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OT EXAM > Biomechanical Approaches: Eval and Intervention > Flashcards

Biomechanical Approaches: Eval and Intervention Flashcards

1
Q

biomechanical approach

A
  • ROM, strength, and endurance
  • commonly used for patients with lower motor neuron deficits or orthopedic problems
  • settings commonly used in
    • hand clinics
    • work programs
    • physical medicine and rehab departments
    • ergonomic programs
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2
Q

conditions when therapists should consult with physician before doing ROM

A
  • bone metastasis
  • unhealed fracture or recent disolocation
  • infection
  • postsurgery
  • myositis ossificans
  • subluxed or unstable joints
  • skin grafts
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3
Q

MMT

A

Stabilization- proximal to the joint the muscles crosses over, do not hold over muscle belly being tested

Resistance- apply in opposite direction of movement

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4
Q

grip strength

A
  • uses dynamometer
  • UE positioning: shoulder adducted to side, elbow flexed to 90, forearm in neutral
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5
Q

types of grip tests

A

dynamometer
- place on position 2
- mean of 3 trials of each trial is compared to norms

one trial in all 5 positions for each hand
- bell curve used if person is applying maximal effort

sphygmomanometer cuff/ bulb dynamometer
- used to evaluated grip strength for person w/ arthritis

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6
Q

pinch strength

A
  • uses pinchmeter
  • UE positioning: shoulder adducted to side, elbow flexed to 90, forearm in neutral
  • 3 trials on each hand for all pinch strengths
  • mean of 3 trials on each hand is compared to norms
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7
Q

types of pinch strength tests

A

key/lateral pinch
three jaw chuck (palmar pinch)
tip to tip

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8
Q

edema measurement

A

eval for circumference
- use tape measure in cm
- compare extremities, document landmarks
- measure whole hand, use figure 8 method

eval for hand and arm mass
- use volumeter in milliliters (mL)
- significant change would be more than 10 mL

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9
Q

MMT grades

A
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10
Q

measuring sensation

A
  • demonstrate test with vision, then occlude vision for actual testing
  • test uninvolved side first, apply stimulus to volar/dorsal surface
  • peripheral nerve injuries assess for peripheral nerve involvement
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11
Q

peripheral nerve order of return

A

pain
moving touch
static light touch
touch localization

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12
Q

standard application procedures for sensory testing

A

spinal cord injuries
- proximal to distal
neurological disorders
- dermatome patterns
peripheral nerve injuries
- distal to proximal

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13
Q

types of sensory testing

A

light touch- yes or no

localization- yes and points area touched with vision

pain (protective sensation)- sharp or dull

temperature sensation- hot or cold

stereognosis- recognition by touch, correct number of objects
- use identical common objects for people w/ expressive aphasia

moving 2-point discrimination

static 2- point discrimination

proprioception- position sense
- therapist positions involved extremity
- patient copies position w/ contralateral extremity

kinesthesia- movement sense
- therapist moves body part
- patient responds up or down

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14
Q

moving 2- point discrimination

A
  • uses Disk-Criminator, Boley Guage, or paper clip
  • applied proximal to distal
  • responds with one or two
  • normal is 2mm
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15
Q

static 2- point discrimination

A
  • uses Disk-Criminator, Boley Guage, or paper clip
  • applied to fingertips in longitudinal orientation
  • responds with one or two
  • normal- 5mm, poor- 11-15 mm
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16
Q

coordination/dexterity/functional assessments

A

Purdue Pegboard
- tests fingertip dexterity and assembly job simulation

Minnesota Manual Dexterity Test
- test of gross hand/arm movements

O’Connor Tweezer Test
- test of eye-hand coordination using tweezers

Crawford Small Parts Dexterity Test
- measures finger dexterity

Jebsen-Taylor Hand Function Test
- test of hand function

Michigan Hand Outcome Questionnaire
- looks at client perceptions of unilateral and bilateral functional activities

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17
Q

increasing strength

A
  • high resistance, low reps
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18
Q

isometric exercise

A

contraction without movement

  • CONTRAINDICATED FOR PEOPLE W/ HYPERTENSION AND CARDIOVASCULAR PROBLEMS
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19
Q

isotonic exercise

A

eccentric- lengthening

concentric- shortening

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20
Q

increasing endurance

A

increase repetitions, and duration
low resistance

21
Q

edema reduction techniques

A
  • elevation- extremity above heart

AVOID EXTREME POSITIONS OF ELEVATION FOR PEOPLE W/ RIGHT SIDE HEART WEAKNESS

Manual edema mobilization (MEM)
- requires specialized training
- hand on techniques that activities lympathic system to reduce edema

retrograde massage

MEM AND RETROGRADE MESSAGE IS CONTRAINDICATED WHEN CARDIAC EDEMA IS PRESENT

Compression garments
- coban wrap (digit is wrapped distal to proximal)
- used to decrease edema in digit
- can perform exercises and ADLs w/ Coban wrap

cold packs- most effective w/ elevation

contrast bath
- putting hand in warm and cold water

22
Q

Contradictions for MEM and edema reduction techniques

A
  • infection
  • grafts
  • wounds
  • vascular/circulation damage
  • blood clots
  • unstable fractures
  • CHF
  • cardiac edema
23
Q

scar management

A
  • ROM - early mobilization is most effective
  • massage (in circular motion)
  • compression
  • splinting
  • edema control (especially in acute phase)
24
Q

desensitization for hypersensitivity

A
  • massage
  • textures
  • vibration
  • desensitization kits
  • fluidotherapy
  • desensitization program (should be performed several times daily
25
Q

sensory re-education

A
  • massage
  • textures
  • vibration
  • desensitization kits
  • review safety precautions
  • loss of protective sensation
    • at high risk of injury
    • use safety precautions
    • avoid use of hand where vision is occluded
  • impaired discriminative sensation has protective sensation
    • can’t differentiate objects when vision is occluded
26
Q

improving coordination

A
  • begin w/ gross motor, them go to fine motor
  • choose activities where ROM are within reach and yet challenging
  • begin w/ slow gross movements, then to faster precise movements
  • accuracy and speed
27
Q

energy conservation and work simplification methods

A
  • short rest periods
  • balance light/heavy activities
  • organize tasks, gather all necessary items before task
  • use cart, bucket, backpack to carry items
  • sit to work at table, high stool for countertop work
  • organize cabinets so that items are easy to reach
  • reachers or AE to avoid bending
  • electrical appliances to decrease effort (mixers, electric can opener)
  • slide heavy items
  • use lightweight equipment
  • rest before fatigue sets in
28
Q

joint principles

A
  • use maximal ROM and strength during daily activities

Use strongest and largest joint possible
- use hip and knees when lifting
- push large items rather than pull
- lift w/ both hands
- carry bags on forearm not wrist

-stand directly in front of item when reaching
- use AE to hold items for long periods (book holder)
- avoids positions of deformity and activities in direction of the deformity
- don’t start activity that can’t be stopped immediately

29
Q

body mechanics

A
  • don’t move items that are too heavy
  • slide/push object instead of lifting
  • directly face object that you can about to lift
  • keep objects close to body when lifting
  • pg. 351 for more examples
30
Q

superficial thermal heat modalities

A
  • hot packs
  • paraffin
  • fluidotherapy
  • whirlpool
31
Q

types of heat transfer

A
  • conduction (hot packs and paraffin) (for superficial structures)
  • convection (fluidotherapy)
  • radiation (laser)
  • conversion (ultrasound) (FOR DEEPER STRUCTURES)
32
Q

benefits of superficial thermal therapy

A
  • relieves pain
  • increases tissue extensibility (increase ROM)
  • assists w/ wound healing
  • decreases muscle spasms
  • check skin prior and after application
33
Q

hot packs

A
  • for larger areas of body
  • temp- 104-113 degrees F
  • treatment length is 20 min
  • 4 layers of towel is required
  • check skin after 5 min
34
Q

paraffin

A
  • used to decrease stiffness and improve range of motion
  • typically used for chronic arthritic conditions, healed amputations, and strains or sprains
  • feels cooler than water at the same temperature
  • treatment time is 20 min
  • temperature is 125-130 degrees F
  • Paraffin conforms so it is ideal for use in hands and digits
  • allows for even distribution of heat to the
    treatment surface, it is easy, efficient, and inexpensive
35
Q

fluidotherapy

A
  • temperature 102-118 degrees F
  • treatment 20 min
  • typically used on distal extremities such as the feet and hands
  • allows the therapist access to the
    patient’s extremities while inside the unit to allow for PROM, joint mobilization, and manipulation
  • used for desensitization, pain, range of motion, wounds, acute injuries, swelling, and increasing blood flow
  • disadvantage is that the extremity is maintained in a dependent position.
36
Q

whirlpool

A
  • most often used as a part of wound care
  • good for graded active mobilization such as with
    clients who have wrist fractures and have been immobilized for several weeks
  • treatment 20 min
  • disadvantage is that extremity is in dependent position of the extremity
    -the hand or arm is below the level of the heart and
    may increase edema, elevate arm above heart or do fisting or pumping
37
Q

benefits of cyrotherapy

A
  • relieves pain
  • controls edema
  • decreases abnormal tone
  • facilitates muscle tone
  • used to treat acute injuries and postsurgical repairs
  • analgesic effect will last approximately 30 minutes or more
  • check skin prior and after application
38
Q

cold packs

A
  • effective and inexpensive
  • they target large or multiple areas for treatment
  • can be combined with elevation to reduce edema
  • treatment time is 10 to 20 min
39
Q

ice massage

A
  • used for targeted areas
  • smaller localized areas are more effectively treated with ice massage
  • treatment time is 3-10 min
40
Q

types of electrical stimulation

A
  • TENS- decreases pain
  • NMES- increases muscle contraction and strength
41
Q

benefits of electrical stimulation

A
  • pain control
  • decreases swelling
  • stimulates and strengthens muscles
  • muscle re-education
  • stimulates denervated muscle (muscle that loss their nerve supply)
42
Q

types of ultrasound

A

continuous (thermal)

pulsed (non thermal)

43
Q

benefits of continuous (thermal) ultrasound

A
  • increases tissue extensibility (increase ROM, decreases joint stiffness)
  • reduces pain
  • increases blood flow and tissue permeability
  • reduces muscle spasms
  • reaches deeper tissues
44
Q

benefits of pulsed (nonthermal) ultrasound

A
  • decreases inflammation
  • heals tissue
  • for acute injury
  • open wounds
  • ulcers
  • myofascial trigger points
  • fracture or bone healing
45
Q

precautions for ultrasound

A
  • Acute inflammation
    -fractures
    -breast implants
  • patient with cognitive, language or sensory impairments
46
Q

contraindications for ultrasound

A
  • pregnancy
  • tumors
  • plastic components
  • thrombophlebitis
    -area of cardiac pacemaker
  • over epiphyseal plates of children
  • malignancy or tumors
  • areas with active bleeding or
    infections.
47
Q

depth for ultrasound

A
  • 3HZ is superficial and for shorter durations
  • 1HZ is deep and for longer durations
48
Q

Phonophoresis

A
  • use of ultrasound to enhance the delivery of topically applied drugs
  • therapist must have a prescription from a physician
49
Q

Iontophoresis

A
  • method of topically delivering medication or drugs into a localized area of tissue by using
    the force of direct electrical current
  • following treatment, you need to apply a soothing lotion which is non-irritating and has a neutral
    PH such as aloe vera gel to the area.

OT EXAM (17 decks)

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