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NBCOT > Biomechanical approaches (ch 11) > Flashcards

Biomechanical approaches (ch 11) Flashcards

1
Q

The biomechanical approach focuses on….

A

ROM, strength, and endurance required to perform an occupation.

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2
Q

The biomechanical approach is commonly used to treat patients with…

A

LMN deficits and orthopedic problems

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3
Q

TAM=

A

total active motion (ROM)

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4
Q

TPM=

A

total passive motion (PROM)

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5
Q

Muscle grade 5=

A

Normal

Part moves through full ROM against gravity and takes max resistance

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6
Q

Muscle grade 4=

A

Good

Part moves through full ROM against gravity and takes mod resistance

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7
Q

Muscle grade 4- =

A

Good minus

Part moves through full ROM against gravity and takes less than mod resistance

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8
Q

Muscle grade 3+ =

A

Fair Plus

Part moves through full ROM against gravity and takes min resistance before it breaks.

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9
Q

Muscle grade 3=

A

Fair

Part moves through full ROM against gravity and is unable to take any added resistance

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10
Q

Muscle grade 3- =

A

Fair minus

Part moves less than full ROM against gravity

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11
Q

Muscle grade 2+ =

A

Poor plus

In gravity-eliminated, part moves through full ROM in and then takes min resistance and breaks

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12
Q

Muscle grade 2=

A

Poor

In gravity-eliminated, part moves through full ROM and takes no resistance

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13
Q

Muscle grade 1=

A

Trace

Tension is palpated in the muscle or tendon, but no motion occurs at the joint

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14
Q

Muscle grade 0=

A

Zero

No tension palpated in the muscle or tendon

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15
Q

Pitting edema is…

A

acute

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16
Q

Brawny edema is…

A

chronic

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17
Q

To measure edema of entire hand, most reliable method is

A

figure-of-eight method (using tape measure, start at pisform, go around back and then front over MCP joint, then back around to pisiform).

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18
Q

SCI’s are tested _____ to _____ following dermatome pattern

A

proximal to distal

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19
Q

Peripheral nerve injuries are tested ______ to ______ following peripheral nerves

A

distal to proximal

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20
Q

Using a MOVING two-point discrimination test, start points of __-__ mm apart. Normal = ___mm.

A

5-8.

Normal= 2mm

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21
Q

Using a STATIC two point discrimination test, start points at ___mm apart. Normal= ___mm.

A

start at 5mm. Normal is 5mm!

Distance between points is increased until 7/10 responses are correct. Testing stops at 15mm.

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22
Q

Purdue Pegboard (what is it? scoring?)

A

Test of fingertip dexterity and assembly job simulation.
Subtests: 30-second test (right hand, left hand, both hands); one-minute test (assembly).
Scoring: 30-second test is the number of pins placed in the board in 30 seconds. Assmbly is the number of parts assembled during one minute.

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23
Q

Minnesota Manual Dexterity Test (what is it? scoring?)

A

Test of gross hand and arm movements.
Subtests: 1. placing test (measures rate of hand movement in one hand only. 2. turning test (measures rate of finger manipulation- bilateral.
Scoring: time to complete board. One practice trial and four scored trials.

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24
Q

O’Connor Tweezer Test (what is it? scoring?)

A

Test of eye-hand coordination using tweezers

Scoring: the number of seconds to place all pins in board using tweezers.

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25
Q

Crawford Small Parts Dexterity Test (what is it? scoring?)

A

Test of fine motor dexterity using small tools (tweezers and screwdriver).
Scoring: time to complete assembly

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26
Q

Nine Hole Peg Test (what is it? scoring?)

A

Measures finger dexterity
Scoring: time for each hand to place nine pegs in a square board and remove them.
(Purdue Pegboard is preferred over the Nine Hole Peg Test because it is unilateral and bilateral, and more reliable.)

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27
Q

Jebson Hand Function Test (what is it? subtests? scoring?)

A

Test of 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

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28
Q

Informal assessment of coordination should include:

A
  • fine motor: observation of routine task performance (examples: handwriting, manipulation of various sized objects, handling money, cutting food, and buttoning)
  • gross motor: (examples: tossing a ball, reaching into cabinets for specific items, and dressing)
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29
Q

what is Codman’s exercise?

A

common form of PROM used for post-surgical shoulder patients (lean over with shoulder hanging and swing shoulder in circles).

30
Q

what are blocking exercises?

A

used to isolate individual joint motions

31
Q

what is an isometric contraction?

A

contraction without movement.
Contraindicated for patients with hypertension and cardiovascular problems. Can increase BP and HR so they should be avoided.

32
Q

what is an isotonic contraction?

A

contraction with movement.
Eccentric= lengthening
Concentric= shortening

33
Q

To increase endurance, work at ___% of maximal resistance or less. Increase ______, not _______.

A

50%

Increase repetitions/duration, not resistance.

34
Q

Edema reduction techniques

A
  • elevation
  • manual edema mobilization (special training needed)
  • retrograde massage
  • BUT NO manual edema mobilization or retrograde massage with cardiac edema!!!
  • compression garments
  • cold packs
  • contrast bath (immerse hand in warm water, and cold water)
  • other (not as common): string wrapping, ace bandage wraps, and intermittent compression pump
  • Heat is contraindicated!!
35
Q

what is Coban wrap?

A

digit is wrapped distal to proximal to decrease edema in digit. Patient can exercise and use hand for ADLs while wearing Coban.

36
Q

Static splint…

A

has no resilient components and immobilizes a joint or part

37
Q

Dynamic splint…

A

includes a resilient component (elastic, rubber band, or spring) which the patient moves. Designed to increase PROM or to augment AROM.

38
Q

Purposes of splinting:

A
  • rest
  • prevent deformities and contractures
  • increase joint ROM
  • protect bone, joint, and soft tissue
  • increase functional use
39
Q

Hand splinting design standards (2)

A

Maintain arches of the hand

Do not impinge upon creases of the hand

40
Q

Resting hand splint (functional position!)… give ROM of joints…

A
  • wrist: 20-30 deg extension
  • MCPs: 30-45 deg flexion
  • IPs: 0-20 deg flexion (“slight flexion”)
  • thumb abducted (“opposition”)
41
Q

Safe position splint (aka intrinsic=plus or anti-deformity splint)… give ROM of joints…

A
  • wrist: 20-30 deg extension (maybe 30-40… but be careful of carpal tunnel canal pressure)
  • MCPs: 70-90 deg flexion
  • IPs in extension
  • thumb abducted and extended
42
Q

Precautions and education for splints

A
  • check patient’s skin condition before and after making splint
  • instruct patient in procedures for splint maintenance and routine skin inspection/care.
  • ensure patient accepts and understands the purpose, function, and limitations of the splint.
  • teach proper technique for donning/doffing splint
  • provide functional training in use of splint in role activities
  • reevaluate patient’s use of splint periodically
43
Q

splint for brachial plexus injury=

A

flail arm splint

44
Q

splint for radial nerve palsy=

A

dynamic wrist, finger, and thumb extension splint

45
Q

splint for median nerve injury=

A

opponens splint, C-Bar or thumb post splint

46
Q

splint for ulnar nerve injury=

A

dynamic/static splint to position MPs in flexion

47
Q

splint for combined median ulnar=

A

figure-of-eight or dynamic MCP flexion splint

48
Q

splint for spinal cord (C6-C7)=

A

tenodesis splint

49
Q

splint for carpal tunnel syndrome=

A

wrist splint positioned in neutral

50
Q

splint for cubital tunnel syndrome=

A

elbow splint positioned at 30 deg flexion

51
Q

splint for DeQuervains=

A

thumb splint, includes wrist; IP joint free

52
Q

splint for Skier’s thumb=

A

(UCL) hand-based thumb splint

53
Q

splint for CMC arthritis=

A

hand-based thumb splint

54
Q

splint for ulnar drift=

A

ulnar drift splint

55
Q

splint for Swan neck=

A

silver rings or buttonhole splint

56
Q

splint for Boutonniere=

A

sliver rings or PIP extension splint

57
Q

splint for arthritis=

A

functional splint or safe splint, depending on stage

58
Q

splint for flaccidity=

A

resting splint

59
Q

splint for spasticity=

A

spasticity splint or cone splint

60
Q

splint for muscle weakness (ALS, SCI, Guillain-Barre)=

A

balanced forearm orthosis (BFO), deltoid sling/suspension sling

61
Q

splint for hand burns=

A

wrist 15-30 deg extension, MCP 50-70 deg flexion, and IPs in full extension

62
Q

Common types of Physical Agent Modalities used by entry-level OTs:

A
  • superficial thermal (paraffin, hot packs, fluidotherapy)
  • superficial cooling agents (cold packs, ice massage)
  • mechanotherapy (ultrasound, whirlpool)
  • electrical stimulation units (neuromuscular electrical stimulation; transcutaneous electrical nerve stimulator; high volt galvonic stimulation; iontophoresis).
63
Q

types of heat transfer

A
  • conduction (hot packs, whirlpool, and paraffin)
  • convection (fluidotherapy)
  • radiation (laser)
  • conversion (ultrasound)… heats deeper structures up to 4-5cms
64
Q

benefits of superficial heat therapy

A
  • relieves pain
  • increases tissue extensibility (increases ROM)
  • assists with wound healing (increased blood flow)
  • decreases muscle spasms
65
Q

precautions and contraindications for heat… DO NOT USE WITH:

A
  • postsurgical repairs
  • acute injuries
  • impaired sensation
  • impaired vascular supply
66
Q

benefits of cryotherapy (cold)

A
  • relieves pain
  • controls edema
  • decreases abnormal tone
  • facilitates muscle tone
  • commonly used to treat acute injuries and post surgical repairs
67
Q

precautions and contraindications for cryotherapy. DO NOT USE WITH:

A
  • sensory deficits including dypersensitivity
  • impaired circulation
  • Raynaud’s disease
68
Q

benefits of e-stim

A
  • pain control
  • decreases swelling
  • stimulates and strengthens muscles
  • muscle reeducation
  • stimulates denervated muscle
69
Q

contraindications for e-stim. DO NOT USE WITH:

A
  • cardiac pacemaker
  • phrenic or urinary bladder stimulators
  • presence of thrombosis or thrombophlebitis
  • over carotid sinus
70
Q

Two types of ultrasound: continuous (thermal effects) and pulsed (nonthermal effects). Benefits of each…

A

Continuous ultrasound…

  • increases issue extensibility
  • reduces pain
  • increases blood flow and tissue permeability
  • reduces muscle spasms
  • reaches deeper tissues (up to 5cms)

Pulsed ultrasound….

  • decreases inflammation
  • heals tissue
71
Q

Contraindications of ultrasound:

A
  • active malignant tumor
  • pregnancy
  • area near pacemaker
  • some joint replacements (cemented or plastic)
  • thrombophlebitis
  • precautions: fractures, growth plates, and breast implants
72
Q

General contraindications for PAMs. DO NOT USE if patient has:

A
  • cancer
  • pacemaker
  • pregnancy
  • cognitive impairment
  • sensory impairment
  • vascular impairment
  • deep vein thrombophlebitis

NBCOT (16 decks)

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