Chapter 5 Trombly – Flashcards
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What is essential for completing occupational tasks?
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mobility (range of motion), use extremities against resistance (strength), for an extended period (endurance)
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Use of assessments establishes what?
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baseline of patient's abilities
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Reassessment produces?
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documentation progress
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Passive ROM
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amount of motion at a given joint when the joint is moved by an outside force
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Active ROM
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amount of motion at a given joint achieved by the patient using his/her own strength
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AROM < PROM
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problem with muscle weakness or tendon integrity in hands
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Evaluation of AROM
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should start with a quick functional scan
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No limitations found during AROM scan
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within normal limits, no further testing required
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if limitations are observed
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therapists attempts to move patient through PROM
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move to end range or not
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problem with active, passive
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In addition to goniometer placement, what other factors can contribute t accuracy and reliability of ROM measurements?
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personal-pain, fear of pain, fatigue, and feelings of stress or tension environment-time of day, temperature, type of goniometer, training and expertise of tester
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what attempts can be made to ensure patient comfort/physical level?
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talking to patient and describing procedure
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ROM pre-test/post-test reliability?
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same goniometer and same time of day same testing position, same approach,
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0-150 elbow flexion
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no limitation
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20-150 elbow flexion
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a limitation in extension (problem with starting position)
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0-120 elbow flexion
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a limitation in flexion (problem with ending position)
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20-120 elbow flexion
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limitations in flexion and extension (problems with both starting/ending positions)
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joint fusion
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starting and ending positions are same, w/ no ROM
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joint cannot move in one direction
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ROM-limited motion is recorded as none wrist flexion 15-80, with a 15 flexion contracture, wrist cannot be positioned in extension; therefore extension is none.
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Wrist Flexion ROM (0-80)
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axis-in line with base of 3rd metacarpal stationary arm-midline of dorsal surface of forearm moveable arm-parallel to 3rd metacarpal
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Wrist Extension ROM (0-70)
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axis-in line with insertion of palmaris longus stationary arm-midline of velar surface of forearm moveable arm-parallel to 3rd metacarpal
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Wrist Ulnar Deviation (0-30) and Wrist Radial Deviation (0-20)
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dorsal aspect in line with 3rd metacarpal stationary arm-midline of forearm moveable arm-midline of 3rd metacarpal
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thumb CMC (0-15) flexion
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movement across the palm axis-radial side, junction of base of 1st metacarpal and trapezium stationary arm-parallel to radius moveable arm-parallel to 1st metacarpal
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thumb CMC (0-20) extension
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movement away from the palm axis-volar side, junction of base of 1st metacarpal and trapezium stationary arm-parallel to radius moveable arm-parallel to 1st metacarpal
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thumb MCP (0-50) flexion/extension
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movement across palm axis-dorsal side, MCP joint stationary arm-midline of first metacarpal moveable arm-midline of prox. phalanx
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thumb IP (0-80) flexion/extension
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movement of distal phalanx to volar surface axis-dorsal side, IP joint stationary arm-along prox. phalanx moveable arm-along the distal phalanx
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thumb abduction
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measurement from midpoint of the head of the 1st metacarpal to the midpoint of the head of the second metacarpal
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thumb opposition
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measure distance from the tip (pad) of thumb to the tip (pad) end of little finger
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Finger MCP flexion/extension
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axis-dorsal side, MP joint of finger being measured stationary arm-dorsal surface, midline of the metacarpal of finger being measured moveable arm-dorsal side, midline of prox phalanx
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Finger PIP flexion/extension
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axis-dorsal side, PIP joint of finger stationary arm-dorsal surface, midline of prox phalanx moveable arm-dorsal side, midline of middle phalanx
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Finger DIP flexion/extension
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axis-dorsal side, DIP joint of finger stationary arm-dorsal surface, midline of middle phalanx moveable arm-dorsal side, midline of distal phalanx
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Composite Total-finger flexion (1)
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sum values for the degrees of flexion motion of MP, PIP, DIP joints (taking into consideration of extension deficits). (MP+PIP+DIP flexion)-(MP+PIP+DIP extension)=Total active/passive motion
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Composite Total-finger flexion (2)
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measuring combined MP, PIP, and DIP or PIP and DIP joints using a centimeter ruler
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finger abduction
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movement of index, ring, and little away from midline. movement of middle moves to radial and ulnar sides.
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Finger abduction measurement
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axis-dorsal side, MP joint of finger being measured stationary arm-along dorsal surface of metacarpal movement arm-along dorsal surface of the proximal phalanx
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finger adduction
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movement of index, ring, and little towards them midline.
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finger adduction measurement
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axis-dorsal side of MP joint of finger being measured stationary arm-along dorsal surface of metacarpal. middle finger not recorded. movement arm-along dorsal surface of the proximal phalanx
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MP deviation correction measurement
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used for ulnar deviation deformity to determine if a fixed deformity exists. AROM is compared to PROM.
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skin, joint, and/or muscle tissues have shortened as a result of immobilization, what should be the goal?
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increase range by stretching
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if limitation is caused by edema, pain, spasticity, or muscle weakness, what should be the goal?
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reduce or correct the underlying problem first, and then prevent loss of ROM caused by immobility imposed by primary condition
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if limitation is caused by bony ankylosis or long stand contracture, what should be the goal?
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teach patient methods of compensation
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for ROM to be considered actual change, the amount of change must?
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exceed measurement error, which was found to be 5 degree for UE and LE
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If in reevaluation, a patient showed 10 degrees of improvement?
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considered minimal improvement, 5 degrees is accounted for measurement error
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measuring edema
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circumferential and volumetric
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circumferential measurements
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a millimeter tape used to measure the circumference of a body part no easily submerged
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volumetric measurements
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document changes in the mass of a body part by use of water displacement. Water vessel allows submersion of hand. Water is then displaced into a beaker and recordings are taken
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Figure-eight technique
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hand edema measurements neutral wrist, fingers adducted tape runs from medial aspect (ulnar styloid) to the lateral aspect (radial styloid) on the palmar side. Then, runs diagonally to 5th MCP, goes behind MCPs of fingers to 2nd MCP. Runs diagonally down to starting position. distance measurement of tape. appropriate to use if there are open wounds or skin conditions
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several report measures of pain include?
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visual analog scale, faces test, color scale, adjective test *VAS most often used. 0-10 pain scale.
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dynamic assessments
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number of repetitions per unit of time or percentage of maximal heart rate
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static assessments
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amount of time a contraction can be held
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1-2 MET
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eating, dressing, desk work, standing
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2.5-3.5 MET
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showering, food prep, playing instrument, small parts assembly, walking 2mi/hr
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4-5 MET
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raking leaves, walking downstairs, heavy assembly work, ballroom dancing
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5-6 MET
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walking with braces, mowing lawn, carpentry, tennis
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7-8 MET
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shoveling, jogging
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8-9 MET
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shoveling+, running, football
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wrist extension
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table stabilizes, ECRL-dorsum/radial side ECRB-mid dorsum ECU-dorsum/ulnar side gravity eliminated-midposition palpate tendons
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wrist flexion
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table stabilizes FCR-volar/over metacarpal heads FCU-volar/over 5th metacarpal head gravity eliminated-midposition palpate tendons
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Finger Extension
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MP-claw hand, support at wrist push down on each dorsal proximal phalanx gravity eliminated-midposition, palpate belly of ED IP-supinated and wrist supported mcp flexion, IP extension apply resistance to IP
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Finger Flexion
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IP-supinated and supported at wrist support middle phalanx, resistance to DIP gravity eliminated-midposition, palpate belly of FDP PIP-supinated and supported at wirst eliminate FDP, resistance to Middle phalanx gravity eliminated-midposition, palpate belly of FDS MP-supported in supination proximal phalanx toward extension gravity eliminated-midposition palpate belly of muscle
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Finger ab/adduction
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same but support wrist and metacarpals are supported
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thumb extension
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IP, MP=same in midposition gravity eliminated-supination, see action, and palpate
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thumb abduction
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APL-radial abductor, supinated wrist in neutral gravity eliminated-midposition, neutral, palpate APB-palmar abductor, supinated, wrist neutral gravity eliminated-midposition, neutral, palpate
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thumb flexion
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IP/MP-elbow flexed, supported on table in supination, resistance same gravity eliminated-supination at 90
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thumb adduction
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pronated, wrist/fingers neutral stabilize metacarpals head of proximal phalanx into abduction gravity eliminated-forearm midposition
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opposition
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OP/ODM hold in neutral position
