OTPT103: Kinesiology for OT and PT Students (Lab)

University of the Philippines Manila | College of Allied Medical Professions Department of Occupational Therapy | Block 21 Occupational Therapy FS 2012 2013 Small Group Learning Activities for the Biomechanics of Upper Extremity Functions And Pathomechanics of Swallowing 4 September 2012 UPPER EXTREMITY FUNCTIONS A. Walking Using Crutches Step 1: Placing crutches in front of the feet (RUE) Joints Motions or Range of Effects of Absence or Muscles Positions Motion Gravity on Presence of Contracting Maintained Required Motions or Resistance Positions (crutch) Shoulder Forward flexion 0-45 degs Against Present Anterior deltoid, Coracobrachialis Abduction Elbow Flexion 0-30 degs 0-30 degs Against Against Against Against Present Present Present Present Supraspinatus, Middle deltoid Biceps brachii Triceps Pronator teres, Pronator quadratus, Supinator Biceps brachii, Triceps Wrist extensors ECRB, ECRL ECU Wrist flexors FCR, FCU Palmaris longus Add poll brevis Flex poll brevis Flex poll longus

Type of Contraction

Concentric

Concentric Concentric Eccentric Isometric

Forearm

Midposition

0-90 degs

Against

Present

Isometric

Wrist

Neutral

0-0 deg

No Effect

Present

Isometric

No Effect

Present

Isometric

Thumb and Fingers

Thumb MP adduction MP flexion IP flexion Fingers MP flexion 1234

0-45 degs 0-30 degs 0-45 degs

No Effect No Effect No Effect

Present Present Present

Concentric Concentric Concentric

0-90 degs

No Effect

Present

PIP flexion 1234 0-90 degs No Effect Present DIP flexion 1234 0-10 degs No Effect Present Minimal Muscle Strength Required: Fair to good because you only need to stand Prehension Pattern/s Used: Power grip (cylindrical) Step 2: Propelling the body through the crutches Joints Motions or Range of Positions Motion Maintained Required Shoulder Extension 0-45 degs

Lumbricals, DI, PI Flex dig super Flex dig prof

Concentric Concentric Concentric

Effects of Gravity on Motions or Positions Against

Absence or Presence of Resistance (crutch) Present

Muscles Contracting

Type of Contraction

Posterior deltoid, Teres major, Latissimus Dorsi Supraspinatus, Middle deltoid Triceps Biceps

Concentric then Isotonic

Abduction

0-30 degs

Against

Present Concentric Concentric/Isotonic Eccentric

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Elbow

Extension

0-150 degs

Against Against

Present Present

OTPT103: Kinesiology for OT and PT Students (Lab) SGLs: Biomechanics of Upper Extremities and Pathomechanics of Swallowing

Forearm

Midposition

0-90 degs

Against

Present

Pronator teres, Pronator quadratus Supinator, biceps brachii Wrist extensors ECRB, ECRL ECU Wrist flexors FCR, FCU Palmaris longus Add poll brevis Flex poll brevis Flex poll longus

Isometric

Against Wrist Extension 0-70 degs No Effect

Present Present

Isometric Isometric

No Effect

Present

Eccentric

Thumb and Fingers

Thumb MP adduction MP flexion IP flexion Fingers MP flexion 1234

0-45 degs 0-30 degs 0-45 degs

No Effect No Effect No Effect

Present Present Present

Concentric Concentric Concentric

0-90 degs

No Effect

Present

PIP flexion 1234 0-90 degs No Effect Present DIP flexion 1234 0-10 degs No Effect Present *Isotonic for extra force Minimal Muscle Strength Used: Good strength in order to carry and propel the body using the crutches Prehension Pattern/s Used: Power grip (cylindrical)

Lumbricals, DI, PI Flex dig super Flex dig prof

Concentric Concentric Concentric

B. Brushing the Hair Step 1: Bring the brush to the top of the head, and then brush the hair upwards from the forehead on the same side of the hand holding the brush Joints Motions or Range of Effects of Absence or Muscles Type of Positions Motion Gravity on Presence of Contracting Contraction Maintained Required Motions or Resistance Positions (crutch) Shoulder External 0-90 degs Against Present Infraspinatus, Concentric Rotation Teres minor Abduction Elbow Flexion 0-90/110 degs 0-150 degs Against Against Against Against No Effect Present Present Present Present Present Supraspinatus, Middle deltoid Brachioradialis Biceps brachii Triceps Pronator teres, Pronator quadratus Supinator, biceps brachii Wrist extensors ECRB, ECRL ECU Wrist flexors FCR, FCU Palmaris longus Add poll brevis Flex poll brevis Flex poll longus Concentric Isometric Isometric Eccentric Isometric

Forearm

Midposition

0-90 degs

No Effect Wrist Neutral 0-0 deg No Effect

Present Present

Isometric Isometric

No Effect

Present

Isometric

Thumb and Fingers

Thumb MP adduction MP flexion IP flexion Fingers MP flexion 1 PIP flexion 1

0-45 degs 0-30 degs 0-45 degs

No Effect No Effect No Effect

Present Present Present

Isometric Isometric Isometric

0-45 degs 0-90 degs

No Effect No Effect

Present Present

Lumbricals, DI, PI Flex dig super

Isometric Isometric
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OTPT103: Kinesiology for OT and PT Students (Lab) SGLs: Biomechanics of Upper Extremities and Pathomechanics of Swallowing

DIP flexion 1 MP flexion 234

0-10 degs 0-60 degs

No Effect No Effect

Present Present

Flex dig prof Lumbricals, DI, PI Flex dig super Flex dig prof

Isometric Isometric Isometric Isometric

PIP flexion 234 0-90 degs No Effect Present DIP flexion 234 0-10 degs No Effect Present *Fingers are separated because number 1 finger has a different range of motion than the rest *Isometric contraction of thumb and fingers is due to the fact that you do not grip the comb harshly Prehension Pattern/s Used: Cylindrical Step 2: Bring the hair upwards on the opposite side of the head Joints Motions or Range of Effects of Positions Motion Gravity on Maintained Required Motions or Positions Shoulder External 0-90 degs Against Rotation Abduction Elbow Flexion (to greater flexion) 0-120/130 degs 0-150 degs Against Against Against Forearm Midposition 0-90 degs No Effect

Absence or Presence of Resistance (crutch) Present

Muscles Contracting

Type of Contraction

Infraspinatus, Teres minor Supraspinatus, Middle deltoid Brachioradialis Triceps Pronator teres, Pronator quadratus Supinator, biceps brachii Wrist extensors ECRB, ECRL ECU Wrist flexors FCR, FCU Palmaris longus Add poll brevis Flex poll brevis Flex poll longus

Isometric

Present Present Present Present

Isometric Concentric EccentricConcentric Isometric

No Effect Wrist Neutral 0-0 deg No Effect

Present Present

Isometric Isometric

No Effect

Present

Isometric

Thumb and Fingers

Thumb MP adduction MP flexion IP flexion Fingers MP flexion 1 PIP flexion 1 DIP flexion 1 MP flexion 234

0-45 degs 0-30 degs 0-45 degs

No Effect No Effect No Effect

Present Present Present

Isometric Isometric Isometric

0-45 degs 0-90 degs 0-10 degs 0-60 degs

No Effect No Effect No Effect No Effect No Effect No Effect

Present Present Present Present Present Present

Lumbricals, DI, PI Flex dig super Flex dig prof Lumbricals, DI, PI Flex dig super Flex dig prof

Isometric Isometric Isometric Isometric Isometric Isometric

PIP flexion 234 0-90 degs DIP flexion 234 0-10 degs Prehension Pattern/s Used: Cylindrical

SWALLOWING Swallow movement of solid or liquid bolus toward the esophagus; deglutition; rate of 2/minute; transit time 1 second or less Eating ability to keep and manipulate food/liquid in the mouth and swallow it (OSullivan,1995) Learning Activity 1a. Identify the anatomical structures involved in eating and swallowing. A. ORAL CAVITY a. Lips b. Hard palate
OTPT103: Kinesiology for OT and PT Students (Lab) SGLs: Biomechanics of Upper Extremities and Pathomechanics of Swallowing

B.

c. Soft palate (velum) d. Uvula e. Mandible f. Floor of the mouth g. Tongue h. Faucial Arches PHARYNGEAL STRUCTURES a. Pharyngeal constrictors b. Pyriform sinuses c. Valleculae d. Cricopharyngeal sphincter
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C.

D. E.

LARYNGEAL STRUCTURES a. Epiglottis b. Aryepiglottic folds c. False and true vocal cords ESOPHAGUS MUSCLES a. Facial Orbicularis oris o O: maxilla, mandible, and skin o I: encircles oral orifice o A: compresses lips together o NS: buccal branch of facial nerve (VII) o AS: superior and inferior labial branches of the facial a., mental a., infraorbital a. Buccinators o O: outer surface of alveolar margins of maxilla and mandible and pterygomandibular ligament o I: angle of mouth and the lateral portion of the upper and lower lips o A: Compresses cheeks and lips o NS: buccal branches of the facial nerve (VII) o AS: facial a. Levator anguli oris o O: arise from the bones and fascia around the oral aperture and insert into the substance of lips o I: angle (corner) of the mouth o A: separates lips o NS: buccal branch of the facial nerve (VII) o AS: infraorbital a., superior labial branch of the facial a. Or risorius o O: parotid fascia o I: modiolus o A: retracts angle of the mouth o NS: buccal branch of the facial nerve (VII) o AS: facial a. b. Mastication Temporalis o O: floor of temporal fossa o I: coronoid process of mandible o A: anterior and superior fibers elevate mandible; posterior fibers retract mandible o NS: anterior and posterior deep temporal nerves from the mandibular division of the trigeminal nerve (V) o AS: anterior and posterior deep temporal aa. Masseter o O: zygomatic arch o I: lateral surface of ramus of mandible o A: elevates mandible to occlude teeth o NS: nerve to the masseter, from the mandibular division of the trigeminal nerve (V)

c.

AS: masseteric branch of the maxillary a. Lateral pterygoid o O: superior head: greater wing of the sphenoid bone; inferior head: lateral surface of the lateral pterygoid plate o I: superior head: capsule and & articular disk of the temporomandibular joint; inferior head: neck of the mandible o A: protracts the mandible; opens the mouth; active in grinding actions of chewing o NS: lateral pterygoid branch of the mandibular division of the trigeminal nerve (V) o AS: pterygoid branch of the maxillary a. Medial pterygoid o O: medial surface of the lateral pterygoid plate, pyramidal process of the palatine bone, tuberosity of the maxilla o I: medial surface of the ramus and angle of the mandible o A: elevates and protracts the mandible o NS: medial pterygoid branch of the mandibular division of the trigeminal nerve (V) o AS: pterygoid branch of the maxillary a. Swallow Suprahyoids Digastric o O: anterior belly: digastric fossa of the mandible; posterior belly: mastoid notch of the temporal bone o I: body of the hyoid via a fibrous loop over an intermediate tendon o A: elevates the hyoid bone; depresses the mandible o NS: anterior belly: mylohyoid nerve, from the mandibular division of the trigeminal nerve (V); posterior belly: facial nerve (VII) o AS: anterior belly: submental a.; posterior belly: occipital a. Geniohyoid o O: mental spines of the mandible o I: body of the hyoid bone o A: elevates the hyoid bone; depresses the mandible o NS: ventral primary ramus of spinal nerve C1 via fibers carried by the hypoglossal nerve o AS: lingual a., submental a. Stylohyoid o O: posterior side of the styloid process o I: splits around the intermediate tendon of the digastric m. to insert on the body of the hyoid bone o A: elevates and retracts the hyoid bone
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OTPT103: Kinesiology for OT and PT Students (Lab) SGLs: Biomechanics of Upper Extremities and Pathomechanics of Swallowing

o NS: facial nerve (VII) o AS: ascending pharyngeal a. Mylohyoid o O: mylohyoid line of mandible o I: midline raphe and body of the hyoid bone o A: elevates the hyoid bone and the tongue; depresses the mandible o NS: mylohyoid nerve from the inferior alveolar nerve, a branch of the mandibular division of the trigeminal nerve (V) o AS: mylohyoid branch of the inferior alveolar a. Infrahyoids Sternohyoid o O: posterior surfaces of both the manubrium and sternal end of the clavicle o I: lower border of the hyoid bone, medial to the omohyoid m. insertion o A: depresses/stabilizes the hyoid bone o NS: ansa cervicalis o AS: superior thyroid a Sternothyroid o O: posterior surface of the manubrium below the origin of the sternohyoid m. o I: oblique line of the thyroid cartilage o A: depresses/stabilizes the hyoid bone o NS: ansa cervicalis o AS: superior thyroid a. Thyrohyoid o O: oblique line of the thyroid cartilage o I: lower border of the hyoid bone o A: elevates the larynx; depresses/stabilizes the hyoid bone o NS: ansa cervicalis (via fibers running with the hypoglossal nerve that leave XII distal to the superior limb of ansa) o AS: superior thyroid a. Omohyoid o O: inferior belly: upper border of the scapula medial to the scapular notch; superior belly: intermediate tendon o I: inferior belly: intermediate tendon; superior belly: lower border of the hyoid bone lateral to the sternohyoid insertion o A: depresses/stabilizes the hyoid bone o NS: ansa cervicalis o AS: transverse cervical a.

Modified Barium Swallow (MBS) Identify: dentition, hard palate, epiglottis, hyoid, esophagus, glottis, soft palate, valleculae, laryngeal vestibule, tracheal opening

(lateral)

Learning Activity 1b. *See atlas for proper and complete labels of parts Fiberoptic Endoscopy Swallowing Study (FEES) Identify: hard palate, uvula, epiglottis, pyriform sinus, true vocal cords, soft palate, faucial arches, valleculae, arytenoids, false vocal cords
OTPT103: Kinesiology for OT and PT Students (Lab) SGLs: Biomechanics of Upper Extremities and Pathomechanics of Swallowing

PHASES OF SWALLOW In some references, there are 4 phases. Oral phase is divided into oral preparatory phase and oral phase. 1. ORAL PREPARATORY PHASE Food is manipulated and masticated Food is formed into a cohesive bolus (ground, rounded mass of food mixed with saliva) Liquid is held in the oral cavity Larynx and pharynx are at rest 2. ORAL PHASE
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Begins when tongue initiates posterior movement of the bolus, as in the ff physiological activities: o Tongue is pulled backward and up against the hard and soft palates o Muscles of neck, oropharynx and base of the tongue also work the bolus to the rear of the mouth and the pharynx Takes 1-1.5 sec. to complete

*For patients with swallowing problem, give them juice because the weight of the liquid claps the epiglottis down making it easier to swallow. *Also suggest to thicken the juice since thicker liquid epiglottis is bigger slower motion of swallowing wave (of motion) shall help propel the liquid down. *Take note!

Learning Activity 2. Most Easy to Swallow Sugar Candy

Most Difficult to Swallow Chicharon Vinegar Squid flakes

Increases Salivation Sugar Candy Bagoong Apple Green mango Sampaloc Calamansi

Decreases Salivation Chicharon Vinegar Pepper (ground) Salt

PHARYNGEAL PHASE Starts when the pharyngeal swallow is triggered Velopharyngeal closure Elevation and closure of the larynx Initiation of pharyngeal peristalsis Relaxation of the cricopharyngeal sphincter During this phase, discharge from the swallowing center inhibit respiration Transit time of 1 sec or less PATHWAY OF THE BOLUS THROUGH THE PHARYNX Over the base of the tongue Divides into Valleculae Passes through Pyriform Sinuses Through Cricopharyngeal Sphincter Esophagus ESOPHAGEAL PHASE Relaxation of the cricopharyngeal sphincter Esophageal peristalsis Relaxation of the lower esophageal sphincter (LES) FACTORS THAT INTERFERE/AFFECT SWALLOW 1. Muscle tone of the face, neck, mouth 2. Sensory input (Afferent and efferent function of cranial nerves) 3. Salivation Learning Activity 3. Prepare and drink the following one at a time: milk, water, juice Which liquid increases salivation most? Milk Which liquid flows the fastest through the pharynx? Water Which liquid produces some resistance within the oral cavity? Juice

OTPT103: Kinesiology for OT and PT Students (Lab) SGLs: Biomechanics of Upper Extremities and Pathomechanics of Swallowing

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