Biomechanical Frame of Reference and Musculoskeletal Disorders

Paradigm

Philosophy, values, ethics, and knowledge base

Example of Paradigm

Occupational therapy practice framework

Occupation-Based Models

Overarching theories

Frames of Reference

Guides choice of assessments and interventions

What model of practice is transactional?

PEO

What does the PEO model of practice address?

The fit between the person, environment, and occupation

According to the PEO model of practice is the person static or dynamic?

Dynamic, always developing and interacting with the environment

According to the PEO model of practice what do environments enable and what can they constrain?

Occupational performance

According to the PEO model of practice are occupations simple or complex?

Complex

True or False: Occupational performance changes over the lifespan.

True

What 3 client factors do occupational therapists using the PEO model of practice assess?

1. Performance components (motor, process, and social skills)

2. Occupations, activities, and tasks

3. Environmental conditions

What are occupational therapists using the PEO model of practice trying to identify?

Occupational performance strengths and weaknesses (problems)

Ideally, should occupational therapists start with a client's strengths or weaknesses?

Strengths (top-down)

What does the PEO model focus on to be considered client-centered?

What the client can currently do successfully

What makes the biomechanical frame of reference unique to occupational therapy?

The way biomechanical principles are applied to understanding occupational performance

What is a criticism of the biomechanical frame of reference?

Bottom-up approach

True or False: All occupations involve persons stabilizing and moving their bodies.

True

How are outcomes evaluated in the PEO model of practice?

By measuring occupational performance

When is the biomechanical frame of reference used?

With persons who experience limitations in motion, strength, and/or endurance that interfere with occupations

What frame of reference was not originally compiled by occupational therapists?

Biomechanical frame of reference (must be translated to an occupational therapy perspective)

What 5 factors does the biomechanical frame of reference focus on?

1. Body design/anatomy

2. Musculoskeletal capacities

3. How motion is accomplished

4. Pain modulation

5. Physical disabilities

What knowledge is the biomechanical frame of reference based on?

Kinetic and kinematic principles

Anatomy of musculoskeletal system

Physiology of bone, connective tissue, neurovascular structures, and muscle

Cardiopulmonary function

Kinematics

The nature of movement and the forces acting on the human body as it moves

According to the biomechanical frame of reference, what 3 factors is capacity based on?

1. Range of motion

2. Muscle strength

3. Endurance

Muscle Strength

The ability of muscles to produce tension for maintaining postural control and for moving body parts

Endurance

The ability to sustain effort over the time required to do a particular task

Biomechanical Activity Analysis

Examination of the endurance, range of motion, and muscle strength needed for the completion of an activity

According to the biomechanical frame of reference, what does motion depend upon?

Joint structure/function and integrity of surrounding structures

What do muscles cross?

Joints

What do muscles exert?

Force

According to the biomechanical frame of reference, why do muscles cross joints and exert force?

To control and produce movements

According to the biomechanical frame of reference, what is endurance?

The ability to sustain functional activities

According to the biomechanical frame of reference, what does performance depend upon?

Simultaneous muscle actions for stability (proximal) and movement (distal)

According to the biomechanical frame of reference, what is sustained muscle activity dependent on?

Muscle physiology, oxygenation, and nutrition

According to the biomechanical frame of reference, what is occupational performance?

Function of circumstances and musculoskeletal capacity

According to the biomechanical frame of reference, what 3 factors affect and are affected by occupational performance?

1. Range of motion

2. Muscle strength

3. Endurance

6 Biomechanical Outcome Measures

1. Occupational performance

2. Motion (goniometry, linear measurements, inclinometers)

3. Strength (manual muscle testing, grip/pinch strength)

4. Endurance (duration of activity)

5. Pain (self-report or scales)

6. Specialized assessments

How can occupational therapists assess occupational performance?

Interviews and self-reports

Within Normal Limits

When, under visual observation, the client looks like they are moving within normal range

Within Functional Limits

When, under visual observation, active range of motion is at least half of what looks like normal range

Generally, pain is rated on what number scale?

0-10 point scale

Who should the occupational therapist develop the intervention plan with?

Client

What 6 factors may limit motion?

1. Joint damage

2. Muscle shortening

3. Edema

4. Pain

5. Skin tightness

6. Spasticity

Elasticity

The ability to stretch and return to original shape and size after movement

True or False: Swelling takes up the necessary space for our body to move.

True

Where does swelling occur in the hand? What occurs as a result?

Swelling occurs in the back of the hand pulling the fingers into intrinsic minus

Where does scar tissue form?

In the center

What can weakness occur as a result of?

Disuse (occurs immediately, 5% a day after 3 days)

Disease affecting muscle physiology

Diseases or trauma to lower motor neurons, spinal cord, and/or peripheral nerves

What can endurance be reduced by?

Confinement

Limited activity

Cardiovascular issues

Respiratory pathology

Muscular diseases

According to the biomechanical frame of reference, what can occupations remediate?

Loss of motion, strength, and/or endurance

According to the biomechanical frame of reference, what will the patient regain if motion, strength, and endurance are regained?

Function

How can function be defined according to the biomechanical frame of reference?

Patient is able to produce isolated, coordinated movements

What principle does the biomechanical frame of reference follow?

Rest and stress

Rest and Stress Principle

Following an exercise session or workout, the body requires adequate rest to recover the energy that was expended and to make repairs to the muscle tissues

What is the guiding continuum of the biomechanical frame of reference (left to right)?

Structural stability

Edema

Maintaining range of motion and strength

Increasing range of motion

Increasing strength

Progressive endurance

3 Biomechanical Intervention Approaches

1. Restoration

2. Prevention

3. Compensation

What do interventions based on the biomechanical frame of reference focus on?

Intersection of motion and occupational performance

Restoration

Improving capacity

Prevention

Avoidance of contracture/maintenance of capacity for motion on the uninvolved tissue

Contracture

The lack of joint mobility caused by abnormal shortening of a muscle (soft tissue contracture → rigid bony contracture)

Compensation

Aims to offset limitations by bridging the gap between the person's capacity for stability or motion and what is required in everyday occupations

Biomechanical Interventions

Increase strength, motion, and endurance

Maintain or prevent limitations in motion

Modify activity

Occupations

Orthoses

Prosthetic devices

Physical agent modalities (PAMs)

What is the goal of the biomechanical frame of reference?

To minimize the gap between existing capacities and functional requirements

What do the interventions of the biomechanical frame of reference address?

Targeted limitations and underlying causes

According to the biomechanical frame of reference, how should occupational therapists administer exercises?

Within the context of client-chosen tasks

According to the biomechanical frame of reference, how is strength developed?

By increasing stress on muscles

5 Ways to Increase the Stress on Muscles

1. Amount of resistance

2. Duration of resistance

3. Rate of exercises

4. Frequency of sessions

5. Work hardening

Work Hardening

An individualized biomechanical approach to treatment aimed at returning an individual back to work

What is the main method of treatment used in work hardening?

Physical reconditioning

Physical Reconditioning

The use of simulated and real work activities along with exercise to improve the person's ability to perform specific work tasks

At what rate should exercises be performed at, fast or slow?

Slow and controlled

2 Ways to Increase Strength

1. Graded exercises

2. Structured daily occupations

4 Ways to Increase Endurance

1. Light resistive exercise

2. Increasing time in occupations

3. Graded cardiovascular exercise

4. Interest-sustaining tasks

3 Ways to Maintain or Prevent Limitations in Motion

1. Compression for edema control

2. Positioning, handling, bracing, and/or orthotics

3. Movement

3 Ways to Increase Motion

1. Passive stretching

2. Active stretching

3. Proprioceptive facilitation

According to the biomechanical frame of reference, what should adapted activities have?

Meaning and relevance

8 Ways to Modify an Activity

1. Reduce or alter demands

2. Positioning

3. Adding weights

4. Assistive devices

5. Modifying tools

6. Changing materials or object sizes

7. Changing methods of completion

8. Special equipment

What 2 factors does activity modification focus on?

1. Intensify demands to increase capacity

2. Match permanently reduced capacity

4 Educational Methods to Modify an Activity

1. Energy conservation techniques

2. Joint protection principles

3. Body mechanics

4. Ergonomics

Example of Joint Protection

Carrying a backpack on two shoulders compared to one shoulder

How can occupation be defined according to the biomechanical frame of reference?

As a natural and motivating circumstance that encourages effort, diminishes fatigue, and diverts from pain or fear by bringing attention to the functional purpose

Orthoses

Support, immobilize, position opposite contracture, and/or enhance function

Splint

A temporary device that immobilizes a fracture site

3 Physical Agent Modalities

1. Superficial heat or cold

2. Therapeutic ultrasound

3. Electrotherapy

Why is therapeutic ultrasound often used?

To produce a physiological response

Why is electrotherapy often used?

To make motion and inhibit a pain response

How are occupations used in the biomechanical frame of reference?

To treat loss of motion, strength, and/or endurance

In order for an occupational therapist to use the biomechanical frame of reference, does their client need to have an intact or damaged central nervous system?

Intact central nervous system

What frame of reference is the oldest form of treatment for physical disabilities?

Biomechanical frame of reference

According to the biomechanical frame of reference, what does function follow?

Gains in motion, strength, and/or endurance

Musculoskeletal Disorders

Injuries or disorders of the musculoskeletal system including muscles, tendons, ligaments, nerves, supporting structures, blood vessels, bones, etc.

True or False: Severity of injury or impairment can vary.

True

What can pain/discomfort interfere with?

Occupations

What does early treatment to ease pain decrease?

Further impairment/damage

Possible Causes of Musculoskeletal Disorders

Sudden exertion or trauma

Prolonged exposure to risk factors (repetition, force, vibration, or awkward posture)

Age

Choice of occupational engagement

Activity levels

Lifestyle habits

Activities that cause wear-and-tear over time

Poor posture

Lack of activity

Occupational Risk Factors for Musculoskeletal Disorders

Body movements

Fixed or constrained body positions

Repetition of movements

Force concentrated on parts of the body

Work pace and recovery time

Exposure to heat, cold, and vibration

Psychosocial factors

Health status and nutrition

How do musculoskeletal disorders most commonly occur?

Via a combination of risk factors

Common Musculoskeletal Disorder Names

Repetitive motion injury

Repetitive stress injury

Overuse injury

Repetitive motion injuries

Repetitive strain injuries

Cumulative trauma disorders

Occupational cervico-brachial disorders

Overuse syndrome

Regional musculoskeletal disorders

Soft tissue disorders

Examples of Musculoskeletal Disorders

Carpal Tunnel Syndrome

Tendonitis

Muscle/Tendon Strain

Ligament Sprain

Tension Neck Syndrome

Thoracic Outlet Compression

Rotator Cuff Tendonitis

Epicondylitis

Radial Tunnel Syndrome

Digital Neuritis

Trigger Finger / Thumb

DeQuervain's Syndrome

Mechanical Back Syndrome

Degenerative Disc Disease

Ruptured/Herniated Disc

What conditions may present similar to a musculoskeletal disorder?

Low back pain

Fibromyalgia

Gout

Osteoarthritis

Rheumatoid arthritis