PPT - Assessment of Endurance

Question 1

BFOR

Answer 1

Became prevalent in 40s
Addresses musculoskeletal capacity and problems that underlie movement in daily occupational performance. 
Range of motion
Strength
Endurance 

Based on the principles of kinesiology and concerned with musculoskeletal capacity, peripheral nerve dysfunction, and cardiopulmonary system dysfunction (endurance)

Best suited for clients with an INTACT central nervous system so that they can perform smooth/isolated movements

Question 2

Assumptions of the BFOR

Answer 2

Occupational performance requires the ability to move the limbs and the endurance to sustain activity/movement until a goal is accomplished.

Purposeful activities can be used to treat loss of ROM, strength, and endurance

However, research shows that improvement of biomechanical components alone does not necessarily improve engagement in occupation.

Based on these ideas, this is a bottom-up approach

Question 3

Limitations of the BFOR

Answer 3

Does not provide a lens for understanding “occupational” problems that do not result from musculoskeletal problems – cannot be used in isolation

Remediation of the impairments may not result in changes in occupation

Question 4

Definition of Endurance

Answer 4

“ability to sustain effort and resist fatigue”

Related to cardiopulmonary and muscular function

Related to intensity, duration, and frequency of activity

Question 5

Cardiopulmonary aspects of endurance

Answer 5

“Cardiopulmonary endurance is the ability of the whole body to sustain prolonged rhythmical activity”

Relates to the demand for oxygen created by muscular work: Muscular work → need for oxygen
- Heart rate and stroke volume (amount of blood pumped per heartbeat) increase. As activity intensity increases, amount of oxygen required also increases

Relates to energy cost of activities and the individual’s cardiopulmonary function

Impacted by bed rest, generalized weakness, age

Question 6

Muscular aspects of endurance

Answer 6

“Ability of a muscle or muscle group to sustain intensive activity”

Relates to integrity of the muscle belly, tendon, or bony attachment (biomechanics)

May be affected by trauma and/or reduction in innervation

Manifests in reduced tension development/inability to maintain contraction

Symptoms: cramping, burning, tremor (fatigue)

Question 7

Endurance assessment

Answer 7

Primarily completed during observation of occupational performance

There is a dynamic and a static assessment of endurance:

• Dynamic – number of repetitions per unit of time
• Static – amount of time a contraction can be held

Intensity, duration, and frequency of activity are all considerations:

• Intensity – rated as light, moderate, or heavy work or based on MET Levels (Metabolic Equivalent Levels)
• Number of METs (basal metabolic rate) – the amount of oxygen consumption which is necessary to maintain metabolic processes or (energy cost of activities)
• Activities are assigned certain MET levels and there are guidelines to what activities a person can and cannot do

Question 8

Documentation

Answer 8

• Activity performed [intensity (resistance/speed), duration, frequency]
• Position of the activity performance
• Heart rate and/or perceived exertion
• Rest breaks needed?
• Duration and quantity of rest breaks
• Other signs/symptoms of fatigue
• Example: “Patient tolerated 60 mins. of seated activity for OT assessment without rest breaks. No c/o fatigue.”

Question 9

Increasing muscle endurance

Answer 9

To increase muscle endurance, the OT must increase the # of repetitions of a specific motion, or add to the resistance of the activity…cardiopulmonary precautions must be considered!

Mild activity with increased repetition

Guide clients to engage in longer periods of occupation at 40-60% of their repetition maximum (RM)