Midterm Flashcards
The OT view of kinesiology is based on…
The Systems Oriented Approach
- looking at more than the disease or disorder
* International Classification of Functioning, Disability, and Healt (ICF)
* OT Framework
- relationship between person, environment, and occupation
How is occupational therapy occupation based?
- Occupations can act as a therapeutic change agent.
- Occupations facilitate transfer of performance skills to multiple contexts.
- Occupations are selected to enhance motivation for improving occupations.
- Occupations promote self exploration and identification of values and interests.
- Chosen therapeutic occupations start with the current capacity of the client.
- Occupations create the opportunities to practice performance skills.
- Occupations are selected to support the appropriate intervention goal.
- Engagement in occupation produces feedback to grade performance.
- Successful occupational experience is necessary for achieving goals.
List and describe the 5 domains of the OT Framework.
- Occupations
- ADLs, BADLs, IADLs
- sleep, work, play, leisure, social participation - Performance skills
- motor, process, and social skills
- building blocks of occupations - Client factors
- body function, structure, values, beliefs, and personality - Performance pattern
- habits, routines, and roles - Contexts and environment
- Physical, personal, social, temporal, and virtual
Describe the OT process.
Evaluation
- referral, assessment, based on OT profile
Intervention
- remediate, compensate, create, maintain, prevent
Outcomes
- functional outcome measures, reevaluation and adjustment of intervention
Biomechanical frame of reference
Looks at the body as a machine.
OT models based on biomechanics allow us to:
- outline and define musculoskeletal problem
- develop exercise and activities to restore and maintain function
- design and fabricate equipment to meet functional goals
- measure musculoskeletal progress
Kinesiology has 2 basic philosophies. What are they?
- Mechanistic
- mind, person is separate from the body
- similar to biomechanical - Transformative
- views the person as an open system that can adapt and change due to injury or conflict
* soft tissue responds to the stresses placed upon it
Types of fibrous joints
suture
gomphosis
syndesmosis
Types of cartilaginous joints
synchondrosis
symphysis
Synovial joints
- diarthrodial
- has a capsule
- synovial fluid
- freely movable
- highly innervated
Movement in joints
Sliding and gliding (nonaxial)
Uniaxial
Biaxial
Polyaxial
Sliding and gliding movement in joints
- Plane joint
- Carpals and metacarpals
- Often overloooked
- important for joint mobilization
- small motions add up
Uniaxial movement in joints
- Hinge (elbow)
- Pivot (radioulnar or atlantoaxial)
- flexion/extension or rotation
Biaxial movement in joints
- Ellipsoid (radial carpal, metatarsalphalange)
- Saddle (CMC)
- flexion/extension, abduction/adduction
- 2 degrees of freedom
Polyaxial movement in joints
- Multiaxial
- Ball and socket (hip, shoulder)
- three degrees of freedom
- abduction/adduction, flexion/extension, and rotation
Joint play
movement not under voluntary control (passive); can’t be achieved by active muscular contraction; movement that happens in the actual joint
Component movement
involuntary obligatory joint motion occurring outside the joint accompanies active motion, i.e. - scapulohumeral rhythm
Happens in a synergy, like scratching your head. You can override the need to scratch.
Roll
New points on one surface come into contact with new points on the other surface
Rolling only occurs when the two articulating surfaces are incongruent (concave on convex or vice versa)
Slide, glide, translate
Translatory motion in which one constant point on one surface is contacting new points or a series of points on the other surface.
Pure gliding can occur when two surfaces are congruent and flat, or incongruent and curved.
Example: carpal bones
Spin
Occurs with rotation
No forward motion.
Occurs with all joints in the transverse plane along a vertical axis.
Spins in the direction of motion.
Concave motion rule
Convex “ ( “ surface is stationary and the concave surface “ ) “ moves
Joint play will be in the same direction
Glide and roll are in the dame direction as the shaft.
Happens with flex/ext and abd/add.
Convex motion rule
Concave “ ) “ surface if stationary and convex “ ( “ surface moves.
Joint play is in the opposite direction.
Glide and roll are in the opposite direction of each other.
The roll is in the direction of the shaft, the glide is in the opposite direction.
Bone goes up, joint surface moves down.
Example: shoulder
Loose or open pack
Point of least stress on the joint surfaces.
Joint capsule and ligament are loose.
Held in place by surface tension and muscle tone.
Easy to dislocate
Can be manipulated easier.
Non-weight bearing position.
Sitting on the edge of the high table, your knee is flexed and open
2 joints come apart.
Generally found in the midrange.
Closed pack
The joint position in which articulating bones have their maximum area of contact and ligaments are the most taut.
Joint stability is greatest.
Joint is “locked.”
“Unlocking” occurs due to slides or rolls.
The close-packed position for the knee, wrist, and interphalangeal joints is at full extension and for the ankle joint at full dorsiflexion.
Easy to damage capsule or ligaments.
Contraction and weight bearing creates a closed pack.
2 joints come together.
Injury in this position is often catastrophic.
What makes a joint stable?
The shape
- ball and socket is most stable
The capsule and ligament
The more mobile a joint is, the less stable.
Muscles can be built up to help stabilize joints.
Ligament stability (sprain)
Should feel the same on both sides.
Normal (0)
1rst - stretch, hurts but normal, like a contusion
2nd - partial tear to ligament but still stable, slightly increased mobility
3RD - ligament is completely torn
Avulsion fracture
End feels
- Soft and capsular can be used together. No hard stop. (elbow flexion)
- Bony (clunk) or hard: hard stop (elbow extension)
- Springy: indicates something is stuck in the joint; labral or meniscal tear; hurts; then you stop putting pressure it jumps back
- Capsular (shoulder flexion)
- Spasm: pt has spasitity; can range from mild to severe; resisting you; like when a pt has a stroke and is locked up.
- Empty: no muscle tension, typically paralyzed
Traction and distraction
Used to open the joint
Relieve approximation
Can be used in treatment
Can be used therapeutically to increase ROM or decrease pain in joint surface
Can be used for diagnosi
- IF it increases pain=connective tissue; soft tissue
- IF it decreases ROM=contractures
- If it Increases ROM=could be damage to support structures
- If decreases pain = arthritis
Forces open pack position
When does this occur?
- with loose pack
- relaxed state
- manual
Compression
Cause approximation of joint structures
Can be used in treatment
- Increase in synovial fluid
- Decrease pain
- Increasing proprioception/feedback (helps with FM, gross motor, etc)
Can be used diagnostically
- If pain increases-internal derangement (cartilage tear), arthritis or loose body (bone fragment)
When does this occur?
- In closed pack
- With contraction/cocontraction
- With weight bearing
- Manually
Forced closed position
Stretch
the ability to get longer without injury
takes low force over a prolonged period of time
Contractility
ability to contract
shortening and lengthening of a muscle
Weight bearing
the ability to handle the proximal compressive forces
Tensile strength
ability to withstand pulling force without injury
Elasticity
ability of stretched tissue to return to the previous state without damage
Plasticity
the ability of a tissue to mold or be altered without damage and without returning to the previous state
Creep
gradual changes in the shape of tissue, temporary or permanent
- If permanent, the elasticity of the tissue has been exceeded and the tissue is plastic
What determines the strength of a muscle?
Diameter, genetics, and length-excursion ability
Types of contraction
Isometric
Isotonic
- Concentric
- Eccentric
Describe movement with brachialis as prime mover.
Prime mover - brachialis
Antagonist - brachii and brachioradialis
Antagonist - tricep
Cocontraction - bicep and tricep working together
Types of movement
Controlled (voluntary)
Involuntary
Ballistic (momentum)
- risk of injury
- not in control of whole movement
- momentum is needed
- results in lack of control, joints slam into itself, increases risk for injury
How do we measure strength?
Activities
Dynamometers
Machines/computers
- BTE
- BIODEX
Manual muscle testing
Types of pinch tests
Tip pincer or 2-point pinch or precision pinch – pinch like a crab; index and thumb
pincer – buttons
Lateral pinch or key pinch (power pinch) – between fist and thumb
2 point pinch or 3 jaw chuck – make a fist, stick index and middle finger out and pinch
Gravity eliminated
We can’t really eliminate gravity, but we can minimize it.
Gravity is a perpendicular force.
We can “eliminate” gravity by changing position or using equipment like an arm skate or pulley.
Describe the scale used to grade manual muscle testing.
N (5) = Full ROM against gravity, max resistance
G (4) = Full rom against gravity, moderate resistance
F+ (3+) = Full rom against gravity, min resistance
F (3) = Full rom against gravity – no resistance
ANYTHING BELOW HERE IS GRAVITY MINIMIZED
F- (3-) = more than ½ of rom against gravity, but not quite full and full range with gravity minimized
P+ (2+) = less than ½ of rom against gravity or full rom with gravity eliminated
P (2) = range of motion against gravity OR full range of motion with gravity eliminated
P- (2-)- = partial rom with gravity eliminated, no motion against gravity
T (1) = trace
0 = nothing
Exception to normal manual muscle testing
If the patient uses a substitution pattern.
If the patient has abnormal tone you shouldn’t do a MMT.
If the patient has muscle mass blocks.
- Pt has big bicep which blocks full flexion. You would say pt has 90 degrees of flexion due to limited ROM from muscle bulk.
What is tone?
Normal tone is the natural state of ready of any given muscle
CNS disorders only.
It is not the same as strength
The firm feeling of a muscle
Tension of a muscle at rest
Types of tone
Normal
Hypertonic
- Increase in tone that results in resistance during passive stretch
Spasticity (sometimes just considered hypertonic)
- Resistance to stretch occurs in the first 1/3 of the range
Rigidity
- Resistance throughout the range, preventing movement
- Extreme hypertonicity
Hypotonic
- Low tone, muscle is “floppy”, not firm to touch
Flaccid
- No tone at all
How do we assess tone using the Ashworth scale?
0 = normal tone
1 = slight increase in tone, “catch” but able to go through full rom
1+ = slight increase in tone, “catch” at ½ mark or more
2 = significant increase in tone, but still able to go through full rom
3 = considerable increase, rom is compromised or very difficult
4 = limb is rigid, little to no rom
How can we increase or decrease tone?
Increase:
- proprioceptive input
- crawling on all fours
- jumping
- ice
- tickle or light touch
- unstable
Decrease:
- slow rocking
- heat
- deep pressure
- weighted vest
- stable
How do we assess tone using the mild-moderate-severe scale?
Mild: catch occurs only at the last 25% of the range
Moderate: catch occurs at mid range (50%)
Severe: catch occurs as soon as range is initiated (first 25%)
Rigid: little or no movement possible
HYPER or HYPO (flaccid) tone is not PNS. It is CNS
- Takes a lot of effort to move normally.
Planes of movement
Median (sagittal)
- Divides the body into right and left side
- Flex/ext of horizontal axis
- Runs parallel to the median plane lateral from the midline
Frontal or Coronal Plane
- Divides the body into front (anterior) and back (posterior) parts
- Abd/add on anterior/posterior axis
Transverse
- Divides the body into top (superior) and bottom (inferior) positions
- Rotation on vertical axis
