Biomechanics

Front 1

what does exercise do for the body?

Back 1

1. enhances the function of muscle
2. maintains or improves joint ROM
3.enhances the efficiency of the cardiopulmonary system.

Front 2

what are the 4 categories of exercise?

Back 2

1. passive (PROM)
2. Active Assistive (AAROM- partial movement from outside forces)
3. active (AROM)
active resistive (ARE- progressive with additional resistance).

Front 3

passive exercise

Back 3

1/ basic techniques
2. patient does not assist
3. gentle, firm support
4. smooth, controlled motions
all planes of movement are followed
5. entire unrestricted normal ROM

Front 4

PROM limitations

Back 4

1. end feel- joints can be injured
2. dont use on unhealed fractures
3. increases or intensifies symptoms
4. don't go over degrees when doing PROM
4. don't use when patient is capable of doing active exercise

Front 5

PROM indications (when I should use them)

Back 5

1. when there is paralysis
2. pain with active contraction
3. comatose
4. to provide sensory stimulation/awareness.
5. to reduce stress on the cardiopulmonary system.

Front 6

PROM limitations

Back 6

1. cant prevent muscle atrophy
2. cannot increase muscle tone, strength, endurance
3. cannot reduce adipose tissue

Front 7

PROM benefits

Back 7

1. Minimize muscle shortening
2. prevent developing joint adhesions
3. maintain mechanical elasticity of muscle
4. maintain local circulation
5. enhance joint health
6. reduce or inhibit pain

Front 8

AAROM

Back 8

1. Movement through the available range
2. Achieved by muscle contraction and assistance from an outside source. i.e. a therapist, pulley, arm skateboard, gravity
3. same principle as PROM- attempting to minimize contraction

Front 9

Active Exercise

Back 9

1. Clients complete shoulder/hip movements on UE/LE charts within the plane (frontal/sagital) they occur.
2. 10 repetitions
3. No additional weight besides gravity or gravity eliminated is applied

Front 10

Benefits of AROM

Back 10

1. Maintains physiological elasticity, strength, and contractile endurance of muscle
2. increases local circulation
3. Increases awareness of joint motion and sensory awareness.
4. maintains and improves cardiopulmonary functions especially with aerobic exercise
5. may assist to prevent thrombus formation (blood clots) in L.E. using ankle flexion-extension movements (i.e. ankle pumping)
6. maintains and promotes structural integrity of tendon-bone interface
7. Improves muscle strength with the use of external resistance.

Front 11

principles of exercise

Back 11

1. The patient should not be challenged to exceed maximum physical capabilities.
2. instruct the patient to maintain a breathing pattern to avoid the Valsalva Maneuver
3. Avoid applying excessive stress to the patient’s skin, soft tissues, joints, and bones when manual or mechanical resistance is used.
4. Protect structures that are unstable or vulnerable to injury, such as hypermobile joints, healing fracture sites, healing surgical sites, and muscle or ligamentous strains or sprains.
5. Monitor the effect of exercise closely for the patient who has a known history of cardiopulmonary dysfunction.
6. Evaluate the equipment used to be certain that it is secure and stable and that it functions properly.
7. All participants should use proper body mechanics during exercise.

Front 12

Active precautions from teacher

Back 12

1. Do not perform exercises at an angle (unless you are using PNF patterns- learn about them later).
2. lift arm to 90 degrees for external and internal rotation
3. with shoulder abduction, rotate at 90 then continue on up
4. Perform scapula protraction with arm at 90 degrees for better isolation of the movement.
5. no medial/lateral on knee joint (only flex/ext)
6. watch for muscle weakness, substituting behavior
7. remember how fatiguing it is for you- keep the exercise level appropriate for the person's context (age, sex, medical condition)

Front 13

Active resistive

Back 13

1. Purpose- to inc. strength or relax antagonist (antagonist is opposite muscle being contracted)
2. entire range with additional resistance
3. weights
4. theraband/putty
5. objects
6. therapist

Front 14

PRE

Back 14

1. max resistance - capable of completing set of 9-10
2. graded progressively
3. number of reps depends on context
4. give clear instruction- speed, ROM, breathing- Valsalva Maneuver or phenomenon is holding air in lungs causing a vein to burst

Front 15

PRE cautions

Back 15

1. don't us in- infections, fractures, critical nursing care
2. pain occurs during or persists after exercise
3. undesired cardiopulmonary stress occurs- >120 pulse, BP systolic >180, diastolic >100
4. the breathing pattern of the patient becomes abnormal
5. the patient exhibits an undesirable, adverse response to exercise; observe total joint precautions
6. when undesired movements or movements patterns occur
7. when the undesired tone of muscle develops or increases
8. The patient's condition or functional ability regresses.
9. when there is a stress to an unstable area or segment
10. when there is "overflow" or shaking
11. if the function decreases
12. subluxation of Glenohumeral Joint
13. hemophilia (bleeding disorder)
14. bony anklosis (additional bony deposits)
15. within 30 days of myocardial infarction (heart attack)
16. pain during or after for 24-36 hours
17. certain surgical procedures such as open heart surgery
18. high blood pressure- must monitor consistently

Front 16

make sure if using PRE

Back 16

1. joint alignment is right
2. there is a proper fit of devices
3. watch for substitute motions
4. there is joint inflammation
5. patient is on pain meds or muscle relaxants
6. osteoporosis
7. hypermobility (double jointed)

Front 17

self rom

Back 17

1. goal of OT generally
2. if they are able to be taught
3. Challenges- cognitive limitations, attention span. Following directions, motivation, decreased body awareness, and decreased sensation.

Front 18

Delorme Method

Back 18

1. 10 reps at 50% of max
2. 10 reps at 75% of max
3. 10 reps at 100% of max

Front 19

Oxford Method

Back 19

1. 10 reps at 100% of max
2. 10 reps at 75% of max
3. 10 reps at 50% of max

Front 20

Strength vs. endurance

Back 20

Strength- people get from increasing resistance
Endurance- people get from increasing the length of time of an activity.

Front 21

General purpose of therapeutic exercise and therapeutic activity is:

Back 21

1. To develop an awareness of normal movement patterns and to improve voluntary, automatic movement responses.
2. To develop strength and endurance in patterns of movement.

Front 22

3 types of muscles:

Back 22

1. Smooth- i.e. stomach, intestines, organs
2. Cardiac- i.e. heart
3. Skeletal- i.e. provide support to arms, legs, core.

Front 23

Muscle Fiber

Back 23

is the cell that covers the entire length of the muscle
• contain the contractile structures
• very thin- 1/10th the width of a human hair
• made up of hundreds of thousands of rod- like myofibrils
• Sarcolemma (cell wall)- transmits the nervous stimulation and nutrients to muscle.

Front 24

During a contraction-

Back 24

• calcium ions released
• myofiliments (Actin and myosin) work to pull the Sarcomere together.

Front 25

Sliding Filament Theory-

Back 25

1. Myosin heads bind to the passive Actin filaments at the myosin binding sites.
2. Upon strong binding, myosin and Actin undergo an isomerization (myosin rotates at the myosin-Actin interface) extending an extensible region in the neck of the myosin head.
3. Shortening occurs when the extensible region pulls the filaments across each other (like the shortening of a spring). Myosin remains attached to the Actin.
4. The binding of ATP allows myosin to detach from Actin. While detached, ATP hydrolysis occurs "recharging" the myosin head. If the Actin binding sites are still available, myosin can bind Actin again.
5. The collective bending of numerous myosin heads (all in the same direction), combine to move the Actin filament relative to the myosin filament. This results in muscle contraction.

Front 26

Structure:

Back 26

• distinct feature: contains two tendons that firmly attach to the bones
• Origin (stable) and Insertion (distal- moving part)
• during contraction the two tendons pull moving the origin and insertion together.

Front 27

Characteristics of muscle

Back 27

1. Contractibility- ability to shorten and move an object when resistance is applied.
2. Extensibility- muscle opposite to contraction is performing a lengthening movement.
3. Elasticity- important for main muscle to be able to return to original shape.
4. Excitability- ability to respond to increased and multiple stimuli.

Front 28

Factors describing muscle names (7 total):

Back 28

1. Location- i.e. Tibialis anterior (front)
2. Shape- i.e. deltoid (Greek triangle)
3. Action- especially true for hands and wrists. i.e. Flexor Pollicis Brevis- flexing. Extensor Digitorium Longus- extending, (Carpi- means wrist region).
4. Size- i.e. gluteus minimus
5. Number of attachment sites- i.e. sternocleidomastoid
6. Number of heads- i.e. biceps, triceps
7. Direction of fibers- i.e. internal abdominal oblique (coming in at an angle)

Front 29

Goniometry-

Back 29

the measurement of angles, particularly those of range of motion of a joint.

Front 30

General Principles of Goniometry that an OT must have:

Back 30

1. the degree and type of motion that will occur at a joint.
2. average range of motion
3. how to position yourself and the client

Front 31

Axis

Back 31

1. rivet or pivot point
2. goes into joint
3. over bony landmark

Front 32

Stationary arm

Back 32

1. Arm that does not move
2. has the protractor on it

Front 33

Moveable arm

Back 33

1. attached to the center axis of the protractor
2. acts as a dial
3. as the dial rotates, the number of degrees is indicated on the side.

Front 34

On recording measurements

Back 34

1. measure the unaffected side in addition
2. functional range of motion is not necessarily functional
3. 0 is starting position (anatomical) if problem getting to it, needs to be reflected on measurement
4. scapular mobility is a factor in Glenohumeral movement.
5. observe and proceed with caution with pain and spasticity
6. range of motion in 5 degree increments

Front 35

what is the key to reading a goniometer?

Back 35

The key to reading the Goniometer is common sense and knowing your norms. try aligning the arms first, then placing the axis point or the anatomical landmark, visually following the moveable arm.

Front 36

basic principles of ROM testing (1-6)

Back 36

1. have the patient comfortable and relaxed in the starting position
2. explain and demonstrate the what, why, and how the goniometry to the patient.
3. establish body landmarks for the measurement
4. stabilize joints proximal to the joint being measured
5. move the part passively through ROM to estimate available ROM and get a feel for joint mobility.
6. return the part to starting position.

Front 37

basic principles of ROM testing (7-11)

Back 37

7. at the starting position, place the axis of the Goniometer over the axis of the joint. place the stationary bar on the proximal or stationary bone and moveable bar on the distal or moving bone.
8. record the number of degrees at the starting position.
9. depending on what type of measurement is being taken (AROM, PROM) move or have the patient move the part to obtain the measurement desired.
10. reposition the moveable arm of the Goniometer, checking that the axis is still accurately placed, and note the number of degrees at the final position.
11. record the reading to the nearest 5 degree, and make any other appropriate notations on the form.