Biomechanical Approach Flashcards
Proprioception
knowing where your body is in space without looking, needed for smooth coordinated movements
Stereognosis
identifying an object with touch only, vision occluded
Kinesthesia
awareness of the position and movement (direction; how fast; force) of the parts of the body by means of sensory organs (proprioceptors) in the muscles and joints
Figure-Ground
screening out other things around to pick one object
Biomechanical Practice Model
applied to people with LROM, decreased muscle strength and/or endurance, intact CNS
Focus is on performance skills in motor and sensory areas and regaining skills in areas of occupation
Biomechanical Treatment
Prevention and maintenance- body mechanics, joint protection techniques, splints, positioning.
Restoration-increase ROM, muscle strength, endurance and stability.
Compensation
Manual Muscle Testing Scores
0: None
1,Trace: No motion, palpable/visible contraction
2-,Poor-: < full ROM, gravity eliminated
2,Poor: Full ROM, gravity eliminated
2+,Poor+: Full ROM, gravity eliminated, Min resist
3-,Fair-: < full ROM, agnst gravity
3,Fair: Full ROM, agnst gravity
3+, Fair+: Full ROM, agnst gravity, Min resist
4,Good: Full ROM, agnst gravity, Mod resist
5,Norm: Full ROM, agnst gravity, Max resist
Shoulder Flexion/Extension
flx 0-180 ext 0-40 to 60
Shoulder ABD/ADD
ABD 0-180 ADD 180-0
Shoulder Horizontal ABD/ADD
Horiz ABD 0-45 Horiz ADD 0-90
Shoulder Internal/External Rotation
0-90 both
Elbow Flexion/Extension
FLX 0- 135-150 EXT 0
Forearm Supination/Pronation
SUP 0-90 PRO 0-90
Wrist Flexion/Extension
FLX 0-90 EXT 0-70
Ulnar/Radial Deviation
ULN 0-35 RAD 0-25
MCP/PIP/DIP Flexion
MCP 0-90
PIP 0-120
DIP 0-80
Thumb MCP/IP Flexion
Thumb MCP 0-50 Thumb IP 0-90
Volumeter
Edema assessment
Significant change in edema would be more than 10ml
Sensation Testing
Demo testing w/vision, then vision occluded
Test uninvolved side first
SCI tested proximal to distal following dermatomes
Neurological disorders assess for dermatome pattern
Peripheral nerve injuries tested distal to proximal.
Assess order: pain, moving touch, static light touch, and touch localization
Purdue Pegboard
Test of fingertip dexterity and assembly job simulation
Scoring: 30sec test is the # of pins placed on board in 30sec. Assembly is the # of parts assembled in 1min
Minnesota Manual Dexterity Test
test of gross hand and arm movements
Scoring: time to complete board.
O’Connor Tweezer Test
Test of eye-hand coordination
Scoring: # of pins in board using tweezers
Crawford Small Parts Dexterity Test
Test fine motor dexterity using small tools
Scoring: time to complete assembly
Nine Hole Peg Test
Measure finger dexterity
Scoring: time for each hand to place nine pegs in a square board and remove them
Jebson Hand Function Test
Test hand function.
7 subtests:
Writing
Simulated page turning
Picking up common objects
Simulated feeding
Stacking
Picking up large light objects
Picking up large heavy objects
Scoring: time to complete each subject
Differential Tendon Gliding
prevent/reduce tendon adhesion. allow each tendon to reach its greatest amount of movement. also help to reduce hand swelling.
Blocking Exercises
used to isolate individual join motion. pt instructed to hold end range position for 3-5 sec
Isometric Exercise Contraindication
contraindicated for persons with hypertension and cardiovascular problems. increase b/p and HR
Scar Sensory Reduction/ Desensitization
Post-surgery, begin in periphery of the scar and as tolerated work over the scar
Massage
Textures
Vibration
Three-phase desensitization kit
Fluidotherapy
Avoid use of hands where vision is occluded
Splinting for Brachial Plexus Injury
flail arm splint
Splinting for Radial Nerve Palsy
Dynamic wrist, finger, and thumb ext splint
Splinting for Carpal Tunnel
wrist splint positioned 0-15 ext
Splinting for DeQuervain’s
long thumb splint, includes wrist, IP joint free
Splinting for CMC Arthritis
hand based thumb splint
Splinting for Arthritis
resting hand splint
Splinting for Flaccidity
resting splint
Splinting for Spasticity
spasticity splint or cone splint
Splinting for Muscle Weakness
balanced forearm orthosis, deltoid sling/suspension sling
Splinting for Axillary Burns
airplane splint
Heat Therapy Benefits and Precautions
Benefits
Relieves pain; increases ROM; assists w/wound healing; decreases muscle spasms
Precautions
Do not use with postsurgical repairs; acute injuries; impaired sensation; impaired vascular supply
Application of Hot Packs
Check skin prior to and after application
Check temp of hydrocollator (165*)
Check skin after 5min Hot pack removed after 20min
Application of Paraffin
Check skin prior to and after application
Check temp of paraffin (125-130*)
Application of Whirlpool
Fill tank w/water at 100-108*; if treating burns, water should be set at body temp
Maintain sterile technique
Treatment lasts 20min
Benefits and Precautions of Cryotherapy
Benefits
Relieves pain; controls edema; decreases abnormal tone; facilitates muscle tone; treats acute injuries and postsurgical repairs
Precautions
Do not use with sensory deficit including hypersensitivity; impaired circulation; Raynaud’s disease
Application of Ice Pack
Check skin prior to and after application
Apply wet/dry towel between client’s skin and cold pack
Check after 3-5min
Use for up to 10min Ice massage- used for smaller areas; applied directly to skin for 3-5min
Electrical Stimulation Benefits and Precautions
Benefits
Pain control; decreases swelling; stimulates and strengthens muscles; muscle reeducation; stimulates denervated muscles
Precautions
Cardiac pacemaker; phrenic or urinary bladder stimulators; presence of thrombosis or thrombophlebitis; over carotid sinus
General Contraindications for PAMs
Cancer
Pacemaker
Pregnancy
Cognitive Impairment
Sensory Impairment
Vascular Impairment
DVT
Treatment for Swan-Neck Deformities
Treatment
Daily ROM to each finger joint and gentle stretches for the PIP joints and intrinsics
Splinting
Three-point finger splint for the PIP joint to prevent hyper-ext
Methods to Avoid
Isotonic, isometric, and resistive exercise
Boutonniere Deformity
Treatment
Daily ROM to each finger joint, gentle assisted and active ext of the PIP joints, and active DIP flx with the PIP extended
Splinting
Ext mobilization or resting splints for the PIP joints
Methods to Avoid
Isotonic, isometric, and resistive exercise
Trigger Finger
Treatment
Tendon protection techniques- heat/ice inflammation
Splinting
Trigger finger splint
Avoid
Repetitive gripping activities
MP Ulnar Drift
Treatment
Daily ROM to MP joints with emphasis on MP ext and radial deviation; joint protection techniques
Splinting
Soft ulnar deviation splints during the day; immobilization splints with MP joints in neutral deviation and 30* flx at night
Avoid
Isotonic, isometric, and resistive exercise; positions of deformity
MP Volar Subluxation-Dislocation
Treatment
AROM of MP joints emphasizing ext; joint protection techniques
Splinting
Resting splints at night
Avoid
Positions of deformity
Wrist Subluxation
Splinting
Wrist support during the day and immobilization splint at night
Sexual Positioning for Spasticity
Lying on affected side while propped w/pillows allows the unaffected right extremities to remain free, and provides weight bearing to the affected side to assist with tone reduction.
The pillows behind the individual allow support, and the individual may lean against the pillows to also provide pressure relief as needed to the affected side, because sensation may be reduced on that side along with movement.
To improve extension of the PIP for functional use of the hand, what is the BEST use of limited therapy time?
prefabricated dynamic PIP extension assist splint
Arthrogryposis
characterized by joint contractures.
Angled utensils promote independence with feeding by allowing a client with contractures in the arms and hands to put food into the mouth.
A client with a chronic median nerve compression at the carpal tunnel has severely diminished functional pinch. In what position should the thumb be splinted to facilitate functional pinch?
The thumb should be splinted in opposition and palmar abduction to facilitate thumb-to-tip prehension.
A client sustained partial-thickness and deep-thickness burns over a total body surface area of 60%, including bilateral arms and legs. Which factors should the COTA® focus on in the acute phase of burn intervention?
Reducing edema
Prevent the development of deformity and contracture.
Independence in ADL skills can improve the client’s sense of control and promote improved ROM.
