Biomechanics Flashcards
Who is the Biomechanical Approach used for?
It is used for children with neurologically based movement disorders eg., cerebral palsy, MS that require artificial and external support for correct positioning
What are the two aims of the biomechanical approach?
- Increase proximal stability to improve opportunity for distal functioning.
- Improve participation in occupational roles by positioning for function.
What are the main changes in body shape that occur from sleeping on your stomach?
- Flattened chest
- Side neck flexion
What are the main changes in the spine that occur from sleeping on your side?
- Scholiosis
- Kyphosis
- Lordosis
What is the ideal night time sleeping position?
Supine
What the the key areas that require support when sleeping in supine?
- Along the trunk (either side)
- Underneath the knees
- Underneath the head and neck
What is the goal of OT for children with flexible postures?
To facilitate and correct in seating.
What is the goal of OT for children with fixed postures?
Accomodate in seating and intervene in night time positioning to correct (NOT during the day)
Describe the three steps of the formal seating process
- Seating assessment
- Assess the child in supine first and then in sitting on a plinth.
- Determine child’s ROM
- As new grads, ALWAYS complete with supervision and assistance from a senior OT - Seating trial
- Determine appropriate options
- Trial these options with the child
- Decide what works best - Seating prescription
- Write an application to get funding
- Provide equipment
What are the 7 key areas that need to be considered when positioning?
- Pelvis
- Hips
- Knees
- Feet
- Trunk
- Shoulder and arms
- Head/neck
What is the ideal seating position for the pelvis?
Pelvis at the back of the seat, neutral to provide a stable base
What are some intervention options for posterior tilt? (5)
- Correct seat depth (may be too long or too short)
- Correct the height of the foot plates
- Sacral pads
- Anterior sloped seat (only when the child has trunk control)
- If fixed, use shaped back rests for comfort
What are some intervention options for obliquity? (1)
- 4x point pelvic strap
What are some intervention options for rotation? (2)
- Pelvic blocks
- Anti-thrust cushions if child has extensor thrust
What are some things to consider when utilising a pelvic strap?
- Width is important, too wide decreases functional movement whilst too narrow will cut
- Must allow for anterior pelvic tilt
What is the ideal seating position for the hips?
Thighs horizontal and supported by seat surface
What are some intervention options for hip flexion? (1)
- Tray
What are some intervention options for hip abduction? (2)
- Gullies in seat cushion
- Lateral thigh blocks
What are some intervention options for hip adduction? (2)
- Gullies in seat cushion
- Pommel
What are two things to consider with seating bases?
- Firm support increases arousal
- Medium density foam conforms and supports - reducing postural stress and hypertonicity
What is the ideal seating position for the knees?
70-90 degrees flexion
What are some intervention options for knee flexion greater than 70 degrees? (2)
- Calf supports
- Stabilising feet on footplates (heel loops, cups, straps etc)
What are some intervention options for knee extension (1)
- Stabilising feet on footplates (heel loops, cups, straps etc)
What needs to be considered when positioning feet?
The feet are supported and protected
What are some intervention options for foot instability (dorsi/plantar flexion, inversion, eversion, torsion etc.) (2)
- Consider why the feet are positioned like this - what need is it meeting?
- Straps (however should be used sparingly when other options are exhausted as it can be restrictive)
What is the ideal seating position for the trunk?
Upright and symmetrical
What are some intervention options for asymmetry of the trunk? (2)
- Lateral support (curved side cushion)
- Thoracic supports
What are some intervention options for a flexed spine/kyphosis? (5)
- Correct seat depth
- Height of foot plates
- Correct armrests
- Sacral pads
- Tray
What are some intervention options for lordosis? (1)
- Pelvic strap
What is the objective of positioning the shoulders and arms?
Neutral shoulders and arms
What are some intervention options for shoulder retraction? (2)
- Curved back cushions
- Custom contoured back
What are some intervention options for shoulder protraction? (1)
- Firm and countered back support
What are some intervention options for dangling of the upper limbs? (2)
- Adjust the height and position of the armrests
- Tray
What should be considered when administering trays for positioning?
- Trays should not be used exclusively
- Should able to be removed for interaction when possible
- Trays should be long enough for the entire arm to be supported and not fall off of the edge.
- Transparent trays are preferred so children can see the world below them too
- Consider what might happen if the the chair can be tilted
What is the ideal seating position for the head and neck?
Head aligned with the trunk, eyes in the horizontal plane
What are some intervention options for hyperextension of the head? (2)
- Proximal control
- Head and neck support
What are some intervention options for side flexion and rotation of the head? (2)
- Proximal control
- Head and neck supports with extended lateral support
