NBCOT Registered Occupational Therapists (OTR) Quiz: Tissue Management
20 questions · exam conditions
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Tissue ManagementQuestion 1 of 20

Silicone sheets help early hypertrophic scars mostly through:

Continuous deep pressure
Hydration and occlusion
Corticosteroid delivery
Blocking ultraviolet light
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NBCOT Registered Occupational Therapists (OTR) Quiz

NBCOT Registered Occupational Therapists (OTR) Quiz: Tissue Management

Practice Tissue Management in NBCOT Registered Occupational Therapists (OTR) with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Tissue Management, giving you a quick way to practice the rules, question types, and explanations that matter most for NBCOT Registered Occupational Therapists (OTR).

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

Silicone sheets help early hypertrophic scars mostly through:

  1. Continuous deep pressure
  2. Hydration and occlusion (correct answer)
  3. Corticosteroid delivery
  4. Blocking ultraviolet light
Explanation: Silicone sheets form a hydrated, occlusive barrier over the scar, reducing water loss and helping normalize collagen, which flattens and softens the tissue. Continuous deep pressure is the tempting wrong answer, but that is the main mechanism of pressure garments, not silicone sheets. Steroid delivery and UV blocking are not primary mechanisms.

Question 2

CRPS allodynia: which intervention targets cortical pain processing?

  1. Retrograde massage
  2. Passive stretching
  3. High-frequency TENS
  4. Graded motor imagery (correct answer)
Explanation: Graded motor imagery engages cortical networks, reorganizing brain maps and calming central sensitization, which directly addresses cortical pain processing in CRPS allodynia. The most tempting wrong answer is high-frequency TENS because it is a familiar pain treatment, but TENS works through spinal/segmental gating, not cortical mechanisms. Retrograde massage and passive stretching act peripherally.

Question 3

Graded desensitization after grafting: which order is best?

  1. Velcro hook, cotton, towel
  2. Rice bin, towel, cotton
  3. Cotton, towel, rice bin (correct answer)
  4. Towel, rice bin, cotton
Explanation: Start with the softest, least irritating texture and gradually increase sensory input. Cotton is smoothest, towel adds moderate friction, and rice bin provides deeper pressure and coarser texture. Beginning with Velcro hook is tempting for stronger stimulation, but it is too abrasive right after grafting.

Question 4

Leg wrapping increases pain in a patient with ABI 0.65. Why?

  1. Arterial inflow worsened (correct answer)
  2. Lymphatic flow blocked
  3. Venous stasis increased
  4. Nociceptors sensitized
Explanation: With ABI 0.65, arterial supply to the leg is already reduced. Leg wrapping adds external pressure that narrows arteries further, decreasing arterial inflow and worsening ischemia, so pain increases. The tempting wrong answer is venous stasis increased, but compression actually reduces venous pooling; the problem here is arterial inflow, not venous return.

Question 5

Cellulitis with hand edema: why avoid retrograde massage?

  1. Worsening ischemia
  2. Spreading infection (correct answer)
  3. Increasing lymph load
  4. Causing skin tears
Explanation: Retrograde massage pushes tissue fluid and bacteria toward the lymphatic system, so in cellulitis it can disseminate the infection. The most tempting wrong answer is increasing lymph load, but that is actually the goal in edema treatment; the infection risk is why massage is avoided here.

Question 6

A client presents with Complex Regional Pain Syndrome (CRPS) Type I in their left hand, 6 months after a distal radius fracture. The OTR observes severe, brawny edema, allodynia, and significant joint stiffness. The client's primary goal is to manage the constant, burning pain. The client's medical history includes congestive heart failure (CHF).

Which intervention strategy BEST addresses the client's pain and edema while considering their medical complexity?

  1. Instructing the client in a stress-loading program involving scrubbing and carrying weighted objects, combined with contrast baths.
  2. Applying an intermittent pneumatic compression pump to the upper extremity followed by wrapping with short-stretch bandages.
  3. Initiating pain management with graded motor imagery, followed by gentle, non-resistive active range of motion in an elevated position. (correct answer)
  4. Using retrograde massage from distal to proximal, followed by fitting for a custom high-pressure compression garment.
Explanation: The correct answer is C. Graded motor imagery (including laterality training, imagined movements, and mirror therapy) is a primary, evidence-based intervention for the central sensitization and pain associated with CRPS. Performing gentle AROM with the limb elevated uses gravity to assist with managing the brawny edema without causing a fluid overload, which is a critical consideration for a client with CHF. A is incorrect because while stress loading is a key component of CRPS treatment, initiating it with scrubbing and carrying for a client with severe allodynia and pain would be intolerable and counterproductive. Contrast baths can be beneficial but may also exacerbate symptoms in some individuals with CRPS and require caution in clients with CHF due to potential fluid shifts. B is incorrect because pneumatic compression pumps are generally contraindicated for clients with CHF due to the risk of mobilizing a large fluid volume back to the heart, potentially causing acute cardiac overload. D is incorrect because retrograde massage is ineffective for brawny (fibrotic) edema. A high-pressure compression garment would likely be intolerable due to the client's severe allodynia.

Question 7

Patient Background

A 45-year-old female is 11 days post–carpal tunnel surgery. She has no complications and has been cleared for gentle hand use.

Presenting Symptoms (Tissue Dysfunction)

She reports:

  • Mild pain (2/10)
  • Swelling that increases after the hand is down at her side
  • Decreased finger range of motion due to stiffness

Current Management Strategies Attempted

She has tried:

  • Elevation intermittently
  • No structured exercise routine

Environmental/Personal Factors

  • Busy work schedule limits therapy time
  • Needs strategies that can be done at a desk

What is the most appropriate intervention for managing edema in this case?

  1. Teach frequent active hand pumping with elevation breaks and add light compression during daytime activities (correct answer)
  2. Use continuous heat at the wrist during the workday to reduce swelling more effectively than movement
  3. Avoid all finger motion to prevent increased swelling and protect healing structures after surgery
  4. Begin desensitization with rough fabrics to reduce edema and improve tolerance for typing tasks
Explanation: This question tests the application of tissue management strategies within occupational therapy practice, focusing on pain, edema, scar, and desensitization management. Effective tissue management requires understanding the appropriate use of interventions like compression, massage, and sensory re-education to address specific symptoms. For this scenario, the patient's condition and current management strategies are critical in determining the most effective intervention, such as choosing active pumping for edema. The correct answer, choice A, is optimal because it aligns with evidence-based practices for edema control with motion, elevation, and compression, suitable for the patient's desk work and schedule. Choice C is incorrect because it misapplies avoidance of motion, which could prolong swelling, often a common mistake when overprotecting. Teaching strategies include emphasizing the importance of selecting interventions based on client-specific factors and staying updated with current best practices. Encourage critical thinking and the use of clinical guidelines to inform decision-making.

Question 8

Patient Background

A 78-year-old with rheumatoid arthritis has chronic bilateral hand pain and swelling. She also has Raynaud's phenomenon (cold sensitivity).

Presenting Symptoms (Tissue Dysfunction)

She reports:

  • Pain (6/10) with grooming and meal prep
  • Stiffness worsened by cold exposure
  • Occasional finger color changes in cold weather

Current Management Strategies Attempted

She has tried:

  • Cold packs recommended by a friend
  • Avoiding outdoor trips when possible

Environmental/Personal Factors

  • Lives in a cold climate
  • Needs a safe home strategy

How can the therapist effectively reduce pain for the patient described?

  1. Use moist heat before activity, teach joint protection and pacing, and recommend warm gloves for cold exposure (correct answer)
  2. Recommend frequent cold packs and cold water baths to decrease pain and improve circulation with Raynaud's
  3. Instruct maximal grip strengthening during flares to stabilize joints and reduce inflammation long-term
  4. Use graded texture desensitization as the primary intervention to replace joint protection and heat use
Explanation: This question tests the application of tissue management strategies within occupational therapy practice, focusing on pain, edema, scar, and desensitization management. Effective tissue management requires understanding the appropriate use of interventions like compression, massage, and sensory re-education to address specific symptoms. For this scenario, the patient's condition and current management strategies are critical in determining the most effective intervention, such as choosing heat and protection for RA with Raynaud's. The correct answer, choice A, is optimal because it aligns with evidence-based practices for pain management using moist heat, joint protection, and warm gloves to address cold sensitivity and stiffness. Choice B is incorrect because it misapplies cold packs, which could trigger Raynaud's episodes, often a common mistake when ignoring comorbidities. Teaching strategies include emphasizing the importance of selecting interventions based on client-specific factors and staying updated with current best practices. Encourage critical thinking and the use of clinical guidelines to inform decision-making.

Question 9

Patient Background

A 45-year-old female is 10 days post–carpal tunnel release on the right hand. She has well-controlled type 2 diabetes and no history of blood clots. She works as an administrative assistant and types most of the day.

Presenting Symptoms (Tissue Dysfunction)

She reports:

  • Mild aching pain at the incision (3/10), worse after typing
  • Visible swelling at the volar wrist and palm
  • Stiffness limiting full finger flexion in the morning
  • Skin intact with no redness or fever

Current Management Strategies Attempted

She has tried:

  • Intermittent elevation on pillows at night
  • Avoiding heavy lifting
  • Occasional ice packs for 5 minutes

Environmental/Personal Factors

  • Limited breaks at work and difficulty keeping the hand elevated during the day
  • Prefers low-profile options that fit under work clothing

What is the most appropriate intervention for managing edema in this case?

  1. Apply moist heat to the wrist for 20 minutes, then encourage repeated gripping to pump fluid out
  2. Provide a light compression glove with short-stretch wrap as needed and teach frequent elevation and AROM (correct answer)
  3. Begin deep transverse friction massage directly over the incision to break up swelling and scar tissue
  4. Start daily desensitization using rough textures to reduce swelling and improve circulation at the incision
Explanation: This question tests the application of tissue management strategies within occupational therapy practice, focusing on pain, edema, scar, and desensitization management. Effective tissue management requires understanding the appropriate use of interventions like compression, massage, and sensory re-education to address specific symptoms. For this scenario, the patient's condition and current management strategies are critical in determining the most effective intervention, such as choosing compression and elevation for edema control post-surgery. The correct answer, choice B, is optimal because it aligns with evidence-based practices for managing edema through light compression, elevation, and active range of motion, considering the patient's work demands and preference for low-profile options. Choice C is incorrect because it misapplies deep friction massage too early, which could irritate the recent incision and is not suitable for acute edema management, often a common mistake when practitioners confuse scar and edema interventions. Teaching strategies include emphasizing the importance of selecting interventions based on client-specific factors and staying updated with current best practices. Encourage critical thinking and the use of clinical guidelines to inform decision-making.

Question 10

Patient Background

A 22-year-old is 6 weeks post-laceration with nerve involvement to the index finger. The incision is healed and cleared for sensory work.

Presenting Symptoms (Tissue Dysfunction)

He reports:

  • Hypersensitivity at the fingertip and avoidance of touch
  • Difficulty tolerating typing and phone use
  • Pain (5/10) with light brushing contact

Current Management Strategies Attempted

He has tried:

  • Keeping the finger covered
  • Limiting use during daily tasks

Environmental/Personal Factors

  • Must use a smartphone for work communication
  • Can practice brief exercises during breaks

What desensitization technique is most suitable based on the patient's condition?

  1. Start with soft textures and light tapping, progressing to rougher textures and increased pressure as tolerated (correct answer)
  2. Apply hot packs for 30 minutes and then rub vigorously with a rough towel to speed nerve recovery
  3. Avoid sensory input until pain is zero, then return directly to normal typing without a graded plan
  4. Use compression wrapping tightly around the fingertip to eliminate hypersensitivity by restricting circulation
Explanation: This question tests the application of tissue management strategies within occupational therapy practice, focusing on pain, edema, scar, and desensitization management. Effective tissue management requires understanding the appropriate use of interventions like compression, massage, and sensory re-education to address specific symptoms. For this scenario, the patient's condition and current management strategies are critical in determining the most effective intervention, such as choosing graded textures for fingertip desensitization. The correct answer, choice A, is optimal because it aligns with evidence-based practices for progressive sensory exposure starting softly, fitting the patient's functional needs like typing. Choice D is incorrect because it misapplies tight compression, which could impair circulation, often a common mistake when confusing pressure with desensitization. Teaching strategies include emphasizing the importance of selecting interventions based on client-specific factors and staying updated with current best practices. Encourage critical thinking and the use of clinical guidelines to inform decision-making.

Question 11

Patient Background

A 77-year-old with rheumatoid arthritis reports persistent hand pain with daily tasks. She has mild ulnar drift and decreased grip.

Presenting Symptoms (Tissue Dysfunction)

She reports:

  • Pain (6/10) with opening containers and carrying groceries
  • Swelling after repetitive grasping
  • Stiffness improved slightly with warmth

Current Management Strategies Attempted

She has tried:

  • Using stronger grip to "stabilize" fingers
  • Avoiding some tasks entirely

Environmental/Personal Factors

  • Wants to continue shopping independently
  • Limited funds for multiple devices

How can the therapist effectively reduce pain for the patient described?

  1. Teach joint protection and energy conservation, recommend adaptive jar opener, and use heat before shopping tasks (correct answer)
  2. Encourage forceful gripping and carrying heavier bags to strengthen joints and reduce pain long-term
  3. Recommend cold packs before shopping to increase joint flexibility and prevent swelling during carrying
  4. Use scar mobilization techniques at the MCP joints as the primary method to decrease rheumatoid pain
Explanation: This question tests the application of tissue management strategies within occupational therapy practice, focusing on pain, edema, scar, and desensitization management. Effective tissue management requires understanding the appropriate use of interventions like compression, massage, and sensory re-education to address specific symptoms. For this scenario, the patient's condition and current management strategies are critical in determining the most effective intervention, such as choosing adaptive tools for RA pain. The correct answer, choice A, is optimal because it aligns with evidence-based practices for pain management with protection, conservation, openers, and heat, supporting the patient's shopping independence. Choice B is incorrect because it misapplies forceful gripping, which could worsen drift and pain, often a common mistake when confusing strength with stability. Teaching strategies include emphasizing the importance of selecting interventions based on client-specific factors and staying updated with current best practices. Encourage critical thinking and the use of clinical guidelines to inform decision-making.

Question 12

An OTR is treating a client who sustained a full-thickness burn to the dorsum of their right hand 5 months ago. The client now has a significant hypertrophic scar that is dark red, raised, and firm. The scar is causing an extension contracture at the metacarpophalangeal (MCP) joints. The client has good skin integrity over the scar.

Which combination of interventions is the MOST effective for managing the scar and improving MCP joint passive flexion at this stage?

  1. Application of a custom thermoplastic static progressive splint for MCP flexion, combined with daily deep friction massage over the scar tissue.
  2. Serial casting of the MCP joints into greater flexion, combined with fluidotherapy prior to stretching to increase tissue extensibility.
  3. Use of a custom-fit pressure garment worn 23 hours per day, combined with scar massage using a moisturizer containing silicone.
  4. Sustained, low-load stretching of the MCP joints using a dynamic splint, combined with silicone gel sheeting applied continuously to the scar. (correct answer)
Explanation: The correct answer is D. This is a multi-step problem involving a mature, contracture-causing scar. A dynamic splint provides a sustained, low-load stretch, which is the most effective method for remodeling dense connective tissue and gradually increasing passive range of motion. Silicone gel sheeting is a first-line, evidence-based treatment for managing hypertrophic scars by improving hydration and collagen alignment. This combination directly addresses both the scar's properties and the resulting contracture. A is incorrect because a static progressive splint, while useful, is generally considered less effective than dynamic splinting for this type of dense contracture. Deep friction massage can be useful but may be less effective than the combination of pressure and silicone for this type of scar and could cause irritation if too aggressive. B is incorrect because serial casting is more commonly used for significant, resistant contractures and may be overly aggressive as an initial approach. Fluidotherapy can increase blood flow and extensibility but may also increase edema if not carefully managed. C is incorrect because while a pressure garment is a standard treatment for burn scars, it may not provide enough targeted force to correct an established contracture. A dynamic splint is more effective for this specific purpose. Scar massage is helpful, but the direct application of silicone sheeting provides more consistent and effective scar management.

Question 13

Patient Background

A 30-year-old male has hypertrophic scarring after a burn injury 6 months ago. The scar is closed, intact, and sensitive.

Presenting Symptoms (Tissue Dysfunction)

He reports:

  • Raised scar with tightness limiting motion
  • Itching and discomfort with pressure
  • Difficulty tolerating long sleeves due to rubbing

Current Management Strategies Attempted

He has tried:

  • Occasional massage without a schedule
  • No silicone or compression use

Environmental/Personal Factors

  • Works in a setting where sleeves rub the scar often
  • Can only commit to brief daily routines

Which intervention would be least effective in this scar management scenario?

  1. Use silicone gel and gradually increase wear time while monitoring skin tolerance and itching
  2. Teach gentle scar massage and stretching to improve pliability and reduce tightness over time
  3. Use compression sleeve or pressure garment if tolerated to help manage raised scar tissue
  4. Use repeated ice massage as the primary method to flatten hypertrophic scar tissue and replace silicone use (correct answer)
Explanation: This question tests the application of tissue management strategies within occupational therapy practice, focusing on pain, edema, scar, and desensitization management. Effective tissue management requires understanding the appropriate use of interventions like compression, massage, and sensory re-education to address specific symptoms. For this scenario, the patient's condition and current management strategies are critical in determining the least effective intervention, such as identifying ice massage for scar flattening. The correct answer, choice D, identifies the least effective intervention because it does not align with evidence-based practices for hypertrophic scars, as ice lacks efficacy compared to silicone or compression for pliability and height reduction. Choice A is incorrect as least effective because it properly uses silicone with monitoring, which is suitable, often a common mistake when undervaluing targeted interventions. Teaching strategies include emphasizing the importance of selecting interventions based on client-specific factors and staying updated with current best practices. Encourage critical thinking and the use of clinical guidelines to inform decision-making.

Question 14

Patient Background

A 22-year-old is recovering from a nerve injury to the hand and is beginning sensory re-education. The skin is intact.

Presenting Symptoms (Tissue Dysfunction)

He reports:

  • Hypersensitivity to light touch and vibration
  • Avoids using the hand for grooming and feeding
  • Fearful that touch will "damage" the nerve

Current Management Strategies Attempted

He has tried:

  • Keeping the hand in a pocket to avoid contact
  • Skipping therapy exercises when uncomfortable

Environmental/Personal Factors

  • High anxiety and needs clear structure
  • Has time for short sessions throughout the day

What desensitization technique is most suitable based on the patient's condition?

  1. Use a graded, scheduled program of textures and pressures with patient control and relaxation breathing as needed (correct answer)
  2. Use prolonged immobilization to prevent stimulation until anxiety decreases and sensation returns spontaneously
  3. Apply deep friction massage until pain stops, then immediately progress to rough textures without grading
  4. Use continuous ice to numb the area daily so the patient can avoid all touch-based activities
Explanation: This question tests the application of tissue management strategies within occupational therapy practice, focusing on pain, edema, scar, and desensitization management. Effective tissue management requires understanding the appropriate use of interventions like compression, massage, and sensory re-education to address specific symptoms. For this scenario, the patient's condition and current management strategies are critical in determining the most effective intervention, such as choosing graded desensitization for hypersensitivity with anxiety. The correct answer, choice A, is optimal because it aligns with evidence-based practices for structured, patient-controlled exposure with breathing, addressing the patient's fear and need for structure. Choice B is incorrect because it misapplies prolonged immobilization, which delays recovery, often a common mistake when prioritizing avoidance over progression. Teaching strategies include emphasizing the importance of selecting interventions based on client-specific factors and staying updated with current best practices. Encourage critical thinking and the use of clinical guidelines to inform decision-making.

Question 15

Patient Background

A 45-year-old female is 2 weeks post–carpal tunnel release with intact incision. She has a history of sensitive skin to adhesives.

Presenting Symptoms (Tissue Dysfunction)

She reports:

  • Swelling around the wrist and palm by afternoon
  • Mild pain (3/10)
  • Stiffness limiting functional grasp

Current Management Strategies Attempted

She has tried:

  • Elevation at night only
  • No compression due to skin concerns

Environmental/Personal Factors

  • Needs to return to typing and light household chores
  • Wants a non-adhesive option

What is the most appropriate intervention for managing edema in this case?

  1. Fit a non-adhesive compression glove and teach elevation plus frequent AROM to support edema reduction (correct answer)
  2. Apply paraffin wax daily to reduce swelling and replace the need for compression or elevation
  3. Recommend no hand use until swelling is absent to prevent further tissue irritation after surgery
  4. Begin aggressive scar friction massage over the incision to control edema and prevent scar formation
Explanation: This question tests the application of tissue management strategies within occupational therapy practice, focusing on pain, edema, scar, and desensitization management. Effective tissue management requires understanding the appropriate use of interventions like compression, massage, and sensory re-education to address specific symptoms. For this scenario, the patient's condition and current management strategies are critical in determining the most effective intervention, such as choosing non-adhesive compression for edema. The correct answer, choice A, is optimal because it aligns with evidence-based practices for edema management with a glove, elevation, and AROM, considering the patient's skin sensitivity and functional needs. Choice B is incorrect because it misapplies paraffin wax, which may not directly reduce edema and could irritate skin, often a common mistake when substituting modalities. Teaching strategies include emphasizing the importance of selecting interventions based on client-specific factors and staying updated with current best practices. Encourage critical thinking and the use of clinical guidelines to inform decision-making.

Question 16

Patient Background

A 45-year-old female is 12 days post–carpal tunnel release. She has mild eczema but no open areas near the incision.

Presenting Symptoms (Tissue Dysfunction)

She reports:

  • Swelling in the hand that increases after computer work
  • Mild pain (3/10) and stiffness
  • No signs of infection

Current Management Strategies Attempted

She has tried:

  • Keeping the hand "still" to avoid pain
  • Elevation only when swelling feels severe

Environmental/Personal Factors

  • Needs to type for work and cannot take long breaks
  • Wants strategies that fit into a short routine

What is the most appropriate intervention for managing edema in this case?

  1. Teach elevation plus frequent active range-of-motion and add light compression that does not irritate skin (correct answer)
  2. Encourage complete rest with no hand motion for one week to allow swelling to resolve naturally
  3. Use hot wax (paraffin) daily to reduce swelling quickly and increase circulation to the incision
  4. Begin aggressive scar friction over the incision to decrease swelling by breaking down tissue
Explanation: This question tests the application of tissue management strategies within occupational therapy practice, focusing on pain, edema, scar, and desensitization management. Effective tissue management requires understanding the appropriate use of interventions like compression, massage, and sensory re-education to address specific symptoms. For this scenario, the patient's condition and current management strategies are critical in determining the most effective intervention, such as choosing light compression for edema. The correct answer, choice A, is optimal because it aligns with evidence-based practices for post-surgical edema control with elevation, AROM, and skin-friendly compression, considering the patient's eczema and work needs. Choice C is incorrect because it misapplies complete rest, which could worsen stiffness, often a common mistake when confusing protection with immobilization. Teaching strategies include emphasizing the importance of selecting interventions based on client-specific factors and staying updated with current best practices. Encourage critical thinking and the use of clinical guidelines to inform decision-making.

Question 17

An OTR in an acute care setting is treating a 75-year-old client who is 2 days post-op from a total knee arthroplasty. The client has 3+ pitting edema in the involved lower extremity, from the foot to the mid-thigh. The client's medical history is significant for renal failure requiring dialysis. The client reports pain at an 8/10 level.

What is the MOST appropriate and safe edema management strategy for this client?

  1. Application of a sequential compression device (SCD) to the lower extremity for 30-minute intervals, three times per day.
  2. Positioning the leg in elevation on pillows, ensuring the knee is in slight flexion, and applying cold packs around the surgical site. (correct answer)
  3. Performing gentle retrograde massage from the ankle towards the knee, followed by wrapping with a long-stretch elastic bandage.
  4. Initiating manual lymph drainage (MLD) techniques for the entire lower extremity to redirect fluid to adjacent lymphatic territories.
Explanation: The correct answer is B. For an acute post-surgical patient with systemic comorbidities like renal failure, the safest initial interventions are the most conservative. Elevation is a primary method to reduce edema using gravity, and positioning the knee in slight flexion avoids pressure on the popliteal space. Cold packs help with vasoconstriction to limit swelling and also provide analgesia for the high reported pain. This approach is safe and does not risk mobilizing large volumes of fluid that the client's compromised renal system cannot handle. A and C are incorrect because both SCDs and retrograde massage/compression wrapping can rapidly move a large volume of fluid into the central circulation. In a client with renal failure, this can lead to fluid overload, hypertension, and cardiac distress. These interventions are relatively contraindicated without physician clearance. D is incorrect because while MLD is gentle, performing it on the entire limb could still mobilize significant fluid. More importantly, it is a specialized technique and the foundational, safer interventions of elevation and cryotherapy should be prioritized in this acute phase.

Question 18

An OTR is treating a client with a healed but severely hypersensitive scar on the dorsal forearm. The client is a carpenter and is unable to tolerate the feeling of sawdust or the pressure of tools against the arm. The OTR has initiated a desensitization program, and the client can now tolerate soft fabrics and cotton balls.

What is the MOST appropriate next step to grade this client's desensitization program towards their vocational goals?

  1. Progress to rubbing the scar with progressively rougher textures, such as burlap and sandpaper.
  2. Incorporate tapping and vibration over the scar, starting with a low frequency and intensity. (correct answer)
  3. Have the client immerse their arm in a bin of sawdust for increasing durations to simulate the work environment.
  4. Apply a silicone gel pad over the scar during the day to dampen sensory input and provide protection.
Explanation: The correct answer is B. A comprehensive desensitization program involves grading stimuli not just by texture, but also by pressure and vibration. Since the client has made progress with constant-contact textures, introducing a different type of stimulus like tapping or vibration is the logical next step. This challenges the nervous system in a new way and is a key component in progressing toward tolerating the variable inputs of a work environment (e.g., tool vibration). A is incorrect because progressing directly to highly abrasive textures like burlap or sandpaper is a very large jump and likely to be painful and unsuccessful, leading to withdrawal. C is incorrect because immersion in sawdust is a very high-level, multi-sensory challenge that is functionally relevant but far too advanced for this stage. It should be a long-term goal, not the next step. D is incorrect because while a silicone pad can be a useful compensatory strategy for protection, it is not a direct progression of the desensitization program itself; it is a method of avoiding, rather than adapting to, sensory input.

Question 19

An OTR is treating a client who sustained a deep laceration to the palm of the hand 2 months ago. The wound is fully closed, but a thick, cord-like scar has formed that tethers the skin to the underlying palmar fascia, limiting composite finger extension. The client reports a deep, aching pain when trying to flatten their hand.

Which scar management technique is specifically designed to address this type of adherent, cord-like scar?

  1. Myofascial release, using sustained pressure and gentle stretching in the direction of the restriction. (correct answer)
  2. Application of a paper tape grid directly over the scar to provide low-intensity, prolonged sensory input.
  3. Retrograde massage with a lubricating cream, performed from the fingertips towards the wrist.
  4. Use of a custom pressure garment with a foam insert to flatten the entire palmar surface.
Explanation: The correct answer is A. Myofascial release is the most appropriate technique for an adherent scar that is tethered to deeper structures. It involves applying sustained, gentle pressure and shear forces to engage the fascial layers and release the adhesions between the scar and the underlying tissue. This directly addresses the mechanical restriction causing the limited extension and pain. B is incorrect because paper taping is primarily used for scar desensitization or to provide proprioceptive feedback, not to release deep mechanical adhesions. C is incorrect because retrograde massage is a technique for managing pitting edema, not for mobilizing adherent scar tissue. D is incorrect because while pressure can help with hypertrophic scarring, a simple foam insert does not provide the specific shearing and releasing force needed to break the deep adhesions of a tethered scar. Myofascial release is a more targeted manual therapy technique for this problem.

Question 20

Patient Background

A 30-year-old male sustained a partial-thickness burn to the dorsal forearm 3 months ago. The wound is closed and he has no infection. He works in food service and washes his hands frequently.

Presenting Symptoms (Tissue Dysfunction)

He reports:

  • Itchy, raised, red scar that feels "tight" with wrist extension
  • Mild pain with stretching (2–3/10)
  • Scar appears thick and shiny, consistent with hypertrophic scarring

Current Management Strategies Attempted

He has tried:

  • Lotion application twice daily
  • Occasional stretching when discomfort increases

Environmental/Personal Factors

  • Sweaty work environment makes some materials hard to tolerate
  • Limited time for lengthy home programs

Which strategy would best address the patient's scar management needs?

  1. Use silicone gel sheeting or silicone gel daily and teach scar massage and stretching within tolerance (correct answer)
  2. Perform aggressive friction massage until redness increases to rapidly flatten the scar tissue
  3. Apply cold packs before work to reduce scar thickness and prevent itching throughout the shift
  4. Avoid touching the scar and restrict wrist motion to prevent further scar formation
Explanation: This question tests the application of tissue management strategies within occupational therapy practice, focusing on pain, edema, scar, and desensitization management. Effective tissue management requires understanding the appropriate use of interventions like compression, massage, and sensory re-education to address specific symptoms. For this scenario, the patient's condition and current management strategies are critical in determining the most effective intervention, such as choosing silicone gel sheets for scar reduction. The correct answer, choice A, is optimal because it aligns with evidence-based practices for managing hypertrophic scarring through silicone application, massage, and stretching, suitable for the patient's itchy and tight scar in a sweaty work environment. Choice B is incorrect because it misapplies aggressive friction massage, which could exacerbate redness and irritation without proper progression, often a common mistake when practitioners confuse intensity with efficacy. Teaching strategies include emphasizing the importance of selecting interventions based on client-specific factors and staying updated with current best practices. Encourage critical thinking and the use of clinical guidelines to inform decision-making.