[Music] welcome to this lecture in this lecture I'm going to be discussing the biomechanical frame of reference uh the biomechanical frame of reference is one of the um fres of reference commonly used in occupational therapy um so as we know in occupational therapy our conceptual uh models or generic occupational therapy models they help us EXP explain why we do what we do and then we have frames of reference that guide us on how we do what we do so we're going to discuss the biomechanical frame of reference and the assessments and interventions that it actually guides us to use uh if we are using this uh particular frame of reference uh from my experience the biomechanical frame of reference is actually one of the frames of reference that can that are easily understood uh especially by by students this frame of reference is based on kinematics and kinetics kinematics being the study of motion of bodies and kinetics being the study of relationships between forces acting on a body it it tends to view the body as a functioning machine uh that is made up of specific components that are connected in specific ways and I expected to function in specific ways um the biomechanical frame of reference also uses principles um of mechanics or mechanical principles to address an individual's motion during occupational performance this PR frame of reference is not only used in occupational therapy but it's also used by many other disciplines um because of obviously of its Origins and the aspects that IT addresses um moving on to the key Focus uh of this frame of reference it mainly focuses on the muscular skeletal capacity to perform occupation and the major three major aspects for this frame of reference are joint range of motion meaning the extent and direction of movement that a joint can achieve uh the second one is muscle strength uh that's the force or the tension that is gener by a muscle when it contracts um you might want also to ref as a measure of power generated by a muscle and then the third one is endurance being the ability uh to remain active during an activity or the capacity for muscles to contract repeatedly without uh without getting tired so it it measures that that's that's the endurance uh there are secondary aspects to to those three that I just mentioned and the secondary aspects include balance um joint stability as well as joint Mobility so there's a difference there between joint range of motion and Joint Mobility joint Mobility refers to the ease with with with which uh The Joint moves from from one position to the other so what are we aiming to do when we're using the biomechanical frame of reference we are aiming to either increase or restore it might be joint range of motion muscle muscle strength uh physical endurance we can also use it um if we are aiming to prevent deformity or if we're aiming to decrease the effects of um of uh deformities of the body who do we use the biomechanical frame of reference with we generally use this frame of reference whenever we know that um our service user or our client is having problems that are affecting their R joint range of motion muscle strength or their endurance so this could be people who are having fractures um arthritic conditions like rheumatoid arthritis osteoarthritis soft tissue injuries for example um muscle injuries injuries to the ligaments or tendons people with amputations um people with uh with uh with pain uh people with peripheral n damage or people with cardiorespiratory problems that affect their endurance generally when we using the biomechanical frame of reference we would expect the central nervous system of the client or service user to be intact the reason being if the central n system is affected for example in traumatic brain injuries or in stroke that's your cardiovascular accident you will actually realize that the muscle tone will be affected when the central n system is involved so if the central system is involved and muscle tone is involved that automatically affect um the other aspects that we were looking at like joint range of motion muscle strength so it it wouldn't be very ideal to use the biomechanical FR of reference um to to address those problems that are coming from abnormal muscle tone uh we would rather select a different frame of reference for example the neurod developmental frame of reference to address problems that are associated with the central nervous system but for the um uh biomechanical frame of reference we would generally expect the service user to have an intact of or a functioning um mature central nervous system however experienced therapists they can still use the biomechanical frame of reference uh with service users who may Beav um an affected central nervous system for example in wheelchair prescription because some of the principles of the biomechanical frame of reference they actually allow therapists to make decision ter decisions in terms of uh the angles at which the person will need to sit in order to prevent deformity and things like that um and then moving on to the settings where the biomechanical frame of reference is commonly used it's commonly used in Falls it's uh pain management Hand Therapy vocational rehab assistive technology uh generally wherever we have service users who are having problems with their range of motion their muscle strength as well as their endurance the the biomechanical frame of reference is usually um appropriate to use so as we know frames they guide us on how to do what we do so when using the biomechanical frame of reference um there are certain assessments that this frame of reference actually guide guides Us in terms of uh using um I will start uh with the assessments that are focusing on performance components where we assess the performance components and generally in some text you might actually find these assessments being referred to as um assessments that are used when using a bottom up assessment uh basically what it means is that if you're using a bottom up assessment doesn't necessarily mean that you're not going to um assess the occupations it just means that you're starting uh with the performance components going upwards okay but sometimes you might find that in in some settings uh these assessments can be used without progressing to uh the occupational or the functional assessments so the first uh component that we can assess if we're using the biomechanical frame of reference is joint range of motion um we can assess gint range of motion by observing asking for example a service user to move their their arm or their limb we can actually be able to observe if there's a limitation in in in their um joint range of motion but that would not be very objective uh because we're just observing the moving so if we want really to be objective to be able to know at what angle they're able to to move what we then need to do is to use gometry uh we we use gomers to measure uh joint range of motion for for all the joints um within within the limbs um identify the joints and then their plan of movement and then we can be able to measure that and objectively document uh the the angle at which the joint is is moving um the Gom come in different forms and and and and shapes um they can be the manual ones like the ones on the picture and then the green ones those are electronic gomers where you just attach um the two parts one distal to the Joint the other one proxim out to the joint and then request the service user to move the joint and then you can then be able to measure the um the joint range of motion so that's that's one the second one is dexterity dexterity basically is the rate of manipulation the speed at which we can use our fingers and the accuracy when when uh performing a task uh so there there are a number of tests that can be used by occupational therapist to test for dexterity um here I've just put two examples that's the nine whole Peg test as well as the box and block test each of the assessments that I'm going to be talking about they have their clear instructions in terms of how how we use them so it's important When selecting an assessment you have to read about that assessment what are the requirements and how is it administered so that you have a good understanding of how to do that then so we've talked about assessing range of motion Now we move on to assessing muscle strength muscle strength we can actually assess using the manual muscle testing grading system commonly known as mmt some in some places refer to as the Oxford scale you might have had or you you might come across um uh information saying the service user has got uh um muscle strength mmt grade two for their elbow flexors or they are having uh grade three for their shoulder abductors um so the table on the right it actually shows you um the grading uh that is given given to the muscles and when do we say this muscle is great one when do we say this is two or plus two so I I allow you to read to read that uh for yourself but that's one of the tests um that we can use when we want to uh measure or assess uh muscle strength uh within Healthcare settings um and MGT teams it's very common for for these uh for this uh mmt to be used and you might see in the uh patient notes that they are recording the strength of the muscle strength of the personent or the service user for the specific muscle groups so that that's what will be used the the mmt we can also uh assess grip strength using a dynamometer that's a jamama dynamometer on that on that uh on that picture um also it comes with a set of instructions in terms of of how do you position the person and how do you measure usually you take three three measurements and then you take an average to get an idea of the person's grip strength you can also be comparing the affected hand and the nonaffected Hand we also have uh the pinch meter the pinch meter basically measures uh the pinch strength that's uh for the fingers and then for endurance we can measure endurance in terms of the C cardiorespiratory endurance we can also measure um endurance in terms of the functional endurance so functional endurance is commonly used in occupational therapy what we are looking at there is basically the time that the person is able to sustain an activity um if if they are to stand for how long are they able to stand um if if they are going to be uh taking a shower for how long are they able to actually uh sustain involv mement in that occupation so functional urance we can measure based on time we can also observe and then there is also edema or we can measure edema by observing um like the image of uh the person seated with two hands we can actually see or we can actually observe that their left hand is actually swollen that's edema we can go on further to test what type of swelling this is whether it's pitting edema or nonpitting edema when it's pitting or organized edema it tell tells us that U it's more of chronic edema um we can also measure edema using a tape measure uh usually this is the figure of eight that we use on the hand uh obviously using those anatomical landmarks to just make sure that we are measuring it consistently and we're able to compare the measurements from the Baseline until the time when we have uh um provided some interventions to see whether there's progress we can also measure Dima using a volumeter so a volumeter is basically that equipment there on the uh first image uh where the image is filled with water until there's no more water dripping and then uh the swollen hand is then brought in and then the water that is displaced by the swollen hand is then collected and measured in terms of uh milliliters and then um when treatment or intervention has been provided and you want to reassess you can still do the same and compare the readings the initial reading from the uh Reading Post intervention to see if you're making a difference in the in the uh patient swelling we can also measure uh sensation sensation is classified as there's light touch there's pressure there's thermal and then there's uh sensation to pain um so we can also be able to to measure those aspects using different kits for for testing sensation or those filaments that are shown in that image um the algometer can also be used to test uh when we're assessing or measuring pressure uh sensation to pressure uh sensation to pain sometimes we can actually use commonly use the visual analog scale which help us uh to at least have an idea of the way in which the service user is perceiving the pain so they can score it in terms of number they can use the uh the fal Expressions shown on that scale there actually a wide range of of pain scales that can be used to assess pain now we've I've just discussed the um assessments for the performance components uh which was referring to as assessments that we normally start with if we're using a bottom up approach now I'm moving on to assess the occupation based assessments um these mainly used in occupational therapy as well and they are commonly used if we're using a top down uh approach where we want we are more interested in um assessing or evaluating occupation um rather than just looking at the performance components just looking at the range of motion so here's a list of some of the examples there it's it's not exhaustive uh we can use the Canadian occupational performance measure um commonly know as the copam um where the service user can actually uh tell the therapists the occupations that they uh consider to be important to them and then they can also uh R their satisfaction with their performance of those occupations also have the B Index this is a an assessment to a standardized assessment tool as well that is used when we are assessing uh mainly self-care activities it has got 10 activities that include uh feeding birthing grooming using the toilet Mobility transfers and things like that um we can use it to to assess that we can also use the uh Dash or quick Dash the disabilities of the arm shoulder in hand commonly used by occupational therapists and other other team members as well uh but it relates to occupational performance um for people with uh injuries that are affecting their arm shoulder and hands we can also use the Osa that's your self occupational self assessment um we also have a whole lot of um self-reporting assessments that can be used by occupational therapists like the RO checklist interest checklist um model of human occupation screening to Mo mohost is also another popular one that we could use um and then we also have our functional assessments where the service user actually performs an occupation it might might be within their uh selfcare domain productivity or Leisure depending on their interest and what is Meaningful to them we can actually observe them performing those those occupations and see if there are any limitations as well as the strengths that they'll be having um and then we can also use um environmental assessments for example home assessments or work work assessments um we can do these these assessments with the with the mechanical frame of reference moving on to the interventions um obviously we can have our occupational based interventions where we focus on specific occupations that are meaningful to the to the service user and then we actually help them to actually engage in those in those occupations um sometimes we might use assisted technology we might use um environmental adaptations or modifications splinting and prothotic for example enhance um its interventions that we we can use uh functional retraining sometimes uh range of motion uh strengthening exercises endurance but sometimes these may not be purely um occupation based we can also use joint protection techniques particularly for people with um arthritic conditions therapeutic exercise also commonly used in Hand Therapy um when providing these interventions using the biomechanical form of reference there's an emphasis on grading of uh of um grading principles so we can upgrade our intervention or downgrade it so we upgrade by increasing complexity or maybe increasing the time if we're working on endurance increasing resistance if we're working on muscle strength so that we can increase muscle strength increasing distance if we're working on joint range of motion or to downgrade we then reduce we can reduce the time or reduce the resistance reduce the distance so that the the service user is having the just right challenge there are some limitations um firstly uh this frame of reference does not automatically provide for client centered practice because of that view of the body like a machine with different components the client may be less engaged and non-compliant is they can actually play a more passive role when we're using this frame of reference um it can be reductionistic doeses not automatically incorporate strengths of a service delivery based on our a philosophy um being occupation based not that much being holistic we can't say it's a sort of like holistic frame of reference so as a result when we are using this frame of reference we usually use it in conjunction with other frames of reference for example we might say we're using the biomechanical frame of reference together with the client centered frame of reference sometimes we start with biomechanical frame of reference and then end up including the rehabilitative or compensatory frame of reference depending on the needs of the the service user um the merits for this frame of reference um it's generally attractive to some OTS especially in acute settings they can easily use adjunct methods and enabling activities um communication between MDT members is easy because some MDT members already use uh the biomechanical approach in their practice it can also be used to achieve occupation as an end there's uh this this discussion around occupation as a means and occupation as an end so by occupation as an end we're basically saying we are we are providing an intervention that may not be purely occupation based but our aim is for the person to engage in an occupation that's occupation as an end and uh for us to use uh occupation as a means it means we are using occupation as a therapeutic medium we are using occupation as the intervention um but for us to do this when using the biomechanical frame of reference it requires what is called an occupational filter where the therapist actually makes it intentional to be creative so that U we incorporate the principles of the biomechanical frame of reference into um um the treatment using occupation as the therapeutic medium this frame of reference is commonly used with um the following conceptual models of course there are many more other conceptual models that you can also be able to use the biomechanical of reference with but Sim of e mo P or um p p they are commonly used um um together with the biomechanical frame of reference okay thank you very much these are the references that I've been using all right thank you