Biomechanical Approaches Flashcards
Biomechanical Approach
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
ROM
Goniometer: end/starting position WFL (fx;al) or WNL. Bony landmarks as reference points.
Fx ROM
ROM needed to perform fx’al mvmts
AROM vs PROM
A: contractile structures-mvmt produced by ones own muscle. B: noncontracticle structures-mvmt produced by ex force
AAROM
Mvmt produced by one own muscle & ex force
Finger ROM
TAM: tot active motion & TPM: tot passive motion
Dynamometer
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
Cervical Spine ROM
Flex, Exten & Lat flex: 45; Rotation: 60
Thoracic/Lumabr Spine ROM
Flex: 80; Exten: 30; Lat flex: 40; Rotation: 45
Shoulder ROM
Flex/Abduction: 170; Exten: 60; Adduction: 0; Horiz Abduction: 40; Horiz Adduction: 130; In rot: 60-70 & Ex rot: 80-90
Elbow ROM
Flex: 0-135-150; Exten: 0
Forearm ROM
Pro/Sup: 0-80-90
Wrist ROM
Flex: 80; Exten: 70; Ulnar dev: 30; Radial dev: 20
Thumb ROM
DIP flex: 0-80-90; MP flex: 0-50; Adduction: 0; Palmar/radial abduction: 0-50; opposition: composite motion
Finger ROM
MP flex: 0-90; MP hyper exten: 0-15-45; PIP flex: 0-110; DIP: flex: 0-80; Abduction: 0-25
Pinchmeter
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.
Edema types
Pitting: acute; Brawny: chronic
Figure 8 Method
Most reliable for measuring full hand - w tape measure in cm
Volumeter
Used to record hand/arm mass. Measured in millileters; Sig changes in edema=greater than 10mL > only true objective tool
Sensory Testing
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
Purdue Pegboard
Test of finger dexterity and assembly of job simulation. 3sec: R, L, Both & 1min: assesmbly
Minnesota Manual Dexterity Test
Test of gross hand/arm mvmts. Placing test: rate of hand mvmts - 1 hand only; Turing test: rate of finger manipulation - bilat
O’Conners Tweezer Test
Eye-hand coordination - pin placing w tweezers
Crawford Small Parts Dexterity Test
Test of FM dexterity using small tools (tweezers/screwdriver)
Nine Hole Peg Test
Finger Dexterity; each hand places 9 pegs in square board and then removes - Purdue is preferred
Jebson Hand Fx Test
7 subtests: writing, sim page turning, picking up common objects, sim feeding, stacking, picking up large light & heavy objects
Informal Assessment of Coordination Should Include
FM: handwriting, manipulation, money handling, cutting foods & buttons; GM: tossing ball, reaching in cabinets, dressing
Passive ROM
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.
Codmans Ex
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
Active ROM
Should be performed when PROM is greater than ROM. Tendon gliding exercises. Blocking ex: used to isolate individual joint motion. Emp fx’al use.
Increasing Strength
High resistance, low reps. Isometrics & isotonics
Isometrics
contraction w/o mvmt - sometimes can produce more forceful contraction & are contraindicated for ppl w HTN, cardiovas probs since can increase HR/BP
Isotonics
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
Increasing Endurance
Work at 50% of max resistance or less. Increase reps/duration, not resistance - e con methods
Decreasing edema
Elevation, retrograde massage, manual edema mobilization (special training), compression garments (coband for digits dist to prox), cold pack (elevate too) - heat contraindicated
Scar Mngt
ROM: early mobilization is most effective. Massage: circles/friction. Compression. Scar pad w compression. Splinting to prevent contractures. Edema control, esp in acute phase.
Sensory Training
Desensitization/re-edu: (begin in periphery of scar) massage, textures, vibrations, 3-phase desensitization kit & fluido therapy.
Increasing Coordination
Bring w GM then to FM. Choose act where ROM is in reach but challenging. Focus on accuracy/speed beginning w gross/slow.
E-con & Work Simplification Principles
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.
Joint Protection Principles
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.
Body Mechanics Principle
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.
Static vs Dynamic Splint
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
Splinting purposes
Rest, prevent deformities/contractures, increase joint ROM, protect bone, joint & soft tissue & increase fx’al use.
Hand Splinting Design Standards
Maintain arches of hand: prox, transverse & longitudinal. Do not impinge upon hand creases: dis/prox palmar, dis/prox wrist & thenar.
Mechanical Principles of Splinting
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.
Resting Hand Splint: Fx’al Position
Wrist: 20-30 ex., MCP: 30-45 flex., IPs: 0-20 flex & Thumb abducted.
Safe Position Splint (intrinsic plus or anti-deformity splint)
Wrist: 20-40 ex., MCPs: 70-90 flex, IPs in exten & thumb abducted/extended
Splinting Precautions
Check skin integrity before and after. Instruct/edu on wear procedures. Provide fx’al training in use for fx’al acts. Re-eval use
Splint for brachial plexus injury
Flail arm splint
Splint or radial nerve palsy
Dynamic wrist, finger and thumb exten splint
Median nerve injury splint
Opponens splint, C-bar or thumb post splint.
Ulnar nerve injury splint
Dynamic/static splint to position MPs in flexion
Combo median ulnar splint
Fig 8 or dynamic MCP flex splint
SC (C6-7) Splint
Tenodesis Splint
Carpal Tunnel Splint
Wrist splint positioned in neutral
Cubital Tunnel Splint
Elbow splint at 30 flex
DeQuervains Splint
Thumb splint, includes wrist, IP joint free
Skiers Thumb Splint
UCL - hand based thumb splint
CMC Arthritis Splint
Hand based thumb splint
Ulnar Drift Splint
Ulnar Drift Thumb Splint
Flexor tendon injury splint
Dorsal protection splint
Swan Neck Splint
Silver rings or buttonhole splint
Boutonniere Splint
Silver rings or PIP ex splint
Arthritis Splint
Fx’al splint or safe splint - depending on stage
Flaccidly Splint
Resting Splint
Spasticity Splint
Spasticity or cone splint
Hand Burns Splint
Wrist: 15-30 ex, MCP 50-70 flex, and IPs full exten
PAMs
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.
Superficial cooling vs heating agents
C- cold packs, ice massage; H- paraffin, hot packs or fluidotherapy
Mechanotherapy
Ultrasound or whirlpool therapy
E-Stim units
NMES: neuromus electrical stim; TENS: trasncutaneous electrical nerve stim; HVGS: high volt galvonic stim or Iontophoresis
Types of hear transfer
Conduction: hot packs, whirlpool, paraffin (1cm). Convection: fluidotherapy. Radiation: laser. Conversion: ultrasound - heats deeper structures (4-5cm)
Benefits vs Precautions w Heat
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.
Hot Packs
Check skin prior/after. Check temp: 165F is standard. 4 layers over heat pack. Check skin every 5min. Hot pack removed after 20min
Paraffin
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.
Fluidotherapy
Preheat machine between 102-118. Adjust blowers to sensitivity. 20min w ther ex.
Whirlpool
To clean/debride wounds. Fill tank w H20 at 100-108F. Maintain sterile tech. 20min tx.
Benefits vs Precautions of Cryotherapy
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.
Ice Pack
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
Benefits vs Contraindications for e-stim
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.
Ultrasound
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.
Contraindications for Ultra Sound
Active malignant tumor, pregs, area near pacemaker, some joint replacements, thrombophlebitis & precautions: fxs, growth plates and breast implants.
General PAMS Contradictions
Cancer, pacemaker, pregs, cog impair, sensory impair, vascular impair or DVT.
