Biomechanics approaches - evaluation and intervention Flashcards
biomechanics approach
focuses on ROM, strength, endurance
should not be used in isolation
most commonly used: ortho, lower motor neuron deficits, hand clinics, work programs
ROM contraindications/restrictions
consult with physician prior with these conditions:
- bone metastasis, unhealed fracture, infection, post surgery, ossifications, subluxed joints, skin grafts
MMT positioning
gravity eliminated or against gravity
stabilize at proximal joint (do not hold over the muscle belly being tested)
sensory testing
demonstrate test with vision, then occlude vision for actual testing
test uninvolved side first to get a baseline
SCI are tested proximal to distal following dermatome pattern
neurologic disorders are tested for dermatome pattern
peripheral nerve injuries are tested distal to proximal following peripheral nerves
order of return for peripheral nerve injuries
pain, moving touch, static light touch, touch localization
purdue pegboard
tests fingertip dexterity and assembly job simulation
# of pins placed in the board in 30 seconds
minnesota manual dexterity test
test of gross hand and arm movements
scoring: time to complete the board
o’connor tweezer test
test of hand-eye coordination using tweezers
# of seconds to place all pins in the board using tweezers
crawford small parts dexterity test
test of fine motor dexterity using small tools (tweezers and screw driver)
nine hole peg test
measures finger dexterity
time for each hand to place nine pegs in a square board and remove them
henson-taylor hand function test
test of hand function
7 subtests (writing, page turning, picking up objects, simulated feeding, stacking, picking up large light and large heavy things)
michigan hand outcome questionnaire
looks at client perceptions of unilateral and bilateral functional activities
pain level, participation in h household and school activities, appearance
informal assessment of coordination
fine motor: observation of routine task performance - handwriting, manipulating objects, cutting food, buttoning, etc
gross motor: observation - tossing a ball, reaching, dressing
intervention - increasing ROM
- passive ROM
- passive stretch: PROM with overpressure
- heat/other thermal agents
- joint mobilization (special training)
- contract/relax and hold/relax
- Codman’s exercise (pendulums for post surgical shoulder)
- HEP
- dynamic or serial splinting
- active ROM (when PROM is greater than AROM)
- tendon gliding exercises
- blocking exercise (isolate a joint motion)
- emphasize functional use
- purposeful and occupation based activities
tendon gliding
flat palm
claw hand
fist thumb in
tabletop
straight finger fist thumb straight
intervention - increasing strength
- high resistance, low repetitions
- types of contractions: isometric (holding), isotonic (eccentric lengthening, concentric shortening)
contraindication for isometrics
people with hypertension and cardiovascular problems
can increase BP and HR, so they should be avoided
increasing endurance
- work at 50% of maximal resistance or less
- increase repetitions and duration, not resistance
- use energy conservation methods
edema reduction techniques
- elevation: extremity above the heart
- manual edema mobilization (requires training)
- retrograde massage: assists with return of blood and lymph fluids to the venous system - gentle stroking in centripetal direction with elevation
- compression garments
- cold packs (monitor vascular status)
contraindications for edema
- avoid extreme positions of elevation for individuals with R sided heart weakness (can cause the fluid to empty in the heart too fast)
- MEM and retrograde massage are contraindicated when cardiac edema is present
- heat is commonly contraindicated
- do not use MEM for people with infection, grafts, wounds, vascular damage, blood clots, CHF
interventions for scar management
- ROM: early mobilization
- massage
- compression
- scar pad
- splinting
- edema control
intervention - sensory training
- desensitization for hypersensitivity
- massage, textures, vibration, a program - sensory re-education
- massage, textures, vibration
- safety precautions
intervention - improving coordination
- gross motor activities
- grade up to fine motor
- select activities with ROM that is attainable and challenging
- focus on accuracy and speed (start slow and controlled, then fast and precise)
energy conservation and work simplification principles
- short rest periods during daily routine
- schedule tasks for the day/week/month to balance heavy/light
- organize everything prior
- avoid multiple trips
- eliminate and delegate
- sit
- everything in reach
- adaptive equipment
- rest before fatigue, not after exhaustion
joint protection principles
- maintain by using maximal ROM and strength
- use strongest and largest joint (knees and hips for lifting, not the back)
- good body mechanics
- don’t keep a joint in one position for too long
- modify as needed
- slide or push objects rather than lift
PAMs (physical agent modalities)
- preparatory for activities
- not appropriate used in isolation
- many states require certification/training
thermal: paraffin, hot packs, fluidotherapy
cooling: cold packs, ice massage
mechanic: ultrasound, whirlpool
electrical stim: NMES (muscles), TENS (pain), HVGS, Iontophoresis (meds)
contraindications for heat
post surgical repairs, acute injuries, impaired sensation, edema, impaired vascular supply, times, MS, lymphedema, DVT
*check skin before and after
contraindications for cryotherapy
sensory deficits, impaired circulation, Raynaud’s
contraindications for electrical stimulation
cardiac pacemaker, bladder stimulators, thrombosis over the carotid sinus
types of ultrasound and benefits
continuous (thermal) - increases ROM, reduce pain and stiffness, increase blood flow, reaches deeper tissues
pulsed (non thermal) - decreases inflammation, heals tissue
contraindications for ultrasound
- pregnancy, malignant tumor, joint replacements, thrombophlebitis, fractures, infections
- do not apply near a pacemaker, growth plates, breast implants, spinal cord, very young or old person
general contraindications for PAMs
- pregnant, cancer, cognitive impairment, sensory impairment, vascular impairment, DVT
Ayres SI approach
principles of inner drive and active involvement in the child – individualized activities based on the child’s interests
MMT grades
5 ROM AG, max res
4+ ROM AG, nearly max res
4 ROM AG, mod res
4- ROM AG, <mod res
3+ ROM AG, min res
3 ROM AG, no res
2+ more than half ROM AG
2 ROM GM
2- does not complete ROM GM
1 palpable contraction, no ROM
0 no palpable contraction
muscle grades
N Full ROM AG and full res
N - slight weakness
G + moderate weakness
G AG and mod res
F + AG and mild res
F full ROM AG
F - full ROM AG one time
P + full ROM, GE, some resistance
P full ROM GE
P - incomplete ROM GE
T contraction
0 no contraction
N = normal; G = good; F = fair; P = poor; T =trace.
