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Biomechanical
Evaluation and Intervention
| Question | Answer |
|---|---|
| What does the biomechanical approach focus on? | ROM, strength and endurance |
| What types of dysfunctions does the biomechanical approach treat? | lower motor neuron dysfunctions and orthopedic conditions |
| What is "Within functional limits (WFL)"? | ROM is functional |
| What is "Within normal limits (WNL)"? | ROM achieves normal ranges (measured by a goniometer) |
| What is the normal ROM for SHOULDER FLEXION? | 0-180 degrees |
| What is the normal ROM for SHOULDER EXTENSION? | 0-60 degrees |
| What is the normal ROM for SHOULDER ABDUCTION? | 0-180 degrees |
| What is the normal ROM for HORIZONTAL SHOULDER ABDUCTION? | 0-40 degrees |
| What is the normal ROM for HORIZONTAL SHOULDER ADDUCTION? | 0-130 degrees |
| Degrees for elbow flexion? | 0-135-150 degrees |
| Degrees for elbow extension? | 0 degrees |
| Forearm pronation? | 0-80-90 degrees |
| forearm supination? | 0-80-90 degrees |
| Wrist flexion? | 0-80 degrees |
| Wrist extension? | 0-70 degrees |
| Wrist ulnar deviation? | 0-30 degrees |
| Wrist radial deviation? | 0-20 degrees |
| Manual Muscle Tests | Break test 1)Test position: gravity eliminated or against gravity... 2)Stabilize joint testing ...3)Provide resistance (in opposite direction of mvmt) 4)Grade muscle (0-5) |
| "Normal" muscle grade | 5 or full ROM + Max resistance |
| "Good" muscle grade | 4 or full ROM + Mod resistance |
| "Good Minus" muscle grade | 4- or full ROM + LESS THAN Mod resistance |
| "Fair +" muscle grade | 3+ or Full ROM + Min resistance |
| "Fair" muscle grade | 3 or full ROM + gravity ONLY |
| "Fair-" muscle grade | 3- or LESS THAN full ROM + gravity ONLY |
| "Poor" muscle grade | 2+ or full ROM +gravity ELIMINATED |
| "Poor-" muscle grade | 2- or LESS THAN full ROM + gravity ELIMINATED |
| "Trace" muscle grade | 1 or Tension in muscle or tendon....NO MOVEMENT |
| "Zero" muscle grade | 0 or NO TENSION |
| measure grip strength | dynamometer: 3 trials |
| measure grip strength for those with arthritis | BP cuff: measure in mm Hg |
| Pinch strength measurement | Pinch meter: 3 trials a. lateral pinch b. 3 jaw chuck c. tip to tip |
| Measure ENDURANCE and ACTIVITY tolerance | 1. count # of repetitions 2. Determine % of Max heart rate 3. Measure time until fatigued |
| How to determine MAX heart rate | 1. Elders age - 220= # 2. # x 0.6= appropriate response for normal activity ex. 220 - 78 y/o= 142 x 0.6= 85 bpm |
| How to determine heart rate | palpate pulse for 15 sec...count the # of beats felt x 4 or 30 sec of palpating x 2= heart rate |
| Mild hypertension | 140/90 mm or greater |
| Moderate hypertension | 160/100 mm or greater |
| When to stop activity and seek help | Nausea...Heavy breathing...pressure,pain or fullness in then chest... light-headed...high BP...drop in systolic BP or failure to rise |
| Edema types | Acute- pitting Chronic- brawny |
| Evaluation of Edema | Volumeter...tape measure...rings |
| Significant edema measurement | Greater than 10ml |
| What is a LOWER MOTOR NEURON dysfunction? | Its caused by a lesion along the lower portion of the neurological structure. |
| Cause of LOWER MOTOR NEURON DYSFUNCTION? | nerve root compression...Trauma...Toxins...Infections: Poliomyelitis, Guillian-barre syndrome...Neoplasms...vascular disorders: diabetes, arteriosclerosis and congenital malformations. 7. degenerative diseases;ALS, |
| Sensation testing | 1st test with vision...2nd test w/o vision (uninvolved side 1st). |
| testing Sensations of a SPINAL CORD INJURY | PROXIMAL to DISTAL |
| testing sensations of a PERIPHERAL NERVE INJURY | DISTAL to PROXIMAL...ASSES FOR peripheral nerve involvement |
| testing sensations of NEUROLOGICAL DISORDER | ASSES FOR dermatome pattern |
| Types of sensory testing | light touch...localization...pain...stereognosis...2 point discrimination...proprioception and kinesthesia |
| Joint mobilization | Requires special training/service competency...more effective if performed before PROM AND Stretching |
| Increasing ROM techniques | Prior to ROM...Heat...Contract/relax or Hold/relax |
| Home exercise program | Important for post-op pt's to facilitate change in ROM...must clearly understand PROM concept |
| Splints to increase ROM | Dynamic splints...Serial splints |
| Exercise equipment to increase ROM | Continuous Passive movement (CPM)...Pulleys |
| AROM exercises | Tendon gliding...blocking exercises (isolating joints)...preparatory (wall walking)..purposeful activity (crafts)...occupational based activity |
| Increasing strength | High resistance, low repetitions |
| Types of contraction | Isometric...Isotonic (contraction/w movement)...eccentric (lengthening)...concentric (shortening) |
| Resistive (preparatory) | progressive resistive (PREs)...handgrips...theraputty...theraband...graded clothespins. |
| Improve strength with purposeful activities | lifting pots, putting away cans |
| Improve strength with occupation-based interventions | grocery shopping, preparing a meal |
| Increasing endurance | Work @50%max resistance...increase repetitions, not resistance...E/C techniques |
| Edema reduction techniques | Elevation...retrograde massage...compression garmets...cold packs...contrast bath...active exercise. |
| Elevation | extremity placed above the heart |
| Retrograde massage | return of blood to venous system...stroking in centripetal direction |
| Compression garments | prevent re-accumulation of fluids...EX...Isotoner glove...Tubigrip (stockinet w elastic)...Ace wraps...Coban wrap |
| Coban wrap | wrap...Distal- Proximal |
| Contrast bath | start warm (104-110 f) to cold (50-64 f)...~15-30 min. tx....end with warm... unless severe edema end in cold~1 min. |
| Edema precautions/contraindications (7) | heat...infection...grafts or wounds...vascular damage...unstable fractures...CHF |
| Scar management | ROM...massage...scar pad w compression (Otoform, elastomers)...splinting...edema control |
| Sensory training | desensitization for hypersensitivity...post surgery; work in the periphery of the scar and slowly work over scar |
| Desensitization/sensory retraining | massage, textures, vibration, fluidotherapy, 3 phase desensitization kit. |
| Improving coordination | gross to fine motor...focus on accuracy +speed |
| E/C and W/S (7 principles, outlined) | plan short rest periods...schedule tasks ahead of time...delegate...eliminate non-essential tasks...sit to work...slide rather than lift... use light wt equipment |
| Types of splints | static...dynamic...serial |
| purpose of splinting | rest...prevent/correct deformities...increase joint ROM...protect...increase functional use |
| hand splinting design standards | maintain arches of the hand...Do not impinge on creases |
| Splinting positions | Functional...Resting ...and Safe positions |
| Functional position | wrist 20-30 degrees extension...MCPs @45 degree flexion...IPs 20-30 degrees flexed...similar to holding a ball or a can of soda. |
| Resting position | Wrist 20-30 degree flexion...MCPs 15-25 degrees flexion...*IPs in extension...similar to resting hand on table w/o effort....(inflammatory conditions, arthritis) |
| Safe position | Wrist 0-20 degrees flexion...MCPs 70-90 degree flexion...IPs in extension...(following hand trauma). |
| Splint wearing instructions | Important to have a wearing schedule...worn too long, may cause weakness or stiffness |
| Splint used to treat arthritis | Resting splint...Wrist immobilization splint...Wrist cock-up splint w MCP support...Finger ring splints (Figure-8 or Silver Ring Splint) |
| Resting Hand Splint | Acute synovitis...protect from ulnar drift...prevent multiple contractures...usually worn when sleeping due to the restrictive movement. |
| Wrist Immobilization splint...Wrist cock-up splint (if MPs involved) | carpal tunnel syndrome |
| Silver Ring Splints or ulnar drift positioning splint | ulnar drift |
Created by:
debbiej
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