KEYTERMS. Concentric Contraction Eccentric Contraction. Isometric Contract Manual Muscle Testing Goniometer Flexion Extension Abduction ‘Adduction Rotation Matter Vector Pounds Newtons Force The Study of Human Movement Concepts from Related Fields CHAPTEROUTEINE ‘CONCEPTS FROM MEDICINE ‘The Central Nervous System ‘The Peripheral Nervous System Control of Movement Bones Joints Muscles ‘Muscle Activity Muscle Strength Muscle Tone ‘Musculoskeletal Movement Medical Diagnoses Affecting Movement CONCEPTS FROM PHYSICS AND ENGINEERING Sealar Quantities Measures of Space Measures of fime a Measures of Mass Vector Quantities Measures of Physical Movement Measures of Weight Measures of Force Measures of Stress Measures of Frition ‘Measures of Work SUMMARY Scanned with CamScannerand physies converge in the study of ‘biomecTianics and Kinesiology: Each discipline has its own perspective and language. An OT practi: tioner must learn vocabulary and concepts from both disciplines to combine and apply this knowledge to fun tional activi The rich language of medicine uses words derived from Greek, Latin, and a variety of other languages to «describe unique physiologic conditions and minute areas of anatomical geography. Although medical terms often Confuse the uninitiated, one word often communicates Concepts that would otherwise require several phrases This chapter explores terms commonly used to describe human movement and diagnoses characterized by abnormal biomechanics and kinesiology ‘Terms from physis serve an equally raluabe purpose a those in medicine, Physics describes the world and its relationships with mathematics, These relationships help ‘explain the past and predict the future. Clasial physics ‘communicates the study of motion in gases liquids, and solids, concepts essential for understanding biomechanics. Although you probably know many of the terms relat. ing tothe musculoskeletal ter, we may apply them in ‘ew and wafamliar ways. We wll review the gross anatomn, euroanatomy, motor control, and muscle physiology necessary for solving the problems presented in this text. This book presents problems so that readers ean solve them without resorting to mathematics, but OT pract- tioners who enjoy mathematics can Find thse solutions n Appendis C. Further reading and study of physics wil help those practitioners who need to apply mathemat: ‘esto human motion more precisely, The brief suramary ‘of concepts that follows provides a guide. It is not a comprehensive fist. Concepts from Medicine dentiffing specific areas ofthe human body forms the Sroundwork for practicing any ofthe medical arts. Asa common point of reference we envision the body in anatomical postion, thatis, upright with the face, fet, and palms facing forward. The Mead lis superior tothe shoulders because the head is above, or higher than, the “shoulders. The shoulders are inferior to the head because they ie below the head when the body is verti ‘al. Those parts closer tothe front ofthe body are ante- for and those near the back are posterior. Medial body Parts lie near the middle of the body, agd lateral parts Nenear the ight o ef sides of the body. Arms and legs ae extremities, and they connect tothe trunk at thei proximal ends. Fingers and toesare located atthe stl tends of the extremities, Tissues close to the suufice are superficial to underlying, or deep, tissues. THE CENTRAL NERVOUS SYSTEM ‘The brain and spinal cord comprise the central nervous system (CNS), which controls all the body's activities, ‘The brain is divided into three major anatomical parts: the cerebrum, cerebellum, and brain stem. The cere: ‘brum receives sensory information and processes it to proxtuce body responses including movement. The cere: brum forms two hemispheres, Fibers that ttansmit impulses feom each hemisphere cross from one side to the other inthe compusallosum and other smaller path- ‘sass allowing one sie of the bran to communicate with the other. ls, each hemisphere receives sensory information from and controls moveunent of the oppo- site side ofthe bo. The cortex makes up the superficial {aver of the cerebrum and processes information for all tasks that require conscious thought, Two strips of ells un from ear to ear over the superior part of the Comtex Each strip contain afunetionally separate cell Population—one for processing of sensory information and one for ditection of motor performance, The fina cofamon pathway for motor signal gener ted in the motor cortex is comprised of neurons whose cell bodies are located in this motor area and whose axonal projections exit the cortex through the brain stem and spinal cord. These neurons are referred to as "upper motor neurons as they synapse at lower levels of the cord onto lower motor neurons. These lower thotor neurons are-called such because they begin (their cell bodies are located) lower than the upper motor nev. Fons, in the ventral area of all levels ofthe spinal cord Their axonal projections exit the spinal cord, travel as peripheral nerves, and connect with skeletal muscles, completing the circyit ta result in voluntary moxement. Although lower motor neurons begin in the CNS, they travel in and connect to the periphery (outside of the ENS); therefore they are considered part ofthe periph eral nervous system (discussed below). (The role of "upper and lower motor neurons in clinical syndvomnes is discussed in A Closer Look Box 2-1.) The cerebrum contains other import Drocessing of sensory information and organiza the subcortical motor responses, which do not require conscious thought, The cortex and corpus callosum centers for on of Scanned with CamScanner_Upper versus Lower Motor Neuron Syndromes In practice, two basic syndromes are identified as pathological movement patterns based on the upper-lower motor neuron scheme. Upper motor neuron syndrome (for example, stroke, spinal cord injury, traumatic brain injury) involves damage to ‘motor neurons otiginating in the motor cortex. It results in paralysis (lack of voluntary motion) accom- panied by abnormally high muscle tone spastic). Lower motor neuron syndrome (for example, polio - imyeltis and peripheral nerve damage) involves damage to the lower motor neuron originating in.” ‘the spinal cord; it results in paralysis accompanied bby abnormally low muscle tone (laccidity), BAP a corona the nic oe and asl ang Clin the Tle govern bei and exon In he Bs fala ells coordinate complex motor responses hc bran tem connetsthe cerebrum 0 he ital cont Wconans numberof differentiated cellar seetrce The thalamus and ypohalamss regulate Drething; digestion aertne, harmonal bale, and cece is out ofthe ra stem to fom a separate structure. The cerebellum chiefly regulates librium, oF balance, reactions. muscle tone and equi also coordinates voluntary motor 2s “The spinal cord carries information tothe brain fom the body and to the bods from the brain Cell that carry Specific kinds of information group together to form now as tracts. The reflex acy pathicays, which are ‘moving directly through synapses in the spinal cord, can. carry out motor responses to some external stimuli before those sensory impulses reach the brain ‘THE'PERIPHERAL NERVOUS SYSTEM Nerve fibers that have cell bodies in the spinal cord orin special structures called ganglia carry information to and from the body to the CNS. (Ganglia are collections of nerve-cell bodies that lie outside the brain or spinal cord). This peripheral nervous system (PNS) extend fron NS, and the two systems operate interdepend Anatomists and physiologists studying the body differ centiate these ystems to understand how they work, SecTiON ONE MULTIDISCIPLINARY BASIS FOR THE UNDERSTANDING OF HUMAN MOVEMENT Afferent nerve fibers carry it Aissues to the spinal cord and brain, fferent fibers carry {information from the brain and spinal cord to muscles and glands, Somatic nerves carry impulses (o and from muscles. Visceral nerves transmit impulses to and from organs and glands, Spinal nerves branch out from the spinal carlin ars ‘organized pattern, Their organization makes it possible to identify the segments of the spinal cord responsible for specific areas of sensation and muscle movernent. In several locations, spinal nerves group into a network that forms a plexus composed of motaxgnd sensory fibers that innervate various structures. The cervical plexus, located in the neck, innervates structures in the neck and shoulder. The brachial plexus, located under the the axilla, supplies the upper extrem supply the lower pulses from the body Shoulder join in ities, Lumbar and strapless ea airs of cranial nerves branch ot tet from the bain and bain stem. All hese nerses except th cana nerve innervate structures the head ered. The tenth nerve The vagus nerve, primarily mer ates organs and other structures the thorax and abdomen. “The CNS controls organs ait glands through @ s)S- temotviseerl efferent fibers and ganglia known a the stam (ANS). Nerve fibers that cart rarriges om the body organs are not considered part em NS. Thee oc aren esr longs the nerves of the ANS and go directy to the brain oF spinal cord, not to autonomic ganglia, The CNS inter frets sensory information and direts a response. The ENS thn carries these reaction messages back tothe autonomic nervous 93 organs and glands. “The ANS balances control of boil functions through the sympathetic and parasympathetic systems. Para- sympathetic (craniosacral) fibers originate in the brain and lower portion of the spinal cord and connect witht secondary fibers in ganglia located throughout the viscera, These fibers transmit impulses that conserve cenergy to calm the body, for example, by slowing the heart rate and facilitating digestion. The sympathetic (thoracolumbar) fibers and ganglia emerge from the imide position of the spinal cord, They respond to envi- ronmental erises and prodtice an excitatory effect on the body known asthe fightorflight react CONTROL OF MOVEMENT The nervous system controls movement in the head, neck, trunk, and limbs through impulses generated in the brain's motor centers. These impulses, initiated by a conscious intention to move or in response to Scanned with CamScannerCHAPTER 2. THE STUDY OF HUMAN MOVEMENT 1 sensory impulses, depend on sensory fee? incom issues. tors in the skin, muscles, and related Skin contains an assortment of sensory end ot that prot withdrawal responses wen stl Skeletal muscles contain muscle spindles. These sensory forgans react 10 prolonged muscle stretch (tonic respons) and api changes in eng (phase respons). Stimulation ofa muscle spine through stretch co the rnuscle most conmogiy results in contraction of the muscle, However, tension sensitive golgi tendon organs protect muscles from tearing by inhibiting muscle con traction when stimulated by very forceful contractions during extreme muscle stretch. Under certain conditions, motor spindle stimulation appear exaggerated. Too much cular activity occurs, and skeletal muscles cannot relax An unyielding contraction ofthe muscle on ane side of joint mis desired movement in the opposite direction ‘These types of imbalance or movement disturbances, called abnormal musce tone, sometimes respond to pha ans ned. responses to muscle ‘macological or physical interventions that allow an inde ‘idual to regan normal motor control and movement Responses to sensory receptors can occur without con cious thought. Thy follow reflexes, which are subeor tical pathways that make a complete sensory-to-motor connection without involving pats of the brain that con- two oltonal movement. Spinal reflexes make a simple sensory to motor synapse in the spinal cor that provides an immediate protective response to noxious stimuli or muscle spindle stretch. Bran ster reflexes make con nections in the brain stem and regulate muscle responses to gravity acting on the body. Brain stem reflexes also regulate head movements that affect the entire body. ‘More complex interconnections that travel pathways to higher levels of the brain stem, called righting reac- tions involve positioning the headin relation to gravity. They respond to stimulation ofthe semicircular canals, cor labyrinths, anl the visual pathways. Equilibrium reac- tions require connections between the cortex, basal gan- glia, and cerebellum, They invohe adjustments of the entire body to changes in its center of gravity Bones More than 200 bones compose the skeletal syste. Although igi dynamic bone tissues constant pond to physiologic and environmental changes throughout ‘fe. The mos obvious ofthese changes occu during a child’ early years as carilage becomes bone. An infant skeleton hasa smaller percentage of bone than a child oF an adult because epiphyseal plates, centers ofcartiagi ‘nous growth, permit bones to grow. This process occurs, throughout childhood and into an inlviduas early 20s. Stress frgm carrying weight, movement, of tra stimulate bony tissue growth. Bone contivially remodels K.M.C. LIBRARY aroun fife becae the skeleton prides both a et "torage for eam. The bor abvorbs pone to harvest calcium for Be along with (or in the tog) itary clam as cere for sare phy ital proces including nerve tranamisson and muscle contraction suet Joints i “Ajoint connects (articulates) a i stave a ified space between two oF more bone sexed ina strong igaentous capsule, Smooth I fin erie cones articulating surfaces of the bones 1) are merous darth jins Elbo, knee hip show ter inger and toe joints owe their mobility 10 ET Jer ail construction. This mobility provides a bess trate audy of movement ane our understanding Of through biomechanics and kinesiology: i uatjoms,composed of aacent BONES connected by cartilage, such as the symphysis joints 1 yertebral bodies and the temporary ep cement. Synarthrodiat involve cent bones, Diarthrodial located betwee plyseal plates allow only light mov joints such as the suture joints of the skull, i 4 fibrous interface between bones that does not more ata. Muscles Muscle tissue has the unique ability to contract. Three sarities exist: smooth, cardiac, and skeletal, Muscle fibersare the cellular units that make up muscles. Their ‘measurements increase or decrease depending on the intracellular buildup oc removal of contractile proteins (A Closer Look Box 22, Skeletal, or striated, muscle interests students of biomechanics and kinesiology most. Skeletal muscle strength depends on the thickness of the muscl’s eross section. Genetics determines the number of fibers contained in a muscle. Strengthening a muscle results in thicker fibers, nota greater quantity of fibers. The length of the muscle fiber determines the distance a muscle can contract to a shorter length or stretch toa longer length. Shorter muscles (shorter fiber lengths) contract less distance (excursion) than longer muscles, Generally, muscle fibers can contractor stretch 50% of their resting lengths. A muscle with centimeter fibers can contract or shorten to a length of 5 cent meters or be stretched by an outside force to a length of 15 centimeters Skeletal muscles vary greatly in shape and fiber cor figuration. The attachment of musctes to bones via ether broad, fleshy attachment} or concentrated, tendinous insertions determines the gross shape of the muscle and its force for movement, The biceps brachii and the hunt Dials in the Aes, All the fibers fusiform into the insertion. les rum from the or Scanned with CamScanner' ' 1 | | ACLOSERLOOK ya Conmatns Versus Contractures contract anvactons and contacts are two words with lenical spelings, but they describe diferent concepts, ede noe bncepts. A contraction occurs ina skeletal muscle. This process depends on the expenditure of ‘energy In concent contraction the muscle fiers shorten, but in an eccentric contraction an oppos- ing force pulls the muscle longer as it contracts to Slow oF stop the effect ofthe opposing force. A con- tracture describes a state of being, nota proces. In a contracture, the esting length ofthe tsue has become physically shorter than a a previous time Contractures occur in muscle and joint ligaments ‘that are inadequately stretched over time or in skin scarred by second- and third-degree bums, A con traction produces a notmal muscle movement, but 4 contracture limits movement through a patho- logical proces. a Pennate and bipennate muscles have fibers that course roma latened, es proximal attachment (02 central tendon, bridging the gap betneen the bers end find the muscle’ sal attachment yeing the appea fice of a feather Pennate and bipennate muscles such as the interossei andthe fog flexors ofthe digits have Short exaisionsbecase of thee short engs. However, teil their excursion may be limited thei ange cross Section provides impresie strength. Imagining a rock “tnnber pulling up the weight of his boy with one small “handhold” comprise of four Fingertips helps one uindertand the way these short, thick cross sections provide impressive strength (Figure 21). Muscles may spread out in broad sheets ike the pronator quadratus and trapezius or asume unique Shapes like de deltoid and serratus anterior Some mus cles like the lasimus dorsi and pectoralis major, wit 160° at their tal atachments. Muscles connect intimately to the skeletal system through sue called fascia, Fascia sheaths surounding bundles of muscle bers and entire muscles continue along the tendons thatatach muscle to bone Muscle fibers contract through a chemical process involing oxygen and adenosine triphosphate (ATR). Myoglobin provides the primary source of oxygen in sce sue Like hemoglobin in the ood yogtbin oni oxygen bonded to iron, which produces a char actrisired color: Red muscles contain bes with high concentrations of myoglobin. These slowtitch fibers EEE ———————— SECTION one mu 'VUTIOISCIPLINARY BASIS FOR THE UNDERSTANDING OF HUMAN MOVEMENT FIGURE 2-1 ‘rock climbers handhold often consists of fur fingertips oF less supporting the weight ofthe entire body. rely on high concentrations of myoglobin ancl rich ‘lood supply: Red postural muscles with slow-twiteh fibers must work for prolonged periods without becom ng fatigued. White muscles, composed of fastuwitel fibers, contain lower concentrations of myoglobin. These fibers can contract rapidly, like the fi birds, Fasttwitch fibers contract quickly for limited amounts of ime because of their lower concentrations of myoglobin. Muscle Activity AMlskeletl muscles have several ypes of contractionsin ‘common. When a muscle contracts, one atachment ust ally remains stationary while the other attachment moves. Concentric contractions cause muscles to shorten (Figure 22). Eocene contractions occur when muscles attempt to shorten but are stretched by an overpow ering external effort. The opposing force pulls the contracting muscle to a longer length. Eccentric con tractions often are used to control or slow down the effect ofan external force. In Figure 23 the weight is controlled; thats, itis let down slowly through an eccen- tric contraction to protect the joint from being Forced into rapid extension by the weight. In isometric contractions the contractile mechanisms are activated, ‘but no appreciable change in fiber length or movernent results. Isometric contractions occur when some force in the opposite direction equally balances the effort of the contraction Different contraction types generate different amounts of force. When we move weight we can exily Scanned with CamScanner‘CHAPTER 2 THE STUDY OF HUMAN MOVEMENT FIGURE 2-2 ‘Concentric contractions result in muscle shortening. The muscle begins the contraction at ‘longer length (A) than the length at completion (B). We all the distance traveled by the ‘moving end ofthe muscle muscle excursion _ Ep ricure 23 In eceneconacton, the muse ble to conta the efec of an external force and protect he on rom damage by face, pid motion, Here the ow exo sont wer the weight instead of ting top rapidly. The mui achives this by atempting to shorten aginst an opposing fore ereting st enough upward ce tat he weight ore comes he conan and the contacton serves a sow the descent ofthe weight Te usc Beis in its shortened length (A) an, while attempting to shorten, experiences Ienthering due tothe ovrwhsiing eect ofthe opposing force (B). Scanned with CamScannernally an ning that to ma to hold (isometic, ‘G.and to lower with control (eccentric) We mustlet the weight ove ‘ome the muscle by creating a Dxard pull that is slighaly tess than the down Pall Of the weight we are lowering Ta weight reaches or exceed Gur contol, the ratio changes. Then the greatestTorce is Associated with eecenttic contra tions and the least with, Concentric contractions; isometric contractions remain in the middle. luis bes wo think of this scenario as sriea of weights being lifted, Imagine you are geting wood for a fire and are trying to carry as much as possible. You Stand with your arms at your sides, elbows slightly flexed, for your friend to load each log into your arms. With the first few logs, you can flex both elbows, lifting the load slightly to adjust the weight (concentric—teast force), As she adds more logs, you can hold it, but no longer ‘an you lift the load (isomeuric—moderate force). Finally she adds one too many logs, and the load begins to pull your arms do eccentric contraction, lift (concentric) + we must overeome; Is the maximum limit of into elbow extension, even as you try 1 hold the load up (eccentric—greatest force). In sum we can lower more weight (eccentric) than we can hold (isometric) and hold more than we can lift (concentric) Every action involves more muscles than those pri- marily responsible for a particular movement, Prime movers, or agonists act to produce a specific movement. Antagonists oppose prime movers. Antagonists must relax before an agonist can move. Cocontraction of ago- nists and antagonist stabilizes joints through simultane- ‘ous activity on opposite sides of the joint as in isometric. « ‘exercise. Antagonists slow and stop movement at the end of range of motion to protect joints. This occurs through ‘eccentric contraction of the antagonist. When gravity ini- tiates movement as the primarf force, antagonists con- (rol that movement through eccentric contraction. Muscles that act-together to produce specific move ments are working i synergy. Ifa muscle performs more than one action, another muscle must neutralize one of | ation. Imagine someone grasping aadoor handle as he pulls open a heavy door. Ifthe wrist extensors did not stabilize the wrist in extension, the fin- Ber flexors would flex both the fingers and the wrist, diminishing the strength of the grip. When a person’s hand halds a bar tightly, finger flex: ors act as agonists for grasp, wrist extensors stabilize the wrist as sy mnengists, and finger extensors relax as antago- Tiss. Other muscles function as supporting muscles that hhold the trunk, arms, andl legs in advantageous positions For example, while opening a heavy doog, the back may extend, shoulders adduct and extend, elbows flex, and the legs alternately stand firm and sip backward to pull the door open. a se STION ONE MULTOISCPUNARY e435 FoR THe UNOLASTANDING OF HUMAN MOVEMENT throughout a r ig¢ of motion. Ballistic move: Is prod apie contractions completed. ~ ily through momentutn. Antagonistic muscles slow these moveme at the end of the range, Uncontrolled balistic monements stop passively throng the limitations of tissues atthe end of uscles, ligaments, andl other joint age of motion. Uncontrolled ballistic movements put joints at moe risk for injury than ballistic movements actively controlled by eccentric contractions of antagonistic muscles Often adolescent baseball pitchermpat themselves at Fisk for elbow injuries because a good fastball req ballistic elbow extension. When Zachary Larson returned to middle schapl baseball practice after spend ing months the previous year ina bivalve cast wile recon ering from surgery to repair his right ulnar nerve, his coach asked the school therapist for advice on how to make sure that Zachary did not reinjure himself ‘Muscle Strength ‘We can measure muscle strength with force gauges (grip and pinch strength dynamometers) oF by the applica- tion of graded resistance in manual muscle testing (MMT), MMT evaluates muscle groups responsible for pure motions and isolates single muscles when possible An individual moves through a specified range of motion against the resistance of gravity, that is, the weight of the body part moved. If this motion is com- plete, the evaluator adds resistance at the endpoint of the range; if the motion is incomplete, the evaluator has, the subjectattempt to move again after minimizing the effects of gravity through positioning. In this way, the evaluator determinés grades above and below fair strength, respectively MMT uses a Gpoint measuring scale of 0 to 5, with 0.45 no movement (no palpable contraction) and 5 as normal strength. A measure of | is trace, or palpable contraction; is poor, or insufficient strength to move the body part through the entire active range of motion with Bravity’s effect minimized; 3 is fait, or the ability to Tift the weight of the body part through its active range of motion against gravity; and 4 is good, or the ability to ‘move through complete range of motion against gravity and hold the dontraction against some but less than ‘maximum resistance. ‘The school therapist used MNT to evaluate Zachary’s arm strength, She found that Zachary could move his left arm through complete range of motion at all joints and could withstand considerable resistance at each muscle group. On the right side Zach's shoulder mus cles all stood tip to “normal” resistanee, the same as ¢ left shoulder muscles. Zachary could not flex ot extend his right elbow as forcefully as the left one. He compleied elbow flexion palm up and palm down with Scanned with CamScannerCHAPTER 2-THE STUDY OF HUMAN MOVEMENT good" resistance (4/5), but not as much resistance as Ne took onthe left sde. Zachary extended his elbow enough to place his right Wand on his head, but could not quite reach into full elbow extension—hand reach- ing toward ceiling. The therapist had Zachary put his right hand over his heart and supported his forearm through full extension, moving at chest level out away from his body, to determine that he had “poor” strength (2/5) in his triceps, Zachary rested his forearms palms down on the desk and lifted both hands at the wrist into full wrist extension; but when the OT pushed down across the knuckles Zachary's right hand collapsed down ‘om the desk. She graded Zachary’s right wrist extensors as “tai” (8/5). Practitioners have questioned the subjectivity and con sistency of MMT scoring. Some earlier sties indicated a high degree of reliability among experienced pract tionets, but more recent work demonstrated otherwise.” Regardless, MMT remains a universally used tech- nique in the assessment of muscle strength; reliability improves with experience. The relatively inexpensive techniques are simple to learn, and a variety of textbooks explain testing in great detail. (Guidelines for the exam ination of isolated muscle functions are provided in later chapters and on the motion CD.) ‘The school therapist at Zachar)’s middle school knew how eagerly he wanted to resume playing baseball. Using information from Zachary's MMT the coach and thera Pist devised a program to strengthen Zachary's elbow and forearm muscles, In addition they found an athletic brace that would prevent full elbow extension during ‘maximum effort asin a game. At the therapist's recom- ‘mendation the coach insisted Zachary avoid using a fast- ball, and instead they worked to perfect his curveball and “knuckler.” Muscle Tone Practitioners use observatiomand palpation (feeling the muscles) to assess muscle tone. Hypertonia, or increased ‘muscle tone, makes muscles feel very firm and causes increased resistance to passive stretching. Although the evaluation of the severity of spasticity has questionable ‘reliability, itis helpful to think of it in terms of a graded Fesponse. Severe spasticity causes resistance to quick stretching inthe fist third ofa range of motion. In mod- erate spasticity resistance occurs during the second third of the range. Mild spasticity results in resistance during the last third of the range of motion. We can also observe hypertonicity as responses to resistance that involve “Laon ad Calderon fund cosine among prac ‘of four muscles tested. Freese and others! a ‘ha demonstrated im cose oe adhering toa cing proc ‘ondicteda lagers rules tested, ten when K.M.C. LIBRARY nuseles on the opposite side of the body oF musa focated above or below those being tested on the same side, We call uncontrollable resistance throughout range of motion rigidity teaching him to feed himself by using a “hand overhand technique. They complained tothe school OT practitioner that Jason often became “uncooperative” anc! fought th sistance, especially when he “knew” they had to finish ina hurry. Once the OT practitioner explained how spas- ticity works, the aides could see that Jason had no control cover his ability to “cooperate” ash rapid, externally dri- ‘en movements. They agreed to lt Jason feed himself with gentle support at the elbows during relaxed mealtimes, and to put food in his mouth as he opened it on those days ‘when school routines called for shortened Iunchtimes. ypotonia, or low muscle tone, causes muscles to feel soft and mushy and-to give in to sustained resistance We observe hypotonicity in the postural muscles as ind ‘duals slump overa table when siting or slouch against wall when standing, Sometimes, but not always, hypo- tonicity contributes to dieke postures. Hypet-and hypo tonic disturbances in muscles invalidate MACT grades Most practitioners agree that st th testing in cases of spasticity (as in upper motor neuron syndromes) is att inappropriate assessment, Instead, practition: the severity of spasticity and its impact on function tion, MUSCULOSKELETAL MOVEMENT We can measure joint movement with a goniometer (Figure 2-4) by placing it directly over the axis of motion joint and aligning the arms of the goniometer with FIGURE 2-4 Goniometers measure joint position and range of ‘motion, Scanned with CamScannerSU Gels ly ot eee Bee ge, Re sectioy j ONE MULTIOISCIUNARY BAS1sfo8 THE UNDERSTANDING OF HUMAN MOVEMENT ihe WO musculoskeletal se ; ments ext ro the joint. A goniometer mess 36 den ter measures a legrees tron within 180 degrees, We typically measure the in relent PY following the motion of the distal segment Slation to the proximal segment. The proximal Stgment serves as a nonmoving reference point forthe measurement. 4n order to accurately communicate with other care Sivers, we document movement by reading the goniome- {er to identify the number of degrees of the arc swept by the distal segment. The segment moves in its circular ath along the surface of a plane, around an axis, We measure pure motion in only one plane, although func. tional motion occurs in a number of planes..(This is ‘most similar to a wiidshield wiper blade, which sweeps ‘ut its arc on the surface of the windshield (plane). The wiper blade moves around an axis located in the “prox imal” end of the wiper where it attaches ("articulates") to the base of the windshield} A FIGURE 2-5 yh hows individual divided into parts by each s. Each plane exists as a-primary plane, ‘multiple “copies” exist as parallel planes for move ments of the various joints. The primary sagital plane clivides the body into right and left halves. Rotary move- ‘ment in this plane (Nexion and extension) centers on an axis oriented left to right, ao referred to as sideoside. Vertebral flexion and extension occur along the surface ‘of this plane. Flexion and extension of joints such as the shoulder, elbow, and wrist occur in a parallel sagt plane. Abduction and adduction occur in the frontal plane This plane divides the body into frome and back halves, and movement orients around an axis that runs front toback, or anteriorto-posterior. Examples of joints dis- playing abduction and adduction include the shoulder, ‘wrist and hip. Rotation occurs in the transverse, or horizontal, plane, which divides the bod! halves. The axis for movemet orients in an up-to-down posi into upper and lower n this plane always jon. As in flexion and ‘We divide the human body into three anatomical planes, each of which is associated with an {axis around which movement takes place. A demonstrates the sagital plane; B, the horizontal plane; C, the frontal plane. The axis of movement is oriented 90 degrees to the plane of ‘movement, and the movement sweeps out an arc around the axis and on the surface of the plane. ln the game “Pin the Tail on the Donkey,” the board onto which we attach the ‘i tail i the plane, and the pi he axis. After the pin is stuck into the board (oriented at 90 degrees to the boar), the tall swings along the surface ofthe board (plane) and around the axis (pi). Scanned with CamScanner fo br ueNW MOVEMENT MAPTER 2 THE STUDY OF HUMAN MOVE ‘extension, rotation at varions joints including shoulder, hipand ke occusalong ransere panes stated allel to the primary transverse plane shown in Figure Goniometry measures the extent of ative ancl passive joint motions within these planes. Active motion oceuts when an individual uses muscle contractions to volun tarily move a body part, Passive motion occurs when someone oF something moves the body part in the absence of muscle contractions across the joints of the part being moved. MEDICAL DIAGNOSES AFFECTING MOVEMENT Any pathological condition that alfects the syster ‘or the musculoskeletal system has some effect on ‘movement. How movement changes varies according to the condition and the individual involved. A brief look at some coiditions that can affect movement follows different pathological processes, from traumatic injuries to illnesses, can affect the CNS, When the head receives severe blows or rocks forward and backward violently, damage to the cerebrum results? Physicians diagnose a cerebral vascular acident (CVA) or sake when GNS damage occurs after intracerebral bleeding or cloting, A variety of illnesses, such as mul Aiple sclerosis, which affects the myelin she nerves, also cause clamage to CNS tissues Inall cases, damage to the cerebrum affects voluntary and involuntary movements. Generally, problems that alflect one hemisphere restrit movements on the oppor site side of the body. Damage to cerebellar structures affects muscle tone and coordination. Spinal cord dam age affects muscle use and sensation below the level of the lesion. We can inap this damage according to the affected ranges of sensory and motor loss. Damage to peripheral nerves affects individual mus- les and areas of sensation, Peripheral nerves get cut, crushed, or atacked by viruses, bacteria, and the body's immune response system. Peripheral nerve fibers have the ability 0 regenerate, unlike CNS structures. Ifthe nerve cell body remains intact after injury, recovery of usc use and sensation often occurs. Metabolic problems, trauma, and disease often result in skeletal disorders, which affect movement. Some Conditions such as scoliosis occur because of abnormally formed but healthy bone tissue. In scoliosis the verte- bral bodies form an abnorn ath covering, spinal curvature. Muscle imbalance, wedge-shaped vertebrae, severe “fans particular ae sce seek muscles ate inslfce shaking can cause bri damage tle this ou of trauma, Thi stale the head, a even bre weakeso lack of adequate ek support scoliosis or scoliosis may have an idiopathic cau known reason) Severe scolosis can compromise the heart, hang, ng axher organs. Although surgery sometimes offers ie only permanent solution, careful positioning that pre sides lateral support to the trunk may slow the progres. of spinal curvatures, very tha ser bone devclopment ean inuenee movement. For example, osteogenesis imperfecta affects the metabolic formation of bone tssue and makes the bone more susceptible w-facture and deformity Fractures or trauma othe epiphyscal plates in growing children may disrupt or halt bone growth. Damage toa bone’s blood supply can lead to avascular necrosis and progressive bone deterioration Oxteopoross affects bone though a gradual decrease in calcium content. The bone becomes weaker until it fractures during normal shifts in body weight or with inusele contractions. Weakened bones place oer alts with age related osteopgrosisat greater risk of fractures from fal. ; h biomechanics and Kinesiology play parts in the treatment of fractures. Normal musele forces can con tribute to the misaliganient of fractured fragments and deserve consideration in splinting or range-ofmotion restrictions such a5 those provided after hip fractures, surgical replacement of hip joint components, or toal hip arthroplasty (A Closer Look Box 2, Damage 1ojointsalso mayrestict movement, Fracres that cross the joint line or extend to the joint surfaee may result limited joint motion after the factre foe baled completely Ligament severely damage through Le Pers ffange of Motion Precautions aftr Hip Surgery ip arthroplasty, vulnerable. fan the carefully placed ignment due to the Hip-teplacement surgery, or total hi Tepairs the hip joint but leaves individual moves the wrong way, artificial joint can move out of ai ‘muscle forces acting on it. Hip precautions differ Slightly depending on the sugical approach used, utmost surgeons usually recommend the folowing ‘movement modifications ater total hip arthroptny. * No hip flexion beyond 90 degrees * No hip internal rotation past the neutral postion '* No hip adduction past the neutral position a Scanned with CamScannergslocation may produce chronic joint instability or predispose the joint to stiffening and decreased! range of motion from osteoarthritis, Rheumatoid acthtit become loose and unsta n contrast, causes joints to le. The joints may exhibit subluation under normal use an and muscle pull, causing misalignments such as ulnar dtift (Figure 26, 4), Boutonniere misalignment consists of hyperflexion in the proximal interphalangeal join (Figure 246, B). Swan neck causes hyperextension of the proximal interpha- {angeal joint, which may oceur with volar subluxation SECTION ONE KIULTIOISCIPLINARY BASIS FOR THE UNDERSTANDING OF HUMAN MOVEMENT (Figure 26, (). Each condition commonly leads to secondary joint contractires involving the distal inter= phalangeal joints (We will explore these four conditions ‘more fully in later chapters.) ‘A pathological condition of the joint aso can occur afver a CVA when the weight of the affected arm stretches the joint capsule and separates the head ofthe humerus from the glenoid fos. In this situation, instead of measuring joint motion with a goniometer, we.often describe shoulder subluxation in terms ofthe distance developed between bony lancmarks FIGURE 2.6 1 i oc ae dente exer dg eo te die ic ag elt mesure taut ina eto he mec wer aaa i sctamioenaess bate tern eer pence OE ed pl mephauge fr San mek aa ex mephdoweton od ny scowl bo srincoeaeptge in eit towne og ge Scanned with CamScanner a be Fick The opt extereMent ‘CHAPTER 2 tHiC STUDY OF HUMAN MOV! TTendons and muscles also suffer from movement: relate pathological conditions. Boutonnic consis ‘a butionhole tear in the elaborate extensor tendon o the extensor digitorum comnis msele, The pros! ral interphalangeal joint protrudes through this hole as the finger flexes. When the tendon falls from the posterior tothe anterior sie of the joint axis of motion, further contraction of the extensor muscle causes the iget to bend rather than straighten (see Figure 26, Bh Imbalances in muscle function make specific move- ments dificult or impossible. For example, weak oF non- fanctioning intrinsic muscles of the hand prevent a strong extensor digitorum communis muscle from extending the fingers completely, When the extensor contracts, the interphalangeal joints extend, but the ‘metacarpophalangeal joint hyperextends. Over time, ‘metacarpophalangeal hyperextension increases and interphalangeal extension becomes less complete Wecall the resulting condition intrinsic ninus (Figure 27) Repeated use ofa teindon causes tendinitis, or inflam mation of the tendon, Painful swelling usually results andl sometimes causes severe crowding of tissues and reduced blood flow. Damage to nearby nerves can fallow severe and prolonged episodes of swelling. Wendy Dabdoub, a frit packer for a mail order com- pany, acquired tn in the thumbs and index fingers of both hands after a particularly busy season, Her physi cian diagnosed carpal tunnel syndrome, caused by long hours of repetitive finger flexion leading to swelling of FiGURE 2:7 The hallmark of intrinsic minus hand ("claw") is metacar- Pophalangeal hyperextension with incomplete interphalangeal extension, K.M. ©. Lipray fnexor tendons anc impingement of RN the nerve. : Concepts from Physics and Engineering sen physicists talk about a body, they refer to collec i Einater. Abody may be ineredibly sal ike pro: tonsand electrons, to unimaginably large, like stars. The aman body i specific collection of mater. In physics the generic term body must heme specific modiliers to «prevent confusion / Physicists quantify space, time, and mass to describe s with one another. Different systems ures. Most their retationships ‘of measurement develop in different cult Americans use the English system, but the scientific community worldwide uses the metric sjstem. This book tuses both systems in different examples to represent practitioners’ typical thinking and problem-solving in various practice settings. (Appendix A contains a complete conversion table for English and metric systems.) SCALAR QUANTITIES We call static quantities, measured by an instrument oF aascale, scalar. These quantities tend to stay in one place, ‘making them relatively easy to measure. Measures of Space Length, area, and yolume are spatial measurements. In the metric system, we measure space in millimeters, centimeters, and meters, The English system measures space in inches, feet, and yards. Length has one dimen- sion, so we use a linear measure of distance (centitine- ters, meters, inches, and miles). Area has two dimensions and usesa planar measure of is fat surface (square cen: timeters or square feet). Volume has three dimensions requiring a cubic measurement (cubic.centimeters, liters, cubic inches, quarts, ard gallons). Measures of Time Time presents a fourth dimension. Both the metric and the English systems use seconds as the basic unit of mea- surement for time. . Measures of Mass . Matter consists of the neutrons, protons, and electrons that come together to make up atoms and further col lect into molecules. The chemical composition ofa sub- stance and the closeness of its molecules determine the quantity gf mass. For example, a hydrogen atom has only Scanned with CamScanner‘proton and electron pair, whe -atbon, nitrogen, and oxygen have 6, 7, and 8 proton electron pairs, Potassium, calcium, andl io have 19,20, and 26, respectively. As OT practitioners, we rately con Sula periodic table to discover the number of proton ectron pais ina particular element, bt we do ence ‘matter daily and need to understand this concept ‘The arrangements of these elements within solids, liquids, and gases affect the mass ofthe different sub stances, Closely packed molecules form solids, In liquids ‘molecules move freely around each other, and in gases they bounce around and keep their distance from every hing else, Water behaves in a clas by itself Uydrogen, carbon, and oxygen compounels form the tissues of the human body in vitious arrangements ‘Thcie slightly different chemical compositions determine their mass, Bone and muscle, which have more calcium and iron in their compositions, have a greater density than fat, for example as larger atoms like er VECTOR QUANTITIES. A veetor indicates movement. Itean be measured ony at a specific moment in time because it constantly changes. Arrows that indicate a starting point (point of application}, magnitude, and direction represent ‘vectors. A simple arrowhead drawn on the end of ine converts a haphazard mark into a story indicating @ specific force, a specific point at which it was applied, and a specific direction in which itis moving. Measures of Physical Movement ‘The vector quantity displacement indicates movement {froma designated starting point, motion in a specific direction, and distance aveled. A more familia vector {quantity velocity (v, requires us to divide displacement (5) by time (1). We cangxpress velocity, the rate at which displacement occurs, as.an equation: vea/t ‘When velociy increases, it accelerates; acceleration is the change in velocity overtime, Therefore we calculate acceleration (a) by subtracting an intial velocity (u) from a final velocity (v) and dividing the result by time (0. Measures of Weight Weight, another familiar vector quantity, reflects both mass and the pull of gravity on that mass, Gravity always pulls toward the center of the Earth, For example, SECTION ONE MuLTIO/SciRLINARY BASIS FOR THE UNDERSTANDING OF HUMAN MOVEMENT duals stand on the Barth's surface with their feet toward the Earths center and experience gravity asa lossvatel pull, vector quantity. As Tong as we stand on the Karih’s surface, we.mustcaletave gravity as a on stan factor therefore as ms tn he English system, we measure weight (a farce) im pounds. In the metric ssn, we measure weight in newtons, named after Sit Isaac Newton efits tealzed that gravity gives massits tection whew an apple Landed com his head eases, weight increases, Measures of Force -_ In physics, forces cause objects to deform or move and are represented in their actions as vectors. The force muscles produce isthe most common force encounered inthis tex. Drawing muscle forces as vectors requires that we understand that a muscle contraction applies force to ‘one segmentat one atachmentof the muscle ane directs the force specifically in the direction of the other attach ment The length of a vector indicates the specific amount ‘of force generated by the mise contraction. Because the arrow indicates the amount of force, we may draw these vectors longer or shorter than the actual muscle ite. Vectors can originate from the proximal attachment or the distal attachment of the muscle, depending on the direction of movement, but the arrowed line always runs parallel to the dection of muscle fibers (Figure 28). Normal forces act perpendicularly toward or away from a surface area. Compressive normal forces push two surfaces together (Figure 29, A). Tensile normal forces pull vo surfaces apart (Figure 29, B). In contrast, shear, or tangential, forces act parallel to surface areas, Figure 29, 0) Gravity isa normal force. Reaction forces, another type of normal force, produce an equal and opposite response to gravity or other forces. Muscle forces pro~ ducing joint motion often result in joint reaction forces respond in a variety of ways to reaction forces. Measures of Stress Unlike force, stress occurs in the material on which forces act. Tensile forces on the knee produce tensile stress inthe tissues of the knee joint. We determine the amount of stress produced by dividing the amount of force by the specific quantity of tissue om which it acts. ‘We measure stress in units of Pascals (Pa) or newtons per square meter (N/m). Stress also can be measured in. pounds per square inch (psi). Measures of Friction Similar to stress, friction occurs on surface areas, ‘To determine friction (#), multiplya normal force (WY) Scanned with CamScannerCHAPTER 2 THE STUDY OF HUMAN MOVEMENT FIGURE 2-8 ‘A Vector representing the pull (force) of a muscle must be drawn from the moving attachment, through the muscle fibers, toward the stationary atachment A FIGURE 2-9 Norma forces act perpendicular to surfaces pus times a coefficient (jt) unique to the material in question: F=yN For instance, the coefficient of cartilage in a synovial joint is essentially 0, whereas the coefficient of a crutch tip on rough wood is about 0.70 to 0.75 (Figure 2-10) The closer a coefficient gets to 1.0, the more force we nneed to move that material acrossa specific surface. Measures of Work We calculate work by multiplying weight by distance by the number of repetitions. For example, to measure the amount of lifting work needed to do a job, tise the following formula: i Lewxhxs Here, L represents lifting work, w represents the weight of the object, h represents the height of objects lifted, and r represents the number of repetitions. To find the amount of hauling work done on a job, use the following formula: Hewxdxr H represents hauling work, wis its weight, d is the distance traveled, and ris the number of repetitions, together as compressive forces (A) or pulling apart as tensile forces (B)-Shearforces act parallel to the surfaces they affect (C). Stress occur in the materials on which forces act. Scanned with CamScannerSECTION 01 ME MUTIISCPUNARY 415 fox THE unocastanoIN OF HUMAN MOVEMENT FIGURE 2-10 ‘We determine fiction by the nature ofthe surface material ‘The friction between a rubber crutch tip and concrete (A) is much greater than that between two cartilaginous joint surfaces coated with synovial uid (B) Summary ‘An OT practiioner’s ability to accurately analye func tional activity eepends on de abilyto understand and apply principles of biomechanics and kinesiology Biomechanics and kinesiology, in turn require fara iavty with the basic concepts of medicine and physics presented inthis chapter. Often OT practitioners and students seem comfortable with medicine, but regard physics as strange territory. The physical concepts presented in this chapter form an intrinsic part of every problem presented in the chapters that follow, so that in solving them the reader develops as much comfort applying physics to human activity as he or she may have orienting to the human musculoskeletal system. Calero ny B APPLICATION 2-1 Appreciating Mass and Gravity ‘We must begin to think about massand gravity separately to understand how they operate, especially once we move beyond the confines ofthis planet, Although our body mass changes throughout fife, the Earth's gravel does not. As mass changes so does gravity’s effect on it~ we experience this as weight. To appreciate mass, We rust remove the effect of gravity 1. Obiain samples of two vastly different elements: lead (a fishing weight) and aluminum (Coil). 2. Crumplea piece of aluminum fil to equal roughly the sizeof the fishing weight. 3. Compare the two weights by eel. ‘Which is heavier? Because gravity affects both equally, ‘what accounts forthe difference in weight? MAPPLICATION 2-2 Identifying the Active Muscle ‘To understand which musclesaffect movements we must reexamine what we learned studying gross anatomy through books and cadaver dissection, Without reali ing it, most of us developed a bias that flexors flex and extensors extend. When we observe elbow flexion a8 4 movement, we often credit elbow flexors the primary source of power, but in the following case, activation of the elbow flexors to control eliow Rexion would lead to disaster Imagine slowly lowering a bowing ball from aboxe your head to the top of your head. The elbow moves From extension into flexion. Elbow extensors work hard to control the rate of elbow Méxion, Don't activate the elbow flexors. The ball wll accelerate and bit your head. “Try this activity: Hold a heavy book above your head with your elbow Fully extended. Lower it slowly about half the distance to the top of your head. At this point the elbow has lexed through about 45 degrees ff motion. Hold it there and think about the active group: 1. Palpate the belly ofthe triceps and compare this feeling to that ofthe biceps. Which muscle feels more active? As you hold the book overhead, which muscle gets sore? 2. Now raise the book two times and palpate the two muscles one ata time each time you raise the book. Which muscle feels more active? 5. Now lower the book slowly two times and again determine the active group. 4. Repeat these steps with the opposite hand and measure the origin-o-insertion distance for the long head of the triceps (infraglenoid tubercle to the olecranon). Now move into lexion, stopping at 45 degrees. Again measure origin to insertion. ‘What happened tothe distance ds you slowly flexed the elbow? Which muscle was active? What kind of contraction takes place? 5. Asyou hold the book steady with a partially flexed. elbow, what happens to he origin-o-insertion Scanned with CamScanner *(CHAPTER 2 THE STUDY OF HUMAN MOVEMENT distance forthe triceps long head? Which muscle was active? What kind of contraction takes place 6. As you raise the book back into full elbow exten sion, what happens to the triceps long head origin- torinsertion distance? Which muscle was active? ‘What kind of contraction occu See Appendix C for solutions to Applications REFERENCES 1. Freese F, Brown M, Norton Bf Clinical eliailiy of manual ‘muscle tesig middle trapezius and gluteus medi muscles Phys The 57(2): 10721076, 1987, 2. Lawson A, Calderon L: Interexaminer agreement for applied. Kinesiology manual muscle testing, Poerpt Mot Skills 84(2):539-546, 1997 CEES at RELATED READINGS RF, A, Jenson Fk Nelson texto of ip 08, Sunes. rain Str ri el, 1978, Chaves Thoms New ik, 18 Ba Fie cer Me Sif Bs of human move me ator, 1387, Witla & Wins een ens € Lise’ oncani of humor matin "69, Paden, 1282 WB Saunders ain Ot, engi PR: nt scr and fc: compo Tanna 2 Pade, 192, A Dai ah Rng and aptied ent T, Philadephia, Lea ete eH ar EH Gye: ei ved 38, New Yor, 1995, Chuccill Betirman RE, Kliegman politics 17, Pia Fiorentino Me Reflex testing of medicine and surges, Livingstone Prsvrishislingcmeg Cerin te aig briny xe Topic Movement in planes around axes Goniometry and Marval Muscle Testing Vectors drawn to represent muscle contraction force Muscle excursion Eccentric muscle contractions controling gravity, lferentiting contractions in activity Laboratory Lab 1 Kinematic Chain, Human Musculoskeletal ‘Movement, Shoulder Model of joint Movement Lab 3 Overview of ROM & MMT . Lab 3 Overview of ROM & MMT Lab 4 Accessory Joint Motions/Muscle Excursion/Active & Passive Insuficiency/ Max Assist Transfers Biomechanical Analysis Lab Scanned with CamScanner