Biomechanics approaches - evaluation and intervention

Question 1

biomechanics approach

Answer 1

focuses on ROM, strength, endurance
should not be used in isolation
most commonly used: ortho, lower motor neuron deficits, hand clinics, work programs

Question 2

ROM contraindications/restrictions

Answer 2

consult with physician prior with these conditions:
- bone metastasis, unhealed fracture, infection, post surgery, ossifications, subluxed joints, skin grafts

Question 3

MMT positioning

Answer 3

gravity eliminated or against gravity
stabilize at proximal joint (do not hold over the muscle belly being tested)

Question 4

sensory testing

Answer 4

demonstrate test with vision, then occlude vision for actual testing
test uninvolved side first to get a baseline
SCI are tested proximal to distal following dermatome pattern
neurologic disorders are tested for dermatome pattern
peripheral nerve injuries are tested distal to proximal following peripheral nerves

Question 5

order of return for peripheral nerve injuries

Answer 5

pain, moving touch, static light touch, touch localization

Question 6

purdue pegboard

Answer 6

tests fingertip dexterity and assembly job simulation
# of pins placed in the board in 30 seconds

Question 7

minnesota manual dexterity test

Answer 7

test of gross hand and arm movements
scoring: time to complete the board

Question 8

o’connor tweezer test

Answer 8

test of hand-eye coordination using tweezers
# of seconds to place all pins in the board using tweezers

Question 9

crawford small parts dexterity test

Answer 9

test of fine motor dexterity using small tools (tweezers and screw driver)

Question 10

nine hole peg test

Answer 10

measures finger dexterity
time for each hand to place nine pegs in a square board and remove them

Question 11

henson-taylor hand function test

Answer 11

test of hand function
7 subtests (writing, page turning, picking up objects, simulated feeding, stacking, picking up large light and large heavy things)

Question 12

michigan hand outcome questionnaire

Answer 12

looks at client perceptions of unilateral and bilateral functional activities
pain level, participation in h household and school activities, appearance

Question 13

informal assessment of coordination

Answer 13

fine motor: observation of routine task performance - handwriting, manipulating objects, cutting food, buttoning, etc
gross motor: observation - tossing a ball, reaching, dressing

Question 14

intervention - increasing ROM

Answer 14

• passive ROM
• passive stretch: PROM with overpressure
• heat/other thermal agents
• joint mobilization (special training)
• contract/relax and hold/relax
• Codman’s exercise (pendulums for post surgical shoulder)
• HEP
• dynamic or serial splinting
• active ROM (when PROM is greater than AROM)
• tendon gliding exercises
• blocking exercise (isolate a joint motion)
• emphasize functional use
• purposeful and occupation based activities

Question 15

tendon gliding

Answer 15

flat palm
claw hand
fist thumb in
tabletop
straight finger fist thumb straight

Question 16

intervention - increasing strength

Answer 16

1. high resistance, low repetitions
2. types of contractions: isometric (holding), isotonic (eccentric lengthening, concentric shortening)

Question 17

contraindication for isometrics

Answer 17

people with hypertension and cardiovascular problems
can increase BP and HR, so they should be avoided

Question 18

increasing endurance

Answer 18

1. work at 50% of maximal resistance or less
2. increase repetitions and duration, not resistance
3. use energy conservation methods

Question 19

edema reduction techniques

Answer 19

1. elevation: extremity above the heart
2. manual edema mobilization (requires training)
3. retrograde massage: assists with return of blood and lymph fluids to the venous system - gentle stroking in centripetal direction with elevation
4. compression garments
5. cold packs (monitor vascular status)

Question 20

contraindications for edema

Answer 20

• avoid extreme positions of elevation for individuals with R sided heart weakness (can cause the fluid to empty in the heart too fast)
• MEM and retrograde massage are contraindicated when cardiac edema is present
• heat is commonly contraindicated
• do not use MEM for people with infection, grafts, wounds, vascular damage, blood clots, CHF

Question 21

interventions for scar management

Answer 21

1. ROM: early mobilization
2. massage
3. compression
4. scar pad
5. splinting
6. edema control

Question 22

intervention - sensory training

Answer 22

1. desensitization for hypersensitivity
   - massage, textures, vibration, a program
2. sensory re-education
   - massage, textures, vibration
   - safety precautions

Question 23

intervention - improving coordination

Answer 23

1. gross motor activities
2. grade up to fine motor
3. select activities with ROM that is attainable and challenging
4. focus on accuracy and speed (start slow and controlled, then fast and precise)

Question 24

energy conservation and work simplification principles

Answer 24

• short rest periods during daily routine
• schedule tasks for the day/week/month to balance heavy/light
• organize everything prior
• avoid multiple trips
• eliminate and delegate
• sit
• everything in reach
• adaptive equipment
• rest before fatigue, not after exhaustion

Question 25

joint protection principles

Answer 25

- maintain by using maximal ROM and strength - use strongest and largest joint (knees and hips for lifting, not the back) - good body mechanics - don't keep a joint in one position for too long - modify as needed - slide or push objects rather than lift

Question 26

PAMs (physical agent modalities)

Answer 26

- preparatory for activities - not appropriate used in isolation - many states require certification/training thermal: paraffin, hot packs, fluidotherapy cooling: cold packs, ice massage mechanic: ultrasound, whirlpool electrical stim: NMES (muscles), TENS (pain), HVGS, Iontophoresis (meds)

Question 27

contraindications for heat

Answer 27

post surgical repairs, acute injuries, impaired sensation, edema, impaired vascular supply, times, MS, lymphedema, DVT *check skin before and after

Question 28

contraindications for cryotherapy

Answer 28

sensory deficits, impaired circulation, Raynaud's

Question 29

contraindications for electrical stimulation

Answer 29

cardiac pacemaker, bladder stimulators, thrombosis over the carotid sinus

Question 30

types of ultrasound and benefits

Answer 30

continuous (thermal) - increases ROM, reduce pain and stiffness, increase blood flow, reaches deeper tissues pulsed (non thermal) - decreases inflammation, heals tissue

Question 31

contraindications for ultrasound

Answer 31

- pregnancy, malignant tumor, joint replacements, thrombophlebitis, fractures, infections - do not apply near a pacemaker, growth plates, breast implants, spinal cord, very young or old person

Question 32

general contraindications for PAMs

Answer 32

- pregnant, cancer, cognitive impairment, sensory impairment, vascular impairment, DVT

Question 33

Ayres SI approach

Answer 33

principles of inner drive and active involvement in the child – individualized activities based on the child’s interests

Question 34

MMT grades

Answer 34

5 ROM AG, max res 4+ ROM AG, nearly max res 4 ROM AG, mod res 4- ROM AG,

Question 35

muscle grades

Answer 35

N Full ROM AG and full res N - slight weakness G + moderate weakness G AG and mod res F + AG and mild res F full ROM AG F - full ROM AG one time P + full ROM, GE, some resistance P full ROM GE P - incomplete ROM GE T contraction 0 no contraction N = normal; G = good; F = fair; P = poor; T =trace.