OT Physical Rehabilitation & Musculoskeletal OT 2 — Questions and Answers
Question 1: Which joint protection principle is MOST important to teach a patient with rheumatoid arthritis who presents with ulnar drift?
- Avoiding activities that promote ulnar deviation of fingers (Correct answer)
- Using large muscle groups and larger joints whenever possible
- Maximizing joint use throughout the entire day
- Avoiding all hand-based activities
Correct answer: Avoiding activities that promote ulnar deviation of fingers
Avoiding activities that create ulnar deviation forces at the MCP joints is critical to preventing progression of ulnar drift in rheumatoid arthritis.
Question 2: What is the PRIMARY purpose of a dynamic splint in hand therapy?
- To reduce edema through static compression
- To prevent all movement at the targeted joint
- To provide a low-load prolonged stretch to increase range of motion (Correct answer)
- To immobilize the joint during acute tissue healing
Correct answer: To provide a low-load prolonged stretch to increase range of motion
Dynamic splints apply low-load prolonged stress to remodel connective tissue and increase passive range of motion through creep and stress relaxation.
Question 3: Which assessment tool is used to evaluate two-point discrimination following peripheral nerve injury?
- Active range of motion goniometry
- Semmes-Weinstein monofilament testing
- Grip strength dynamometry
- Disk-Criminator or aesthesiometer (Correct answer)
Correct answer: Disk-Criminator or aesthesiometer
Two-point discrimination is assessed with a Disk-Criminator or aesthesiometer, which measures the minimum distance at which two simultaneous touch stimuli are perceived as separate.
Question 4: Following a total hip replacement via the posterior approach, which position is CONTRAINDICATED?
- Lying on the non-operative side with a pillow between the knees
- Hip flexion beyond 90° combined with internal rotation and adduction (Correct answer)
- Hip extension with external rotation
- Sitting with hips at 90°
Correct answer: Hip flexion beyond 90° combined with internal rotation and adduction
The combination of hip flexion beyond 90°, internal rotation, and adduction places the femoral head at risk for posterior dislocation after posterior-approach total hip replacement.
Question 5: When teaching energy conservation to a patient with osteoarthritis, which principle is MOST important?
- Working through pain to maintain function
- Avoiding all physical activity
- Completing all tasks at once to minimize transitions
- Pacing activities and taking planned rest breaks throughout the day (Correct answer)
Correct answer: Pacing activities and taking planned rest breaks throughout the day
Pacing activity with scheduled rest breaks prevents fatigue-induced joint stress, reduces pain flares, and allows sustained participation in meaningful occupations.
Question 6: What is the PRIMARY purpose of retrograde massage in hand therapy?
- To improve joint passive range of motion
- To decrease edema by moving fluid proximally toward the lymphatic system (Correct answer)
- To increase muscle strength in intrinsic muscles
- To desensitize hypersensitive tissue
Correct answer: To decrease edema by moving fluid proximally toward the lymphatic system
Retrograde massage uses distal-to-proximal strokes to mechanically move interstitial fluid toward lymphatic drainage channels, reducing edema in the hand.
Question 7: Which patient-reported outcome measure is MOST commonly used to assess upper extremity disability in musculoskeletal conditions?
- Modified Rankin Scale
- FIM (Functional Independence Measure)
- DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire (Correct answer)
- Barthel Index
Correct answer: DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire
The DASH questionnaire is specifically designed to measure physical function and symptoms in the upper extremity across a wide range of musculoskeletal and neurological conditions.
OT Physical Rehabilitation & Musculoskeletal OT 2
Which joint protection principle is MOST important to teach a patient with rheumatoid arthritis who presents with ulnar drift?