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Biomechanical Approaches
Chapter 11
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Post-Graduate
06/17/2014

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Term
Biomechanical approach
Definition
ROM, strength and endurance primarily used with lower motor neuron deficits and orthopedic problems
Term
Total active motion for fingers measurments
Definition
Add extension deficits and subtract from flexion measurement -
MCP 10-50
PIP 15-75
DIP 0 - 10
equals TAM 110
Term
Cervical Spine ROM
Definition
Flex 0-45
Ext 0-45
Lateral Flexion 0-45
Rotation 0-45
Term
Thoracic and Lumbar Spine ROM
Definition
Flex 0-80
Ext 0-30
Lat. Flex 0-40
Rotation 0-45
Term
Shoulder ROM
Definition
Flex 0-170 ABD, lateral tilt, slight elevation, slight upward rotation
Ext 0-160 Depression, adduction, upward tilt
ABDuction 0-170 Upward rotation, elevation
Adduction 0 Depression, adduction, downward rotation
Horiz. ABD. 0-40 Adduction, reduction lateral tilt
Horiz. Add 0-130 Abduction lateral tilt
Internal rotation 0-70 in ABD 0-60 in ADD.
External rotation 0-90 in ABD 0-80 in ADD.
Term
Elbow ROM
Definition
Flex. 0-135-150
Ext. 0
Term
Forearm ROM
Definition
Pronation and Supination 0-80-90
Term
Wrist ROM
Definition
Flex 0-80
Ext. 0-70
Ulnar deviation 0-30
Radial deviation 0-20
Term
Thumb ROM
Definition
DIP flex 0-80-90
MP flex 0-50
adduction 0
palmar aBd. 0-50
radial aBd. 0-50
Opposition composite motion
Term
Finger ROM
Definition
MP flexion 0-90
MP hyperextension 0-15-45
PIP flex0-110
DIP flex 0-80
ABD 0-25
Term
Hip ROM
Definition
Flexion - 0-120
Extension 0-30
ABD 0-40
ADD 0-35
Int. Rot. 0-45
Ext. Rot. 0-45
Term
Knee ROM
Definition
Flex 0-145
Term
Ankle and Foot ROM
Definition
Plantar flexion 0-50
Dorsiflexion 0-15
Inversion 0-35
Eversion 0-20
Term
MMT Grade 5 Normal
Definition
Part moves through full ROM against gravity and takes maximal resistance
Term
MMT Grade 4 Good
Definition
Part moves through full ROM against gravity and takes moderate resistance
Term
MMT Grade 4- Good minus
Definition
Part moves through full ROM against gravity takes less than moderate resistance
Term
MMT Grade 3+ Fair plus
Definition
Part moves through full ROM against gravity takes minimal resistance before it breaks
Term
MMT Grade 3 Fair
Definition
Part moves through full ROM against gravity and is unable to take any added resistance
Term
MMT Grade 3- Fair minu
Definition
Part moves through less than full ROM against gravity
Term
MMT 2+ Poor
Definition
Part moves full ROM in gravity-eliminated plane, no resistance
Term
MMT 2- Poor minus
Definition
Part moves partly ROM in gravity-eliminated plane
Term
MMT 1 Trace
Definition
Tension is palpated in muscle or tendon, no motion
Term
MMT 0 Zero
Definition
No tension is palpated
Term
Grip and pinch strength
Definition
The mean of three trials for each position is used. For dynamometer - use one trial ina ll five positions for each hand and a bell curve is observed if the individual is applying maximal effort. df
Term
Activity/Endurance Tolerance
Definition
count repetitions per unit of time
Determine percent of maximum heart rate
Measure time until fatigue
use metabolic equivalent (METS) levels
Term
Edema
Definition
fluid from blood stream moves to interstitial tissue, can be localized or diffuse
pitting - acute
brawny - chronic
Eval - measurment tape, document landmarks, for hand use figure-of-eight method
Eval of hand mass - volumeter - true tool
Any change of more than 10ml is significant
Term
Sensation
Definition
Demonstrate w/ vision then occlude vision for testing
Test uninvolved surface first both dorsal and volar surfaces
SCI - test proximal to distal
Periph. Nerve inj. - test distal to proximal following dermatomes
Neurological - assess for dermatome patterns
Order of return for peripheral nerve injuries: Pain, moving touch, static light touch, and localization.
Types of testing: Light touch, localization, pain, temperature, stereognosis, moving two point discrimination (start 5-8mm apart, proximal to distal on fingertips horizontal, normal is 2mm, 7 out of 10) static two point (begin at 5mm, stop at 15 mm, 7 out of 10, at fingertips longitudinal, normal is 5mm)
proprioception (person copies movement on other side) kinesthesis (person responds which direction extremity was moved)
Term
Coordination (informal assessments)
Definition
Observation of handwriting, manipulation of objects and everyday tasks, money, food
Gross motor - tossing a ball, reaching in a cabinet for specific items, dressing.
Term
Purdue pegboard
Definition
Fingertip dexterity, assembly job simulation 30 sec and 1 minute tests
Term
Minnesota Manual Dexterity Test
Definition
Gross hand and arm movements
Placing (one hand )and turning test (bilateral finger)
Term
O'Connor Tweezer Test
Definition
Eye hand coordination using tweezers and pins
Term
Crawford small parts dexterity test
Definition
fine motor dexterity using tweezers, screwdriver, etc.
Term
9 hole peg test
Definition
finger dexterity - 9 pegs
the Purdue is more reliable and unilateral and bilateral
Term
Jebson Hand Function Test
Definition
Writing
Simulated page turning
picking up common objects
simulated feeding
stacking
picking up large light objects
picking up large heavy objects
Term
PROM
Definition
gently move to resistance or desired range, passive stretching with overpressure
heat prior to inc. extensibility
joint mobilization requires special training.
manual stretching w/in pt. tolerance contract/relax hold/relax increases ROM.
Codman's exercise post surgical shoulder pt.s
splinting
Home exercise equipent
CPMs, pullies
Term
AROM
Definition
Should be performed when PROM is greater than AROm
Tendon gliding exercises
Blocking exercises
Function use
Preparatory interventions
Purposeful occupations
Precaution of myositis ossificans from over-stretching.
Term
Increasing Strength
Definition
high resistance low repetitions, Isometrics - Are contraindicated for persons with HTN, CArdiovascular. They can increase blood pressure and heart rate
Isotonic eccentric - lengthening and concentric - shortening
Term
Increasing Endurance
Definition
Work at 50% of max resistance or less
Increase reps, duration - not resistance
Use energy conservation methods
Term
Edema Reduction Techniques
Definition
Elevation - Contraindicated with circulation problems
Retrograde massage - return of blood and lymphatic fluids to the venous system - stroke in centripetal direction with extremity elevated.
Compression garments (wraps are wrapped proximal to distal)
Cold packs with elevation - Monitor vascular status
Contrast bath
Manual edema mobilization
Contraindications - Heat, infection, grafts or wounds, vascular damage, unstable fracture, CHF.
Term
Scar Management
Definition
ROM
Massage (circles and friction
Compression
Scar Pad
Splinting - to prevent contractures
Edema control - in acute phase
Term
Sensory Training
Definition
Desensitization - periphery of scar to start
Massage
Textures
Vibration
Three phase desensitization kit
Fluidotherapy
Re-Education
Safety
Compensation - use two hands, use vision, etc.
Term
Improving coordination
Definition
Gross motor - Fine Motor
Accuracy and speed
Term
Energy Conservation and work Simplification Methods
Definition
5-10 min. rest periods during routine
Schedule tasks alternate heavy/light
Organize tasks
Avoid multiple trips
Eliminate non-essential
Delegate tasks, combine tasks
Sit to work
A/E, electrical
rest before fatigue,
slide rather than lift
Term
Joint protection
Definition
use max ROM and strength during activities
use strongest joing
push instead of pull
use joint in most stable and functional position
avoid sustained contractions, use A/E
Avoid positions of deformity that cause ulnar drift
don't start something you can't stop
recognize discomfort and warnings
Term
Body Mechanics
Definition
push instead of pull
Face objecct and keep it close at at COG
Feet flat, broad base of support
bend at knees, back straight
breathe, lift with legs,
move smoothly
don't rotate,
lower body to level of work
Term
Splinting
Definition
Static and Dynamic
To rest
prevent deformities/contractures
increase ROM
protect bone, joint and soft tissue
increase functional use
Maintain arches of hand
Do not impinge on creases of the hand
Term
Splinting principles
Definition
Decrease pressure
Sling applied with 90 degree angle of pull
Low load
maintain three-point pressure
Avoid deformity positions:
wrist flexion, MCP hyperextension, IP joints flexed, thumb adducted
Term
Resting position splint
Definition
Wrist 10-20 extension
MCPs 30-45 flexion
IPs 0-20 flexion
Thumb aBducted
Term
Safe position splint
Definition
Wrist 20-30 extension
MCPs 50-70 flexion
IPs extension
thumb abducted and extended
Term
Precautions and education for splinting
Definition
check skin condition before and after
education for wear and skin checks and care of splint
ensure pt.s understanding of it
teach donning doffing
provide functional training
re-evaluate splint in intervals
Term
OTA's w/ splints
Definition
assess w/ OT for appropriate splint
OT sets splinting goals
OTA can fabricate static splints and assist with dynamic splints.
Term
brachial plexus injury
Definition
flail arm splint
Term
radial nerve palsy
Definition
dynamic wrist, finger, and thumb extension splint
Term
median nerve injury
Definition
opponens splint, C Bar or thumb post splint
Term
ulnar nerve injury
Definition
dynamic/static splint to position MPs in flexion
Term
combined median ulnar splint
Definition
figure-of-eight or dynamic MCP flexion splint
Term
spinal cord C6-C7
Definition
tenodesis splint
Term
carpal tunnel syndrome
Definition
wrist splint positioned in neutral
Term
cubital tunnel syndrom
Definition
elbow splint positions at 30 degrees of flexion
Term
dequervains
Definition
thumb splint, includes wrist, IP joint free
Term
skier's thumb
Definition
UCL hand based thumb splint
Term
CMC arthritis
Definition
hand based thumb splint
Term
ulnar drift
Definition
ulnar drift splint
Term
flexor tendon injury
Definition
dorsal protection splint
Term
swan neck
Definition
silver rings or buttonhole splint
Term
boutonniere
Definition
silver rings or PIP extension splint
Term
arthritis
Definition
functional splint or safe splint
Term
flaccidity
Definition
resting splint
Term
spasticity
Definition
spasticity splint or cone splint
Term
muscle weakness (ALS, SCI, Guillain-Barre-)
Definition
balanced forearm orthosis (BFO) deltoid sling/suspension sling
mounts to w/c must have shoulder movement
Term
hand burns
Definition
wrist 15-30 extension
MCP 50-70 flexion
IPs full extension
Term
PAMs
Definition
Used as preparatory interventions only and precede, support or enable purposeful and meaningful occupations

Precautions/Contraindications
Cancer,
Pacemaker
Pregnancy
Cognitive impairment
Sensory impairment
Vascular impairment
Never used over a growth plate
Term
ESTIM
Definition
FES, NMES, TENS
Relieves pain
Decreases swelling
Stimulates and strengthens muscles
Stimulates denervated muscle
Term
Ultrasound
Definition
Relieves pain
decreases inflammation
Increases tissue extensibility
Decreases adhesions
Term
Contrast Baths
Definition
Reduces edema
Term
Whirlpool
Definition
cleans and debrides open infected wound
Does not provide heat benefits per say
Term
Cryotherapy
Definition
Relieves pain
Controls edema
Decreases abnormal tone
Facilitates muscle tone
Term
Superficial Heat
Definition
Relieves pain
Increases tissue extensiblity
Assists with wound healing
Term
CN V
Definition
Anterior facial region
mastication
ingestion
Term
C3
Definition
Neck region
Sterocleidomastoid, upper trapezius
Head control
Term
C4
Definition
Upper shoulder region
Trapezius (diaphragm)
Head control
Term
C5
Definition
Lateral aspect of shoulder
Deltoid, bicepts, rhomboid major and minor
Elbow flexion
Term
C6
Definition
Thumb and radial forearm
Extensor carpi radialis, biceps
Shoulder abduction, wrist extension
Term
C7
Definition
Middle finger
Triceps, extensors of wrist and fingers
wrist flexion, finger extension
Term
C8
Definition
Little finger, ulnar forearm
Flexor of wrist and fingers
C8 finger flexion
Term
T1
Definition
Axilla and proximal medial arm
Hand intrinsics
Abduction and adduction of fingers
Term
T2-12
Definition
Thorax
Intercostals
Respiration
Term
T
Definition
Term
T4-T6
Definition
Nipple line
Intercostals
Respiration
Term
T11
Definition
Midchest region, lower rib
Abdominal wall, abdominal muscles
T5-7 superficial abdominal reflex
Term
T10
Definition
Umbilicus
Psoas, iliacus,
Leg flexion
Term
L1-2
Definition
Inside of thigh
Cremasteric reflex, accessory muscles
Elevation of scrotum
Term
L2
Definition
Proximal anterior thigh
Iliopsoas, adductors of thigh
Reflex voiding
Term
L3-4
Definition
Anterior knee
Quadriceps, tibialis anterior, detrusor urinae
Hip flexion, extensors of knee, abductors of thigh
Term
L5
Definition
Great toe
Lateral hamstrings
Flexion at knee, toe extension
Term
L5-S1
Definition
Foot region
Gastrocnemius, soleus, extensor digitorum longus
Flexor withdrawal, urinary retention
Term
S2
Definition
Narrow band of posterior thigh
Small muscles of foot (flexors)
bladder retention
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