Biomechanics Final

What variables are used to determine in muscle grade?

Contractility, gravity, and resistance

Kinetics

analysis of forces that create motion or maintain equilibrium

Kinematics

used to describe the motion of the body without regard to force

Osteokinematics

used to describe the movement of the skeletal system through planes of motion with the body in anatomical position as a reference

What variables are used to determine muscle grade

Contractility, gravity, and resistance

Center of gravity

the point of the body in which all parts are considered exactly balanced, the part in an object where torque is equal on all sides, the part of the body at which the entire weight of the body may be considered balanced; the intersection of the center of all three of these planes

Base of support

is the part of the body that is in contact with the supporting surface

1st class levers

exists when forces are exerted on opposite sides of the axis or fulcrum ex. A seesaw. In the body, the atlanto-occipital joint is an example of this lever as is the erector spinae in relation to the intervertebral joints in sitting or standing.

2nd class levers

the weight or resistance is situated in between the effort force and the axis; a large amount of weight is supported or moved by a smaller force; force multiplier Ex: For this lever in the body, think about rising up on your toes. The mtp joints are the axis, the muscles inserting into the heel are the effort forces, and the weight of the body acting through the ankle is the resistance force.

3rd class levers

most common in the body; effort force is located in between the axis and the resistance force; force reducers (effort force is greater than the resistance or load) Ex: Tweezers and chopsticks are two examples of this lever. In the body, we are looking at small muscular forces producing larger movements of long body segments, such as the biceps brachii, the deltoid, the extensor carpi radialis, and the iliopsoas muscles.

Linear force

two or more forces act upon an object in the same line in roughly the same point of application Ex: We can look at how the muscles of the lower leg, such as the gastric and the soleus work together to plantarflex the foot.

Force couple

two or more muscles, which alone generate force in different linear directions, contract simultaneously and produce rotary movement Ex: Think about abduction of the humerus. The lower trapezius depresses and upwardly rotates the scapula, while the upper trapezius elevates and upwardly rotates the scapula. This can be visualized as two hands on a steering wheel, with the left hand "pulling" and the right hand "pushing" the wheel to turn the car to the left.

Parallel force

two or more forces acting on an object, in the same plane, but not necessarily in the same direction Ex: We can consider a brace post spinal laminectomy. (Figure 2-14 gives a visual)

Frontal plane

anteroposterior axis; Ulnar and radial deviation, lateral flexion, abduction and adduction

Sagittal plane

mediolateral axis; Extension, flexion, hyperextension

Transverse plane

vertical axis;Internal and external rotation, supination and pronation, head and trunk rotation, horizontal abduction and adduction

Active Range of Motion

arc of motion through which a joint passes when moved by muscles acting on a joint

Passive Range of Motion

arc of motion through which a joint passes when moved by an outside force

Active Assistive Range of Motion

arc of motion through which a joint passes when moved initially by muscles then completed by an outside force

What are precautions for performing ROM

Infected and inflamed joints Client on pain meds or muscle relaxants Hypermobile joints Subluxed joints

What are contraindications for performing ROM

Dislocations Unhealed fracture Myositis ossificans Immediately following surgery to tendons, ligaments, muscles, joint capsule, or skin

What factors influence ROM

Client factors (genetics, health status, age and gender, pain) Psychological factors (prior experience, fear, cognitive issues, anxiety, depression) Environmental factors (temperature, time of day, clinic environment) Skeletal factors (tissue type, type of joints) Methodological and measurement factors (method of testing, testing procedures, instruments used, clinician knowledge and experience)

Functional strength

the use of muscles in a smooth, coordinated manner during functional and real-world tasks and activities

Muscle power

the product of force and velocity or the amount of work per unit of time

Endurance

the ability to maintain a force over time or for a set number of contractions or repetitions.

Torque

the product of the muscle force and the perpendicular distance between the axis of rotation and the muscle force.

Torque Equation

Torque = moment arm X force

Isometric contractions

Isometric contractions enable muscles to act in a restraining or holding action. tension produced against resistance is in equilibrium, the external muscle length does not change, and no motion is observe.

Isotonic contractions

In this type of muscle contraction, internal forces result in movement of the joint, which may include lengthening (eccentric) or shortening (concentric)

Suture joint

immovable joint joined by dense fibrous connective tissue that directly unites bone to bone (example: skull)

Syndesmosis joint

fibrous joint help together by an interosseus ligament or membrane (motion is limited by extensibility of connecting ligament or membrane) (example: sacroiliac ligament)

Gomphosis joint

fibrous joint characterized by a peg in socket alignment (example: teeth insertion into mandible and maxilla)

Symphysis joint

formed by fibrocartilage or hyaline cartilage (typically characterized by relatively restrained movement) (example: symphysis pubis)

Synchondrosis joint

temporary joints that are present as the skeleton grows but become thinner and are ultimately replaced by bony union when skeletal maturity is reached (example: physeal/growth plate)

Sarcomere

the basic contractile unit of the muscle

Fascicle

fibers that are organized into various-sized bundles

Perimysium

dense connective tissue that encases fascicles

Epimysium

wraps the entire muscle and protects the muscle from friction during muscle contraction. This structure also transfers muscular tension to the tendons and then to the bone.

What elements are included in assessing a client's pain

Rating scale, self-report, pain assessment including time, duration, cause, severity, aggravating and relieving factors.

What are appropriate assessment procedures

regardless of what joint you may be evaluating, Occupational profile Observation and palpation Range of motion Strength Stability Impingement

Observation

Visually noting active, coordinated movements, compensatory and substitution movements, indications of pain, symmetry, winging, rounded posture, elevation of shoulders, overall posture, etc.

Palpation

Hands on - used to discriminate differences in muscle tension to assess if there is effusion, edema, muscle spasm, or muscle tone (spasticity, rigidity, flaccidity). It can be used to distinguish differences in tissue texture, thickness, direction, and shapes of structures and tissue types including tissue integrity and temperature.

Jobe

Subacromial impingement

Neer

Subacromial impingement

Hawkins-Kennedy

Subacromial impingement

Roos

Thoracic outlet syndrome

List possible pathology of the shoulder (overall)

Brachial plexus injury, Cervical spondylosis Cervical disc herniation Thoracic outlet syndrome Bursitis Arthritis Adhesive capsulitis Contusions Fractures Subluxation Dislocation SprainsTendonitis Bursitis Acute/subacute/chronic conditions

Describe the movements associated with the shoulder

Flexion, Extension, Abduction, Adduction, Internal and external rotation, scapular elevation/depression, protraction/retraction, upward/downward rotation

Name appropriate provocative tests and explain what potential issue is being assessed for the elbow

Mill's Test (Lateral epicondylitis) Elbow Flexion Test (Cubital Tunnel syndrome)

List possible pathology (overall)

Lateral Epicondylitis (Tennis Elbow) Medial Epicondylitis (Golfer's Elbow)

Describe the movements associated with the elbow

Flexion Extension Pronation Supination

Name appropriate provocative tests and explain what potential issue is being assessed

WHAT Test; DeQuervain's tenosynovitis; causes: repetitive hand and wrist movements; pain and inability to resist to pressure indicates a positive sign.

List possible pathology (overall)

FOOSH (supinated - radial head fracture) (forceful wrist extension - distal radius fracture (Colles fracture); Carpal Tunnel Syndrome; Pathology involving the triangular fibrocartilage complex; TFCC (degenerative processes (natural wear and tear) OR injury; neurological, muscles and tendons, overuse/cumulative trauma, hand deformities, vasomotor changes

Describe the movements associated with the wrist and hand

Wrist: Flexion/Extension, Radial deviation, ulnar deviation; Hand: Flexion (MCP/PIP/DIP), extension (MCP/PIP/DIP), abduction, adduction, opposition, Thumb: Flexion (CMC/MCP/IP), extension (CMC/MCP/IP), abduction, adduction, opposition/reposition

Review the elements of posture/impact of movement on posture

Posture: the position of the head, limbs and trunk and their relationship to each other. Changes in posture occur any time a body part is moved.

What elements create stability in the hip

Bony anatomy, acetabular labrum and the ligaments of the hip

Describe the relationship between center of gravity and base of support in relation to stability

posture, and functional mobility, Changes in COG and BOS can alter our stability if we are unable to maintain our COG within our BOS. Stability is maintained if the COG remains within the BOS. Stability: COG and BOS. Function of the Ues is dependent on stability in the pelvis and postural structures.

Biomechanical Approach Defining factors/concepts

Bottom-up approach, Restore or establish client-level factors, performance skills, and performance patterns, Teach/train new performance skills and patterns, Musculoskeletal capacities, peripheral nerves, integumentary system, cardiopulmonary systems, Related fields: Exercise physiology, kinetics, anatomy, and kinematics

Biomechanical Approach Elements of intervention

Teach new skills, behaviors, or habits to reduce dysfunction and/or enhance performance, Change the biological or physiological processes, Use of procedural reasoning skills to incorporate disease and prognostic information into intervention planning, Correlation of the physical demands of the graded activities to the subskills and role-relevant behaviors, Motivation and meaningful activities meet individual needs and interests in social roles, Provide graded activities that simulate the physical requirements of the task and demand increasing levels of ROM, strength, and endurance

Biomechanical Approach Expected outcomes

Reduction in limitations, Learn new skills, Slow declines, Maintain or improve the quality of life

Rehabilitation Approach Defining Factors/Concepts

Top-down approach, Evaluation of the performance areas of work, play, and self-care, Identify environmental demands and resources, Focus on clients' strengths and ability to participate in areas of occupation, Little or no expectation for change or improvement in impairments, Focus on context, activity demands, performance patterns, activity limitations, and participation restrictions

Rehabilitation Approach Conceptual Background

Activity limitations and participation restrictions limit occupational

performance

Problems with safety during occupational performance, Little/no expectation for change or improvement in performance skills and

abilities

Residual impairments, Top-down approach, Emphasis on client and caregiver education for adapted tasks, environments,

and relearning of lost skills

Rehabilitation Approach Function/Dysfunction Criteria

Function: the ability to maintain oneself and take care of others and the home; the ability to advance oneself through work, learning, and financial management; the ability to enhance oneself through self-actualization activities. The ability to engage in constructive activity successfully along a continuum of independence Dysfunction: loss of ability to engage in previously mentioned occupations and roles. Occurs as a result of degenerative disorder, disease, or trauma

Rehabilitation Approach Strengths/Limitations

Strengths: widely documented, extensively used, concepts easy to explain, intervention often visual (concrete), range of options available - can be easily matched to the needs of the individual, intervention results may be rapid Limitations: may have a tendency toward reductionism; needs full analysis of need of device or method matched with person, environment, and occupation; not appropriate for clients with impaired cognition; seen as conflicting with other types of intervention; needs to understand what the changes mean to the client (psychologically, socially, culturally, etc.); transfer and generalization may not occur

Rehabilitation Approach Elements of Intervention

5 different strategies Reduce the impairment (remediation), Change the method (compensate), Change the objects (adaptation), Change the context (physical), Change the context (social)

Rehabilitation Approach Methods

Changing the task via: Adapted tasks or procedures, Adapting the task objects, adaptive devices, or prosthetics Changing the context via: Environmental modification, Training the caregiver or family, Mobility adaptation, Disability prevention

Rehabilitation Approach Teaching strategies

Identify client needs, goals, and preferred learning styles. Determine potential barriers to learning. Evaluate current skills and potential barriers. Use a collaborative approach to enhance the learner's participation, trust, and progression from extrinsic to intrinsic feedback. Individualize the learning process to the learner's capabilities, and provide the "just right" challenge. Provide opportunities for active learning and practice. Present learning in real contexts with common objects. Arrange practice environments to reflect skill objectives of automaticy, transfer of learning, or generalization. Test the client's learning by requiring the task to be done independently or in an appropriate time and place. Collaboratively discuss progress and revise learning plans with the client.

Rehabilitation Approach Expected Outcomes

Learning new skills or use of devices to resume life roles. Maintaining or improving quality of life. Prevention of disability. Enhanced self-efficacy and satisfaction with performance. Improved adaptation to occupational challenges

Occupational Adaptation Defining factors/concepts

OT empowers client to become agent of change. Human development is a process of adaptation—biological, sociological, and psychological factors may impair this process. Model focuses on client's internal process of adaptation, his/her self-advocacy, and the need for mastery - motivates to accomplish functional performance.

Occupational Adaptation Elements of intervention Press for mastery

lifelong internal and external demand to perform. Intervention focuses on providing the client with necessary tools to foster adaptive and masterful engagement in occupational functioning. Occupational environment demands mastery from the person. To navigate the press for mastery, the person goes through the normative and developmental process of occupational adaptation. A person may experience an occupational performance breakdown. Occupational Restriction - forced disuse, occupation-as-end, use of assistive devices. Occupational Engagement - promotion of functional use, occupation-as-means & occupation-as-end, therapist educates client in functional movement to be resumed. Occupational Execution - promotes occupation in context, challenge of an appropriate task, forcing shoulder stability. Occupational Spontaneity - efficient, satisfied use of body, body is fluent and pain free, body meets demands of occupation.

Occupational Adaptation Approach Expected outcomes

Client can participate in occupation, facilitate the environment, and use occupations to empower the occupational adaptation process. Success in occupational performance is a direct result of the person's ability to adapt with sufficient mastery to satisfy self and others. Person has sufficient mastery and the ability to adapt to occupational challenges. Results in successful occupational performance of tasks associated with valued occupations