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Physical Disabilities > Week 4. OT Assessment and Treatment of Strength and Endurance Deficits/Grip and Pinch Testing > Flashcards

Week 4. OT Assessment and Treatment of Strength and Endurance Deficits/Grip and Pinch Testing Flashcards

1
Q

Grip and Pinch Strength what kind of tests are they ?

A

Maximally Resistive Tests

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2
Q

What are the contradictions to grip and pinch tests?

A

healing fracture
Ligament repair
Tendon laceration
Tendon Transfer of forearm, wrist and hand.

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3
Q

What are precautions to grip and pinch tests?

A

acute joints, ligament or tendon injury until resistive exercises are appropriate.

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4
Q

True or False. A structure after an injury must be healed enough for maximal load during strength assessent?

A

Ture.

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5
Q

Grip Testing with Dynamometer

A

Measures the extrinsic and intrinsic muscles of the hand.
used to measure hand dysfunction and recovery
Should be measured with a calibrated dynamometer
Second Rung of the dynamometer is used for standard testing (if used different rung need to be documented)
Average of 3 trails (unless painful)
Grip held for 3 seconds
15 seconds intervals between trails
Compare to uninvolved side
Compare to establish norms

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6
Q

Standard position when assessing grip strength

A

patient seated with arm adducted at the side
elbow flexed 90 degrees, forearm in neutral, wrist at 15-30 of extension and 0-15 of ulnar deviation
Patient instructed to squeeze as hard a possible
Therapist gently support the base of the dynamometer

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7
Q

Alternative methods for grips strength include?

A

Five-Rung Grip test ( to determine bell curve)

Rapid exchange grip test.

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8
Q

Dynamometer and Rungs position ?

A

1st measures intrinsics (hand muscles)
2nd standard grip
3rd someone with a large hands
4th and 5th extrinsic strength

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9
Q

Pinch Testing kinds..?

A 
2-point pinch (tip to tip pinch)
3-point pinch (3 jaw chuck)
Lateral pinch (key pinch)
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10
Q

2-point pinch (tip to tip pinch)?

A

index finger and thumb

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11
Q

3-point pinch (3 jaw chuck)

A

index finger with middle finger against thumb

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12
Q

Lateral pinch (key pinch)

A

Radial side of index finger and thumb

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13
Q

What is the most common manual muscle test?

A

Break Test

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14
Q

What are the 3 based factors associated with break test?

A

Evidence of contraction
Gravity as a resistance
Amount of manual resistance.

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15
Q

Manual Muscle Testing Process

A

Explain and demonstrate MMT to the patient
Assess unaffected side
Test- position either gravity eliminated or against gravity
Stabilize the site of attachment of the origin of the muscle
Prevent substitutions
Gradual resistance is applied in the opposite direction of movement.

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16
Q

MMT grade 0 zero

A

No tension is palpated, no motion occurs

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17
Q

MMT grade 1 (trace)

A

Tension is palpated, no motion occurs

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18
Q

MMT grade 2- (Poor minus)

A

Moves through less than full ROM in gravity eliminated plane.
Takes no added resistance

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19
Q

MMT grade 2 (poor)

A

Moves through full ROM in gravity eliminated plane.

Takes no added resistance

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20
Q

MMT grade 2+ (poor plus)

A

Moves through full ROM in gravity eliminated plane

Takes min resistance.

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21
Q

MMT grade 3- (Fair minus)

A

Moves less than full ROM against gravity

22
Q

MMT grade 3 (fair)

A

Moves through full ROM against gravity, unable to take resistance

23
Q

MMT grade 3+ (fair plus)

A

Moves through full ROM against gravity, and takes min resistance

24
Q

MMT grade 4- (good minus)

A

Moves through full ROM against gravity, and takes less then mod resistance

25
Q

MMT grade 4 (good)

A

Moves through full ROM against gravity, and takes mod resistance

26
Q

MMT grade 5 (normal)

A

Moves through full ROM against gravity, and takes max resistance

27
Q

What are compensation for strength limitation?

A

Modifications can compensate for limitations

28
Q

What are Three main types of interventions strategies can be utilized for compensation for strength limitations?

A

Activity method is altered = one handed techniques
Object can be adapted = build up utensils
Environment is modified = wheelchair ramp

29
Q

Remediation for weakness what to do?

A

Always link interventions to impairments
Educated patient/caregiver how interventions will lead to improvement
Provide opportunity to transfer gains into functional tasks.
Good for patients with few impairments and who are expected to improve

30
Q

Therapeutic Exercise

A

Exercise and activity are complementary in the intervention plan
Should be used to remediate sensory or motor dysfunction.
Augment purposeful activity and prepare the patient to perform occupations.
Can be used to increase ROM, flexibility, strength, endurance, cardiovascular capacity, coordination, work tolerance and to prevent from contractures.
Most often used with orthopedic disorder or lower motor neuron disorders.

31
Q

What are contraindications/precautions for Therapeutic exercise?

A

Poor health, inflamed joints, recent surgeries, permanent contractures, lack of voluntary control over motion.
Consider healing stage and muscle grade

32
Q

Considerations for therapeutic exercise

A 
length and angle of muscle tension unit
Amount of resistance 
duration of contraction
reps 
patient goals
returning to activity, work, sport.
33
Q

Isotonic exercise is?

A

Muscle move joint through ROM
Concentric- muscle shortens as it develops tension
Eccentric - muscle lengthens as it develops tension

34
Q

Isometric exercise are?

A

static muscle contracture with no change in muscle length

35
Q

Physical conditioning (cardiovascular fitness) should be?

A

3-5 days/wk.
60 to 90% max heart rate or 50-85% max o2 uptake
between 15-60 minutes.

36
Q

Grading activity (grading task progression)?

A

Beginning with an easy task and progressing to a harder one

37
Q

Grading activity (Increasing complexity)

A

Meal prep (making sandwich - cooking a meal)

38
Q

Grading activity (vary performance environment)

A

Clinic = Home, Therapist = caregiver

39
Q

Grading activity (problem solving)

A

Shifting from therapist to patient

40
Q

Activity tolerance is combination of what types of endurance?

A

Cardiovascular and muscular

41
Q

What are precautions for endurance training ?

A

Know the patients limitations and contradictions
Clearance from MD
Know the signs of exceeded cardiopulmonary capacity
Monitor for breathing (SOB), heart rate, (20 beats over resting HR), BP, oxygen saturation levels, cognitive changes.

42
Q

What are the signs of cardiopulmonary distress?

A

Dyspnea, weakness, angina, cognitive changes, changes in BP, decreased HR, pollor or cyanosis.

43
Q

How is muscular endurance measures?

A

By the amount of lactic acid build up in the blood

44
Q

Dynamic assessment of muscular endurance

A

reps/unit of time

45
Q

Static assessment of muscular endurance

A

time contraction is held

46
Q

Grading to increase endurance

A

Low intensity with high reps

Graded by intensity or time

47
Q

Endurance and Fatigue

A

Endurance is reflection of cardiovascular state and fitness level.

48
Q

Measuring Fatigue two assessments?

A

multidimensional assessment of fatigue

Fatigue severity scale

49
Q

multidimensional assessment of fatigue what is it?

A 
16 items, measuring fatigue across the four dimensions;
Degree and severity 
Distress that it causes
Timing of fatigue
Impact on ADL's.
50
Q

Fatigue Severity Scale

A

9- item self report scale that measures the severity of fatigue and its effect on a person’s activities.

51
Q

Therapeutic Management of Fatigue

A 
Use energy conservation techniques
Budget energy throughout the day
Good sleep habits 
Stress Management 
Coping strategies/support groups 
Life-Style redesign 
Patient should learn to monitor symptoms
52
Q

Energy Conservation Methods

A

Rest
Examine/Modify priorities
Reduce task demands.

Physical Disabilities (12 decks)

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