Biomechanical approaches (ch 11) Flashcards
The biomechanical approach focuses on….
ROM, strength, and endurance required to perform an occupation.
The biomechanical approach is commonly used to treat patients with…
LMN deficits and orthopedic problems
TAM=
total active motion (ROM)
TPM=
total passive motion (PROM)
Muscle grade 5=
Normal
Part moves through full ROM against gravity and takes max resistance
Muscle grade 4=
Good
Part moves through full ROM against gravity and takes mod resistance
Muscle grade 4- =
Good minus
Part moves through full ROM against gravity and takes less than mod resistance
Muscle grade 3+ =
Fair Plus
Part moves through full ROM against gravity and takes min resistance before it breaks.
Muscle grade 3=
Fair
Part moves through full ROM against gravity and is unable to take any added resistance
Muscle grade 3- =
Fair minus
Part moves less than full ROM against gravity
Muscle grade 2+ =
Poor plus
In gravity-eliminated, part moves through full ROM in and then takes min resistance and breaks
Muscle grade 2=
Poor
In gravity-eliminated, part moves through full ROM and takes no resistance
Muscle grade 1=
Trace
Tension is palpated in the muscle or tendon, but no motion occurs at the joint
Muscle grade 0=
Zero
No tension palpated in the muscle or tendon
Pitting edema is…
acute
Brawny edema is…
chronic
To measure edema of entire hand, most reliable method is
figure-of-eight method (using tape measure, start at pisform, go around back and then front over MCP joint, then back around to pisiform).
SCI’s are tested _____ to _____ following dermatome pattern
proximal to distal
Peripheral nerve injuries are tested ______ to ______ following peripheral nerves
distal to proximal
Using a MOVING two-point discrimination test, start points of __-__ mm apart. Normal = ___mm.
5-8.
Normal= 2mm
Using a STATIC two point discrimination test, start points at ___mm apart. Normal= ___mm.
start at 5mm. Normal is 5mm!
Distance between points is increased until 7/10 responses are correct. Testing stops at 15mm.
Purdue Pegboard (what is it? scoring?)
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.
Minnesota Manual Dexterity Test (what is it? scoring?)
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.
O’Connor Tweezer Test (what is it? scoring?)
Test of eye-hand coordination using tweezers
Scoring: the number of seconds to place all pins in board using tweezers.
Crawford Small Parts Dexterity Test (what is it? scoring?)
Test of fine motor dexterity using small tools (tweezers and screwdriver).
Scoring: time to complete assembly
Nine Hole Peg Test (what is it? scoring?)
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.)
Jebson Hand Function Test (what is it? subtests? scoring?)
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
Informal assessment of coordination should include:
- 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)
what is Codman’s exercise?
common form of PROM used for post-surgical shoulder patients (lean over with shoulder hanging and swing shoulder in circles).
what are blocking exercises?
used to isolate individual joint motions
what is an isometric contraction?
contraction without movement.
Contraindicated for patients with hypertension and cardiovascular problems. Can increase BP and HR so they should be avoided.
what is an isotonic contraction?
contraction with movement.
Eccentric= lengthening
Concentric= shortening
To increase endurance, work at ___% of maximal resistance or less. Increase ______, not _______.
50%
Increase repetitions/duration, not resistance.
Edema reduction techniques
- 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!!
what is Coban wrap?
digit is wrapped distal to proximal to decrease edema in digit. Patient can exercise and use hand for ADLs while wearing Coban.
Static splint…
has no resilient components and immobilizes a joint or part
Dynamic splint…
includes a resilient component (elastic, rubber band, or spring) which the patient moves. Designed to increase PROM or to augment AROM.
Purposes of splinting:
- rest
- prevent deformities and contractures
- increase joint ROM
- protect bone, joint, and soft tissue
- increase functional use
Hand splinting design standards (2)
Maintain arches of the hand
Do not impinge upon creases of the hand
Resting hand splint (functional position!)… give ROM of joints…
- wrist: 20-30 deg extension
- MCPs: 30-45 deg flexion
- IPs: 0-20 deg flexion (“slight flexion”)
- thumb abducted (“opposition”)
Safe position splint (aka intrinsic=plus or anti-deformity splint)… give ROM of joints…
- 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
Precautions and education for splints
- 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
splint for brachial plexus injury=
flail arm splint
splint for radial nerve palsy=
dynamic wrist, finger, and thumb extension splint
splint for median nerve injury=
opponens splint, C-Bar or thumb post splint
splint for ulnar nerve injury=
dynamic/static splint to position MPs in flexion
splint for combined median ulnar=
figure-of-eight or dynamic MCP flexion splint
splint for spinal cord (C6-C7)=
tenodesis splint
splint for carpal tunnel syndrome=
wrist splint positioned in neutral
splint for cubital tunnel syndrome=
elbow splint positioned at 30 deg flexion
splint for DeQuervains=
thumb splint, includes wrist; IP joint free
splint for Skier’s thumb=
(UCL) hand-based thumb splint
splint for CMC arthritis=
hand-based thumb splint
splint for ulnar drift=
ulnar drift splint
splint for Swan neck=
silver rings or buttonhole splint
splint for Boutonniere=
sliver rings or PIP extension splint
splint for arthritis=
functional splint or safe splint, depending on stage
splint for flaccidity=
resting splint
splint for spasticity=
spasticity splint or cone splint
splint for muscle weakness (ALS, SCI, Guillain-Barre)=
balanced forearm orthosis (BFO), deltoid sling/suspension sling
splint for hand burns=
wrist 15-30 deg extension, MCP 50-70 deg flexion, and IPs in full extension
Common types of Physical Agent Modalities used by entry-level OTs:
- 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).
types of heat transfer
- conduction (hot packs, whirlpool, and paraffin)
- convection (fluidotherapy)
- radiation (laser)
- conversion (ultrasound)… heats deeper structures up to 4-5cms
benefits of superficial heat therapy
- relieves pain
- increases tissue extensibility (increases ROM)
- assists with wound healing (increased blood flow)
- decreases muscle spasms
precautions and contraindications for heat… DO NOT USE WITH:
- postsurgical repairs
- acute injuries
- impaired sensation
- impaired vascular supply
benefits of cryotherapy (cold)
- relieves pain
- controls edema
- decreases abnormal tone
- facilitates muscle tone
- commonly used to treat acute injuries and post surgical repairs
precautions and contraindications for cryotherapy. DO NOT USE WITH:
- sensory deficits including dypersensitivity
- impaired circulation
- Raynaud’s disease
benefits of e-stim
- pain control
- decreases swelling
- stimulates and strengthens muscles
- muscle reeducation
- stimulates denervated muscle
contraindications for e-stim. DO NOT USE WITH:
- cardiac pacemaker
- phrenic or urinary bladder stimulators
- presence of thrombosis or thrombophlebitis
- over carotid sinus
Two types of ultrasound: continuous (thermal effects) and pulsed (nonthermal effects). Benefits of each…
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
Contraindications of ultrasound:
- active malignant tumor
- pregnancy
- area near pacemaker
- some joint replacements (cemented or plastic)
- thrombophlebitis
- precautions: fractures, growth plates, and breast implants
General contraindications for PAMs. DO NOT USE if patient has:
- cancer
- pacemaker
- pregnancy
- cognitive impairment
- sensory impairment
- vascular impairment
- deep vein thrombophlebitis
