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Clinician Activities

• Clinical work requires utilization of proper body
mechanics to effectively and efficiently perform
daily skills.
• Not only does a clinician risk injury if proper
techniques are not used, but fatigue because of
inefficient execution of those skills serves to wear
and tear on the clinician physically.
• To be stable, the body’s center of mass must
fallwithin its base of support.
• Stability during dynamic activity requires that the
feet be placed in the direction of forces applied.
• Further stability occurs if the center of mass is
• A “straight” spine provides the greatest stability for
the back and the most efficient transfer of forces
from the legs to the arms.
• In that same vein, to maximize effectiveness and
preserve the smaller joints, it is advantageous to
use the powerful leg muscles to provide the
clinician with the leverage and power while
minimizing repeated large stresses to smaller and
weaker upper body segments.
Patient Protective Measures:
Spotting during Ambulation
• Specific techniques are used to protect the patient
as well as the clinician during ambulation
instruction and progression to independence.
• We will assume that the patient has advanced from
ambulation instruction in the parallel bars to
ambulation instruction with crutches, and the
clinician has already provided the patient with
instructions and demonstration so the patient is
now ready to begin ambulation. This patient is
partial weight bearing on the left lower extremity.
Sequence of Movement
Joint Motion
• Since the clinician is in a forward-backward straddle
position with the lower extremities, the right hip is
in slight flexion with partial flexion of the knee and
slight plantarflexion of the ankle. The clinician
begins with most of her weight on the left lower
extremity; the hip knee, and ankle are all close to
neutral in the sagittal plane.The left hip is slightly
laterally rotated.The head, neck, and trunk are in
alignment over the pelvis.
• The clinician’s left upper extremity is positioned with
• the shoulder in slight flexion; the elbow is flexed to
• about 90° (the actual amount of flexion depends on the
• clinician’s and patient’s heights); the forearm is supinated;
• the wrist is in its power position of slight extension;
• and the hand is in a power grasp around the belt behind
• the patient. The clinician’s right upper extremity is in
• shoulder flexion with upward rotation of the scapula (the
• actual amount of glenohumeral flexion and scapular
• rotation depends on the patient’s height); the elbow is in
• some flexion; the forearm is pronated; the wrist is in
• slight flexion; and the fingers are in slight flexion to
• make contact with the patient’s anterior shoulder.
Clinician Ergonomics: Manual
• As mentioned earlier, it is vital that the clinician be
aware of correct body mechanics and use his or her
body safely and efficiently to both protect against
injury and conserve energy.

• To make the activities difficult, we will assume that
the patient in each example has a grade of 4/5
strength in the muscles resisted. We will also
assume that the patient is male and the clinician is
Upper Extremity Resistance
• If the patient is supine and the clinician provides
manual resistance to shoulder abduction, the
clinician stands at the side of the patient with one
hand just proximal to the lateral wrist and the other
hand just proximal to the
• The clinician faces the patient, in front of and slightly
• to the right of his right knee. She kneels down on her
• right knee and maintains good spinal alignment. The
• left leg is flexed at the hip and knee with the foot flat
• on the floor and ahead of the right knee. She places
• her right hand at the anterior ankle. In this
• position, the clinician’s right hip is extended (gluteal
• muscles and hamstrings) while the left one is flexed
• (iliopsoas and rectus femoris) (Fig. 13.11). Both of her
• knees are flexed to about 90° (hamstrings). As the
• clinician leans forward from the hips, her right gluteus
• maximus and hamstrings eccentrically control the
• amount of motion. Her right hand is positioned with
• the thumb opposing the other fingers (opponens
• pollicis) and all the digits are in some flexion (flexor