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OT Process > Biomechanical Approaches > Flashcards

Biomechanical Approaches Flashcards

1
Q

Biomechanical Approach

A

Focuses on ROM, strength & endurance req to perform na occ; most commonly used to tx patients w LMN deficits & othro probs. Should NOT be used in isolation, most effected when paired with other approaches that focus on engagement. Settings most commonly seen: hand clinics, work programs, phys med & rehab depts & ergo programs

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2
Q

ROM

A

Goniometer: end/starting position WFL (fx;al) or WNL. Bony landmarks as reference points.

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3
Q

Fx ROM

A

ROM needed to perform fx’al mvmts

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4
Q

AROM vs PROM

A

A: contractile structures-mvmt produced by ones own muscle. B: noncontracticle structures-mvmt produced by ex force

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5
Q

AAROM

A

Mvmt produced by one own muscle & ex force

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6
Q

Finger ROM

A

TAM: tot active motion & TPM: tot passive motion

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7
Q

Dynamometer

A

Grip strength; Shoulder adducted to side, elbow flexed at 90 and forearm in neutral. Mean of 3x. Sphymomanometer cuff or vigormeter/bulb dynamometer used for person w arthritis

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8
Q

Cervical Spine ROM

A

Flex, Exten & Lat flex: 45; Rotation: 60

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9
Q

Thoracic/Lumabr Spine ROM

A

Flex: 80; Exten: 30; Lat flex: 40; Rotation: 45

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10
Q

Shoulder ROM

A

Flex/Abduction: 170; Exten: 60; Adduction: 0; Horiz Abduction: 40; Horiz Adduction: 130; In rot: 60-70 & Ex rot: 80-90

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11
Q

Elbow ROM

A

Flex: 0-135-150; Exten: 0

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12
Q

Forearm ROM

A

Pro/Sup: 0-80-90

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13
Q

Wrist ROM

A

Flex: 80; Exten: 70; Ulnar dev: 30; Radial dev: 20

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14
Q

Thumb ROM

A

DIP flex: 0-80-90; MP flex: 0-50; Adduction: 0; Palmar/radial abduction: 0-50; opposition: composite motion

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15
Q

Finger ROM

A

MP flex: 0-90; MP hyper exten: 0-15-45; PIP flex: 0-110; DIP: flex: 0-80; Abduction: 0-25

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16
Q

Pinchmeter

A

For pinch strength; Position of UE: shoulder adducted to side, elbow at 90 and forearm in neutral. Lat pinch, 3 jaw chuck & tip 2 tip. Mean of 3 trials.

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17
Q

Edema types

A

Pitting: acute; Brawny: chronic

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18
Q

Figure 8 Method

A

Most reliable for measuring full hand - w tape measure in cm

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19
Q

Volumeter

A

Used to record hand/arm mass. Measured in millileters; Sig changes in edema=greater than 10mL > only true objective tool

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20
Q

Sensory Testing

A

Demo w vision - then occlude. Uninvolved side first. Stim to volar and dorsal surfaces. SCI tested prox to distal. Peripheral nerve injuries tested distal to prox. Light touch, localization, pain, temp, stereognosis, moving/static 2pt discrim, proprioception & kinesthesia

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21
Q

Purdue Pegboard

A

Test of finger dexterity and assembly of job simulation. 3sec: R, L, Both & 1min: assesmbly

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22
Q

Minnesota Manual Dexterity Test

A

Test of gross hand/arm mvmts. Placing test: rate of hand mvmts - 1 hand only; Turing test: rate of finger manipulation - bilat

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23
Q

O’Conners Tweezer Test

A

Eye-hand coordination - pin placing w tweezers

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24
Q

Crawford Small Parts Dexterity Test

A

Test of FM dexterity using small tools (tweezers/screwdriver)

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25
Q

Nine Hole Peg Test

A

Finger Dexterity; each hand places 9 pegs in square board and then removes - Purdue is preferred

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26
Q

Jebson Hand Fx Test

A

7 subtests: writing, sim page turning, picking up common objects, sim feeding, stacking, picking up large light & heavy objects

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27
Q

Informal Assessment of Coordination Should Include

A

FM: handwriting, manipulation, money handling, cutting foods & buttons; GM: tossing ball, reaching in cabinets, dressing

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28
Q

Passive ROM

A

Moving the joint to the desired range using ex force. Can be performed by therapist gently moving extremity. Passive stretching is PROM w overpressure. MUST review physicans orders. Heat prior helps ROM.

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29
Q

Codmans Ex

A

Pendulum exercises akaCodman’s exercises are intended to be a passive motion of the shoulder. The momentum of the movement of the body should be the driving force for the gentle swinging of the arm -PROM

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30
Q

Active ROM

A

Should be performed when PROM is greater than ROM. Tendon gliding exercises. Blocking ex: used to isolate individual joint motion. Emp fx’al use.

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31
Q

Increasing Strength

A

High resistance, low reps. Isometrics & isotonics

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32
Q

Isometrics

A

contraction w/o mvmt - sometimes can produce more forceful contraction & are contraindicated for ppl w HTN, cardiovas probs since can increase HR/BP

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33
Q

Isotonics

A

Contraction w movement.
Eccentric - lengthening & Concentric - shortening
Utilized when move limbs: curls - slight more force to initiate contraction but force does not change while contracting

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34
Q

Increasing Endurance

A

Work at 50% of max resistance or less. Increase reps/duration, not resistance - e con methods

35
Q

Decreasing edema

A

Elevation, retrograde massage, manual edema mobilization (special training), compression garments (coband for digits dist to prox), cold pack (elevate too) - heat contraindicated

36
Q

Scar Mngt

A

ROM: early mobilization is most effective. Massage: circles/friction. Compression. Scar pad w compression. Splinting to prevent contractures. Edema control, esp in acute phase.

37
Q

Sensory Training

A

Desensitization/re-edu: (begin in periphery of scar) massage, textures, vibrations, 3-phase desensitization kit & fluido therapy.

38
Q

Increasing Coordination

A

Bring w GM then to FM. Choose act where ROM is in reach but challenging. Focus on accuracy/speed beginning w gross/slow.

39
Q

E-con & Work Simplification Principles

A

Plan short rest periods during activities. Schedule & balance light/heavy. Avoid multiple trips and use equipment if needed. Elim non-essential tasks. Delegation. Sit for counter-top work. Organize cabinets so freq used objects are easy to reach. AE & electrical appliances. Slide rather than lift heavy objects. Rest before/after work.

40
Q

Joint Protection Principles

A

Maintain joint ROM/mus strength by using max ROM/strength during daily acts. Use strongest/largest joints for task completion - knees/hip for lifting, push rather than pull, lift w both hands. Avoid holding joints in 1 position/deformity positions for extended periods. Use AE.

41
Q

Body Mechanics Principle

A

Do not move objects that are too heavy, ask for help. Slide or push object rather than lift. Directly face object that is about to be lifted. Keep object close to the body while lifting & hold at waist level. Feet flat and maintain firm/broad base of support. Bend at knees/hips not waist w back as straight as possible. Breathe while lifting. Lift by straightening legs. Move slowly & do not rotate trunk. Lower body to level of work.

42
Q

Static vs Dynamic Splint

A

S: no resilient components & immobilizes a joint or part.
D: Includes resilient component (elastic, rubberband or spring) which the individual moves > designed to increase PROM or increase ROM

43
Q

Splinting purposes

A

Rest, prevent deformities/contractures, increase joint ROM, protect bone, joint & soft tissue & increase fx’al use.

44
Q

Hand Splinting Design Standards

A

Maintain arches of hand: prox, transverse & longitudinal. Do not impinge upon hand creases: dis/prox palmar, dis/prox wrist & thenar.

45
Q

Mechanical Principles of Splinting

A

Decrease pressure: wide/long splint base is most desirable w rounded edges. Sling applied w 90 angel of pull. Use low load to increase duration. Avoid position of deformity: wrist flex, MCP hyperexten, IP joint flex, thumb adducted.

46
Q

Resting Hand Splint: Fx’al Position

A

Wrist: 20-30 ex., MCP: 30-45 flex., IPs: 0-20 flex & Thumb abducted.

47
Q

Safe Position Splint (intrinsic plus or anti-deformity splint)

A

Wrist: 20-40 ex., MCPs: 70-90 flex, IPs in exten & thumb abducted/extended

48
Q

Splinting Precautions

A

Check skin integrity before and after. Instruct/edu on wear procedures. Provide fx’al training in use for fx’al acts. Re-eval use

49
Q

Splint for brachial plexus injury

A

Flail arm splint

50
Q

Splint or radial nerve palsy

A

Dynamic wrist, finger and thumb exten splint

51
Q

Median nerve injury splint

A

Opponens splint, C-bar or thumb post splint.

52
Q

Ulnar nerve injury splint

A

Dynamic/static splint to position MPs in flexion

53
Q

Combo median ulnar splint

A

Fig 8 or dynamic MCP flex splint

54
Q

SC (C6-7) Splint

A

Tenodesis Splint

55
Q

Carpal Tunnel Splint

A

Wrist splint positioned in neutral

56
Q

Cubital Tunnel Splint

A

Elbow splint at 30 flex

57
Q

DeQuervains Splint

A

Thumb splint, includes wrist, IP joint free

58
Q

Skiers Thumb Splint

A

UCL - hand based thumb splint

59
Q

CMC Arthritis Splint

A

Hand based thumb splint

60
Q

Ulnar Drift Splint

A

Ulnar Drift Thumb Splint

61
Q

Flexor tendon injury splint

A

Dorsal protection splint

62
Q

Swan Neck Splint

A

Silver rings or buttonhole splint

63
Q

Boutonniere Splint

A

Silver rings or PIP ex splint

64
Q

Arthritis Splint

A

Fx’al splint or safe splint - depending on stage

65
Q

Flaccidly Splint

A

Resting Splint

66
Q

Spasticity Splint

A

Spasticity or cone splint

67
Q

Hand Burns Splint

A

Wrist: 15-30 ex, MCP 50-70 flex, and IPs full exten

68
Q

PAMs

A

Not appropriate when only used. Appropriate if the precede, support or enable individuals ability to perform purposeful acts or occs. Preparatory intervention method. Many states req special training.

69
Q

Superficial cooling vs heating agents

A

C- cold packs, ice massage; H- paraffin, hot packs or fluidotherapy

70
Q

Mechanotherapy

A

Ultrasound or whirlpool therapy

71
Q

E-Stim units

A

NMES: neuromus electrical stim; TENS: trasncutaneous electrical nerve stim; HVGS: high volt galvonic stim or Iontophoresis

72
Q

Types of hear transfer

A

Conduction: hot packs, whirlpool, paraffin (1cm). Convection: fluidotherapy. Radiation: laser. Conversion: ultrasound - heats deeper structures (4-5cm)

73
Q

Benefits vs Precautions w Heat

A

B: relieves pain, increases tissue extensibilty, assists w wound healing by increasing blood flow & decreases musc spasm. P: postsug repairs, acute injuries, impaired sensation & impaired vascular supply.

74
Q

Hot Packs

A

Check skin prior/after. Check temp: 165F is standard. 4 layers over heat pack. Check skin every 5min. Hot pack removed after 20min

75
Q

Paraffin

A

Check skin prior/after. Check temp: 125-130F is standard. Wash/thoroughly dry. Dip/pull out 8-12x, then wrap hand in cellophane and cover w towel.

76
Q

Fluidotherapy

A

Preheat machine between 102-118. Adjust blowers to sensitivity. 20min w ther ex.

77
Q

Whirlpool

A

To clean/debride wounds. Fill tank w H20 at 100-108F. Maintain sterile tech. 20min tx.

78
Q

Benefits vs Precautions of Cryotherapy

A

B: Relieves pain, controls edema, decreases abnorm tone, facilitates muscle tone & commonly used for post surg/acute injuries. P: no w sensory defs, impaired circulation or raynauds.

79
Q

Ice Pack

A

Check skin prior and after. Apply towel (dry/wet) between skin and cold pack. Check skin after 3-5min - 10min tx; Ice massage is directly to skin for 3-5min

80
Q

Benefits vs Contraindications for e-stim

A

B: pain control, decreased swell, stim/strengthens muscle, muscle re-edu & stim denervated mus. C: cardiac pacemaker, phrenic/unirary bladder stims, presence of thrombosis/thrombophlebitis or over carotid sinus.

81
Q

Ultrasound

A

Continuous (thermal) or pulsed (non-thermal). Benefits of continuous: increased tissue extensibility, pain reduction, increased blood flow and tissue permiability, reduces muscle spasms & reaches deeper. Benefits of pulse: decrease inflam /heal tissue.

82
Q

Contraindications for Ultra Sound

A

Active malignant tumor, pregs, area near pacemaker, some joint replacements, thrombophlebitis & precautions: fxs, growth plates and breast implants.

83
Q

General PAMS Contradictions

A

Cancer, pacemaker, pregs, cog impair, sensory impair, vascular impair or DVT.

OT Process (16 decks)

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