theory 2 1st test

what is the biomechanical FOR

• focuses on improving

  • range of motion

  • strength

  • endurance

  • postural stability

  • mobility

  • activity tolerance

theoretical assumptions of biomechanical FOR

• occupation requires adequate physical capacity

• improved body functions can improve occupational performance

• motion can be measured objectively

• repetition and graded activity improve

• body responds predictably to exercise and positioning

biomechanical factors

• ROM

• strength

• endurance

• edema

• pain

• joint stability

• posture

• mobility

• tissue integrity

• active tolerance

common populations for biomechanical

• orthopedic injuries

• arthritis

• stroke related physical limitations

• spinal cord injuries

• hand injuries

• burns

• general deconditioning

common assessments in biomechanical

• MMT

• goniometry

• dynamometry

• edema measurements

• functional endurance testing

• observation of ADL performance

• pain scales

intervention principles of the biomechanical FOR

• improving ROM (ex: use active, passive, or assisted exercises to increase joint mobility)

• increase strength (ex: apply graded resistance exercises)

• increased endurance (ex: build tolerance for sustained activity through repetitive and graded activity)

• promote postural control and stability (ex: improve alignment and body positioning during tasks

  • prevent deformity and injury (ex: use splints, positioning, and education on joint protection and body mechanics)

ROM intervention examples in biomechanical

• AROM exercises

• PROM exercises

• stretching

• prolonged low load stretch

• - joint mobilization

• functional reaching acitivities

strengthening approaches in biomechanical

• theraband exercises

• free weights

• resistive putty

• functional lifting/carrying

• closed chain activities

• repetitive task pracitice

endurance/activity tolerance

• repetitive functional tasks

• standing tolerance activities

• community mobility training

• simulated ADLs/IADLs

edema management in biomechanical

• elevation

• compression

• retrograde massage

• AROM for circulation

pain management in biomechanical

• positioning

• joint protection

• modalities

what is the rehab FOR

• focuses on maximizing independence and participation

• emphasizes compensation rather than remediation

• uses adaptation and environmental modification

• supports meaningful occupational engagement

theoretical assumptions for rehab FOR

• people can lead meaningful lives despite disability

• function can improve through adaptation

• environmental supports influence occupational performance

key concepts of rehab FOR

• compensation

• adaptation

• environmental modification

• assistive technology

• energy conservation

• work simplification

common population for rehab FOR

• stroke

• spinal cord injury

• multiple sclerosis

• PD

• arthritis

• amputation

role of occupational therapy in the rehab FOR

• assess occupational performance

• train ADLs and IADLs

• recommend adaptive equipment

• educate caregivers and families

• modify home and community environments

evaluation process when using the rehab FOR

1. occupational profile: client priorities and goals

2. analysis of occupational performance

` assess functional performance

` environmental analysis

` safety evaluation

adaptive equipment

• reacher

• sock aids

• grab bars

• raised toilet seats

• adaptive utensils/plates

• adaptive keyboards

environmental modifications

• bathroom accessibility

• kitchen setup

• lighting and contrast

• ramp installation

• community accessibility

energy conservation and work simplification

• alternate rest and activity

• prioritize tasks

• plan activities

• pace activities

• use seated position when possible

strengths of rehab FOR

• promotes independence

• highly client centered

• supports participation

• practical and functional

• applicable across settings

limitation of rehab FOR

• may overemphasize compensation

• equipment access may be limited

• home modifications can be expensive

• potential reduced focus on remediation

sensory integration FOR

• brain must organize sensory information effectively for adaptive behavior and participation

• neurological process that organizes sensation from one’s body and environment, makes it possible to use body effectively within the environment

key concepts of sensory FOR

• registration: noticing sensory input

• modulation: regulating responses

• discrimination: interpreting details

• praxis: planning and executing movement

• adaptive response: successful interaction with the environment

what are the senses

1. tactile

2. vestibular

3. proprioceptive

4. visual

5. auditory

6. gustatory

7. olfactory

8. interoception

tactile system

• receptors in skin

• functions

  • detects touch, pressure, pain, temperature

  • protective awareness

  • discrimination

  • body awareness

  • emotional security

• ex: feeling clothing textures

vestibular system

• receptors in inner ear

• function

  • balance

  • spatial orientation

  • postural control

  • movement processing

  • eye head coordination

• ex: riding a bike

proprioceptive system

• receptors located in

  • muscles

  • tendons

  • joints

• Function:

  • body position awareness

  • force grading

  • coordination

  • motor planning

• ex: knowing how hard to push a door

visual system

• functions

  • visual discrimination

  • spatial awareness

  • visual tracking

  • depth perception

  • visual motor integration

• ex: reading

auditory system

• function

  • detecting sounds

  • processing language

  • sound discrimination

  • auditory attention

• ex: listening to instructions

gustatory system

• function: detecting flavor

  • sweet

  • salty

  • sour

  • bitter

• ex: eating preferred foods

olfactory system

• functions

  • detects odors

  • influences memory/emotion

  • supports taste perception

  • alerts to danger

• ex: smelling smoke

interoception

• functions: detects internal body signals

  • hunger

  • thirst

  • pain

  • temperature

  • bladder/bowel signals

  • heart rate

  • emotional states

• ex: knowing you are hungry

what is ayres’ sensory integration

• child led

• play based

• sensory rich

• adaptive response focused

• individually tailored

eval using Ayres’ sensory integration

1. occupational profile

2. clinical observations

3. standardized testing

4. play observation

5. parent/caregiver interview

clinical observations in Ayres’

*clinical observations are critical in ASI

• postural control

• bilateral coordination

• eye movements

• motor planning

• balance

• muscle tone

• responses to movement/touch

standardized testing when using sensory approach

• sensory integration and praxis tests (gold standard)

• evaluation in ayres sensory integration

ASI intervention environment

• platform swings

• bolsters

• scooter boards

• crash pads

• climbing pads

• climbing structures

• tactile materials

components of a just right challenge

1. achievable

2. motivating

3. slightly challenging

strengths of the sensory integration FOR

• holistic and occupation centered

• child directed and play based

• supports emotional regulation and participation

• based on neurodevelopmental and sensory processing theory

• encourages adaptive responses and active engagement

• can improve attention, body awareness, and motor planning

• highly motivating for many children

• sensory informed strategies can be used across settings

limitations of the sensory integration FOR

• research evidence is mixed

• intervention can be difficult to standardize

• requires specialized training for true ASI implementation

• risk of overuse “sensory” explanations for behavior

• not all challenging behaviors are sensory based

• access to equipment and sensory gyms may be limited

• insurance and school constraints may impact intervention

• some sensory based strategies lack strong evidence

key takeaways of ASI

• theory and intervention approach

• adaptive responses are central

• play and motivation drive learning

• vestibular, proprioceptive, and tactile systems are foundational

• eval combines standardized testing and clinical observation

• intervention must follow fidelity principles

sensory processing approaches

• winnie dunn’s sensory processing model

• lorna jean king’s sensory processing approach

• tina chapagne’s sensory modulation approach

dunn’s sensory processing model

• neurological threshold

• behavioral response

• processing patterns (low reg, sensory seeking, sensory sensitive, sensory seeking)+

dunn’s behavioral responses

1. high threshold: needs more sensory input to respond, may miss sensory cues

2. low threshold: notices sensory input quickly, responds easily to stimulation, may become overwhelmed

3. passive response: person allows sensory experiences to happen, doesn’t try to control input

4. active response: person attempts to manage or change sensory experiences

common assessments when using dunn’s sensory processing

1. sensory profile 2

2. infant/toddler sensory profile

3. adolescent/adult sensory profile

4. school companion sensory profile

a student constantly rocks in class, chews pencils, and seeks movement

dun’s sensory processing would be best used

possible interpretation: high threshold, active response sensory seeking pattern

ot strategies: scheduled movement breaks, heavy work before seated tasks

king’s sensory processing approach

• focused heavily on the relationship between

  • sensory processing

  • arousal regulation

  • psychiatric symptoms

king’s sensory: arousal and regulation

• optimal arousal: attention, participation, emotional control, occupational performance

• hyperarousal: anxiety, agitation, restlessness, emotional escalation

• hyperarousal: fatigue, withdrawal, low initiation, flat affect

mental health based intervention approaches using king’s

• rocking chairs

• deep pressure

• music

• weighted items

• aromatherapy

• movement

• quiet rooms

• tactile tools

• breathing exercises

a client on an impatient psychiatric unit becomes increasingly agitated in noisy group settings

• best to use king’s sensory processing approach

• ot intervention may include

  • offer quiet sensory space

  • use calming tactile tools

  • provide rocking chair

  • teach grounding techniques

  • gradually increase participation tolerance

champagne’s sensory modulation approach

• trauma infomred perspective

• trauma changes nervous system responses

• sensory experiences may trigger trauma reactions

• regulation is necessary before participation

• individuals need safety, predictability, and control

key concepts of champagne’s sensory approach

• sensory modulation

• sensory diets

sensory modulations

• the ability to regulate responses to sensory input in an adaptive way

  • maintaining appropriate arousal

  • regulation emotional responses

  • staying engaged in occupation

sensory diets

• personalized set of sensory strategies used throughout the day to support regulation

• examples:

  • schedules movements

  • sensory breaks

  • relaxation routines

  • grounding activities

  • environmental modifications

intervention approaches using champagne’s sensory approach

• calming strategies: deep breathing, weighted blankets, soft lighting

• alerting strategies: movement, bright light, cold temperature, stretching

a client with ptsd becomes overwhelmed in crowded environments and experiences panic symptoms

• best to use champagne’s sensory approach

• ot intervention might include

  • noise canceling headphones

  • grounding techniques

  • deep breathing

  • weighted lap pad

  • identifying safe sensory tools

  • developing sensory coping plan

sensation in ot functional implications

• SAFETY

  • use of items with hot/cold like showering and cooking

  • use of items that could be sharp

  • pressure relief

• assessing sensation allows ot’s to determine deficits in sensation of ue

sensation assessments

• light touch/deep pressure

• localization

• thermal

• sharp/dull

• 2 point discrimination

• proprioception

• kinesthesia

• stereognosis

light touch/deep pressure and localization

• assess a person’s ability to sense touch and pressure

  • light touch assessed with items like tissue or cotton ball

  • deep pressure assessed with item like eraser side of a pencil

  • localization assesses a person’s ability to pinpoint location of touch or sensory stimuli on the skin

thermal sensation

• assess a person’s ability to perceive temperature

• use something that is cold and hot alternating between the two and asking the client what they feel

sharp/dull

assess a person’s ability to distinguish between sharp and dull sensations

2 point discrimination

assess a person’s ability to distinguish 2 separate points of touch being applied to skin

proprioception assessment

assess a person’s ability to perceive position of their limbs and joints while their eyes are closed STATIC JOINT POSITION

kinesthesia assessment

assess a person’s ability to sense joint movement and position DYNAMIC MOVEMENT

stereognosis

assess a person’s ability to pinpoint location of touch or sensory stimuli on the skin

semmes weinstein monofilaments

• measures touch sensation using monofilaments which vary in thickness and provides numerical result

• tests for protective sensation, neuropathy, and sensory

upper extremity assessments

• disabilities of arm, shoulder, and hand (DASH questionnaire)

• box and block test

• 9 hole peg test

• purdue peg board

• minnesota manual dexterity assessment

• fugl meyer aassessment

• chedoke arm and hand inventory

• wolf motor function test

DASH

• measures disability of the ue and monitors change over time

• 30 items self reported questionnaire

• results are scored from 1 to 5 (1 no difficulty 5 unable to perform)

• quick dash 11 items instead of 30

9 hole peg test

• quantitative assessment of fine motor coordination and finger dexterity

• equipment: 9 holed board, 9 pegs, stop watch

• test is administered in 1 to 3 minutes

• scored by timing how long it takes client to put each peg in a hole 1 at a time then remove them 1 at a time

box and block

• measures UE function, coordination, and dexterity

• used for individuals with brain injury, limb loss, MS, pain, PD, neurological impairment, stroke

• consists of rectangular box divided into 2 square compartments

  • 150 colored wooden blocks

  • stop watch

• measure how many blocks the individual moves over the partition from 1 side to other in 60 seconds

• take 2 to 5 minutes to administer

purdue peg board

• assess gross motor movements of fingers, hands, and arms and fine motor coordination (finger dexterity necessary in assembly tasks)

• 5 min to administer

• large rectangular with 2 rows of 25 holes for pegs, to complete the assessment have the client put as many pegs in the holes as they can in 30 seconds (60 seconds for assembly)

• 5 areas scores

  • right hand

  • left hand

  • both hands

  • right + left hand + both hands

  • assembly (pins, collars, washers)

minnesota manual dexterity assessment

• measure eye hand coordination and gross motor skill

• uses turning and placing of objects to assess both unilateral and bilateral manual dexterity as well as eye hand coordination

• assesses speed and accuracy

• 15 min to administer

• 5 subtests

  • placing

  • turning (pickup with hand that leads)

  • displacing

  • 1 handed placing and turning

  • 2 handed placing and turning

WOLF motor function test

• measures ue function, strength, and dexterity

• quantitative measure of ue motor ability through timed and functional tasks

• takes about 35 min to administer

• 17 motor items

  • 6 functional tasks

  • 8 strength measures

  • 9 analyze quality of movement

• 6 point rating scale

  • 0 = no attempt

  • 5 = arm moves and appears normal

chedoke arm and hand inventory

• assesses functional recovery in ue following stroke

• 7 point quantitative scale

• administration in 15 to 30 min

• uses functional items and encourages bilateral coordination

fugl meyer assessment

• performance based impairment index that tests motor sensation, balance, joint range of motion, and joint pain

• based on brustromm’s stages of motor recovery

• typically only complete the ue motor subsection

• equipment

  • tennis ball, reflex hammer, piece of paper, pencil, cylindrical shaped item

  • time for administrating 15 to 20 min for ue