OTA 104-Kinesiology Midterm Review Notes

Occupational Therapy Practice Framework and Clinical Procedures

• OTPF-4 (Occupational Therapy Practice Framework, 4th Edition): It is essential to be familiar with the framework, specifically regarding performance skills and client factors.

  • Performance Skills: These are observable, goal-directed actions and include:

    • Motor skills: Actions related to moving oneself or objects.

    • Process skills: Actions related to selecting, interacting with, and using tools and materials.

    • Social interaction skills: Actions related to interacting with others during occupation.

  • Client Factors: These are internal factors residing within the client and include:

    • Values / beliefs / spirituality: Concepts that influence the client's motivation.

    • Body functions: Physiological functions of body systems.

    • Body structures: Anatomical parts of the body.

Biomechanics of Gait: Phases and Pathologies

• Primary Phases of the Gait Cycle:

  • Stance phase: Defined as the period when the foot is in contact with the ground. This phase accounts for approximately $60\,\%$ of the gait cycle.

  • Swing phase: Defined as the period when the foot leaves the ground and before it comes into contact with the ground again. This phase accounts for approximately $40\,\%$ of the gait cycle.

• Abnormal Gait Patterns:

  • Hemiplegic: Characterized by dragging the leg or performing a circumduction movement of one leg while walking.

  • Antalgic: A limp resulting from pain.

  • Parkinsonian: Characterized by short, accelerating steps; frequently referred to as a propulsive or festinating gait.

  • Waddling: A duck-like gait involving exaggerated movements of the upper body.

  • Shuffling: Walking without completely lifting the feet off the ground.

Joint Mechanics: End Feels, Mobility, and Positions

• End Feel Descriptions:

  • Hard: Occurs when two bones block motion (e.g., during elbow extension and knee extension).

  • Firm: Occurs when a ligament stretches at the end range of motion (e.g., during wrist flexion and wrist extension).

  • Soft: Occurs when soft tissue is compressed at the end range (e.g., during knee flexion and elbow flexion).

• Open vs. Close Packed Joint Positions:

  • Open / Loose Pack:

    • Features less total contact area of joint surfaces.

    • The joint is less stable.

    • There is an increased risk of injury.

    • Example: $25^{\circ}$ of knee flexion.

  • Close Pack:

    • Features the closest contact possible over the greatest surface area.

    • The joint is most stable.

    • There is less risk of injury.

    • Example: Full knee extension.

• Defining Joint Dynamics:

  • Joint Distraction: The act of pulling a joint apart (e.g., during hanging activities).

  • Joint Compression: The act of pushing a joint together (e.g., during weight-bearing activities).

Principles of Neurokinesiology

• Afferent vs. Efferent Neurons:

  • Afferent Neurons: Sensory neurons that bring information from the environment. They are ascending toward the brain.

    • Mnemonic for Afferent: Affect (feeling) / Ascending / Afferent.

  • Efferent Neurons: Motor neurons that bring information from the brain to the muscles for movement.

    • Mnemonic for Efferent: Efferent neurons Exit the brain.

• Muscle Tone Definitions:

  • Flaccidity: The absence of muscle tone.

  • Spasticity: High muscle tone accompanied by exaggerated reflexes.

  • Hypertonia: An increase in muscle tone.

  • Hypotonia: A decrease in muscle tone.

• Coordination and Movement Terms:

  • Ataxia: Impaired coordination of voluntary movement.

  • Hemiparesis: Paralysis of one side of the body.

  • Dysmetria: The inability to estimate the range of motion ($\text{ROM}$) needed to reach a specific target.

Structural and Functional Muscle Classification

• Skeletal Muscle: Responsible for voluntary movement; characterized as striated muscle.

• Smooth Muscle: Found in organs; responsible for involuntary movement; characterized as not striated.

• Cardiac Muscle: Found exclusively in the heart; responsible for involuntary movement; characterized as striated muscle.

Anatomical Planes, Axes, and Movement Terminology

• Planes of Movement and Corresponding Axes:

  • Sagittal / Longitudinal Plane: Divides the body into left and right sides. It corresponds with the frontal axis.

  • Frontal / Coronal Plane: Divides the body into anterior and posterior sections. It corresponds with the sagittal axis.

  • Transverse / Horizontal Plane: Divides the body into upper and lower sections. It corresponds with the vertical axis.

• Movement Terminology:

  • Flexion / Extension: Movement occurring in the sagittal plane.

  • Abduction / Adduction: Movement occurring in the frontal plane.

  • Pronation / Supination: Rotational movement occurring in the transverse plane.

  • Internal / External Rotation: Rotational movement occurring in the transverse plane.

  • Ulnar / Radial Deviation: Lateral movement of the wrist toward either the ulna or the radius.

  • Inversion / Eversion: Tilting the foot toward (inversion) or away from (eversion) the midline.

  • Protraction / Retraction: Forward movement (protraction) or backward movement (retraction).

  • Elevation / Depression: Upward movement (elevation) or downward movement (depression).

Kinematic Chains and Joint Dynamics

• Open Chain:

  • The distal segment can move freely.

  • The activity is non-weightbearing.

  • Joints within the chain can move in isolation.

  • Example: Typically the upper extremity.

• Closed Chain:

  • The distal segment is fixed or stabilized.

  • The activity is weight-bearing.

  • Movement in one joint requires movement in other joints within the chain.

  • Example: The lower extremity when in a standing position.

Postural Variations and Spinal Curvatures

• Kyphosis: An excessive convex curvature of the spine, commonly referred to as hunchback.

• Lordosis: An excessive concave curvature of the spine, commonly referred to as swayback.

• Scoliosis: A lateral curvature of the spine that occurs in the frontal (coronal) plane.

Pelvic Alignment and Position

• Lateral Pelvic Tilt (Obliquity): Occurs in the frontal plane when one hip is more elevated than the other. This condition is often associated with scoliosis and discrepancies in leg length.

• Pelvic Rotation: Occurs in the transverse plane where one hip is positioned further forward than the other. This is associated with back pain, leg pain, and postural problems.

• Anterior Pelvic Tilt: A forward pelvic tilt that results in lumbar lordosis and a protrusion of the abdomen.

• Posterior Pelvic Tilt: A backward tilting of the pelvis, resulting in a slumped posture and increased pressure on the sacrum while in a seated position.

Biomechanical Levers and Laws of Motion

• Lever Systems in the Human Body:

  • First Class Lever: Example includes the atlantooccipital joint during neck extension.

  • Second Class Lever: Example includes the lower leg when standing on tiptoes.

  • Third Class Lever: Example includes the elbow joint during flexion.

• Newton's Laws of Motion:

  • First Law (Inertia): An object persists in its state of rest or motion in a straight line unless it is acted upon by an external force.

  • Second Law (Acceleration): The acceleration of an object is directly proportional to the force ($F$) acting on it and inversely proportional to its mass ($m$). This is expressed by the formula $F = m \times a$.

  • Third Law (Action and Reaction): For every action, there is an equal and opposite reaction.

• Biomechanical Definitions:

  • Resistance Arm: The distance between the axis and the point of resistance.

  • Effort / Force Arm: The distance between the axis and the point of force application.

  • Torque: A rotational force occurring around an axis.

  • Friction: A force acting in the opposite direction of the desired movement.

Balance, Stability, and Functional Movement Continuum

• Systems Involved with Balance: Balance is a complex process involving the Visual, Vestibular, Proprioceptive, and Neuromusculoskeletal systems.

• Balance Definitions:

  • Base of Support ($\text{BOS}$): This is contained within the area of the body parts currently in contact with the ground or the seat.

  • Center of Gravity ($\text{COG}$): The balance point where all sides are equal.

  • Stability Condition: Stability and balance are achieved when the center of gravity falls within the base of support.

• Functional Movement Continuum:

  • Abnormal Atypical Movement: Characterized by significant impairment; the individual is unable to complete the activity.

  • Normal Atypical Movement: Occurs during a new task or when previous strategies do not work; movement may appear awkward or uncoordinated.

  • Normal Typical Movement: Varies by individual (e.g., waving a hand); movement is smooth, coordinated, and automatic.

  • Normal (Enhanced) Typical Movement: Highly trained or specialized movement; characteristics include high efficiency and consistency.

Clinical Safety: Precautions and Contraindications

• Precautions/Contraindications for ROM and MMT: It is critical to screen for the following before performing Range of Motion ($\text{ROM}$) or Manual Muscle Testing ($\text{MMT}$):

  • Recent surgery

  • Pain experienced by the client

  • Inflammation

  • Osteoporosis

  • Recent bone fracture

  • Cognitive deficits