Kinesiology Unit 1

balance + stability: to increase stability

-Make the base of support wider -Increase the weight - Make sure LINE OF GRAVITY IS WITHIN BOS -Lower the center of gravity

o Analysis of the forces acting on a body provides insight so that OTs can

-Minimize deformity -Prevent stress on joints -REMEDIATE underlying neuromusculoskeletal structures

arthrokinematics: arthrokinematic movements: compression + distraction

TRANSLATORY movement where joints approximate or are pulled away from each other

angular movement: torque

a TWISTING force that tends to cause rotation. 1) Measured in NM 2) generated when a FORCE IS APPLIED PERPENDICULAR TO A LEVER creating angular movement. 3) T = F x R -perpendicular force in newtons (F) x perpendicular distance (or moment arm/radius, r: distance between axis + force) -Greater force (with same length r ) will generate greater torque -A longer moment arm (FA) will require less force to create angular movement (AE/AT) + produces more torque -External resistance (casts, braces, plates of food, dumbells) are often APPLIED DISTALLY 6) Turning effect of a force: Around COR 7) Contracting muscle applies force to bone it attaches and causes bone to rotate about an axis at the joint

functional activities typically involve angular or linear movements?

a combo of both

principle of levers ??

a lever of any class will balance if the product of the effort force (F) and its moment arm (FA) are equal to the product of resistance (R ) and its moment arm (RA) ( F x FA = R x RA) -F x Fa = torque of effort -R x RA = torque of resistance -When they are equal, no acceleration of the lever occurs ; when out of balance, acceleration occurs

goniometer measurement: shoulder horizontal ab/adduction

ab = 0-90 ; ad = 0-45 1) Client position: seated with shoulder flexed to 90 and elbow extended 2) Axis: placed ON TOP OF ACROMION PROCESS -Stationary arm: BOTH ARMS OVER HUMERUS -Movable arm: over humerus; will follow the humerus 3) Abd: Directions for client: Move arm out to side as far as possible 4) Add: move arm toward the center of the body, as far as possible

3rd class levers *M + J

effort force is between axis and the resistance force 1) MC (most common)? In body 2) The Fa is always shorter than the Ra 3) M = muscle force (contraction of muscles; lifting weight up?), J= joint force (Reaction force of bone on bone; weight pushing it down?) 4) Permit speed or movement of a small weight for a LONG DISTANCE (force reducers: effort force is greater than the resistance or load) -EFFORT FORCE IS ALWAYS GREATER THAN RESISTANCE: sacrifices mechanical advantage to produce WIDE RANGES of motion and HIGH VELOCITY movements 5) Eg) broom, fishing pole, tweezer, chopsticks

goniometer: interpreting results

either WNL, WFL, or "Limitation of (# of degrees) of (action and joint) needed for (functional activity related to deficit)" 1) If not WNL, ask if they can do functional activities -> if functional = WFL -If not function = limitation -Eg) limitation of 45deg of shoulder flexion needed for shampooing hair 2) Compare the results to other extremity, if applicable (nondominant side tends to have greater range)

osteokinematics: degrees of freedom

equal to number of planes that motion occurs in 1) Ex. DIPs allow only motion in single axis -Flexion/extension around M-L axis -1 degree of freedom 2) Ex. Glenohumeral joint -Flexion/extension, abduction/adduction, internal/external rotation -3 degrees of freedom 3) Classified according to the number of planes through which joint segments move -Choices are 1, 2, or 3 (uniaxial, biaxial, triaxial) -Eg) ankle joint: dorsal/plantar flexion, inversion/eversion = 2 a) Uniaxial: Hinge joint (eg. elbow, humeroradial/humeroulnar, IP) ; pivot joint (eg. ATL-AXIAL) b) Biaxial -Condylar/ellipsioid: flex, extend, abd, add + circumdunction (WRIST, MP) -Saddle joint (CMC, sternoclavicular) c) Multiaxial: ball and socket (hip + shoulder) -Can rotate 4) Why do we care???: need motion for occ performance

kinesiology

study of the 1) FORCES nd of the 2) ACTIVE/PASSIVE STRUCTURE that are involved in human movement 1) Anatomy (structure of person; produce movement by muscles) + Mechanics /Biomechanics (study of FORCES AND MOTION; forces related to the body and their effect on body movement/size/shape/structure; structure + function) 2) Biomechanics = Statics (no movement; forces not moving or moving at constant speed (equilibirium)) + Dynamics (movement) 3) Dynamics = Kinematics: "the geometry of motion", study of motion of bodies in space over time considered with amount/direction of movement (displacement), speed (velocity) and acceleration, and determination of joint angles (but no reference to what's creating it: forces) + Kinetics (study of forces acting on movement of body -> produce stability or mobility) 4) KINEMATICS = Arthrokinematics (joint movement) + Osteokinematics (bone movements) 5) KINETICS = Linear + Angular (forces)

leverage is a function of

the angle of pull of the muscle at its bony attachment -Optimal leverage: when muscle pulls in a perpendicular direction to the axis of the bone (but this rarely occurs) -Leverage of the muscle changes from 1 joint position to another because the angle of pull relative to the bone changes

angular movement

(AKA MOTION): Motion that occurs around an axis or pivot point 1) Measured in degrees 2) Represents primary movement in the human body 3) Kinetics depends on AMOUNT OF FORCE APPLIED + DISTANCE FROM AXIS -Individual points on the object travel greater or lesser distances depending on how close they are to the axis (but move through the same angle) 4) Angular velocity + acceleration are the vectors 5) OCCURS WHEN TORQUE IS APPLIED -> Requires a lever

goal: increase ROM (interventions)

(BIOMECHANICAL: PASSIVE + ACTIVE STRETCH = INTERVENTION) 1) Depends where the limitations are 2) JOINT MOBILIZATIONS 3) MYOFASCIAL RELEASE 4) TONE MANAGEMENT TECHNIQUES 5) Stretching-: process where tissues are lengthened, usually by an external force, to reduce tightness -produces change only if it is done to the point of maximal stretch = "a few degrees past the point of discomfort" ; held for 15 to 30 seconds -Force, speed, direction, and extent of stretch must be controlled -Different tissues can be stretched more aggressively than others (muscles can be stretched more than joint capsules) -Gentle stretching in small increments over time is more effective -Residual pain after stretching indicates that the stretch was too aggressive and has caused micro-trauma to the tissues -two types: active + passive stretching

goal: prevent loss of ROM

(REHAB: AE AND AT INTERVENTIONS) 1) Goniometric assessment: What are the predicted results of goniometric assessment? 2) Interventions a) PROM -Teach patient or caregiver to move joints -Passively move joints if patients cannot b) Edema control -Compression -Elevation of the body part above heart -Retrograde massage (take measurement of edema; massage; then measure again) -Lymphedema garmets, ready-to-wear legwear, wraps, bandaging, donning aids + accessories c) Positioning -Place body part in a functional position, anti-deformity position, or opposite of typical patterns of tightness -May require a splint, orthosis, or brace

goal: increase ROM: active stretching

(muscle contraction) 1) GOAL: increase ROM through the use of occupations 2) Assumption: a person who is actively engaged in a purposeful activity will be more relaxed, anticipate pain less, more motivated to complete the task, and move more spontaneously 3) Muscle action is the source of the stretching a) Reaching up to the top shelf in the kitchen -Actively uses what muscles?: shoulder extensors -What soft tissues could it be stretching? ?????? b) You may need to adapt the activity to get the desired results -Change location of an item -Alter the patient position 4) muscles are stretched when the opposing muscles contract

goniometer measurement: elbow flexion/extension

-Available ROM:: 0-150 1) Client position: seated with arm parallel/in line to trunk 2) axis: over LATERAL EPICONDLYE of humerus -Stationary arm: parallel to humerus -Movable arm: parallel to radius; remains in line with radius for flexion 3) Directions for client: measure starting position: if 0, that is full extension. If hyperextension is present, place it at 0 (hyper measured separately) . Ask client to move hand towards shoulder as far as they can

goniometer measurement: shoulder flexion/extension

-flexion: 0-180; extension: 0-60 1) Client position: seated, upright, with arm in alignment with trunk 2) Axis: 1 INCH BELOW ACROMION PROCESS (ON LATERAL PART OF ARM) -Stationary arm: parallel with trunk -Movable arm: parallel with humerus 3) Flex: Ask patient to move arm up towards the ceiling as high as it will go, leading with thumb and palm facing towards the body. Reposition goniometer at end before recording. 4) extend: Ask patient to move arm behind them as far as it will go, leading with the pinky finger.

functional activities for shoulder

-flexion: shampoo hair -extension: reaching back to tuck shirt in -abduction: putting hair into a hair tie -adduction: washing contralateral side of body -IR: fastening bra -ER: reaching behind body for shirtsleeve when dressing

functional activities for elbow

-flexion: washing face -extension: reaching to put on/off pants

goniometer that starts with the goniometer fully open

-shoulder IR/ER: open at 90 degrees -elbow flexion/extension -forearm pronation/supination -wrist flexion/extension -radial/ulnar deivation

functional activites for forearm

-supination: brushing teeth -pronation: turning a key in a lock

functional activities for wrist

-wrist extension: shutting a cabinet door -flexion: pulling up a car door handle to open it -radial/ulnar deviation: open a door

goniometer measurement: IP flexion/extension (DIP or PIP) HELP!!!

0-100 for PIP, 0-90 for DIP 1) Client position: seated with forearm in neutral + resting on stable surface -measured dorsally 2) axis: proximal IP joint of finger -Stationary arm: aligned with midline of proximal phalanx -Movable arm: aligned with midline of middle phalanx 3) Directions for client: If finger is straight: full extension. Have client bend finger.

goniometer measurement: shoulder adduction/abduction

0-180 1) Client position: client seated with arm comfortably at side 2) Axis: MEDIAL TO POSTERIOR ASPECT OF GH JOINT -Stationary arm: parallel to the trunk -Movable arm: parallel to the humerus * both behind the humerus 3) Directions for client: move arm out to side with palm down. When the arm is parallel to the floor, turn palm up and continue the motion as far as they can go. Reposition goniometer at end before recording. *Record 0 at start if start at full adduction (arm completely at side)

goniometer measurement: thumb CMC flexion/extension

0-20 1) Client position: seated with forearm fully pronated + resting on table (HAND FLAT, palm down) 2) Axis: on dorsal surface of CMC JOINT OF THUMB -Stationary arm: on dorsal surface, parallel to forearm -Movable arm: on dorsal surface, parallel with metacarpal I * DOES NOT START AT 0, USUALLY LIKE 10-15???? THEN SUBTRACT TO MAKE THE MOTION EG. 15-30 -> 0-15 3) Directions for client: if thumb is touching hand = 0 (full flexion?). Have client move thumb toward midline of body.

goniometer measurement: thumb CMC adduction/abduction HELP!!!

0-45 1) Client position: seated with forearm in neutral position + resting on table (have hand to side not flat!!) 2) Axis: over 1st CMC joint on radial side. -Stationary arm: parallel with radius -Movable arm: parallel with 1st metacarpal 3) Directions for client: if thumb can touch palm = full adduction. Have client move thumb to midline of body as far as possible.

goniometer measurement: forearm supination/pronation

0-80 1) Client position: seated with shoulder adducted against body, holding a piece of paper in place to ensure no excess movement. elbow is flexed to 90 with wrist in neutral position, while holding pen perpendicular to floor 2) Axis: in line with third proximal phalanx -Stationary arm: perpendicular to floor -Movable arm: parallel to pen; follows pen 3) SUP: Directions for client: Move palm toward ceiling as far as possible 4) PRO: Turn palm of hand towards the floor as far as possible

goniometer measurement: MP flexion/extension digits 2-5

0-90 1) Client position: seated with forearm in neutral + resting on stable surface. 2) Axis: dorsal MP joint of finger being measured -Stationary arm: aligned with metacarpal -Movable arm: along midline of proximal phalanx 3) Directions for client: if finger is straight: full extension. Have client bend finger.

PROM procedure

1) 2x a day 2) 3 reps each joint 3) Slow and gentle motion through full motion while paying attention to planes of motion and joint mechanics -SCAPULOHUMERAL RHYTHM FOR GH PROM 4) EXCEPTION: tenodesis (don't have muscle control of hand; do have control of wrist, so can create a grasp by extending wrist *want tightness in muscles because it creates the grasp; do not stretch)

goal: prevent loss of ROM : ROM that can/cannot be addressed by occupation and excercise: for those that cannot, goal becomes..

1) Adaptive equipment: Equipment that assists a person to become independent with task completion 2) Adaptive techniques: Changing the way something is done so that a person can do it independently 3) Is the patient or caregiver ready to learn? 4) AE for decrease ROM: -Long handled AE -Built up (thick) handles for decreased hand ROM -Environmental adaptations that will help the patient be able to reach what is required 5) Tx GOAL: help client become as independent as possible given limitations

assumptions about PROM (immobilization)

1) An individual's ROM is a combination of anatomy and occupations 2) Immobilization reduces ROM - Loss of muscle fiber - Changes in sarcomere (↓ length and # ) -Disorganized collagen synthesis - Ligament weakness -Disruption of synovial fluid, synovial membrane, and articular cartilage - Elastic stiffness in muscle (m. filaments lose their ability to slide) - Edema -> adhesions and contractures 3) Changes begin within 24 hours of immobilization 4) PROM is needed for those who cannot move their joints independently and motion is not contraindicated -ie. coma, paralysis, imbalanced muscles due to spasticity 5) PROM prevents joint discomfort, skin breakdown, hygiene concerns, mobility issues resulting in caregiver challenges

goal: prevent loss of ROM : ROM that can/cannot be addressed by occupation and excercise

1) Can: -Ligaments Tendons Muscles -Skin -Joint capsules -Other soft tissues 2_) Cannot: -Joint ankylosis (stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint) -Arthrodesis (surgical immobilization of a joint by fusion of the adjacent bones) -Longstanding contractures -Severe joint destruction

what to assess based on problems

1) If pain -> assess VAS (pain scale), pain diary -> goals and interventions 2) If endurance -> assess vital signs etc. -> goals and intervention 3) Strength -> assess MMT, etc. -> goals and intervention 4) ROM -> assess eg. goniometer -> goals and interventions

functional activities for fingers

1) MCP flex: Holding a book 2) PIP/DIP flexion; Handwriting 3) MCP/DIP/PIP extension: typing 4) thumb CMC Adduction/abduction: pinching/letting go the pages of a book as you turn them 5) Thumb CMC Flexion: Reaching across the keyboard with your thumb when texting 6) Thumb CMC Extension: releasing a bunch of coins from your hand into a bowl

goniometer: interventions

1) Stretching: active + passive 2) Functional Activities 3) Problems that can be changed: contractures of soft-tissue (eg. ski, muscles, tendons, ligaments) 4) If ROM limitations cannot be overcome -> compensatory techniques

goniometer: goniometry as part of a comprehensive evaluation

1) What functional limitations exist? 2) Is ROM a limiting factor? 3) What is limiting ROM? -Pain -Strength (PROM, AROM) -Structural blockage -Other?

goal: increase ROM: passive stretching

Done manually by an outside force (OT, CG, client) to the client with tight soft tissues 1) Continuous passive stretch can occur with splints or casts 2) Consider what tissues are being stretched and plan accordingly 3) Often a preparatory method

goniometer measurement: shoulder external + internal rotation

ER: 0-90 ; IR: 0-70 1) Client position: seated with shoulder abducted to 90 and elbow flexed to 90 2) Axis: on OLECRANON process of ulna -Stationary arm: in line with trunk; perpendicular to floor -Movable arm: PARALELL TO ULNA (STANDING ON SIDE) 3) ER: Directions for client: Have client move knuckles toward ceiling 4) IR: ask client to move hand toward the floor as far as possible

goniometer: goniometric assessment

The measurement of angles created at joints by the bones of a body. -Use big goniometer (not the one you have) for shoulder and elbow

goniometer measurement: wrist flexion/extension

flex = 0-80 ; extend = 0-70 1) Client position: seated with forearm in neutral position, resting on table 2) axis: distal to radial styloid process -Stationary arm: parallel to radius -Movable arm: parallel to second metacarpal *MAKE SURE TO FOLLOW THE SECOND METACARPAL NOT FINGERS -FLEX: Directions for client: move hand toward midline as far as possible -EXTEND: move hand away from midline as far as they can

movement (relative to..)

observable behavioral responses resulting in displacement of one or more limb segments of the body -The desire to move sets off series of physiologic responses to produce efficient volitional movement (brain, cognition, spinal reflexes, perceptual process, etc.) Motion: displacement of the body's position in space or a change in position relative to TIME OR VELOCITY (Types: Linear or Translatory & angular)

focus of this class

occupational performance -MOTION ANALYSIS, strength, and ROM

goniometer measurement: wrist ulnar/radial deviation

ulnar = 0-30 ; radial = 0-20 1) Client position: client seated in a chair and have hand + forearm pronated flat on table 2) axis: on dorsal surface of wrist -Stationary arm: in line with CENTER OF FOREARM -Movable arm: in line with third metacarpal 3) ULNAR: Directions for client: move hand in direction of pinky finger away from midline as far as possible 4) RADIAL: move hand in the direction of the thumb as far as possible

goniometer: WNL/WFL (definition + including #s)

(function ROM, normative ROM) 1) WNL = have full range of motion 2) WFL = enough to do their functions (ask them if they're able to do a certain functional task) -Shoulder flexion: 0-180 -Shoulder extension/hyperextension: 0-60 - Shoulder add/abd: 0-180 -Shoulder external rotation: 0-90 -shoulder IR: 0-70 -shoulder hor abd: 0-90 -shoulder hor add: 0-45 -Elbow flexion/extension 0-150 -Forearm supination/pronation: 0-80 -Wrist extension: 0-70 -Wrist flexion: 0-80 -Ulnar deviation: 0-30 -radial deviation: 0-20 1) Digits 2-5 -MP ABD/AD: No norms -MP flexion/ext: -90° -PIP flexion/ext: 0-100° -DIP flexion/ext: 0-90° 2) Digit 1 (thumb) -CMC ADD/ABD:0-45° -CMC flex/ext : 0-20° -*MP flexion/ext 0-50° -*IP flexion/ext 0-80°

arthrokinematics: arthrokinematic movements: rolling

-Angular motion in which each subsequent point on the surface contacts a new point on the other surface -Eg) rocking chair -Surfaces are incongruent -Results in angular motion of the bone -Always in SAME DIRECTION AS ANGULATING BONE MOTION -If occurs alone, causes COMPRESSION of surfaces on the side to which bone is angulating and SEPARATION on the other side (eg. passive stretching) -In normally functioning joints: does not occur alone, but in combination with joint sliding + spinning

goniometer: respect + professionalism

-Ask permission touch -Explain where you will be touching -Always use "professional touch" -Be respectful of client (culture, background injures) -Essential foundation for OT education at IC

application: 5kg purse held 20cm from elbow jt. & Biceps must produce force of 277N VS. 5kg purse held 10cm from elbow jt & biceps must produce 152N force

-Biceps must work twice as hard to hold the bag at the wrist -Increased compression at elbow joint -Easy to protect joints if you move the loads closer to the affected joints

what muscles used to sit to stand transfer ???

-Dorsal + plantar + wrist flexors -Knee/hip/elbow extensors -Erector spinae -Scapular depressors -*Have patient lean forward + put into feet to get weight off hip /hands ; push off hands holding onto seat of wheelchair

balance + stability: degrees of stability

-Height of center of gravity -Size of base of support (larger = more support; crutches/walkers widen it) -Location of gravity line within the base of support - Weight of the body (greater mass= more support) -Level of skill: train ourselves to have better balance, age

osteokinematics: unqiue actions

-Radioulnar joints?: pronation + supination -Subtalar joint?: inversion + eversion -Talocrural joint?: plantar/dorsal flexion - Wrist joint in coronal plane?: radial/ulnar deviation -Trunk motion in coronal plane?: lateral flexion -Scapulothoracic joint?: depression/elevation, retraction/protraction, downward/upward rotation -Glenohumeral joint?: horizontal ab/ad, er/ir

osteokinematics: perpendicular to the cardinal planes (Plane / Axis / Example)

-Sagittal / Frontal (ML) / Biceps curl -Frontal / Sagittal (AP) / Jumping jack -Transverse / Vertical (SI) / Spinning on ice skates

arthokinematics: end feel: examples of pathological??

-Soft end feel in joint that is normally hard: edema or synovitis -Hard feel in cervical spine: osteophytes -Abnormal hard feel and pain free: osteoarthritis (osteophytes restrict movement but are not compressing nerves or sensitive structures) -Vibrating spasm: due to prolonged muscle contraction -Capsular end feel: similar to tissue stretch, but occurs earlier in ROM (Soft capsular end feel: result of synovitis or edema) -Springy block: joint rebounds at end of ROM to internal articular derangement -> due to intra-articular blocks eg. torn meniscus or articular cartilage -Muscle guarding: involuntary muscle contraction in response to acute pain

what muscles used to move a wheelchair ???

-Trunk muscles to stabilize (angled seat helps) -Wrist: radial/ulnar deviation -Back muscles: scapular elevators + depressors -Shoulder flexors (move forward) + extensors (move back) -Shoulder abductors -Elbow flex/end -Forearm stabilize + a lil supination/pronation -Some thumb opposition, CMC abduction + finger flex

balance + stability: stability and cognition

-What is most stable?: Stand tall our crouch low? = crouch down low -Feet close together or spread apart?: spread apart -Leaning forward, backward, leftward, or planted directly over feet?: over the feet -When our COG falls outside of our BOS, we lose our balance

goniometer: instructing the client / your steps

1) "we are doing this to measure how your joints move" -Be explicit and demonstrate if necessary 2) Record motion with 2 numbers - RANGE! -Left hand: hold steady -Right hand: goes with distal segment -Stationary arm: degrees are marked -Movable arm: center line/ pointer to indicate angular measurement -Axis: point at which these two arms are riveted together (over axis of joint) -When using a half-circle goniometer, the protractor must be positioned opposite to the direction of motion so that the indicator remains on the face of the protractor -Interpret: WNL, WFL, Limitation

wheel and axle mechanics ???

1) A configuration of levers that can be 2nd or 3rd class 2) Axis: center of rotation of the wheel 3) Moment arm: radian of the circle 4) Axle + rim are where application of force occurs -If wheel is turned by a small force at its rim, a larger force can be generated at the axle 5) Eg) rotary movements of the scapula = like turning a wheel (contraction of upper trapezius muscle produces upward rotation of scapula)

motion: linear or translatory movement

1) All points (parts) of an object/person move in the same direction at the same velocity (same direction/same time) 2) Movement that occurs in a line 3) Measured in linear terms (inches, meters, etc.) 4) Rare in human motion 5) Rectilinear: both points move in parallel straight lines ?? 6) Curvilinear: both points move in parallel but not straight lines ??

the movement of bony levers: swing ???

1) Amount of swing is measured in degrees of motion using goniometer 2) Pure motions: flexion, extension, abduction, adduction, and rotation (other movements are combination of them) 3) Many movements of human body are combination of linear + angular movements (eg. running = linear motion of head + trunk and angular motion of arms and legs)

arthrokinematics: arthrokinematic movements: spinning

1) Angular motion in which one point of contact on each surface remains in CONSTANT CONTACT with a fixed location on the other surface 2) Eg) GH and FA joints during flex/ext (ball and sock joints) 3) One bone rotates around a stationary longitudinal axis: same point on the moving surface creates a circle as the bone spines 4) The more incongruent a surface is: the more rolling occurs

osteokinematics: joint axes during functional tasks

1) Are complex 2) Do not remain stationary like inanimate objects 3) Instantaneous axis of motion -Change in position of the center of axis of rotation (ie. goniometric assessment) -Are often OBLIQUE -Examples: Finger dip from extension to full flexion; Elbow extension from full flexion

goniometer: if both AROM + PROM are limited, underlying causes could include

1) Bony block to motion 2) Capsular tightness around joint 3) Tightness of muscle-tendon unit 4) Edema 5) Contracture*: limited ROM due to soft tissue shortening or bony ankylosis -bony akylosis: UNION OF BONES OF A JOINT BY LOSS OF ARTICULAR CARTILAGE -Dupuytrens: painless deformity of the hand in which one or more fingers (in this case, the pinky) are bent toward the palm and can't be fully straightened.

process of case study with client

1) CONCERN: what the client states as the problem 2) Model: chosen to help with assessment and intervention process 3) Assessment: actual tool used to assess the concern 4) PROBLEM: the deficit, as determined by the assessment tool 5) Goal: LTG and STGs 6) Intervention: related to the model selected, problem identified, and goal

goniometer: reliability

1) Characteristic of a measuring instrument 2) Stability of findings between testers 3) Decreasing variables increases reliability 4) What variables play a role in reliability of using a goniometer? -Must place axis + arms appropriately (same point of measurement) -Patient-related: fatigue, pain, fear of pain, feelings of stress/tension (make them feel comfortable!) ; Position of patient: record testing position and use the same one when retesting -Environmental factors: time of day, temperature of room, type of goniometer used, training and experience of tester -Same tester should use same goniometer at same time of day 5) Intra-rater: one therapist consistently measures same joint angle over multiple trials -More accurate 6) Inter-rater: multiple therapists consistently measuring the same joint angle -May be more dependent on training than experience 7) AROM vs PROM -Active measurements are more reliable than passive ones 8) +/- degrees standard of error (5)

goniometer: factors influencing ROM

1) Client factors -Health/pathology -Gender (women have more ROM) -Age -Activity Levels -Cardiovascular fitness 2) PSYCHOLOGICAL Factors -Motivation -Expectation -Fear of injury/reinjury -Cooperation -Anxiety/stress 3) SKELETAL factors -Types of tissues -Types of joints -Normal limiting factors (tendons, ligaments) 4) Environmental factors -Temperature -Noise -Number of people -Time of day -Activities done 5) METHODOLOGICAL + MEASUREMENT factors -Instrument (big vs. little goniometer) -Experience of tester -Testing procedure -Characteristics of test 6) Don't forget occupational profile!

arthrokinesis: joint positions

1) Closed-packed: increased joint congruence (joint surfaces match perfectly), greatest stability 2) Loose-packed :decreased joint congruence, supporting structures lax (all other positions of joint that are not closed-packed)

goniometer: recording ROM

1) Electornically or paper: medical record and legal document (include date, whether AROM or PROM, starting/ending positions, right vs. left side, and signature) 2) Record the range: 2 numbers! -1st number: starting position of extremity -2nd number: limit of motion at end range 3) results WITH THE MOVEMENT WRITTEN AFTER! eg) 0-135 of shoulder flexion 3) Notation system 0 -180 degrees from the anatomic position -Each motion is listed separately, with the start and stop position noted - Hyperextension is listed as a separate motion -There are various notation systems; facility specific 4) Neutral Zero Method -The anatomical position is considered to be 0, or if a given starting position is different from anatomical position, it is defined as 0. Measurement is taken from the stated starting position to the stated end position. If patient cannot achieve the stated starting/end positions, the actual starting/end positions are recorded to indicate limitations in movement.

rehabilitation approach

1) Expect little change in client factors and performance skills (not looking for improvement) -Focus on client's remaining strength -Use when there is limited time for intervention or when remediation is not possible (eg. chronic condition) 2) Focus on performance of task/activity that client identifies as being important to them 3) Modify/Compensate/Adapt -Modifying how task is done -Adapting components of the task (task method, task object) -Adapt environment -Change context -Client/family education

biomechanical approach

1) Expect reductions in limitations (looking for improvement) 2) Change underlying structures limited by clinical conditions (disease, trauma, overuse), with the understanding that these gains will lead to improvement in occupational performance 3) Establish/restore/remediate ROM, strength, endurance, and tissue integrity (these influence performance of occupations) 4) Eg) enabling activities, sensorimotor techniques, graded exercicses, physical agent modalities, or manual techniques

arthrokinematics: joint types

1) Functionally, certain types of joints are primarily responsible for stability, while others are responsible for mobility -Stability: Synarthroses (sutures, teeth, between tib/fib and rad/ulna) -Stability and Mobility: Amphiarthrosis (epiphysis of long bones in children, pubic symphysis, costal cartilage) -Mobility: Diarthrosis (synovial joints...jt. capsules, fluid) *the majority of joints in our body 2) Other ways to categorize: structural classification -Fibrous: fibrous connective tissue -Cartilaginous: cartilage -Synovial: space, including additional strucutrs like joint capsule with synovial lining + synovial fluid

goniometer: goals

1) Increase Rom (eg. if skin, joint, or muscular tissues have shortened as result of immobilization; stretch them) -Eg) biomechanical 2) Don't lose ROM (if limited by edema, pain, spasticity, or weakness; primary goal is to reduce the problem AND also prevent loss) -Eg) rehab model 3) Be able to do functional activities (eg. if cause is contracture or bony ankylosis, teach patient methods of compensation because cannot fix these without surgery)

arthrokinematics: arthrokinematic movements: sliding (aka gliding)

1) LINEAR motion in which the movement of one joint surface is parallel to the other 2) One point of reference contacts new points on the other surface 3) Eg) ice skate: keep hitting new point with movement 4) Surfaces must be congruent (flat OR CURVED) - pure sliding does not occur in joints because none are completely congruent -The more congruent the surfaces are: the more sliding occurs 5) Direction of sliding -If Moving joint surface is convex: Opposite direction of the angular movement of the bone -If moving joint surface is CONCAVE: SAME direction as angular movement -*Basis for determining direction of mobilizing force when joint mobilization gliding techniques are used

force systems ???

1) Linear force systems: occur along same action line & Produce tension or compression 2) Parallel force systems: forces acting in the SAME PLANE but along DIFFERENT ACTION LINES 3) Concurrent force systems: when all of the forces meet in one point (do not act along same line) -Resultant force is always less than combined magnitutde -Whenever vectors are slightly off parallel 4) General force system: when all of the forces are in the same plane but are not covered in the above categories 5) When parallel or general force systems are applied to the same object, the object reacts as a lever

momentum ?????

1) Linear momentum = mass of object x velocity (P = mv) -Rotary motion produces powerful moment -Doubling mass (at same velocity) will result in doubling moment 2) Angular momentum: builds exponentially (doubling mass at same velocity will result in quadrupling the momemntum) 3) Increasing momentum arm: efficient way to build momentum 4) Can be helpful or hazardous -Helpful: in transfer, have patient rock to get momentum -Bad: shorter therapist may not have sufficient leverage to hold patient 5) Pulleys: act to change the direction of force -Exist in body in form of bony prominences and ligaments (control direction of muscle pull through controlling placement of their tendons) -Capability of increasing mechanical advantage by changing line of action of force, thereby increasing the moment arm

mechanical advantage (MA) *the formula

1) MA = FA length / RA length 2) *MA goes to whatever the arm is longer (eg. 3rd class = MA is resistance, 2nd class = MA is force) 3) LEVERS PROVIDE MA (they differ in capacity to balance and overcome resistance) 4) Increased efficiency of movement and power (because little magnitude of effort, but little speed and distance) 5) LEVERAGE -LOST IF FORCE IS CLOSE TO AXIS -GAINED IF FORCE IS FAR FROM AXIS (Manual muscle testing) - A lighter weight with enough leverage operates as effectively as a heavier weight

goniometer: precautions/contraindications

1) Not always safe to perform ROM: AROM safer than PROM because there is voluntary cooperation from client 2) Contraindications - Dislocations, unhealed fractures, immediately following surgery, MYOSITIS OSSIFICANS 3) Precautions - Infection, inflammation, hypermobile joints, .. ? client on pain meds/muscle relaxants, marked osteoporosis, subluxed joints, hemophiliacs, regions of hematomas, bony ankylosis

levers: line of action ???

1) Number of active muscle fibers determines the magnitude of muscle force 2) Direction of pull establishes line of action, which determines the force moment arm -Typically the direction of the alignment of the muscle fibers and can be seen as a line "the line of action" that is parallel to the fibers and intersects the attachment of the muscle -Torque (turning force): muscle force x moment arm (and is the resultant force available to move the bone) 3) Muscle often pulls in a line other than the direction of movement, and some of the efficiency of the muscle is reduced -Horizontal: applies a compressing force to the joint = stability -Vertical: applies rotational force to move the bone 4) Effectiveness of the muscle as a stabilizer or moboilizer can be estimated based on comparisons of lengths of horizontal + vertical vectors and angle of muscle pull -Length: Stabilizing line is logner than rotary or angular line: stabilizer -Angle of pull: Farther from perpendicular angle of insertion = becomes a weaker joint mover 5) Knowing strength of the muscle in any position of the muscle fibers helps prevent injury -Also splint effectiveness: if force is applied perpendicular to the segment being mobilized, the translational forces are lessened so there is less unwanted tension on the joint surfaces, and the splint is more effective

osteokinematics: position vs. action

1) Position: fixed/static (eg. elbow is flexed) 2) Action: motion; dynamic (occurring: START + END) (Eg. he is flexing his elbow( 3) Why do we care -DIFFERENT REQUIREMENTS for both -Evaluate positions + actions required for occupations

deformation: angular

1) Shear forces: INTERNAL DEFORMATION IN AN ANGULAR DIRECTION and WHEN FORCES ARE PARALLEL to the surfaces in contact -Avoid when fabricating splints by ROUNDING SHARP EDGES 2) Torsion: TWISTING force that creates a shear stress over the entire bone 3) Bending: when force is applied to a part with no support of the structure - One side becomes convex, the other side becomes concave - Important when designing adaptive equipment and splints

effect of forces

1) Stress: measure of FORCE INTENSITY THAT RESULTS FROM PRESSURE -NOT VISIBLE -Can result in deformation if surface cannot support the force (VISIBLE) 2) Deformation: Applied forces that change size/shape of an object or material -Amount depends on the load and the ability of the material to resist the load (NEWTONS 3rd law) -Permanent or temporary (depends on material and magnitude of force); Eg) permanent: when walking on hard surfaces, foot arch can flatten; pitting edema = push and mark remains -Deformation of soft tissues (eg. patient uses a wheelchair ; eg. . Decubitus ulcer (pressure/bed sore); bony parts are most prone) 3) PRESSURE= FORCE/ AREA (ideally want low force in high area) -To reduce pressure: decrease the force or increase the area of skin contact (eg. distribute body weight over larger area using special cushions, use wider, longer splints, etc.) -types of deformation: linear, angular

forces act in pairs

1) There is no movement or equilibrium without PAIRING of forces 2) If force is greater than resistance offered by object -> movement occurs 3) If a force is not applied to an object that is moving -> object continues to move a constant speed until acted upon by another force 4) Equilibrium: sum of all forces applied to the object equals ZERO -Stability 5) Eg) standing = static (gravity pushing down; GROUND pushing up) 6) Eg) holding arm out = gravity pushing down; muscles pushing up

goniometer: AROM scan (Screen for UE)

1) Visual and verbal instructions -Mirror imaging or side by side -Can modify based on client -Can use occupation to guide the motions 2) Done before an assessment to save time and direct the appointment 3) ST (scapulothoracic), GH, Elbow, Forearm, wrist, finger, thumb -ST: not one axis, can measure distance from inf. angle of scapula to spine

concave convex relationship??

1) When the bone with the convex surface moves on the bone with the concavity, then the convex surface moves in the opposite direction to the bone segment (convex stationary + concave moving = same) 2) When the bone with concavity moves on the convex surface, the concave articulation moves in the same direction as the bone segment (concave stationary + convex moving = opposite) 3) One joint surface is mobile + the other is stable

types of muscle contraction *& force production ranking

1) isotonic: internal forces result in movement of the joint (shorten = concentric + lengthen = eccentric) -Concentric Contraction: Internal force produced by muscle >external force and resistance that produces shortening of muscle -Eccentric Contraction: Internal force < external force and resistance 2) Isometric: when internal force generated by muscles = external force of resistance *Force production: Eccentric > Isometric > Concentric -Can put heavy weight down but might not be able to lift it up over head (good to start exercise program with eccentric)

arthrokinesis: joint positions: loose-packed

:decreased joint congruence, supporting structures lax 1) Joint surfaces do not fit perfectly 2) Least amount of joint congruency 3) Ligaments and jt. capsule are slack 4) Allows for ACCESSORY MOTIONS + DECREASED JOINT FRICTION 5) Typically in MID-RANGE of motion 6) Preferred position for JOINT MOBILIZATIONS 7) All other positions of joint that are not closed-packed

angular motion: lever

A simple machine used toINCREASE the EFFICIENCY of a force about an axis or fulcrum ("any rigid object, usually depicted as a rigid bar with a fulcrum, a point around which the object will rotate when force is applied) 1) Multiplies the effort that can be applied (magnifies the force) 2) PARALLEL FORCE SYSTEM -Muscle force (effort) -contact with environment and/or gravity (load/resistance) 3) In the human body -Rigid bar ~ bone segment -Pivot point ~ joint ; Axis (goniometer positioned over) ; COR (center of rotation) 4) Three classes represent variations in the location of the: -Axis (fulcrum): Pivot point, COR -Force arm (FA): Distance from force to the axis (Longer the FA, less force required) -Resistance arm (RA): distance from resistance to the axis (Longer the RA, less resistance can be moved)

arthrokinematics: arthrokinematic movements

AKA ACCESSORY MOVEMENTS OR JOINT PLAY (motion that accompanies active motion and is necessary for normal motion, but CANNOT BE ISOLATED voluntarily) -Little motions happening at joint -* Most normal joint motion is a combination of all of these. -Little problem = big problems in ROM -include: ROLLING, sliding, spinning, compression + distraction

osteokinematics: planes

ANATOMICAL (CARDINAL) PLANES (location of movement occurs in 3 planes that are at right angles to each other) 1) Sagittal -Right & left halves -Flexion/extension -Dorsi and plantar flexion 2) Frontal (Coronal) -Front & back -Abduction/adduction -Radial + ulnar deviation -Foot eversion + inversion 3) Transverse (Horizontal) -Upper & lower - Rotation (ER, IR, supination and pronation)

kinematic chains

Combination of several joints uniting successive segments 1) Allows compensation to occur (compensate for loss of motion at one joint by substituting combined motions of other joints, but this requires MORE ENERGY) 2) Eg) when have cast, can still move around but other joints are working more 3) Distal segments have HIGHER DEGREES OF FREEDOM -> enables body to transform stereotyped ANGULAR MOTION of joints into EFFICIENT curvilinear motion 4) Open chain: distal segment moves ; proximal skeleton remains still while force of muscles move the less stabilized, distal extremity 5) Closed chain: proximal segment moves -Hand/feet remain on ground/stable (distal is stabilized) -Movement occurs closer to the core of the body

Your client is holding a 2 lb weight in his hand, but having trouble lifting it in the full AROM (shoulder flexion with elbow extension.) What are two ways that you could modify the exercise to make the client successful?

Decrease the size of weight & bring the weight in closer to the body... A principle of body mechanics.

balance + stability: center of gravity

Exact center of a uniform object; theoretical point around whichmass of an object is balanced (point of body where entire weight is concentrated) 1) Bodies 3D, so COG at exact center of the 3 planes -Aka. Balance point at which vertical + horizontal planes meet 2) Constantly changing with movement (stability is maintained as long as the line of gravity is maintained within the base of support - stability is dependent upon relationship of COG!) 3) In upright position: Entire body: anterior to S2 vertebrae -UE: just proximal elbow joint -LE: just proximal to knee joint - UB : anterior to T11 body and below xiphoid process 4) Postural control enables the body to remain in equilibrium or in balance -Balance is maintained by AUTONOMIC POSTURAL ADJUSTMENTS (equilibrium reactions)

types of muscle contraction: eccentric

Internal force < external force and resistance 1) Results in visible lengthening of the muscle 2) Ex. Lowering an object with control (sitting down, placing object down) 3) Often controlling the descent of an object towards earth -Muscle tension is less than gravity pulling the body down but sufficient to allow controlled movement -Occur in every movement in the direction of gravity: active muscles are those that are antagonists of the same movement when it is made against gravity 4) ? Antagonist muscle can eccentrically contract = lengthen, which serves as braking action to motion + can also relax/lengthen to allow movement - Eg) braking action to motion = quad when going down stairs 5) ? Develop the same force output as other types of muscle contractions at the level of the sarcomere but with fewer muscle fibers activated (more efficient + use less oxygen) 6) ? May be related to delayed-onset muscle soreness (cross-bridges stay attached to active sites while resistance lowers)

Newton's Laws of Linear Motion: 2nd law

Law of Acceleration (Mass and Acceleration) 1) Acceleration occurs when inertia is overcome and movement begins (it is RATE OF CHANGE IN VELOCITY) 2) A GREATER FORCE IS REQUIRED TO STOP/MOVE MOTION OF A LARGE MASS THAN A SMALL ONE -Eg) when muscle is strained, need to recover because force to move muscle may be more than the force the muscle can produce 3) If unbalanced forces act on an object, ACCELERATION OCCURS IN DIRECTION OF STRONGER FORCE (F = MA) 4) Eg) if force applied to 2 shopping carts (one empty + one full) is the same, the empty cart has more acceleration than the loaded cart -But if larger force is exerted (eg. push harder), acceleration increases

Newton's Laws of Linear Motion: 3rd law (when object is immobile?_

Law of Action-Reaction 1) For every action force, there is an equal and opposite reaction force -Forces are EQUALIZED (SUM TO ZERO): whenever two objects are pressed together, they exert an equal and opposite force on each other . Eg) when jump onto boat, it pushes it in the opposite direction 2) When interacting object is immobile, results in PRESSURE -Pressure= sum of forces/area 3) Newton's Cradle (hit back in forth) 4) "What goes up, must come down" 5) Ex. Ground reaction force 6) E) scoliosis: brace, put cushions on side of wheelchair,

Newton's Laws of Linear Motion: 1st Law

Law of Inertia (or Law of Equilibrium) 1) A body at rest will stay at rest and a body in motion will stay in motion (with constant speed/direction/velocity in a straight line) ... until an outside force acts upon it (Eg. kick soccer ball) 2) A force is required to start a motion, to change direction or speed of a motion, and stop a motion (eg. soccer ball moves until it hits goal) 3) Momentum (p): AMOUNT OF FORCE REQURIED TO CHANGE INERTIAL STATE -P=mv (momentum= mass*velocity...speed with a direction) -OBJECT AT REST HAS NO OBSERVABLE MOVEMENT BECAUSE ITS VELCOITY IS ZERO (inertial state can be changed by any additional force) -The larger and FASTER an object is = the more momentum it has (eg. bigger car causes more damage) 4) STATIC EQUILIBRIUM: All external forces acting on a body must add (in vector sense) to zero -Equilibrium: velocity is not increasing!! Can still be moving! 5) Linear motion- bicycle coasting (stay at same speed) 6) *TENDENCY TO KEEP DOING WHAT ALREADY DOING

mechanical advantage: 3rd class levers

MA = Resistance (means that the muscle has to work harder to move the body segment: MINIMAL MA) 1) Magnitude of force is large (inefficient) -BUT Produces SPEED and LARGE EXCURSIONS OF MOVEMENT at the distal segment (why the majority of human body levers are 3rd class) -Use the strongest joints possible to do the work 2) RA>FA 3) Keep objects closer to the body so less force is needed to lift the objects + greater stability -Squat bend: back is straight, decreasing the lever arm of the weight of the trunk and upper body

mechanical advantage: 2nd class levers

MA = force ( muscles don't have to work as hard ) -Magnitude of force is small - Small gains with speed and distance -FA>RA (mechanical advantage because its always more than 1)

goniometer: assessment steps

Observe functional activities (functional active ROM scan) -> strength and ROM sufficient for client's needs? (if yes: no further assessment needed) -> proceed with ROM assessment if no -> is the information sufficient to write a treatment plan? Yes: no further assessment. No: proceed with further testing

friction

RESISTANCE to movement between objects that are in contact with other 1) Pushing force must be greater than object to produce motion 2) Friction can stabilize/retard movement (eg. carpet easier to walk on) OR can cause instability 3) Quantity of friction depends on: -How firmly two surfaces are being pushed together (eg. how much it weighs) -Type of surface (flat vs. round) -Type of material of surfaces ( ie. Synovial fluid in a joint - not as much friction = don't move as smoothly (RA); Ie. Blisters or skin breakdown with orthoses) 4) *To change the degree of friction, must change the forces that hold the surface together or change the nature of the surfaces 5) Newtons Third Law: largely dependent upon the net forces focused on two contacting surfaces 6) Decreasing friction is important when designing splints an in adapted equipment (to avoid blisters, skin irritation, etc.)

2nd class levers

Resistance force is in the middle between the axis and the effort force -The resistance arm is always shorter than the force arm (MA is force) -Resistance lies closer to the axis than to the force -Occurs when a large amount of weight is supported by a smaller force ("a force magnifier": able to move large mass with little force) -Eg) wheelbarrow, foream and brachilais: center of gravity of the forearm between elbow and insertion of brachilais

arthokinematics: end feel

Resistance to further motion at a joint (the feel when end of joint range of motion is reached during PROM -Normally dictated by the joint's structure -Compare both sides of body to make sure it's normal -Can be described as: 1) Hard : bone on bone (ie. elbow ext, forearm PRONATION, PIP + MCP THUMB FLEXION) 2) Firm or springy: tension but there is a give; due to muscles, capsules, ligaments -ie. forearm SUPINATION, MCP EXT, HIP FLEX, most SHOULDER movments + WRIST movements 3) Soft: soft tissue is compressed -ie. knee/ELBOW/CMC flex 4) Pathological: there is a problem (can't get an end feel) - Empty- pain on motion, but no resistance

deformation: linear forces

STRAIGHT deformation ; FORCE IS APPLIED IN A PERPENDICULAR DIRECTION 1) Compression force: push bones/parts together and the direction of forces is at right angles to the surfaces -Produced by muscles, weight bearing on a limb, gravity, or external loading along length of bone -Aka PRESSURE 2) Tension/distraction: elongates tissues and pulls bones apart -Maximum stress is perpendicular to the plane of the applied load - Sprains, strains, some dislocations

torque + MMT

When testing elbow flexion, resistance is applied to the wrist instead of middle of forearm -> half the amount of force due to shorter resistance arm (if force is applied distally, forces might be small but there is a large torque that the muscles must match)

goniometer: AAROM

active assistive range of motion: therapist, client, or another caregiver may provide support during active motion to allow the client to move beyond their current AROM limits

goniometer: AROM

active range of motion: amount of motion at a given joint achieved when patient contracts the muscles that control the desired motion -If joint is free to move to end range, the problem is with active motion

deformation: elasticity

allows structures to return to original shape) -Injury= normal forces exceed a tissue's elasticity -Ankle sprain when forces acting around ankle tear ligamentous tissues -Younger + healthy = less likely to injure

forces acting on the body: internal forces

arise from sources within the body 1) Muscle contraction 2) Passive resistance of ligaments/bones -Elbow extension = bone on bone = less movement 3) Elastic properties of connective tissues (tendons, ligaments, skin, etc.) -Stability of joints depends upon bony architecture, ligamental support, and tendon & muscle tension

goniometry

assessment of angular movement 1) measure quantity of joint motion 2) Useful in measuring changes in AROM/PROM 3) Eg Shoulder abduction: Occurs along coronal plane & Gonio set up in coronal plane 4) Axis is perpendicular to plane: coronal = Ant-posterior axis, transverse = superior-inferior, sagittal = medial-lateral - Fulcrum~axis (center of rotation) 5) Motion must be in a single plane to be measured in goniometry

forces acting on the body (balance between ... + types)

balance between STABILITY AND MOTION (they are inversarely proportionate; work in pairs to produce human movement) 1) Forces affecting stability/mobility (internal, external, observable, indiscnerible)

goniometer: reassessment

do in same position each time (note if done modified) -Re-evaluation: compare initial evaluation measurements to evaluate progress -> make changes if necessary -Measurement error of 5 degrees for UE: must be greater than 5 to show actual change

arthrokinesis: joint positions: close-packed

increased joint congruence, greatest stability (where joint surfaces match perfectly) 1) Maximum joint surface contact (where it is most stable): cannot make further passive movement 2) Attachment of ligaments are furthest away 3) Taut joint capsule 4) Joint is mechanically compressed 5) Extreme in joint's ROM 6) Examples: - Full extension for elbow, wrist, hip, knee, IPs - Dorsiflexion for ankle -Full FLEXION of MP joints -GH: 90 deg ABD + ER -Forearm: supination -Any other position of joint is loosely-packed 7) Don't want to work with joints in closed-pack position 8) During healing,SPLINT KEEPS JOINTS IN FLEXED POSITION so that when recovery begins, joint is still able to move through its entire range (if in open-packed position, ligaments may shorten and become stiff)

types of muscle contraction: isotonic

internal forces result in movement of the joint (shorten = concentric + lengthen = eccentric) -Isotonic means equal tension, BUT muscle force changes through ROM, so tension must also change - so isotonic here means description of muscle length and not tension -Concentric Contraction: Internal force produced by muscle >external force and resistance that produces shortening of muscle -Produces shortening of a muscle (visible) -what you think of when u think of contracting muscles -+ contraction velocity ??? (As the load the muscle is required to lift decreases, contraction velocity increases. This occurs until the muscle finally reaches its maximum contraction velocity, Vmax. ??????) -Often working against the force of gravity -Lifting something up -Produces the least force output -Ex. Bicep curl (lifting up), walking up stairs: quadriceps is extending knee

osteokinematics: axis

line around which movements take place (determines direction of movement) -Axes: what are the main options for axes of motion in the body? (three axes divide three planes into four quadrants) 1) Medial to lateral (M-L): horizontally from side to side -Determines direction of movement for sagittal plane 2) Anterior to posterior (A-P): extends horizontally from front to back -Determines direction of movement for coronal plane 3) Superior to inferior (S-I): vertical line -Determines direction of movement for transverse plane

ROM ???

maximal distance that bones move about a connecting joint 1) Involves length and excursion of muscles + extrensibility of connective tissues that cross the joint + structures surrounding moving segments 2) Functional ROM: range necessary to perform 3) When a joint is not put through its full ROM, physiological changes in the connective tissues occur -Muscle: changes in length/number of sarcomeres, thickening of tissue, loss of fibers, potential atrophy -Ligaments, joint capusles, and tendons: decrease in collagen fibers; if regrow, funky pattern -Joints: breakdown of articular cartilage because synovial fluid is no longer moving to carry necessary nutrients 4) Intervention methods -Decrease edema: elevation, crytotherpay, compression, massage -Minimize contractures (contractures: static shortening of muscle + connective tissue that result in reduced joint mobility + increase in resistance to passive joint movement) -Movement through full ROM (Controlled motion applied early in rehab helps minimize negative effects; Teach patients to move joints that are injured or passively moving the joints if patients are unable to do it themselves (want them to do it themselves because contraction helps pump fluid out))

arthokinematics

movement of articulating surfaces (in relation to the DIRECTION of movement of the DISTAL segment; cannot be observed)

osteokinematics

movement of bones that are observable (focusing on angular changes between bones forming the joints) -planes -axis

occupational intervention involves

optimal occupational performance + preventing injury by recommending appropriate positioning of the body

angular movement: force couple ??

parallel forces are equal in magnitutde but opposite in direction (powerful in causing rotation of the lever) eg. muscle co-contraction to stabilize a joint -Pathology to them can result in imbalance, instability, and loss of smooth coordinated movement

goniometer: PROM

passive range of motion: amount of motion at a given joint when the joint is moved by an outside force (therapist or a therapeutic equipment) -Normal to have slightly more PROM than AROM; however, if AROM is significantly less, there is a problem -If end range cannot be attained when therapist moves limb, problem is with passive motion -When recording PROM, should also note any abnormal end-feel

analysis of forces: resolution of forces ???

replace a single force by 2+ equivalent forces 1) Determine the combined effect of a force by breaking down force into its horizontal and vertical component; construct a rectangle around the original vector 2) A square? 3) F = T1 + T2 (triangle) - draw parallelogram around it

human motion

result of complex interaction of FORCE and STABILITY, following PHYSICAL LAWS and ANATOMICAL CAPACITY of the body 1) Occurs due to an imbalance of forces acting at a joint(s) -Stability occurs when the forces acting at a joint or group of joints are balanced 2) Forces acting in pairs produce movement (one movement stabilize, one mobilizes) -Eg) while FCR contracts, the wrist flexes ; when ECRB contracts, wrist extends ; when both contract, they cancel out each other and there is no movement = stabilization

analysis of forces: composition of forces ???

show the combined effect of 1+ forces in the same plane (co-planar) and on the same point (concurrent) , and same line (co-linear) 1) Analyze a linear force system 2) Linear forces are vector quantities -They have both magnitude and direction -They can be expressed both graphically and mathematically 3) Resultant force: add the 2 forces acting together (if occurring in same line + same direction) 4) If two forces are on the same line but opposite directions: difference between the two forces (Force 1 minus force 2) 5) Graph via polygons and parallelograms (construct by replicating the angle formed; the resultant R bisects the parallelogram, beginning at the tail of the first vector and ending at the point of the second)

force: vector diagrams

study of linear forces involves use of 1) Shown using an arrow -Length of arrow = its magnitude (size/amount) -Direction of arrow = its direction 2) Eg) Consider a 160 lb. person sitting in a chair for 10 seconds -Force being exerted on the chair is represented by a vector -Vertical orientation and magnitude of 160 lbs. -Force is directed downward and the point of application is the seat 3) analysis of forces -Composition of Forces: show the combined effect of 1+ forces in the same plane (co-planar) and on the same point (concurrent) , and same line (co-linear) -Resolution of forces: replace a single force by 2+ equivalent forces

mechanical advantage: 1st class levers

vary depending on location of axis in relation to the resistance force and effort force arms -Muscles that attach further from the joint generally have greater mechanical advantage

forces acting on the body: external forces

whatever the muscles must work against to produce motion (eg. pushing cart in order to start momentum, lifting weights, etc.) 1) Gravity: A constant force that has an effect on all objects; it effects equilibrium and movement -Directed vertically downward at an acceleration rate of 32 feet/sec^2 or 9.8m/sec2 -Force acts on a body's center of gravity (COG): Pulls it toward center of the earth -Affects stability of body + movements of extremities/head/neck -Both a stimulus and a barrier (Helpful OR challenging when doing activities) -Movement caused by gravity in one direction typically leads to movement by muscle contraction in the opposite direction (Ex. Neck extensors (baby on floor lifting neck up)) 2) External resistance: wind, water, friction, etc.

1st class levers

when forces are exerted on opposite sides of each other with the axis or fulcrum in between them -Greater force = if axis is closer to the resistance force -Greater speed = if axis is closer to the effort force -See-saw: heavier child sits closer to to axis

types of muscle contraction: isometric

when internal force generated by muscles = external force of resistance 1) No change in length of muscle fibers: no movement (contracts but doesn't shorten) 2) ZERO contraction velocity 3) Enable muscles to act in restraining or holding action -Ex. Holding onto an object, wall sits 4) Forces balanced: tension is in equilibrium 5) STATIC muscle work being done (energy is expended), but no joint (mechanical work) -All dynamic work involves an initial static (isometric) phase as tension in muscle develops 6) No change in angle of joint (JOINT TENSION) -> more likely to get injured