COMP EXAM.

FIM

18 items: 13 motor tasks and 5 congitive

minimal contact assistance

4: patient can perform 75% or more of tasks

top-down

Begins with Occupational Profile & Analysis of Occupational Performance and how that effects how client is performing important activities (dressing, bathing, etc.)

fixed vs non-fixed

Curvatures in the first 3 regions are not fixed, but dynamic and change with movement and varied posturing; Sacrococcygeal curvature is fixed with anterior concavity and posterior convexity

slide board clinical indicators

Good static sitting balance Decreased -> good dynamic sitting balance Poor static and dynamic standing balance Unable to actively accept weight through one or both lower extremities

vestibular system

Inertia guided Two components in detecting motion: 1. Detect angular acceleration (shake or nod your head) Semicircular Canals 2. Detect linear acceleration (e.g riding in car, elevator) Utricle and Saccule

concentric muscle contraction

Muscle is producing a pulling force as it contracts (shortens). The joint angle decreases during contraction

principles of biomechanical FOR

ROM, strength, endurance, ergonomics, pain (effects of or avoiding)

equilibrium

What information does the person need to maintain postural stability? Proprioception Vestibular Vision

key ideas related to MMT

amount of force applied, stabilization, angle of force applied, speed of force applied

what does rehabilitative FOR focus on?

context(s), activity demands, performance patterns

transfers

includes all aspects like locking wheels, removing footrests, etc.

CNS lesions that contribute to dizziness

migraine brainstem and cerebellar stroke post concussion syndrome

signs and symptoms of basal ganglia disorders

tremors at rest rigidity chorea dystonia tics

utricle and saccule

1 utricle and 1 saccule on each side Detects linear acceleration: Horizontal motion (utricle) (side-to-side motions, forward and backward, car movement), once at constant speed, equilibrium; Vertical (saccule) ( up and down, elevator) Contain macula (contains hair cells)

bathing

10 parts of wash, rinse, and dry: chest, abdomen, 2 arms, perineal area, buttocks, 2 upper legs, 2 lower legs/feet

total assistance

1: patient can perform less than 25% of tasks

eating

2 parts: loading food, bringing food to mouth trick: 5 with cutting up food and opening packages trick: 4 with placing utensils in patient hands, initiate feeding, occasionally scoop food onto utensil

maximal assistance

2: patient can perform 25% to 49% of tasks

toileting

3 parts: lower pants, perineal hygiene, raise pants

semicircular canals

3 semicircular canals on each side- 6 total arranged in parallel planes (x, y, and z) complimentary to one another. Superior, Posterior, Horizontal Angular acceleration

moderate assistance

3: patient can perform 50%-74% of task

upper body dressing

4 parts: thread 2 arms, over head, straighten shirt bra has 4 parts trick: amputee has fewer parts

grooming

4 parts: washing face, combing hair, brushing teeth, washing hands optional: shaving, putting on makeup

supervision or set up

5

modified independence

6: use of device, extra time

complete independence

7

lower body dressing

7 parts: thread 2 legs, pants over hips, 2 socks, 2 shoes

how does rehabilitative FOR change the task?

Adapted task methods or procedures To substitute for lost or decreased ROM (Lack of full reach or ROM, or Lack of full hand closure) To substitute for loss of strength. To provide stability To substitute for decreased endurance. To substitute for limited vision. To simplify work. To conserve energy Changing or substituting objects or tools; high tech or low tech options Recommendations seem deceptively simple Adaptive equipment may radically change the way things are done, may change the way the device looks or make the task easier

alignment of the trunk

Alignment/biomechanical considerations Optimal alignment: Anterior pelvic tilt; Lumbar extension; Thoracic extension; Cervical extension Ear, shoulder, and hip in line

expression

Basic: Communicates daily activities such as pain, hunger, toileting, sleep Complex: Understanding complex or abstract directions or conversations such as current events, finances, discharge plans FIM trick: if patient is independent with basic and skill struggles with complex, is a 5 on FIM. If patient is able to perform complex problem solving but needs more time or adaptive tech/device is a 6

comprehension

Basic: Daily needs such as feeding, toileting, self-care, 1 step commands Complex/abstract: Current events, finances, discharge plans, multistep commands FIM trick: if patient is independent with basic and skill struggles with complex, is a 5 on FIM. If patient is able to perform complex problem solving but needs more time or adaptive tech/device is a 6 Lots of cues, but not a walk through of the entire task = 2

continuing adjustment

Begins with discharge from a rehabilitation program: patients who function safely at home face challenge of structuring lives to their current skills; Patients with more limited recovery or family resources discharge to long-term care or assisted living; Strive to maintain independence and meaningful activity in a supported environment (top-down)

closed chain

Distal segment of the kinetic chain is fixed to the earth or other immoveable object Little bit more functional Contracting multiple muscles groups

open chain

Distal segment of the kinetic chain is not fixed to the earth or other immoveable object Free to move Isolating a few muscles

maculae

Each organ has a sheet of hair cells (the macula) whose cilia are embedded in a gelatinous mass The gelatin has crystal embedded in it called otoconia When you move to one side, the gel mass drags the hair cells Sense change in position and movement

contraction force of muscles

Eccentric contractions generate greater force than isometric contractions Isometric contractions generate greater force than concentric contractions

how does rehabilitative FOR change the context

Environmental modification Training the caregiver or family Disability prevention

purpose of vestibular system

Equilibrium, organ of balance Recognizes motion and position of head and body Maintains head upright on body Postural reflex and eye movement

lower thorax during shoulder motion

Extension during arm elevation: Greater in sagittal plane elevation; Greater during bilateral elevation Contralateral sidebend during unilateral elevation Extension during bilateral flexion

upper thorax during shoulder motion

Extension during arm: Less than lower region Contralateral axial rotation during unilateral elevation

bottom-up

Focus on client's generic abilities with rationale that impairments and abilities will affect future (balance, coordination, fine motor, etc)

trunk control

Foundation of all head, neck, and limb movement: Pelvic position has direct influence Functionally: Reach beyond arm's length; Interaction with environment Anticipates distal movement: Trunk control mm anticipate what is going to happen distally abdominals and lumbar extensions Perceptual influence: Cant tell how far away the floor is from them; Don't know where they are in space; Decrease in trunk control, increase fear/anxiety/fall

Vestibular-Ocular Reflex

Gaze stabilization - Maintains visual fixation while the head moves- Keeps eyes in alignment Mechanism for producing eye movements that counter head movements Semicircular canals exert direct control over the eyes muscles-head turns L, eyes move R Faster than visual tracking After a neurologic impairment: walls may look wavy and stair wobbly, signs of an impairment of VOR

modified stand pivot clinical indicators

Good static sitting balance; Decreased dynamic sitting balance; Decreased static and dynamic standing balance; Able to actively accept weight through at least one lower extremity Weaker than those who can do stand pivot

intervention

Improving these components (motor skills (mobility, strength), process skills (organization, adaptation), communication skills (eye contact, clear and understandable speech, collaboration with others), client factors (strength, ROM, attention, visuospatial skills, etc.) may or may not predict improved occupational performance in ADL, IADL, education, work, leisure, social participation; Important to work on occupations, but also smaller skills

scapulohumeral rhythm

In a normal shoulder has 2:1 ratio; 2 parts humeral movement to 1 part scapular movement Normal biomechanics

social interaction

Includes skills related to getting along and participating with others in therapeutic and social situations. It represents how one deals with one's own needs together with the needs of others Examples of socially inappropriate behaviors include temper tantrums; loud, foul or abusive language; excessive laughing or crying; physical attack; or very withdrawn or non-interactive behavior FIM 7: the patient interacts appropriately (controls temper, accepts criticism, is aware that words and actions have an impact on others) FIM 6: patients interacts appropriately, in most situations, and only occasionally loses control, may require more than a reasonable amount of time to adjust to social situations, or may require medications for control FIM 5: patient requires supervision (monitoring, verbal control, cuing, or coaxing) only under stressful or unfamiliar conditions, but less than 10% of the time FIM 3: does not come down from emotion in a moderate amount time FIM 1 & 2: may need restraint due to socially inappropriate behaviors

acute stage

Initial days following onset of injury: Hospital inpatient Intervention focus: preventing development of secondary impairments and maximizing recovery of motor and cognitive function (bottom-up)

rehabilitation stage

Integrated rehabilitation therapy program (rehabilitation facility or subacute facility Return to home and participate in home - based or outpatient rehabilitation Intervention focus: continue with acute stage focus as well as [romote skills and activity patterns within reemerging motor and cognitive function; promote safe and independent occupational performance with available recovery (move between top-down and bottom-up)

precautions and contraindications of MMT

Manual muscle testing is appropriate for those clients who are able to voluntarily contract muscles Manual muscle testing is often not performed with children younger than three Manual muscle testing is contraindicated for those with dislocations Extra care and attention in testing should be taken for clients with cardiovascular and chronic respiratory diseases (i.e., COPD), as well as those clients just recovering from abdominal surgery. Manual muscle tests might need to be modified when testing older clients due to the inability to assume and/or tolerate some testing positions. pain, joint deformities or limitations in endurance and flexibility and extra caution is advised in the presence of osteoporosis

locomotion: walk or wheelchair

Measurement of assistance and distance FIM trick: distances FIM score 7: patient moves a minimum of 150 feet FIM score 6: patient moves a minimum of 150 feet with assistive device FIM score 5: minimum of 50 independently with or without a device OR a minimum of 150 feet with supervision FIM score 4: patient moves a minimum of 150 feet FIM score 3: patient moves a minimum of 150 feet FIM score 2: a minimum of 50 feet FIM score 1: requires the assistance of 2 people, or walks to less than 50 feet

assumptions of biomechanical FOR

Motor activity is based on physical mobility and strength Purposeful activities remediate loss of ROM, strength & endurance (Movement only) Activities can be graded Participation in activities maintains and improves function If ROM, strength and endurance are regained, patient will automatically use these prerequisite skills to regain function (Does not always happen) Reliant on the principles of rest and stress

isotonic muscle contraction

Muscle force is produced by either shortening or lengthening a muscle

eccentric muscle contraction

Muscle is producing a force as it is being elongated (lengthened) by another more dominant force. The joint angle increases during the contraction

isometric muscle contraction

Muscle is producing force while maintaining a constant length

dynamic dissociation

Normal control requires the ability to dissociate (separate) different parts of the body from each other: Eccentric/concentric muscle contraction Difficulty with dissociation: Soft tissue tightness; Bony contracture; Efforts by patient to decrease movement

hoyer lift clinical indicators

Poor static and dynamic sitting balance Poor static and dynamic standing balance Unable to accept any weight through both lower extremities Requires two people to complete transfer

dependent sitting pivot clinical indicators

Poor static and dynamic sitting balance Poor static and dynamic standing balance Unable to actively accept weight through both lower extremities Low arousal, low cognitive, low movement level patients

why is postural control complex?

Postural control is what allows balance- balance is the output An entity that includes many systems and is not simple Includes interaction between individual, task the individual is performing, and the environment More than 130 different risk factors for falling have been noted We rarely find THE problem for balance therefore avoid cookbook approaches All functional tasks involve postural control

intervention options for posture and balance

Posture ROM Strengthening Body awareness Visual activities Visual challenges Sensory stimulation Postural responses Vestibular responses Motor learning

OT prevention roles in physical function

Preventing deformity Preventing accidents Preventing dependency Preventing the need for institutional care Preventing invalidism of cardiac patients Preventing vocational misfits (in terms of interest, attitude, skill or prevocational exploration and evaluation) Preventing misunderstanding and mistreatment

curves of the spine

Primary is a kyphotic curve: in sagittal plane, concave anteriorly and convex posteriorly; Born in full kyphosis Secondary is a lordotic curve: Bend backwards; in sagittal place, convex anteriorly and concave posteriorly; Occur while we develop

memory

Recognizing and remembering while performing daily activities 7: recognizes people often seen (doesn't need to know names), remembers daily routine, no reminders needed 6: uses self-initiated device/environmental cues (calendar, memory book, schedule) 5: helper needed to recognize and remember 10% or less of the time 4: patient recognizes and remembers 75-90% of the time 1: doesn't recognize any person, role

cervical lordosis

Secondary: At 3 months, pull head up: extensor muscles pull on head and neck as infant begins to observe its surroundings

lumbar lordosis

Secondary; 8-12 months, start to walk: hip flexors tip pelvis anteriorly

kinematic chain

Series of articulated segment links, constructed so that motion at one joint will produce motion at the other joints in predictable manner

locomotion: stairs

Stairs includes going up and down 12 to 14 steps (one flight) indoors in a safe manner Measurement of assistance and number of steps FIM score 7: at least one flight of stairs FIM score 6: at least one flight of stairs, with an assistive device FIM score 5: 4 to 6 independently OR one flight of stairs with supervision FIM score 4: at least one flight of stairs FIM score 3: at least one flight of stairs FIM score 2: go up and down 4 to 6 steps FIM score 1: goes up and down fewer than 4 steps, or requires the assistance of two people

intervention techniques for biomechanical FOR

Teaching new skills, behaviors or habits to reduce dysfunction and/or enhance performance Correlation of the physical demands of the graded activities to the sub skills and role-relevant behaviors Motivating and meaningful activities meeting individual needs and interests in relation to social roles

assumptions of rehabilitative FOR

The ability to function is essential to well being There are secondary benefits to improving performance Humans are capable of adapting to their limitations and capitalizing on their strengths Motivation is based on the clients values, roles and context

evaluation process

The evaluation process is focused on finding out what the client wants and needs to do and on identifying those factors that act as supports or barriers to performance

what muscles are most vulnerable to immobilization atrophy

antigravity muscles, cross a single joint, contain relatively large proportion of slow-twitch fibers

PNS conditions that contribute to dizziness

begin parozysmal positional vertigo menieres disease (fluid builds up in saccule and utricle)

balance assessments

berg functional reach timed up and go tinnetti balance

rehabilitative

compensation; aiming at making people as independent as possible in spite of a residual impairment; consists of compensatory strategies and environmental adaptation combines physical and psychosocial aspects; changes the tasks; change the context

purpose of cerebellum

coordination of movement, maintenance of posture, and equilibrium primary function is proprioception: awareness of the body in space

sarcopenia

degenerative loss of skeletal muscle mass quality and strength (0.5% to 2% per year after age 40, 4% to 6% per year after age 60)

purpose of basal ganglia

developmental automated movement patterns when impaired, demonstrates as difficulty initiating and terminating movements

prevention protocol for scapula movement

education to prevent peripheral injury; no PROM before scapula mobilization; no pain during exercise/activity; no infusions into affected hands

dix-hallpike test

for Benign Paroxysmal Positional Vertigo: patient sitting upright with the legs extended, the patient's head is then rotated 45 degrees to one side, and the clinician helps the patient to lie down backwards quickly with the head held in approximately 20 degrees of extension. Clinician observes for nystagmus

stand pivot with device clinical indicators

good sitting balance (static and dynamic), fair static standing balance, decreased dynamic standing balance, able to actively accept weight through at least one LE

stand pivot clinical indicators

good sitting balance (static and dynamic), good static standing balance, decreased dynamic standing balance, able to actively accept weight through both LE's

frame of reference

guide a plan of action for assessment and intervention; intervention decisions; created for use with specific age groups and/or types of disabilities; guides the selection of methods used to evaluate the problem on how disability is defined: motor, sensory, psychological, social functioning

signs and symptoms of cerebellar dysfunction

intention tremor dysmetria hypotonicity hypertonicity ataxia nystagmus dysarthria

soft end feel

limits further motion due to tissue compression in soft tissue: knee flexion, elbow flexion

areas of practice biomechanical FOR is used

musculoskeletal disorders (fracture, replacement), neurological injuries, cumulative trauma (back injury, carpal tunnel syndrome, hand injuries), work hardening, ergonomics, prevention

firm end feel

occurs when there is tension in the way the joint feels but also a slight give in the structures; due to muscular stretch, capsular stretch, or ligamentous stretch: scapular elevation/depression, shoulder abduction/adduction, IR/ER rotation, forearm supination wrist flexion/extension, ulnar deviation

lower trunk stability

pelvic position co-contraction of muscles: anterior abdomials & lumbar extensors; right and left lateral abdominals Dynamic, changes in base of support

sternum/thorax

posterior/lateral ribs articulate with scapula between ribs 2-7 thoracic kyphosis Scapular is the foundation from shoulder out distally

Sacrococcygeal kyphosis

primary

thoracic kyphosis

primary

expected outcomes for biomechanical FOR

reduction in limitations, learning new skills, slowing declines, maintaining quality of life, consistency of approach with performance

biomechanical

remediation (correction, reversal, stopping); applies the principles of physics to human movement and posture with respect to the forces of gravity; how the body works, physics components

problem solving

routine: basic tasks such as dressing, bathing, grooming, etc. if patient is independent with basic tasks, can only go up to a 5 on FIM complex: Novel tasks such as home management tasks, money management, discharge planning 6 or 7 on the FIM scale

aligntment/approximation of UE

scaplua:acromian higher than root of spine, inferior angle is against the rib cage, sits in neutral plane of elevation/depression, abduction/adduction humerus: humeral head approximated into the glenoid fossa "rotate the globe"

torque rations of shoulder muscle groups

shoulder IR > shoudler ER (ER is ~70% of IR); shoulder EXT > shoulder flex (flex is ~70% of ext); shoulder ADD > shoulder ABD (ABD ~80% of ADD)

vestibular therapy

t is an exercise-based program primarily designed to: repositioning exercises; reduce vertigo and dizzines; gaze instability imbalance and falls

hard end feel

there is an abrupt sensation at the extreme end of ROM: elbow extension, forearm pronation, knee extension, radial deviation

movement of pelvis

tilt in sagittal plane; hike in coronal plane; rotation in transverse plane

scapulothoracic motions

upward/downward rotation: 60 degrees internal/external rotation: 10-20 degrees anterior/posterior tipping: 20 degrees elevation/depression protraction/retraction