Movement Final Flashcards
Function of the shoulder
Postion the UE in space to allow the distal hand to perform necessary daily tasks, joint function promotes mobility, not stability, function dependent upon integrity of structures.
joints for shoulder and scapula
sternoclavicular, acromioclavicular, scapulothoracic, glenohumeral
Movement of scapula
elevation and depression, protraction and retraction, upward and downward
Goniometer
Tool used to measure joint range of motion
stationary arm
Place on the proximal portion of the joint
Fulcrum
Rivet on the goniometer
Appropriate to complete a standardized Rom assessment instead of functional ROM assessment
When functional ROM or joint ROM is limited.
Steps of ROM
- Make sure patient is in a comfortable supported position. 2. Explain the goniometer to the patient. 3. Move the limb through the motion to be able to estimate the available Functional ROM. 4. Palpate the body landmark for measurement. 5. Place the goniometer over the joint axis in the correct position. 6. Establish the starting range of motion number at 0 or -. 7. Have the patient do the AROM or PROM movement that your are assessing. 8. Reposition the moveable arm of the goniometer checking that the axis is still placed accurately. 9. Note the number of degrees at final position. 10. Record the number of degrees to the nearest 5 degrees.
Spasticity
muscle being in a prolonged contraction and muscle fibers shorten. Strength is the muscle contractibility to move the joint through ROM.
May affect muscle strength
age, muscle spasms, muscle fatigue, medical instability
Scapula
pair of flat bones. Primary function: site for muscle attachment. 15 major muscles acting on the shoulder attach to the scapula. Abnormal position means dysfunction to the scapula.
Assessments measure movement
coordination tests, handwriting tests, CNS motor recovery tests, AROM/PROM/ AAROM, MMT
WFL
Within normal limits
Joint movement
is adversely affected by disease, trauma, and aging process
Joint measurement
data assist in accurately evaluating a patients progress
Functional/Informal ROM
the minimum ROM need for performance of occupations
Goniometer ROM testing
calibrated at 0 degrees at starting position up to 180 to 360 degrees. 3 parts stationary bar, moving arm, and fulcrum(axis). Measure Rom in anatomic position except when rotation is measured.
When do you do formal AROM and PROM in testing
When you observe ROM that is not WFL when directed to do so by OTR. When you have demonstrated competent in performing assessment.
MMT limitations
cannot measure muscle endurance, coordination, or performance capabilities. Cannot be used when spasticity is present, Client fatigue/ able to follow commands, client positioning.
General MMT procedure
- OTA instructed by OTR to perform MMT. 2. Check diagnosis and MD order. 3. visual check of muscle. 4. Observation of quality of movement during ROM. 5. Postioning: firm surface, feet on floor trunk/ UE supported. Client performs AROM against gravity,
ROM/ MMT precautions
Inflammation, pain, recent surgery(location of surgery, MD orders allowed ROM), bone cancer, Osteoporosis(limited MMT or none), dementia, COPD, cardiovascular disease, MS, arthritis(modify MMT), CVA(no MMT unless normal AROM),
2 joints at elbow
humeroulnar, and humeroradial
joint in forearm
proximal radioulnar joint
Elbow flexors
biceps, brachialis, brachioradialis, pronator teres
Elbow extensors
triceps and aconeus
Thumb
1st digit
opposition
combination of thumb flexion, and abduction
Functional hand position
Wrist: 20 degree extension, Fingers: slight flexion@ all joints with more flexion at 5th digit than 2nd digit. Thumb: opposed to 2nd digit.
Functional hand position
wrist 20 to 30 degrees of extension and slight ulnar deviation, Fingers in 45 degrees of MCP. 15 degrees PIP, and DIP flexion. Thumb 45 degrees of abduction.
Cylindrical
All fingers flexed around an object in one direction and thumb flexed in opposite direction. Examples holding golf clubs, steering wheel, hammer
Spherical
all fingers and thumb abducted around object with fingers apart. Examples: holding an orange, turning door knob, opening jar
Hook
fingers flexed around object in hook pattern. Carrying briefcase, bucket.
Lateral key/ pinch
hold object between thumb and index finger. Example holding key
Palmar pinch/3 point
thumb at 2nd and 3rd digit. Example: holding a pen
Tip/two point pinch
thumb @ 2nd digit picking up a bead
Extrinsic muscles
muscle origins outside of hand. wrist and digit flexors/extensors
Intrinsic muscles
muscle origin inside hand(originate and insert distal to carpal bones) thenar, hypothenar, interossei, and lumbricals.
Factors influencing hand function
sensation, skin suppleness, arthritic deformities, CNS/ PNS disorder(hand injuries), joint laxity,
Trunk bending
Trunk side bending in frontal plane. 0 to 35 degrees.
Standing with shoes off and shoulder width apart and
Slide left hand down and come back up don’t want to see contralateral .
Distal end long finger tip to floor
Palpate S1 process over her iliac crest and coming across and approximately L3, L4.
L4 inferior to that L5 S1 and that’s where my fulcrum goes to be perpendicular to the floor.
Line up moving arm with C7 spinous process
Trunk rotation
Feet on floor back not supported by the chair
Arms over chest occurs in transverse plane normal value 0 to 45 degrees. Stand behind the patient.
Fulcrum cranial aspect of the head the stationary arm is parallel to the imaginary line that connects the two iliac crest which . Palpate the acromion process. Turn body look at the right side
Trunk Flexion
Trunk flexion in sagittal plane. Bend as far as they can and take distal end of their long finger perpendicular down to the floor.
Chin to chest and slowly bend down hands down to floor as far as they can. C7 spinous process and the S1 spinous process. Find iliac crests were going to. Approximate L3 L4 Junction. 1st spinous process at L4 if I keep coming down inferiorly L5 and the next S1. Tape measure C7 and S1
Trunk extension
In sagittal plane and it Put hands on your hips. Arch your back but not your neck. C7 spinous process to S1 spinous process.
Hip flexion
Hip flexion in the sagittal plane. O to 120 degrees. Patient in supine measure the right hip. Place hand on your stomach. Bring knee to chest. Fulcrum greater trochanter of her femur. IStationary arm lateral midline of the pelvis. moving arm lateral midline of femur
Hip abduction
Hip Abduction in frontal plane. Normal hip abduction 40 degrees and hip adduction 20 degrees. Patient supine on the bed. Palpate the patients AnteriorSuperior Iliac Spine(ASIS). Fulcrum goes over the ASIS on the test the side is the hip your using. Stationary arm is going to go across the contralateral ASIS. Moving arm is going to line up with the anterior midline of the patella.
Hip adduction
Palpate two bones at hip. Fulcrum over ASIS of the hip that I am testing. The stationary arm goes to contralateral ASIS my toes and kneecap point to top of ceiling. Bring leg close to other leg as far as can go. Moving arm Anterior midline of patella
Hip Extension
Hip extension in sagittal plane. Normal value 0 to 30 degrees. Patient lying prone. Place pillow under her abdomen to protect her low back. Leg straight and lift your whole leg up off the bed as high as you can. Fulcrum on greater trochanter. Palpate the greater trochanter. Stationary arm lined up with the lateral midline of the pelvis. Moving arm lateral midline of femur.
hip internal rotation
Anatomical position in the transverse plane. Short sit on edge of plinth. Internal and external rotation in frontal plane. 0 to 45 degrees. Towel under distal femur so that your femur is parallel with the ground and then. Internal rotation with foot out toward the wall. Make sure buttock is not coming off. No lateral trunk side bending. Fulcrum is going to go over the center aspect of the anterior aspect of the patella. The stationary arm is perpendicular of the floor. Moving arm lines up the tibial crest and need to palpate where the tibial crest is.
hip external rotation
External rotation of hip. Bring other foot toward other foot and if. Fulcurm in anterior aspect of the patella. Stationary arm perpendicular to the ground palpate the tibial crest
Knee flexion GOM
Minus 4. Bend and straighten it. Bring hip down. Sit on table bring knee back at 90 degrees. 0 to 150 degrees. Fulcrum: lateral epicondyle of femur.. Stationary arm: greater trochanter of femur
Moving arm : fibula