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THE BOARDS > Biomechanics approaches - evaluation and intervention > Flashcards

Biomechanics approaches - evaluation and intervention Flashcards

1
Q

biomechanics approach

A

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

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2
Q

ROM contraindications/restrictions

A

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

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3
Q

MMT positioning

A

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

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4
Q

sensory testing

A

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

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5
Q

order of return for peripheral nerve injuries

A

pain, moving touch, static light touch, touch localization

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6
Q

purdue pegboard

A

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

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7
Q

minnesota manual dexterity test

A

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

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8
Q

o’connor tweezer test

A

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

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9
Q

crawford small parts dexterity test

A

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

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10
Q

nine hole peg test

A

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

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11
Q

henson-taylor hand function test

A

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

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12
Q

michigan hand outcome questionnaire

A

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

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13
Q

informal assessment of coordination

A

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

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14
Q

intervention - increasing ROM

A
  • 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
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15
Q

tendon gliding

A

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

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16
Q

intervention - increasing strength

A
  1. high resistance, low repetitions
  2. types of contractions: isometric (holding), isotonic (eccentric lengthening, concentric shortening)
17
Q

contraindication for isometrics

A

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

18
Q

increasing endurance

A
  1. work at 50% of maximal resistance or less
  2. increase repetitions and duration, not resistance
  3. use energy conservation methods
19
Q

edema reduction techniques

A
  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)
20
Q

contraindications for edema

A
  • 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
21
Q

interventions for scar management

A
  1. ROM: early mobilization
  2. massage
  3. compression
  4. scar pad
  5. splinting
  6. edema control
22
Q

intervention - sensory training

A
  1. desensitization for hypersensitivity
    - massage, textures, vibration, a program
  2. sensory re-education
    - massage, textures, vibration
    - safety precautions
23
Q

intervention - improving coordination

A
  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)
24
Q

energy conservation and work simplification principles

A
  • 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
25
Q

joint protection principles

A
  • 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
26
Q

PAMs (physical agent modalities)

A
  • 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)

27
Q

contraindications for heat

A

post surgical repairs, acute injuries, impaired sensation, edema, impaired vascular supply, times, MS, lymphedema, DVT

*check skin before and after

28
Q

contraindications for cryotherapy

A

sensory deficits, impaired circulation, Raynaud’s

29
Q

contraindications for electrical stimulation

A

cardiac pacemaker, bladder stimulators, thrombosis over the carotid sinus

30
Q

types of ultrasound and benefits

A

continuous (thermal) - increases ROM, reduce pain and stiffness, increase blood flow, reaches deeper tissues

pulsed (non thermal) - decreases inflammation, heals tissue

31
Q

contraindications for ultrasound

A
  • 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
32
Q

general contraindications for PAMs

A
  • pregnant, cancer, cognitive impairment, sensory impairment, vascular impairment, DVT
33
Q

Ayres SI approach

A

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

34
Q

MMT grades

A

5 ROM AG, max res
4+ ROM AG, nearly max res
4 ROM AG, mod res
4- ROM AG, <mod res
3+ ROM AG, min res
3 ROM AG, no res
2+ more than half ROM AG
2 ROM GM
2- does not complete ROM GM
1 palpable contraction, no ROM
0 no palpable contraction

35
Q

muscle grades

A

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.

THE BOARDS (31 decks)

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