Functional movement

What ways in which OTs assess function

evaluation, observation, standardized testing

Biomechanics in relation to OT

study of mechanical laws and their application to living organisms, espically the human body and its locomotor

Kinesiology in relation to OT

scientific study of muscular activity and the anatomy, physiology, and mechanics of movement of body parts

Biomechanical frame of OT

OTS go beyond kinesiology analyzing performance, skills, function and environment

Isotonic movement

muscle contraction where the muscle changes length while moving a joint against load or tension

Concentric

muscle shortens when it contracts and moves end of distal segment closer to origin, working against gravity

Eccentric

muscle is stretched by external force that overpowers the muscles own force, working with gravity

Isometric

no change in fiber length in muscle, force is equally balanced

what is another term for isometric

static work

agonists

prime move, muscles act together to produce movement

antagonists

oppose prime movers, must relax before the agonist can move

what supports proximal joints

fixators

co-contarction

agonists and antagonists stabilizes joints through simultaneous activity on opposite side of joint

what is synergy

muscles acting together to produce a specific movement

compression force

a push or squeeze that acts inward

tensile force

oad that stretches or elongate the line of force

shearing

skin stays in one place while bones and tissue slide

how does gravity affect the body?

stimulates reflexes turning into stimulate movement, influences the development of movement in infants and children as they work against gravity

what is the center of gravity

point where the body/object would balance

what influences COG

body shape, position, what is worn on a person

what affects stability?

base of support, height, weight, COG projection, shoes

what is COG projection

shifting your position and project your COG beyond your base of support, losing our balance

what is body mechanics

the way we move the body, spine, and extremities during activities to protect our body

Why do we have appropriate body mechanics

efficient use of muscles, conserving energy, reduce strain or stress to body parts, simplify tasks, prevent injury, safety

what do appropriate body mechanics look like

wide base of support, maintain alignment of spine, hold objects close to COG, shift weight, push, lift with legs

what does posture in standing look like

natural pelvic tilt, balanced curves in spine, head over shoulders over pelvis over knees over feet, symmetry, good footwear

what does posture in sitting look like

neutral pelvic tilt, balanced curves in spine, head over shoulders over pelvic, symmetry and comfort, visual alignment, UE support, reach

what does posture lying down look like

prone, supine, side lying, changing position, use of equipment if necessary

what are transitional movements

supine to side lying, side lying to sitting, sitting to standing

what does lfiting and carrying look like

plan ahead, communicate, keep feet shoulder width apart, lift close to body, tighten ab muscles, avoid bending at waist, lift with legs, avoid twisting

what does AROM test

shoulder flexion, wrist extension, shoulder horizontal abduction, pronation, internal rotation

what does MMT test

shoulder flexors, elbow flexors, wrist extensors

what is posture

position of the body influenced by bearing of ones body

what is postural control or adaption

ability to maintain balance automatically and remain upright during alterations in position and challenges to stability

what is balance

an even disturbing of weight enabling someone or something to remain upright

what are impacts of balance deficits

increased fall risk, health care costs, decreased independence, negative social implications

what contributes to posture and balance impairments

decreased ROM, strength, motor coordination, abnormal tone, impaired sensation, pain, impaired cognition, natural aging process

how do OTS asses posture?

through observation of symmetry, and alignment of the front, side, rear of body parts

what is lordosis

excessive inward curve of the spine in cervical and lumabr

what is kyphosis

excessive forward curvature of the thoracic spine

what is scoliosis

lateral curve of spine combined with vertebral rotation

what body parts are required for posture

head, neck, shoulders spine, trunk, arms, pelvis, legs

what is the role of OTs in improving posture adaption

learn the safest, most effective and efficient position or engaging in tasks, adaption

what might improving posture look like

move through ROM, move body parts independently, stop and hold movement at midrange to stabilize, increase and decrease muscle contractions, move both sides of body symmetrically

how do OTs improve posture

incorporate traditional movements patterns into activities, position activites and objects strategically, provide supports

What are ankle, hip, and stepping strategies?

automatic. motor responses the body uses to maintain balance, control pressure and prevent falls

resources required for postural control

biomechanics constraints, sensory modalities, cognitive processing, perception of verticality, movement strategies, sensory integration and reweighing

what are the three sensory modulation

somatosensory afferents, visual, vestibular

what % of somatosensory afferents stabilizes a person

70%

what % of visual stabilizes a person

10%

what % of vestibular stabilizes a person

20%

sensory integration and reweighting

integration of the 3 systems is essential for postural control = integration and reweighting performed by COS

what is most important about biomechanical constraints

quality. and size of base of support

how does stroke affect BOS

weakness and impairs control of affected LE, decreased ROM, impaired tone, pain, poor trunk control

movement strategies

normal strategies to maintain balance rely on patterns and synergies of movement that originate a ankle, hip or stepping. can be reactive or anticipatory.

ankle movement strat

maintaining balance for small amounts of sway, ankle movement occurs to maintain COG over BOS

him movement strat

with larger perturbations to the body, characterized by swaying of hips

stepping movement strat

when perturbation is too large, ankles and hips are not able to compensate so we step

people with strokes rely on…

compensatory strategies and on stepping

cognitive processing

as task difficulty increases, increase attention is required

balance control is affected by

exceptions, alterness, attention, experience, environmental context, difficulty task

perception of verticality

ability to maintain adequate orientation in space, requires visual and vestibular input, influenced by CVA

pusher syndrome

resistance to supporting weight on unaffected side, push away from non-hemiparetic side, loss of balance, fear of falling toward unaffected, perceives body as upright when its tilted

examples of sensory integration and reweighting

unstable surface, dark room

what is anticipatory movement

actions that the brain generates before an event occurs

what is reactive movement

neuromuscular response triggered by external stimulus

what is dynamic movement

physical action that takes muscles and joints through full ROM

what is functional balance movement

ability to control and maintain bodys COG over BOS while in motion

reaching and grasping requires what?

vision

what is critical in reaching and grabbing

proprioception

gross grasp/cylindrical grasp

the entire palmer surface of the hand is grasping around a cylindrical object

power grasp

thumb assits with stabilization of object on the handle rather than opposing the digits

spherical grasp

cupping the thenar and hypthenar eminences with varying degrees of finger flexion

hook grasp

gripping like a hook formed by flexed fingers

tip pinch

most precise, tip of thumb opposes tip of pointer

lateral pinch

pad of thumb against lateral side of index finger

3 jaw chuck

pad of thumb opposes both index and middle finger, 80% of prehension

dynamic quadrapod

used for grasping pencil

components of motor evaluation

ROM, MMT, muscle tone, reflexes, coordination, balance, endurance

PROM

amount of motion at a given joint moved by a outside force

AROM

amount of motion at a given joint achieved by the client

AAROM

use of own muscles but needs help to complete

TAM

combined ROM

self-PROM

moving a joint helping with opposing hand

What signs/symptoms might our patients demonstrate that would indicate an issue with their motor systems?

weak muscle control, coordination, muscle spasticity, hyperflexia,

where is the axis put on

point where movement occurs

where does the stationary arm go

parallel to long axis of body segment proximal to joint

where does moveable arm go

parallel to long axis of body segemnt distal to joint

how do you record ROM

start to end, anatomical position is 0, if not achieved indicate limitations

what is strength

ability to perform activities that require high levels of muscular force

what is weakness

lack or reduction of power in a muscle or muscle group

Why would we screen the LE

rule out pathology, establish a baseline, identify asymmetries

Principles of ROM testing

AROM before PROM, positioning, stabilization, instruments

ROM/strength screening vs. formal ROM/MMT assessment

ROM rules out impairment, formal ROM/MMT measures specific deficits

Procedures/techniques to follow for goniometry assessments of the UE

explain, observe, rule out, if there are deficits meausre

Impact of gravity on ROM/strength

resistance factor or assisting factor

what is against gravity

moving a limb upward against gravity

what is gravity eliminated

movement in a horizontal plane removes downward pull of gravity

what is anti-gravity

muscle lifts the weight of the limb upward, opposing downward pull of gravity

procedure for MMT

explain, position client so movement is against gravity, stabilize proximal end, ask clint to more into end range, apply resistant to distal end