Chapter 11 Biomechanical Approaches Evaluation and Intervention Flashcards
1
Q
Biomechanical Frame of reference
A
- focuses on the range of motion, strenth, and endurance required to perfom an occupation
- used to treat patients with lower motor neuron deficits and orthopedic problems
- this approach is most effective when used in compbinaton with other OT treatment approaches with the focus on the client’s engagement in meaningful occupations and desired purposeful activities.
- Example of settings - hand clinics, work programs, physcial medicine and rehabilitatin, ergonomic programs
2
Q
Types of ROM
- Functional ROM
- AROM
- PROM
- AAROM
- Finger ROM
A
- Functional ROM - ROM needed to perform functional movements (reach top of head, small of back)
- AROM - active ROM (contractile structures) movement produced by one’s own muscle
- PROM - Passive ROM (noncontractile structures) movement produced by an external force
- AAROM - active assisted ROM, movement produced by one’s own muscles and asssested by an external force.
- Finger ROM - total active motion (TAM) and total passive motion (TPM).
3
Q
- WFL
- WNL
A
- WFL - ROM is functional
- WNL - achieves normal ranges (recorded with specific degress)
4
Q
MMT testing grading system
- 5
- 4
- 4-
- 3+
- 3
- 3-
- 2
- 2-
- 1
- 0
A
- 5 :Normal. the part moves through full ROM against gravity and takes maximal resistance
- 4: Good. the part moves through full ROM against gravity and takes moderate resistance
- 4- : Good minus. the part moves throught full ROM against gravity and takes less than moderate resistance
- 3+ : Fair plus. the part mvoes throught full ROM against gravity and takes minimal resistance before it breaks
- 3 : Fair. The part moves throught full ROM against gravity and is unable to take any addes resistance
- 3- : Fair minus. The part moves less than full range of motion against gravity
- 2 : Poor. The part moves throught full ROM in a gravity-eliminated plane with no added resistance.
- 2- : Poor minus. The part moves less than full ROM in a gravity-eliminated plane.
- 1 : Trace. Tension is palpated in the muslce or tendon, but no motion occurs at the joint.
- 0 : Zero. No tension is palpated in the muscle or tendon.
5
Q
Edema
- description
- Types
- evaluation
A
- description - body’s resonse to injury where the fluid from the blood stream moves to the interstitial tissue. can be localized or diffuse
- Types -
- pitting - acute
- brawny - chronic
- Evaluation - tape measure, compare extremities, or measure using volumeter. Significant change in edema would be more than 10 ml
6
Q
Testing sensation
- Spinal cord injuries
- peripheral nerve injuries
A
- Gereral Sensory testing
- Demo test with vision, then occulud vision for actual testing.
- Test uninvolved side first
- SCI - test proximal to distal
- Peripheral nerve injuries - test distal to proximal following dermatomes.
- assess for nerve involvment. Order of return: Pain, moving touch, static light touch, and touch localization
7
Q
Type of Sensory Testing
- Light touch
- localization
- pain
- temperature
- stereognosis
- moving two point discrimination: disk-criminator or caliper
- static 2 point discrimination: disk-criminator or caliper
- Proprioception: position sense
- Kinesthesia
A
- Light touch - cotton swab person responds “yes” or “touched”
- Localization - with person’s vision occluded touch an area, then with vision, point to area touched
- Pain - person responds sharp or dull when touched, vison occluded
- Temperature - test tubes, person responds hot or cold
- Stereognosis -recognition by touch (second set of identical common objects shoudl be used for individuals with expressive aphasia
- Moving 2 point discrimination - applied proximal to distal on finger tips in a horizontal orientation. starts with points 5-8mm apart. person responds with the number of points they feel “one” or “two”. Normal is 2mm
- Static 2 point discrimination - test begins at 5mm.applied to finger tips in a longitudinal orientation. person responds with the number of points they feel “one” or “two”. Normal is 5mm.
- Proprioception - poisition sense. Therapists positions involved extremity, person duplicates position with contralateral extremity.
- Kinesthesia - Movement sense. Therapists moves segment or involved extremities with eyes occluded. person responds “up” or “down”
8
Q
Coordination/Dexterity assessments
- Purdue Pegboard
- Minnesota Manual Dexterity Test
- 9 Hole Peg Test
- Informal assessment of coordination should include
A
- Purdue Pegboard - Test of fingertip dexterity and assembly job simupation. Score the number of pins that are placed on the board in 30 seconds. Assembly score is the number of parts assembled during one min.
- Minnesota Manual Dexterity Test - tests of gross hand and arm movements. Placing tests measures rate of hand movements. Turning test: measures rate of finger manipulation. Score the time it takes to complete board.
- 9 hole peg test - measure finger dexterity. Score is tiem for each hand to place 9 pegs in square board and remove them. (Purdue Pegboard is performed because it’s unilateral and bilateral)
- Informal assessment of coordination -
- fine motor - observation of routine task performance, manipulation of various sized objects, handling money, handwriitng, cuttin gfood, buttoning etc.
- gross motor - observation that inclue gross motor movments, tossing a ball, reaching into cabinets for ites, dressing etc.
9
Q
Intervention
Increasing Range of Motion
- Passive ROM and passive stretching
- Active ROM
- Precuations
A
- Passive ROM and passive stretching -
- Active ROM - should be performed wwhen PROM is breater than AROM.
- tendon gliding exercises - differentiates tendon movment and increases tendon excursion
- blocking exercises - used to isloate indiviaul joint motion
- Purposeful ADL, crafts, games and sports. emphasize functional use preparatory wall walking, AROM, cane axercises, etc.
- Precautions - Myositis ossifican may result from over stretching
10
Q
Intervention
Increasing strength
- Isometrics
- Isotonic
A
- high resistance, low repetitions
- type of contracitons
- Isometric - Contraction without movment. Sometimes can produce more foreceful contractions.Isometrics are contraindicated for persons with hypertention and cardiovascular problems as they can increase blood pressure and heart rate!
- Isotonic - contraction wtih movment. eccentric = lengthening, concentric = shortening
11
Q
Interventions
Increasing Endurance
A
- work at 50% of maximal resistance or less
- increase repetitions and duration, not resistance.
- use energy conservation methods
12
Q
Interventions
Edema Reduction Techniques
A
- Elevation - extremity placed above the heart. contraindicated if individual has circulation problems.
- retrograde massage - assists the return of blood and lyphatic fluids to the venous system, stroking is applied in centripetal direction, massage performed with extremity elevated.
- Compression garments - prevents re-accumulation of fluids folliwng retrograde massage (isotoner glove, stockinet with elastic, ace wraps, custom made compression garments, coban wrap)
- Coldpacks - effective when combined with elevation, need to monitor vasular status.
- contrast bath - Alternate immersing the hand in warme and cold water.
- Containdications/Precautions - Heat. infection, grafts or wounds, vascular damage, unstable fractures, Congestive Heart failure (CHF)
13
Q
Interventions
Scar Management
A
- ROM - early mobilization programs are most effective,
- Massage - circular and friction massage.
- Compression - coban for digits, isotoner glove for the nad and tubigrip for the upper extremity
- Scar pad with compression (otoform, elastomer, topigel are common scar pads)
- Splinting to prevent contractures resulting from scar
- Edema control (especially in acute phase)
14
Q
Interventions
Sensory Training
- Desensitization
- Sensory re-education
- compensation
A
- Desensitization - s/p surgery - begin in peripherphy of the scar as tolerated work over scar, massage, textures, vibration, fluidotherapy
- Sensory re-educaiton - Massage, textures, vibrations, three phase desensitation kit
- compensations - educate on using hands with visual cues. avoid using hands when vision is occluded. observe safety precautions.
15
Q
Inteventions
Improving Coordination
A
- begin with gross motor activities and drade up to fine motor activities.
- select activities in which ROM required is withing the person’s reach and yet challenging
- fous on acuracy and speed, begin with slow gross movements and gradually progress to faster precise movements.
21
Q
Hand Splinting standards
A
- Maintain arches of the hand
- proximal transverse arch
- distal transverse arch
- longitudinal arch
- Do not impinge upon creases of the hand
- distal and proximal palmar creases
- distal and proximal wrist creases
- thenal crease
27
Q
Splints for common diagnoses
- CMC arthritis
- Ulnar drift
- Flexor tendon injury
- Swan neck
- Boutonniere
A
- CMC arthritis - hand based thumb splint
- Ulnar drift - Ulnar drift splint
- Flexor tendon injury - Kleinert or Duran dorsal protection splint (dorsal block splint so fingers can’t extend very far)
- Swan neck - silver rings or buttonhole splint (to prevent hyperextension of PIP joint)
- Boutonniere - silver rings or dynamic PIP extension splint (to prevent flexion of PIP joint)
