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59 Cards in this Set

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List the 6 components of functional use of the upper extremity
- reach
- grasp
- in-hand manipulation
- carry
- voluntary release
- bilateral coordination
What is the goal of reaching?
to transport the hand to the target with precision in both SPACE and TIME (goal directed movements)
List important elements locating on object in space for UE functional use
- coordinated movements of eyes head and trunk depending on distance of the object
- range of head and eye movements
- locating the object in the fovea for precision tasks
Describe the general ROM of head vs. eyes for locating objects in functional tasks of the UE
- Head accounts for 60-70% of movement
- Eye movement depends on level of detail
List the typical positions of each joint of the UE in a mature reach to object at about table height
- shoulder flexion
- external rotation
- elbow extention
- forarm supination towards neutral
- slight wrist extension
- trunk extension
- lateral weight shift towards object
Describe how saccadic eye movements are important in functional activities of the upper extremity
Allow scanning of objects to find what is needed for the next step (like making a sandwhich)
Describe how the two streams of visual procssing play a role in the functional use of the upper extremity
(there are vental and dorsal streams)
- processing in parietal lobe: how to act on an object
- processing in temporal lobe: identification of an object
How does lack of somatosensory information change the functional use of the upper extremity
Changes speed and quality and requires visual compensation
Describe how reach and grasp are related/paired
They occur TOGETHER is space and time
Describe the sequence of reach and grasp
- arm moves quickly initially
- hand opens
- arm slows
- hand closes
When does maximum hand opening occur during reach/grasp?
At 2/3-3/4 of total movement TIME the hand reaches maximum apperature
Describe how reach/grasp changes overall when object is smaller
- total movement time is longer
- hand opens sooner
- more time is spend slowing the arm down and positioning the hand
How do you decide how much grip to give an object?
- experience
- afferent information
Describe how decreased roughness of an object influences grip
Decreased roughness leads to tighter grip and slower movement
Describe what happens to adjust when on object you are holding slips
- Increases grip strength within 30ms
- decreases elbow flexor force to decrease the rate of lifting
Define prehensive movements
movements in which an object is seized and held paritally or wholly within the boundary of the hand
List three examples of non-prehensive movements of the upper extremity
push, lift, poke
List 2 anatomic categories of prehension
- palmar grip
- digital prehension
Define palmar grip
palm and fingers, usually thumb involvement
Define digital prehension
thumb and one or two fingers (pads)
List 2 purpose-based categories of prehension
- power grip
- precision grip
Define power grip
used for moving an object immobilized within the hand through space (to TRANSPORT, not necessarily a lot of force)
Define precision grip
Used in moving an object within the hand in preparation for USE
Why is a palmar grip for power purposes sometime useful?
Sustained force, counterforce with thumb, move hand as a whole
* less freedom but greater stability
Why is digital prehension for precision handling sometimes useful?
the rest of the fingers are available to move within the hand
Give a major functional example of prehension with power grip
bringing food to the mouth
List the 4 major types of power grips
- cylindrical grasp
- spherical grasp
- hook grasp
- lateral prehension
Key features of the cylindrical grasp
- a power grip
- often with ulnar deviation (heavier = more deviation)
Key features of the spherical grasp
- a power grip
- each finger has a force from a different direction towards center
- fingers more spread than cylindrical grasp
Key feature of the hook grasp
- a power grip
- IP flexes
- in pure hook the thumb does very little
- can be sustained a long time without fatigue
Describe lateral prehension and give an example of when it's used
- power grip with 2 adjacent fingers
- example: smoking a cigarette
List 3 major types of prcision grips
- palmar pinch
- lateral pinch
- tip to tip pinch
Synonyms for palmar pinch
pad to pad; 3 jaw chuck
Synonyms for lateral pinch
key pinch, pad to side
Features of the palmar pinch
- most common pinch for holding small objects
- can be 2 or 3 fingers
Define precision grips
static grips with the object stabilizaed between fingers and thumb
Features of the lateral pinch
- useful to hold flat objects and turn
Features of the tip to tip pinch
- more circular than other pinches
- pick up very small objects
Pounds of functional pinch needed to pull on a sock
7.7# of pinch
Pounds of functional pinch needed to hold a soup spoon
1.6# on pinch
List 3 types of pecision handling
- translation
- rotation
- shift
Define the general concept of precision handling
these are types of IN-HAND manipulation of an object
Define translation (precision handling)
moving from finger to palm or palm to finger
Define simple rotation (precision handling)
- object held at finger pads
- turned 90 degrees or less
- object often held in other hand
- example: opening a jar lid
Define complex roation (precision handling)
- movement of an object around one or more of its axes 180-360 degrees
- example: turning a pencil around to use the eraser
Average force (rounded) in males and females (age 30) for cylindrical grasp
- men: 120 pounds
- women: 80 pounds
Average force (rounded) in males and females (age 30) for palmar pinch
- men: 25 pounds
- women: 20 pounds
Average force (rounded) in males and females (age 30) for lateral pinch
- men: 25 pounds
- women: 20 pounds
Average force (rounded) in males and females (age 30) for tip to tip pinch
men: 20 pounds
women: 15 pounds
Define shift (precision handling)
linear movement of an object on the finger surface to allow repositioning the object on the pads of the fingers
- example: sorting through cards
- example: shifting pens down to fingertips
Describe stabilization (precision handling)
- use ulnar hand with 4th and 5th finger to stabilize or store an object
- makes further tasks with the hand more difficult
Why is it unlikely that we would create a separate motor program for each type of grasping action we need?
- too many degrees of freedom...need to coordinate joints in real time
- it would be too many motor programs to store
- we would not suceed with novel situations (but we do)
What is the propsed solution to us not being able to have a motor program for each reach/grasp activity?
***self-organizing system***
- prefered patterns of movement with small adaptations
- organized for most effecient movement
- when an adjustment needs to be made, usually a little change happens in each component
Describe the importance of complexity and automaticity of functional UE movements
- give goal oriented directions: people do better with "touch my hand" rather than "straighten your elbow"
How can we use the relationship of reach and grasp in retraining movement?
Pair them. If trying to work on writst extension, use reaching movements not just isolated wrist extension, because the wrist automatically extends a bit when you reach
Why should we train grasp with reach in retraining (such as in stroke)?
- patterns more easily relearned than isolated movements
- uses entire limbe as soon as possible after injury
If you are training someone with grasp, be such to also train _______
voluntary release
List the limitations of static grasps in relation to the importance of in-hand manipulation
- not a lot you can do functionally with just holding an object
- in hand manipulation hard early in injuries
- in hand manipulation hard with UE prosthesis
- individual finger movements are important
- training in-hand manipulation tends to generalize easily to functional activities
Describe the importance of using real objects in training reach and grasp
- studies done in MS and stroke
- with real objects also get anticipatory movements of trunk and other body parts
- real objects provide important feedback about weight, etc.