Tissue Management - Nbcot Registered Occupational Therapists Otr

1. Which modality is typically used to decrease acute pain and inflammation during early injury phase?

   Cryotherapy (cold). Cryotherapy vasoconstricts vessels and reduces metabolic rate, effectively minimizing swelling and pain in acute inflammatory responses.

2. Which sensory-based intervention uses immersion in materials (for example, rice or beans) to reduce hypersensitivity?

   Particle immersion (sensory bins). Immersion in particles provides constant, varied tactile stimulation, facilitating neural adaptation and tolerance in hypersensitive areas.

3. Which tool is a 0–10 patient-rated scale used to quantify pain intensity quickly?

   Numeric Pain Rating Scale (NPRS). NPRS allows quick self-reporting of pain on a numerical scale, facilitating reliable intensity assessment in clinical settings.

4. Which topical scar product is commonly used to hydrate and reduce hypertrophic scar thickness?

   Silicone gel sheeting. Silicone sheeting maintains moisture and modulates cytokine activity, promoting scar remodeling and decreased elevation.

5. Which positioning strategy most directly promotes venous and lymphatic return for distal extremity edema?

   Elevation above heart level. Elevation utilizes gravity to facilitate fluid drainage via venous and lymphatic pathways, reducing hydrostatic pressure in extremities.

6. Which desensitization principle progresses stimuli from least noxious to most noxious over time?

   Graded exposure. Graded exposure systematically habituates neural pathways by incrementally increasing stimulus intensity, reducing hypersensitivity responses.

7. Which scar intervention best targets adhesions by mobilizing tissue in multiple directions?

   Scar massage/mobilization. Scar massage breaks down fibrotic adhesions through shear forces, improving tissue glide and flexibility in various planes.

8. Which desensitization method uses repeated contact with textures (for example, cotton to Velcro)?

   Texture stimulation program. Texture programs desensitize through progressive tactile input, normalizing sensory processing via repeated, controlled exposures.

9. Which manual technique uses light, superficial strokes to direct lymph fluid proximally?

   Manual lymph drainage. Manual lymph drainage employs gentle, directional strokes to stimulate lymphangions and redirect fluid toward functional pathways.

10. Which scar type extends beyond the original wound borders and may continue to grow?

    Keloid scar. Keloids result from dysregulated healing with collagen overproduction extending beyond wound margins, potentially enlarging indefinitely.

11. Which active intervention reduces edema by using muscle contraction to assist fluid return?

    Active range of motion (muscle pump). Muscle contractions during AROM create a pumping action that propels fluid proximally through vascular and lymphatic systems.

12. Which edema management principle uses external pressure to reduce interstitial fluid accumulation?

    Compression. Compression opposes capillary filtration pressure, enhancing fluid resorption and preventing excessive buildup in tissues.

13. Which modality is contraindicated over areas of impaired sensation due to burn risk?

    Superficial heat (hot packs/paraffin). Superficial heat increases burn risk in insensate areas because patients cannot detect excessive temperatures leading to tissue damage.

14. Which edema management method uses multilayer short-stretch wraps to provide high working pressure?

    Short-stretch compression bandaging. Short-stretch bandages yield high pressure during muscle activity while allowing low resting pressure to support lymphatic flow.

15. Which edema type is characterized by protein-rich fluid and often does not pit in later stages?

    Lymphedema. Lymphedema involves lymphatic dysfunction causing protein accumulation, leading to fibrotic changes that resist pitting in advanced stages.

16. Which pain type is defined as pain from actual or threatened tissue damage (IASP definition)?

    Nociceptive pain. IASP defines nociceptive pain as arising from activation of nociceptors due to actual or threatened non-neural tissue damage.

17. Identify the most appropriate first step for hypersensitive fingertip: severe pain with light touch after laceration.

    Begin graded desensitization with soft textures. Starting with soft textures follows graded exposure principles, minimizing pain while building tolerance in post-injury hypersensitivity.

18. Which scar management technique applies controlled pressure to decrease hypertrophic scar formation?

    Pressure therapy (compression garments). Pressure therapy mechanically flattens scars and inhibits fibroblast activity, reducing hypertrophy in susceptible tissues.

19. Which pain management approach teaches pacing, relaxation, and activity modification to improve function?

    Cognitive-behavioral pain strategies. Cognitive-behavioral strategies empower patients by reframing pain perceptions and promoting adaptive behaviors to enhance daily functioning.

20. Which scar type remains within original wound borders and is raised and erythematous early on?

    Hypertrophic scar. Hypertrophic scars form from excessive collagen deposition confined to the wound site, appearing raised and red during maturation.

21. Which condition is a key contraindication for compression due to risk of impaired arterial perfusion?

    Severe peripheral arterial disease. Severe PAD impairs blood flow, and compression may further compromise perfusion, risking ischemia or tissue necrosis.

22. Which pain type is characterized by burning, shooting pain with allodynia or hyperalgesia?

    Neuropathic pain. Neuropathic pain results from somatosensory nervous system lesions, often presenting with dysesthesias like burning or shooting sensations and sensory changes.

23. Which timing is most appropriate to begin scar massage after surgery when there is no drainage?

    After incision is closed and fully epithelialized. Initiating massage post-epithelialization ensures wound stability, minimizing infection risk while allowing early intervention for pliability.

24. Which measurement method uses a tape measure at set landmarks to track limb edema over time?

    Circumferential girth measurements. Girth measurements provide objective, repeatable data on limb volume changes, aiding in monitoring edema progression or resolution.

25. Which clinical sign best distinguishes edema from simple adipose enlargement in a limb?

    Pitting on palpation. Pitting occurs when pressure displaces interstitial fluid in edematous tissue, unlike non-compressible adipose tissue.

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