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91 Cards in this Set
- Front
- Back
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biomechanical frame of reference overview
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based on: reconstruction model (Bird T. Baldwin), orthopedic model (Marjorie Taylor, & kinetic model (Dr. Sydney Licht, and William Dunton, Jr.)
focuses on ROM, strength, endurance most commonly used with lower motor neuron deficits & orthopedic problems should not be used in isolation |
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Common setting for biomechanical model
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hand clinics
work programs physical medicine and rehabilitation departments ergonomic programs |
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Finger ROM
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total active motion (TAM) and total passive motion (TPM)
measures tendon excursion add ext deficits and subtract from flexion measurements Digit #2: MCP 10-50 PIP 15-75 DIP 0-10 -------------- TAM 110 |
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Cervical spine normal ROM
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flexion: 0-45
Extension: 0-45 Lateral Flexion: 0-45 Rotation: 0-60 |
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Thoracic and Lumbar Spine normal ROM
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flexion: 0-80
extension: 0-30 lateral flexion: 0-40 rotation: 0-45 |
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Shoulder normal ROM
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Flexion: 0-170 (shoulder girdle abd, lateral tilt, slight elevation, & slight upward rotation during movement)
extension: 0-60 (shoulder girdle depression, add, & upward tilt during movement) abduction: 0-170 (shoulder girdle upward rotation & elevation during movement) adduction: 0 (shoulder girdle depression, add, downward rotation during movement) horizontal abd: 0-40 (gridle add, reduction of lateral tilt during movement) horizontal adduction: 0-130 (girdle abd, lateral tilt during movment) internal rotation: (girdle abd, lateral tilt during movement) 0-70 (arm in abd), 0-60 (arm in add) external rotation (girdle add, reduction of lateral tilt during movment) 0-90 (arm in abd), 0-80 (arm in add) |
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Elbow normal ROM
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flexion: 0 to 135-150
extension: 0 |
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Forearm normal ROM
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pronation: 0 to 80-90
supination: 0 to 80-90 |
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wrist normal ROM
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flexion: 0-80
extension: 0-70 ulnar deviation (adduction): 0-30 radial deviation (abduction): 0-20 |
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Thumb normal ROM
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DIP flexion: 0 to 80-90
MP flexion: 0-50 Adduction, radial and palmar: 0 Palmar abduction: 0-50 radial abuduction: 0-50 opposition: composite motion |
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Fingers normal ROM
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MP flexion: 0-90
MP hyperextension: 0 to 15-45 PIP flexion: 0-110 DIP flexion: 0-80 Abduction: 0-25 |
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Hip normal ROM
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flexion: 0-120 (bent knee)
extension: 0-30 abduction: 0-40 adduction: 0-35 internal rotation: 0-45 external rotation: 0-45 |
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Knee normal ROM
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flexion: 0-145
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Ankle and Foot normal ROM
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plantar flexion: 0-50
dorsiflexion: 0-15 inversion: 0-35 eversion: 0-20 |
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MMT grade 5
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normal: part moves through full ROM against gravity and takes max resistance
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MMT grade 4
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Good: part moves through full ROM against gravity and takes mod resistance
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MMT 4-
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good minus: part moves through full ROM against gravity and takes less than moderate resistance
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MMT 3+
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Fair plus: part moves through full ROM against gravity and takes min resistance before it breaks
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MMT 3
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Fair: part moves through full ROM against gravity and is unable to take any added resistance
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MMT 3-
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Fair minus: part moves less than full ROM of motion against gravity
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MMT 2
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Poor: part moves through full ROM in a gravity eliminated plane with no added resistance
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MMT 2-
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Poor minus: part moves less than full ROM in a gravity eliminated plane
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MMT 1
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trace: tension is palpated in the muscle or tendon, but no motion occurs at the joing
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MMT 0
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Zero: no tension is palpted in the muscle or tendon
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vigorometer or sphygmomanometer cuff
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used to eval the grip strength of a person with arthritis
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three jaw chuck (palmar pinch)
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pulp of thumb to pulps of index and middle fingers
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Endurance/Activity Tolerance
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count number of repetitions per unit of time, determine percent of max heart rate, measure time until fatigue, use METs levels
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types of edema
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Pitting: acute
brawny: chronic |
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Spinal cords tested
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proximal to distal
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peripheral injuries tested
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distal to proximal following dermatomes
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Types of sensory testing
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1. light touch: cotton swab; person responds yes or touched when touched. Scoring: + (intact), - (impaired), or 0 (absent)
2. localization: cotton swab; person responds yes when touched and then with vision points to area touched. Scoring: +, -, 0 3. pain: paper clip; person responds sharp or dull, scoring: S+, D+, D, S, S-, D- 4. temperature sensation: test tubes or thermal kit; person responds hot or cold. Scoring: +, -, 0 5. sterognosis: recognition by touch of common objects: scoring: # of correct items (use 2nd set of identical common objects with individuals with expressive aphasia) 6. moving two point discrimination: disk-criminator or caliper 7. static 2 poing dicrimination: disk-criminator or caliper 8. proprioception: position sense (therapist positions involved extremity, person duplicates position with contralateral extremity) 9. kinesthesia: movement sense (therapist moves segment, person responds up or down) |
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Moving 2 point discrimination: disk-criminator or caliper
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testing begins with points 5-8 mm apart, applied promximal to distal on fingertips in a horizontal orientation, person responds to # of points feels (1 or 2), 7/10 responses must be correct before decreasing distance of 2 points, scoring: normal=2mm)
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static two point discrimination: disk-criminator or caliper
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test begins at 5 mm, applied to fingertips in an longitudinal orientation, person states 1 or 2 in response to the # of points he/she feels, distance between points is increased until seven out of ten responses are correct, test is stopped at 15 mm, scoring (normal: 5mm, fair: 6-10mm, poor: 11-15mm, protective: one point perceived, anethetic: not points perceived)
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CN V
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dermatone location: anterior facial region
muscles facilitated: mastication fxn: ingestion |
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C3
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Dermatome location: neck region
muscles faciitated: sternocleidomastoid, upper trapezius fxn: head control |
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C 4
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dermatome location: upper shoulder region
muscles facilitated: trapezius (diaphragm) fxn: head control |
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C 5
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dermatome location: lateral aspect of shoulder
muscles facilitate: deltoid, biceps, rhomboid major andminor fxn: elbow flexion |
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C 6
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dermaome location: thumb and radial forearm
muscles facilitated: extensor carpi radialis, biceps fxn: shoulder abduction, wrist extension |
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C 7
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dermatome location: middle finger
muscles facilitated: triceps, extensors or wrist and fingers fxn: wrist flexion, finger extension |
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C 8
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dermatome location: little finger, ulnar forearm
muscles facilitated: flexor of wrist and fingers fxn: wrist flexion, finger extension |
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T 1
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dermatome location: axilla and proximal medial arm
muscles facilitated: hand intrinsics fxn: abduction and adduction of fingers |
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T2-T12
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dermatome location: thorax
muscles facilitated: intercostals fxn: respirations |
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T 4- T 6
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dermatome location: nipple line
muscles facilitated: intercostals fxn: respirations |
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T 11
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dermatome location: midchest region, lower rib
muscles facilitated: abdominal wall, abdominal muscles fxn: T5-7 superficial abdominal reflex |
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T 10
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dermatome location: umbilicus
muscles facilitated: psoas, iliacus fxn: leg flexion |
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L1- L2
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dermatome location: inside of thigh
muscles facilitated: cremasteric reflex, accessory muscles fxn: elevation of scrotum |
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L2
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dermatome location: proximal anterior thigh
muscles facilitated: iliopsoas, adductors of thigh fxn: reflex voiding |
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L 3-4
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dermatome location: anterior knee
muscles facilitated: quadricipes, tibialis anterior, detrusor urnae fxn: hip flexion, extensors of knee, abduction of thigh |
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L 5
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dermatome location: great toe
muscles facilitated: lateral hamstrings fxn: flexion at knee, toe extension |
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L5- S 1
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dermatome location: foot region
muscles facilitated: gastrocnemius, soleus, extensor digitorum longus fxn: flexor withdrawal, urinary retention |
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S 2
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dermatome location: Narrow band of postior thigh
muscles facilitated: small muscles of foot (flexor digitorum, flexor hallucis) fxn: bladder retention |
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Purdue Pegboard
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test of fingertip dexterity and assembly job simulation
subtests: 30 second test: right hand, left hand, both hands, R+, L+, both. And One minute test (assembly) scoring: 30 sec test is hte number of pins placed in the board in 30 seconds. Asssembly is the number of parts assembled during one minute |
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Minnesota Manual Dexterity Test
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test of gross hand arm movements
Subtests: placing test (measures rate of hand movment (one hand only), turning test (measures rate of finger manipulation: bilateral) scoring: time to complete board, one practice trail and four scored trials |
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O'Conner Tweezer Test
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test of eye-hand coodination using tweezers
scoring: the number of seconds to place all pins in board using tweezers |
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Crawford Small Parts Dexterity Test
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Test of FM dexterity using small tools (tweezers and screwdriver)
scoring: time to complete assembly |
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Nine Hole Peg Test
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measures finger dexterity
scoring: time for each hand to place nine pegs in a square board and remove them the purdue pegboard is preferred over the nine hole peg test because it is unilateral and bilateral. It is also more reliable |
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Jebson Hand Function Test
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test of hand function
seven subtests: writing, simulated page turning, picking up common objects, simulated feeding, stacking, picking up lg light objects, picking up lg heavy objects) scoring: time to complete each subject |
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Codman's exercise
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PROM used for post surgical shoulder pts (pendulum exercises)
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isometrics
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contraction without movement
contraindicated for those with hypertension and cardiovascular problems. Can increase BP and heart rate so they should be avoided |
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Isotonic exercises
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contraction with movement
-eccentric: lengthening -concentric: shortening |
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Differential tendon gliding exercises
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differentiates tendon movement and incresese tendon excusion
straight (A), Hook (B), Fist (C), Tabletop (D), Straight fist (E) |
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contraindications/precautions for edema reduction techniques
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infection
grafts or wounds vascular damage unstable fractures CHF |
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Scar Management
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ROM (early mobilization programs are most effective)
massage (circles & friction) compression: corban for digits, isotoner glove for hand and tubigrip for UE scar pad with compression splinting edema control |
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Densensitization for hypersenstivity
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if post-surgery begin in periphery of the scar and as tolerated work over scar
massage textures vibration 3 phase desensitization kit fluidotherapy |
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Sensory re-education
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massage
textures vibration three phase desensitzation kit fluidotherapy review safety precautions |
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Compensation for sensory training
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avoid use of hands where vision is occluded
observe safety precautions |
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deformity positions
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wrist flexion, MCP hyperextension, IP joints flexed, thumb adducted
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Resting position
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wrist: 10-20 extension
MCPs: 30-45 flexion IPs: 0-20 flexion thumb abduction |
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Safe position
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wrist: 20-30 extension
MCPs: 50-70 flexion IPs in extension Thumb abducted and extended |
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Roles of OT & OTA in splinting
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both assess for most appropriate splint
OT must set splinting goals OTAs can fabricate static splints and assist with dynamic splints (if experienced) |
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flail arm splint
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brachial plexus injury
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dynamic wrist, finger, and thumb extension splint
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radial nerve palsy
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opponens splint, C-Bar or thumb post splint
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median nerve injury
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dynamic/static splint to position MPs in flexion
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ulnar nerve injury
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figure-of-eight or dynamic MCP flexion splint
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Combined median ulnar
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tenodesis splint
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Spinal cord (C6-C7)
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wrist splint positioned in neurtral
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carpal tunnel syndrome
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elbow splint positions at 30 degrees of flexion
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Cubital tunnel syndrome
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Thumb splint, includes wrist, IP joint free
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DeQuervains
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(UCL) hand based thumb splint
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Skier's thumb
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hand based thumb splint
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CMC arthritis
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ulnar drift splint
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ulnar drift
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dorsal protection splint
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flexor tendon injury
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silver rings or button hole splint
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swan neck
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silver rings or PIP extension splint
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Boutonniere
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functional splint or safe splint, depending on stage
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Arthritis
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resting splint
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flaccidity
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spasticity splint or cone splint
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Spasticity
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balanced forearm orthosis (BFO), deltoid sling/suspension sling
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muscle weakness (ALS, SCI, Guillain-Barre)
-mounts to wheelchair must have shoulder or trunk movement |
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wrist 15-30 degrees extenstion, MCP 50-70 degress flexion, and IPs in full extension
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Hand burns
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contraindications for PAMS
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cancer, pacemaker, pregnancy, cognitive impairment, sensory impairment, vascular impairment
-prior to using PAMs diagnostic and age considerations must be carefully reviewed (i.e. ultrasound should never be used over a growth plate) |
