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