  • Log roll your client to their other side, and adjust the brace.
  • Log roll your client onto their back, and fasten the brace.

Exercises Post-Shoulder Arthroplasty

This video shows three exercises to use to progress your client’s post-shoulder arthroplasty.

Video is licensed under CC BY 4.0.

Exercises Post-Shoulder Arthroplasty Video Transcript

Exercises Post-Shoulder Arthroplasty Tips

• This pendulum exercise is for someone who has balance.
  • Have your client bend at the waist, and let their arm dangle down.
  • Have your client lean back and forth and side to side to get their arm to passively move.
  • Make sure that your client does not actively move their arm.
• This yoga ball pendulum exercise is for someone who does not have good balance or who does not have good enough balance to bend.
  • Place a yoga ball on a flat surface. Have your client put their arm up on the yoga ball.
  • Have your client lean back and forth, side to side.
  • Make sure that your client does not actively move their shoulders.
• This four-way isometrics exercise is for someone who is ready to train to stabilize and reuse their muscles.
  • Have your client stand against the wall. Place the towel or ball between the client and the wall.
  • Have your client face the wall, and push their arm into the wall. This will be flection of their shoulder.
  • Move your client to stand parallel to the wall, and push their arm into the wall. This will be an abduction.
  • Face your client away from the wall, and have them push their arm back into the wall. This action is extension.
  • Have your client place a towel or small ball between them and their body. Have them push their arm into their body. This action is adduction.

Mobility Training

This video teaches the OT practitioner how to instruct their client to perform a log roll.

Video is licensed under CC BY 4.0.

Mobility Training Video Transcript

Log-Roll Mobility Training Tips

• The log roll is for clients with back precautions: no bending, lifting or twisting. Getting out of bed a normal way breaks all spinal precautions.
• Have your client grab the side rails to help pull with the upper body. Bend the knee on the opposite side that they’re rolling to, and push off with the knee. Do both movements at the same time.
• Aid your client by pushing their shoulder and knee.
• Have your client swing their legs off the bed. The legs act as a counterweight to the upper body, moving their legs down as their body moves up.

Resources

• Orthopedic Precautions 101 for New Occupational Therapists by Sarah Stromsdorfer, OTR/L
• Total Shoulder Arthroplasty / Hemiarthroplasty Protocol from Brigham and Women’s Hospital