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Evaluation and Intervention

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 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