Biomechanical Approaches: Evaluation And Intervention

Front 1

BIOMECHANICAL APPROACH

Back 1

Focus: ROM, strength and endurance

Commonly used to treat patients with lower motor neuron deficits and orthopedic problem

Common settings: hand clinics, work programs, physical medicine and rehabilitation, ergonomics programs

Front 2

MMT GRADE: 5

Back 2

Normal
Full ROM against gravity & max resistance

Front 3

MMT GRADE: 4

Back 3

Good
Full ROM against gravity & mod resistance

Front 4

MMT GRADE: 4-

Back 4

Good minus
Full ROM against gravity & less than moderate reistance

Front 5

MMT GRADE: 3+

Back 5

Fair plus
Full ROM against gravity & minimal resistance

Front 6

MMT GRADE: 3

Back 6

Fair
Full ROM against gravity & no resistance

Front 7

MMT GRADE: 3-

Back 7

Fair minus
Less than full ROM against gravity

Front 8

MMT GRADE: 2+

Back 8

Poor
Full ROM in gravity-eliminated with no added resistance

Front 9

MMT GRADE: 2-

Back 9

Poor minus
Less than full ROM in gravity-eliminated

Front 10

MMT GRADE: 1

Back 10

Trace
Tension is palpated in the muscle or tendon, but no motion occurs at the joint

Front 11

MMT GRADE: 0

Back 11

No tension is palpated in the muscle or tendon

Front 12

EDEMA EVALUATION

Back 12

Body's initial response to injury

Pitting - acute
Brawny - chronic

Measure with tape measure, record in centimeters
Compare extremities, document landmarks

Volumeter, records in millileters, signficant change in edema is more than 10 ml

Front 13

SENSORY TESTING

Back 13

Text uninvolved side first, apply stimulus to volar and dorsal surfaces

SCI: test proximal to distal
Periphreal nerve injuries: distal to proximal
Neurological disorders: assess for dermatone patterns

Front 14

PURDEU PEGBOARD

Back 14

Test of fingertip dexterity and assembly job simulation

Front 15

MINNESOTA MANUAL DEXTERITY TEST

Back 15

Test of gross arm and hand movements

Front 16

O'CONNER TWEEZER TEST

Back 16

Test of hand-eye coordination using tweezers

Front 17

CRAWFORD SMALL PARTS DEXTERITY TEST

Back 17

Test of fine motor dexterity using small tools (tweezers and screwdrivers)

Front 18

NINE HOLE PEG TEST

Back 18

Measures finger dexterity

- The Perdue Pegboard is preferred over the Nine Hole Peg Test because it is unilateral and bilateral, it is also more reliable

Front 19

JEBSON HAND FUNCTION TEST

Back 19

Test of hand function

7 substests: Writing, simulated page turning, picking up common objects, simulating feeding, stacking, picking up large light objects, picking up heavy large objects

Front 20

EDEMA REDUCTION TECHNIQUES

Back 20

1. Elevate extremity (contraindicated for individuals with circulation problems)
2. Retrograde massage
3. Compression garments
4. Cold packs
5. Contrast baths; immerse hand in warm than cold water, technique is conflincting as ot its effectivness in reducing edema
6. Manual edama mobilization: special technique that requires training

Heat is commonly contraindicated for edema (can be used in mild cases in combination with elevation)

Precautions/Contraindications:
Infection
Graft/wound
Vascular damage
Unstable fractures
CHF

Front 21

SCAR MANAGEMENT

Back 21

1. ROM
2. Massage
3. Compression
4. Scar pad with compression
5. Splinting to prevent contractures from resting scar
6. Edema control

Front 22

IMPROVING COORDNATION

Back 22

1. Begin with gross motor activities and gradually grade up to fine motor activities
2. Select activities in which the ROM required is within the person's reach and yet challenging
3. Focus on accuracy and speed, begin with slow gross movements and gradually progress to faster precise movements

Front 23

JOINT PROTECTION PRINCIPALS AND METHODS

Back 23

1. Maintain ROM by using maximal ROM during activities
2. Maintain strength by using maximal strength during daily activities
3. Use strongest and largest joints possible for task completion
4. Use each joint in its most stable and functional position
5. Avoid holding joints in one position or sustaining muscle contractions for extended periods of time
6. Avoid positions of deformity and activities in the direction of deformity (eg ulnar drift)
7.Do not start activities that cannot be immediately stopped
8. Recognize discomfort may be a reality of activity, but pain is a warning sign

Front 24

HAND SPLINT DESIGN STANDARDS

Back 24

1. Maintain arches of hand (proximal transverse arch, distal transverse arch, longitudinal arch)
2. Do not impinge upon crease of the hand (distal and proximal palmar creases, distal and proximal wrist creases, thenar crease)

Front 25

MECHANICAL PRINCIPALS OF SPLINTING

Back 25

1. Decrease pressure; wide, longsplint base is the most disirable, round edges needed
2. Use sling applied with a 90 degree angle of pull
3. Use low load to increase duration
4. Maintain three point pressure verse circumfrence
5. Avoid postisions of deformity (wrist flexion, MCP hyperextension, IP joint flexed, thumb adducted)
6. Select appororaite splinting position

Front 26

RESTING POSITION (SPLINTING)

Back 26

Wrist: 10-20 degrees extension
MCPs: 30-40 degrees flexion
IPs: 0-20 degrees flexion
Thumb: abducted

Front 27

SAFE POSITION (SPLINTING)

Back 27

Wrist: 20-30 degrees extension
MCPs: 50-70 degrees
IPs: extension
Thumb: abducted and extended

Front 28

BRACHIAL PLEXUS INJURY

Back 28

Flail arm splint

Front 29

RADIAL NERVE PALSY

Back 29

Dynamic wrist, finger and thumb extension splint

Front 30

MEDIAN NERVE INJURY

Back 30

Opponens splint, C-Bar or thumb post splint

Front 31

ULNAR NERVE INJURY

Back 31

Dynamic/static splint to position MPs in flexion

Front 32

COMBINED MEDIAN ULNAR

Back 32

Figure-of-eight or dynamic MCP flexion splint

Front 33

SPINAL CORD (C6-C7)

Back 33

Tenodesis splint

Front 34

CARPAL TUNNEL SYNDROME

Back 34

Wrist splint positioned in neutral

Front 35

CUBITAL TUNNEL SYNDROME

Back 35

Elbow splint positioned at 30 degrees flexion

Front 36

DEQUERVAINS

Back 36

Thumb splint, includes wrist, IP joint free

Front 37

SKIER'S THUMB (UCL)

Back 37

Hand based thumb splint

Front 38

CMC ARTHRITIS

Back 38

Hand based thumb splint

Front 39

ULNAR DRIFT

Back 39

Ulnar drift splint

Front 40

FLEXOR TENDON INJURY

Back 40

Dorsal protection splint

Front 41

SWAN NECK

Back 41

Silver rings or buttonhole splint

Front 42

BOUTONNIERE

Back 42

Silver rings or PIP extension splint

Front 43

ARTHRITIS

Back 43

Functional splint or safe splint, depending on stage

Front 44

FLACCIDITY

Back 44

Resting splint

Front 45

SPASTICITY

Back 45

Spasticity splint or cone splint

Front 46

MUSCLE WEAKNESS (ALS, SCI, GUILLAIN-BARRE)

Back 46

Balaced forearm orthosis (BFO), deltoid sling/suspentsion sling
- mounts to wheelchair,
-individual MUSThave shoulder or trunk movement

Front 47

HAND BURNS

Back 47

Wrist 15-30 degrees extension, MCP 50-70 degrees flexion, IP in full extension

Front 48

BENEFITS OF SUPERFICIAL HEAT

Back 48

1. Relieves pain
2. Increases tissue extensibility (increase ROM)
3. Assists with wound healing

Front 49

BENEFITS OF CRYOTHERAPY

Back 49

1. Relieves pain
2. Controls edema
3. Decreases abnormal tone
4. Facilitates muscle tone

Front 50

BENEFITS OF WHIRLPOOL

Back 50

1. Cleans and open infected wound
2. Temperature of water does not reach a therapeutic range to use as a heat modality

Front 51

BENEFITS OF ELECTRICAL STIMULATION

Back 51

1. Relieves pain
2. Decreases swelling
3. Stimulates and strengthens muscles
4. Stimulates denervated muscles

Front 52

BENEFITS OF ULTRA SOUND

Back 52

1. Relieves pain
2. Decreases inflammation
3. Increases tissue extensibility (increase ROM)
4. Decreases adhesions

Front 53

BENEFITS OF CONTRAST BATH

Back 53

1. Reduces edema

Front 54

CONTRAINDICATIONS FOR PAMS

Back 54

1. Cancer
2. Pacemaker
3. Pregnancy
4. Cognitive impairment
5. Sensory impairment
6. Vascular impariment