Biomechanical Approach Flashcards Preview

COTA Musculoskeletal Dx and Biomechanical Interventions > Biomechanical Approach > Flashcards

Flashcards in Biomechanical Approach Deck (58):
1

Proprioception

knowing where your body is in space without looking, needed for smooth coordinated movements

2

Stereognosis

identifying an object with touch only, vision occluded

3

Kinesthesia

awareness of the position and movement (direction; how fast; force) of the parts of the body by means of sensory organs (proprioceptors) in the muscles and joints

4

Figure-Ground

screening out other things around to pick one object

5

Biomechanical Practice Model

applied to people with LROM, decreased muscle strength and/or endurance, intact CNS

Focus is on performance skills in motor and sensory areas and regaining skills in areas of occupation

6

Biomechanical Treatment

Prevention and maintenance- body mechanics, joint protection techniques, splints, positioning.

Restoration-increase ROM, muscle strength, endurance and stability.

Compensation

7

Manual Muscle Testing Scores

0: None

1,Trace: No motion, palpable/visible contraction

2-,Poor-: < full ROM, gravity eliminated

2,Poor: Full ROM, gravity eliminated

2+,Poor+: Full ROM, gravity eliminated, Min resist

3-,Fair-: < full ROM, agnst gravity

3,Fair: Full ROM, agnst gravity

3+, Fair+: Full ROM, agnst gravity, Min resist

4,Good: Full ROM, agnst gravity, Mod resist

5,Norm: Full ROM, agnst gravity, Max resist

8

Shoulder Flexion/Extension

flx 0-180 ext 0-40 to 60

9

Shoulder ABD/ADD

ABD 0-180 ADD 180-0

10

Shoulder Horizontal ABD/ADD

Horiz ABD 0-45 Horiz ADD 0-90

11

Shoulder Internal/External Rotation

0-90 both

12

Elbow Flexion/Extension

FLX 0- 135-150 EXT 0

13

Forearm Supination/Pronation

SUP 0-90 PRO 0-90

14

Wrist Flexion/Extension

FLX 0-90 EXT 0-70

15

Ulnar/Radial Deviation

ULN 0-35 RAD 0-25

16

MCP/PIP/DIP Flexion

MCP 0-90

PIP 0-120

DIP 0-80

17

Thumb MCP/IP Flexion

Thumb MCP 0-50 Thumb IP 0-90

18

Volumeter

Edema assessment

Significant change in edema would be more than 10ml

19

Sensation Testing

Demo testing w/vision, then vision occluded

Test uninvolved side first

SCI tested proximal to distal following dermatomes

Neurological disorders assess for dermatome pattern

Peripheral nerve injuries tested distal to proximal.

Assess order: pain, moving touch, static light touch, and touch localization

20

Purdue Pegboard

Test of fingertip dexterity and assembly job simulation

Scoring: 30sec test is the # of pins placed on board in 30sec. Assembly is the # of parts assembled in 1min

21

Minnesota Manual Dexterity Test

test of gross hand and arm movements

Scoring: time to complete board.

22

O'Connor Tweezer Test

Test of eye-hand coordination

Scoring: # of pins in board using tweezers

23

Crawford Small Parts Dexterity Test

Test fine motor dexterity using small tools

Scoring: time to complete assembly

24

Nine Hole Peg Test

Measure finger dexterity

Scoring: time for each hand to place nine pegs in a square board and remove them

25

Jebson Hand Function Test

Test hand function.

7 subtests:

Writing

Simulated page turning

Picking up common objects

Simulated feeding

Stacking

Picking up large light objects

Picking up large heavy objects

Scoring: time to complete each subject

26

Differential Tendon Gliding

prevent/reduce tendon adhesion. allow each tendon to reach its greatest amount of movement. also help to reduce hand swelling.

27

Blocking Exercises

used to isolate individual join motion. pt instructed to hold end range position for 3-5 sec

28

Isometric Exercise Contraindication

contraindicated for persons with hypertension and cardiovascular problems. increase b/p and HR

29

Scar Sensory Reduction/ Desensitization 

Post-surgery, begin in periphery of the scar and as tolerated work over the scar

Massage

Textures

Vibration

Three-phase desensitization kit

Fluidotherapy

Avoid use of hands where vision is occluded

30

Splinting for Brachial Plexus Injury 

flail arm splint

31

Splinting for Radial Nerve Palsy

Dynamic wrist, finger, and thumb ext splint

32

Splinting for Carpal Tunnel 

wrist splint positioned 0-15 ext

33

Splinting for DeQuervain's 

long thumb splint, includes wrist, IP joint free

34

Splinting for CMC Arthritis 

hand based thumb splint

35

Splinting for Arthritis 

resting hand splint

36

Splinting for Flaccidity 

resting splint

37

Splinting for Spasticity 

spasticity splint or cone splint

38

Splinting for Muscle Weakness 

balanced forearm orthosis, deltoid sling/suspension sling

39

Splinting for Axillary Burns

airplane splint

40

Heat Therapy Benefits and Precautions

Benefits

Relieves pain; increases ROM; assists w/wound healing; decreases muscle spasms

Precautions

Do not use with postsurgical repairs; acute injuries; impaired sensation; impaired vascular supply

41

Application of Hot Packs

Check skin prior to and after application

Check temp of hydrocollator (165*)

Check skin after 5min Hot pack removed after 20min

42

Application of Paraffin

Check skin prior to and after application

Check temp of paraffin (125-130*)

43

Application of Whirlpool

Fill tank w/water at 100-108*; if treating burns, water should be set at body temp

Maintain sterile technique

Treatment lasts 20min

44

Benefits and Precautions of Cryotherapy

Benefits

Relieves pain; controls edema; decreases abnormal tone; facilitates muscle tone; treats acute injuries and postsurgical repairs

Precautions

Do not use with sensory deficit including hypersensitivity; impaired circulation; Raynaud's disease

45

Application of Ice Pack

Check skin prior to and after application

Apply wet/dry towel between client's skin and cold pack

Check after 3-5min

Use for up to 10min Ice massage- used for smaller areas; applied directly to skin for 3-5min

46

Electrical Stimulation Benefits and Precautions

Benefits

Pain control; decreases swelling; stimulates and strengthens muscles; muscle reeducation; stimulates denervated muscles

Precautions

Cardiac pacemaker; phrenic or urinary bladder stimulators; presence of thrombosis or thrombophlebitis; over carotid sinus

47

General Contraindications for PAMs

Cancer

Pacemaker

Pregnancy

Cognitive Impairment

Sensory Impairment

Vascular Impairment

DVT

48

Treatment for Swan-Neck Deformities

Treatment

Daily ROM to each finger joint and gentle stretches for the PIP joints and intrinsics

Splinting

Three-point finger splint for the PIP joint to prevent hyper-ext

Methods to Avoid

Isotonic, isometric, and resistive exercise

49

Boutonniere Deformity

Treatment

Daily ROM to each finger joint, gentle assisted and active ext of the PIP joints, and active DIP flx with the PIP extended

Splinting

Ext mobilization or resting splints for the PIP joints

Methods to Avoid

Isotonic, isometric, and resistive exercise

50

Trigger Finger

Treatment

Tendon protection techniques- heat/ice inflammation

Splinting

Trigger finger splint

Avoid

Repetitive gripping activities

51

MP Ulnar Drift

Treatment

Daily ROM to MP joints with emphasis on MP ext and radial deviation; joint protection techniques

Splinting

Soft ulnar deviation splints during the day; immobilization splints with MP joints in neutral deviation and 30* flx at night

Avoid

Isotonic, isometric, and resistive exercise; positions of deformity

52

MP Volar Subluxation-Dislocation

Treatment

AROM of MP joints emphasizing ext; joint protection techniques

Splinting

Resting splints at night

Avoid

Positions of deformity

53

Wrist Subluxation

Splinting

Wrist support during the day and immobilization splint at night

54

Sexual Positioning for Spasticity

Lying on affected side while propped w/pillows allows the unaffected right extremities to remain free, and provides weight bearing to the affected side to assist with tone reduction.

The pillows behind the individual allow support, and the individual may lean against the pillows to also provide pressure relief as needed to the affected side, because sensation may be reduced on that side along with movement.

55

To improve extension of the PIP for functional use of the hand, what is the BEST use of limited therapy time?

 prefabricated dynamic PIP extension assist splint

56

Arthrogryposis

characterized by joint contractures.

Angled utensils promote independence with feeding by allowing a client with contractures in the arms and hands to put food into the mouth.

57

A client with a chronic median nerve compression at the carpal tunnel has severely diminished functional pinch. In what position should the thumb be splinted to facilitate functional pinch?

The thumb should be splinted in opposition and palmar abduction to facilitate thumb-to-tip prehension.

58

A client sustained partial-thickness and deep-thickness burns over a total body surface area of 60%, including bilateral arms and legs. Which factors should the COTA® focus on in the acute phase of burn intervention?

Reducing edema 

Prevent the development of deformity and contracture.

Independence in ADL skills can improve the client’s sense of control and promote improved ROM.