Occupational Therapy Precautions
Cardiac Precautions
Cardiac Precautions
Measure vital signs before, during, and after the session
Prioritize and manage all wires and tubes during the session
Abide by all precautions (e.g., sternal, lifting)
Design interventions according to the prescribed Rate of Perceived Exertion (“RPE”; Borg Rate of Perceived Exertion) or recommended MET Level.
Encourage energy conservation techniques such as pacing, rest periods, and completing the most necessary tasks (e.g., ADLs) during times of highest energy. (e.g., first thing in the morning).
Normal Ranges for Vital Signs
Blood Pressure
Infants (0 to 6 months): 65/45 - 90/65
Infants (6 to 12 months): 80/55 - 100/65
Children (1 to 11 years): 90/55 - 110/75
Teens to Adults (12 years and older): 110/65 - 135/85
Pulse (Beats Per Minutes)
Infants (0 to 12 months): 100-160 bpm
Children (1 to 11 years): 70-120 bpm
Teens to Adults (12 years and older): 60 to 100 bpm
Respiration (Breaths Per Minute)
Infants (0 to 6 months): 30-60 breaths per minute
Infants (6 to 12 months): 24-30 breaths per minute
Children (1 to 5 years): 20-30 breaths per minute
Children (6 to 12 years): 12-20 breaths per minute
Teens to Adults (12 years and older): 12 to 18 breaths per minute
Borg Rate of Perceived Exertion (RPE)
6 – Nothing at all: e.g., reading, watching television
7-8 – Very, very light: e.g., tying shoes, writing
9-10 – Very light: e.g., folding laundry
11-12 – Fairly light: e.g., walking, shopping
13-14 – Somewhat hard: e.g., brisk walking, vacuuming, cleaning
15-16 – Hard: e.g., swimming, bicycling
17-18 – Very hard: e.g., highest level of sustainable activity
19-20 – Very, very hard: e.g., a burst of activity that cannot be sustained for a long time
MET Levels
A Metabolic Equivalent of Task (“MET Level”) is the amount of energy a person uses to complete a physical activity. MET Levels are used as references in cardiac rehabilitation to ensure that patients who have undergone cardiac procedures or are recovering from cardiac events do not exceed what the heart can tolerate.
New York Heart Association Functional Classification of Heart Failure
The NYHA Functional Classification of Heart Failure is a system that categorizes heart disease into four classes by activity level tolerance.
Class I: Can tolerate greater than MET Level 4.5. The patient has no limitations and does not experience discomfort (i.e., heart palpitations, shortness of breath, extreme fatigue) during normal physical activity.
Class II: Can tolerate up to MET Level 4.5. The patient has slight limitations where the patient is comfortable at rest, however, ordinary physical activity results in discomfort.
Class III: Can tolerate up to MET Level 3.0. The patient has significant limitations where the patient is comfortable at rest, however, light-to-moderate physical activity results in discomfort.
Class IV: Can tolerate up to MET Level 1.5. The patient is unable to tolerate physical activity. The patient experiences discomfort even at rest and physical activity increases the severity of symptoms.
An example of physical activities and their MET Levels can be found in this research article here.
Post-surgical Precautions
Cervical Precautions
Cervical collar should be worn as recommended by the prescribing doctor
No lifting greater than 5 pounds
No flexion or abduction of the shoulder above 90 degrees
No flexion or rotation of the neck
Craniotomy Precautions
Head should be higher than the body at all times
Post-Craniotomy Considerations:
Sleeping: Prop the head on pillows for an incline
Dressing: Bending forward to lower body dress
Chores: Any reaching that requires bending forward for more than a few seconds
Hip Precautions
Anterolateral
No external rotation of the affected hip
No adduction of the affected hip
No abduction of the affected hip
Post Anterolateral Hip Considerations:
Functional mobility and transfers: Pivoting toward the outside of the body; crossing the affected leg; stepping outward with the affected leg
Dressing: Crossing the legs to don socks
Posterolateral
No flexion of the affected hip beyond 90 degrees
No internal rotation of the affected hip
No adduction of the affected hip
Post Posterolateral Hip Considerations:
Functional mobility and transfers: Pivoting toward the inside of the body; crossing the affected leg; leaning forward to press up from a chair or bed
Dressing: Bending forward to lower body dress; crossing the legs to don socks
Toileting: Leaning forward to press up from the toilet
Rotator Cuff Repair Precautions
No pushing or pulling the self up
No weight bearing on the affected shoulder
No internal rotation of the affected shoulder
No abduction of the affected shoulder
Wear an immobilizer at all times except for ADLs including bathing and dressing, and prescribed exercises
Post Rotator Cuff Repair Considerations:
Functional mobility and transfers: Using the affected arm to push or pull up out of bed, from a chair, from the toilet
Dressing: Reaching behind the back to tuck in a shirt; raising the arm out to the side to donn a shirt
Toileting: Reaching behind the back for toilet hygiene
The occupational therapist should refer to the surgeon’s guidelines for progression and incorporate activities and exercises to increase range of motion and strength accordingly.
Spinal Precautions
No hip flexion beyond 90 degrees
No lifting greater than 5 pounds or per doctor’s instructions
No rotation of the spine
Post Spinal Surgery Considerations:
Dressing: Bending forward to lower body dress
Bathing: Bathing lower body
Avoid prolonged sitting; can cause flexion in spine
Sternal Precautions
No bilateral stretching of the arms
No hyperextension of the arms
No lifting, pushing, or pulling greater than 10 pounds
Limit the use of the arms during mobility and transfers
No trunk flexion and rotation when going from supine to sit
Post Sternum Surgery Considerations:
Functional mobility and transfers: No propelling a wheelchair, need assistance if the person uses arms to support in transferring to/from the toilet or to/from a tub bench, no sitting up and twisting to reach for an object
Transmission Precautions
Standard Isolation Precautions
These are considered the “universal” precautions for isolation.
Intervention
Washing hands with soap and water
Gloves
Masks
Prevention of injury
Goggles/eye shield
Airborne Precautions
Used For
Infection particles transmitted by airborne droplets
These particles can travel long distances over long periods of time
Intervention
Single room
Negative pressure
Staff and visitors are required to wear N95 respirator masks
Examples include:
Tuberculosis (TB), smallpox, measles, chickenpox, severe acute respiratory syndrome (SARS)
Droplet Precautions
Used For
Infection particles transmitted by airborne droplets
These particles can travel short distances over short periods of time
Intervention
Single room
Surgical mask
Eye protection
Gown
Gloves
Examples include:
Influenza, pneumonia, Neisseria, meningitis, mumps, COVID-19
Contact Precautions
Used For
Known or suspected illness transmitted by direct or indirect contact with objects
These particles can travel long distances over long periods of time
Intervention
Gloves
Gowns
Washing hands with soap and water or hand sanitizer
Examples include:
Gastrointestinal, skin infection, wound infections, multi-drug resistant organisms (MDROs) including Methicillin-resistant staphylococcus aureus (MRSA)
Weight-Bearing Precautions
Non-weight-bearing (NWB)
The affected leg shall not touch the floor
No weight (0%) should be supported on the affected leg
Crutches or other devices are recommended for mobility
Touch-down weight-bearing or Toe-touch weight-bearing (TDWB)
The toes or foot may touch the floor for balance only; the occupational therapist should be able to slide a piece of paper beneath the patient’s toe easily
No weight (0%) should be supported on the affected leg
Partial weight-bearing (PWB)
The affected leg may touch the floor
A small amount of weight may be supported on the affected leg and gradually increased up to 50% of the body weight; this would permit the person to stand with their body weight evenly supported by both feet, however, they would not be able to walk
Weight-bearing as tolerated (WBAT)
Weight may be supported on the affected leg between 50% to 100%, with the patient choosing the amount of support as tolerated according to the circumstances
Full weight-bearing (FWB)
100% of the body’s weight can be supported by the affected leg which permits normal walking
Wound Precautions
Pressure Sores/Ulcers
No prolonged positions
If prolonged sitting: Use cushions under hips (e.g., air, hybrid)
If prolonged side lying: Use cushions between knees in side lying
If prolonged supine lying: Use foam cushion under heels
Weight shift often to reduce instances of pressure sores from bony areas
Fragile Skin
Take great consideration of where tape is applied and when it is removed
Take extra caution when repeating blood pressures