Lecture notes on Human Occupations for Occupational Therapy Assistant students (Diploma).

1. HUMAN OCCUPATIONS
HDOT 104
SIR OAK
(ACCRA SCHOOL OF HYGIENE)
+233249702470

2. What is Human Occupation?
*When you hear the word "occupation," what
comes to your mind?
*How do humans occupy the space around them?
*How do humans occupy time?
*How do they occupy themselves in the course of
their daily lives? And why?

3. Class discussion
*Imagine that it is morning, and you are just
waking up.
*What is the first thing that you do?
*Why do you do that first?
*What do you engaged yourself in during the day?
* If you live with others, do they do the same routine?
Why? Why not?

4. *Occupational therapy is the art and science
of helping people do the day-to-day
activities that are important to them despite
impairment, disability or handicap.
*”Occupation” in occupational therapy does
not simply refer to jobs or job training; but
rather all the activities that occupy peoples
time and give meaning to their lives.

5. In occupational therapy, human occupation has
traditionally been categorized into:
(i) productive occupations
(ii) self-care occupations
(iii) leisure or restorative occupations
*Why might “human occupation” be important for an
occupational therapy assistant student?

6. O.T. believe that humans:
• are unique
• can make choices about life
• have some potential to change
• are occupational beings
• have diverse abilities for participating in occupations
• shape and are shaped by their environment

7. *gives meaning to life
* is an important determinant of health and well being
*organizes behaviour
*develops and changes over a lifetime
*shapes and is shaped by environments
*has therapeutic effectiveness
Occupational Therapists believe that occupation:

8. In conclusion:
*Occupations are fundamental to health,
well-being and identity.
*Occupations are the therapeutic media
employed by the occupational therapist.

9. Two ways we can use occupations:
*As the end point that we are aiming for in
our intervention.
*As the means to improve someone’s
impaired abilities.

10. Occupation as end point;
*The O.T. can help the person learn/relearn these
occupations, and/or can make adaptations if
necessary.
Occupation as a means to an end;
*We can introduce occupation as intervention to
help improve someone after illness or when
disabled.
*We choose occupations which interest the client and
which have therapeutic value.

11. Two ways we can analyse occupation – (Nelson,
1988, p634) are as follows;
*Occupational form
(a ‘pre-existing structure that elicits, guides, or
structures subsequent human performance’)
*Occupational performance (‘the doing, the active
behavior, or the active responses exhibited within
the context of an occupational form)

12. Occupational form has two dimensions, namely:
* The physical dimension (can be observed and
measured) eg. the environment, the human
aspects, the objects and their properties, etc.
*The sociocultural dimension (cannot be observed
and measured) eg. roles, norms, language, etc.
Occupational Occupational
form performance

13. Occupational performance has two aspects, namely:
(i) Overt Occupational Performance (can be observed)
*Speech and related vocalizations
*Facial expressions
*All movements and postures under
voluntary motor control.
(ii) Covert Occupational Performance (may not be observed
directly)
*Cognitive processes
*Emotional reactions

14. Chains of occupational performance
Class discussion
Outline the occupational performance and its’
aspects of form that will be involved in
picking up a milk from a fridge and pouring it
into a glass on your dining table.

15. Chains of occupational performance
Occupational Performance Aspects of form
Walks to the refrigerator
Opens the fridge door
Looks for milk
Picks up milk
Pushes shut fridge door
Walks to table
Pours milk into glass

16. Can opening a fridge door be a complex activity?
• Reach out to handle
• Grasp handle
• Firmly pull the handle (to break the hold of the rubber seal)
• Gently pull the handle
• Stop pulling
What might be possible hindrances ?

17. *What if some of the muscles are weak?
*What if you cannot initiate muscle action?
*What if you cannot control muscle action?
*What if you have no movement in one or
more of your joints?
*What if you cannot recognize the handle?
*What if you cannot see it?

18. In summary:
• The developmental structure of human has
Sensorimotor,
Cognitive and
Psychosocial;
which developed over time and enhances abilities.
• Occupational performance depends on:
the occupational form which is encountered plus
The unique developmental structure of the individual.

19. Evaluation of Occupational Performance
• Activities of Daily Living (ADL) refers to all tasks that individuals
perform routinely. (Deaver, 1982)
• ADL also known as self-maintenance tasks (AOTA, 1994) include 15
domains:
grooming, oral hygiene, bathing or showering, toilet hygiene, personal
device care, dressing, feeding and eating, medication routine, health
maintenance, socialization, functional communication, functional
mobility, community mobility, emergency response, and
sexual expression.

20. Cont…
• Similarly, home management is generally classified as an Instrumental
Activity of Daily Living (IADL), a term applied to tasks required for
independent living.
• Synonyms for IADL are independent-living skills, advanced ADL, and
extended ADL
NB: O.T practitioners need to be aware of these differences in
terminology and usage when communicating with professionals,
selecting evaluation instruments and responding to referral.

21. Purpose of evaluation of ADL and home management activities.
Dysfunctions in ADL and home management tasks are called
disabilities in the model of disablement developed by the World Health
Organisation (WHO, 1980)
Evaluation is a key aspect of Occupational Therapy process because it
establishes direction for therapeutic actions.
At the level of individual client care, evaluation may be done to:
i. screen for disability
ii. plan occupational therapy intervention
iii. facilitate decision making concerning actions

22. i. Screening
It is a case-finding procedure intended to separate individuals who have
or are at risk for developing disability.
It is often applied to a large group of individuals such as all new clients
in an outpatient clinic, hence, they should be brief, easy to administer,
inexpensive and must have sufficient sensitivity to detect disability.
Screening procedures do not need to be done by Occupational Therapy
practitioners; they form the basis of any referral and may be conducted
by health care, social services and educational personnel.

23. Evaluation
This is more comprehensive and detailed than screening and must be conducted
by an Occupational Therapy Practitioner.
Its purpose is to identify the ADL and home management tasks for which
disability is present or may be developing.
Evaluation data may be used to plan and monitor occupational therapy
interventions or to assist in decision making.
The extent of data gathering depends on the specific purpose for which the
evaluation is being conducted.

24. ii. Plan and monitor occupational therapy intervention
When an evaluation is conducted to plan occupational therapy
intervention, four (4) types of data are needed:
*First, tasks in which performance is deficient need to be identified.
To target intervention appropriately, the identification of deficits needs
to be very precise.
*The second type of data that is needed is data about the cause or causes
of disability. (students should identify causes of disability in driving
and cooking)

25. *Thirdly, data about client capacities for modifying their task
performance is needed.
These data also assist in establishing an overall approach to OT
intervention.
Interventions involving skill acquisition would be feasible for clients
who demonstrate the ability to learn, whereas environmental
modifications would be appropriate for those lacking this ability.
*Lastly, the evaluation should yield data about the kinds of OT
interventions that are most likely to improve task performance. The
practice of OT incorporates a broad array of restorative, compensatory
and preventive interventions.

26. In summary,
*identifying disabilities and their causes
(the first two types of evaluation data) are diagnostic
*determining clients’ modifiability and
ascertaining potential interventions are therapeutically
(the last two types of evaluation data) oriented

27. iii. Facilitate decision making
The primary question to be answered through the evaluation is: Does
the client meet the functional criteria? This question can generally be
answered by identifying tasks in which disability is present.
The ability to care for oneself and one’s home lies at the interface
between independent and supported or assisted living.

28. Evaluative Approaches
• The parameters of task performance may be evaluated through
qualitative or quantitative approaches.
• In the qualitative approach, task performance is described.
• In the quantitative approach, task performance is measured.
• Both approaches incorporate clinical reasoning to integrate evaluative
data and ascertain its meaning.

29. Qualitative Approach
• The salient characteristics of clients’ task performance are described.
• These descriptions are used to formulate inferences about clients’ task
performance on the evaluation parameters of interest.
• A practitioner might note, for instance, that a client named Mr. Joe could
not bend at the waist sufficiently to reach his feet with his hand and could
not bend his lower extremities sufficiently to move his feet closer to his
hands.
• From these observations, the practitioner might infer that the client is
unable to wear socks and other lower extremity garments and, thus, is
rated as dependent in lower extremity dressing.

30. Quantitative Approach
• The evaluation parameters of interest are quantified through the
assignment of numbers (Wade, 1992)
• Numbers can aid in determining the severity of dysfunction and the
extent of improvement or deterioration.
• It is important to understand the numbers that are generated by
various measures and the mathematical procedures that can be
appropriately applied to them.
• Students should mention and describe the four levels of
measurement used by O.T. in evaluation.

31. Evaluation methods.
• O.T. may use a combination of data-gathering methods to evaluate
clients’ ADL and home management tasks.
• The fundamental or basic methods are
asking questions,
observing and
testing.
• The specific procedures used to gather data within each of these
methods range from unstructured to structured.

32. Asking Questions
• In the questioning method of data gathering, questions are posed about ADL and
home management tasks.
• It may be implemented in an oral or a written format, using interviews or
questionnaires, respectively.
• It is preferable to have clients respond to questions about their performance
because they are the most knowledgeable about it.
• However, if they have not performed tasks in a while, they may report their
abilities inaccurately because they believe they can perform task that they
actually can no longer perform.
Students should suggest an appropriate solution to the situation when clients are
unable to respond on their own behalf.

33. Advantage and Disadvantages of Asking questions.
• The questioning method is particularly useful for screening for
disability because a large number of tasks can be queried in a limited
amount of time.
• However, it is less useful when evaluating disability for the purposes
of intervention, because:
 clients may not be able to describe their disability in sufficient detail
to target the components of tasks that are problematic.
clients do not have the medical, rehabilitation, and occupational
therapy knowledge to isolate the factors that may be causing
disabilities.

34. Observing
• O.T. obtain data by watching clients as they perform ADL and home
management tasks.
• O.T may observe task performance either under natural condition
(within the context that it usually takes place or is expected to take
place) or laboratory condition (occupational therapy clinic or
temporary space occupied by clients in the hospital room).
• Observation provides O.T. with the opportunity to analyze
impairments that may be interfering with task performance.

35. Testing
• When questions and observations are systematically
structured and when a numerical score or a category system
is used to describe task performance, the questions or
observations constitute a test.
• The traditional approach to testing has been norm-
referenced.
• The purpose of norm-referenced testing is to compare a
client’s performance on a test with that of others on the
same test.

36. In summary;
• The primary purposes of the questioning procedure is to:
1. Provide an overall profile of clients’ abilities and disabilities.
2. Understand clients’ priorities for learning how to manage their
disabilities and
3. Target tasks requiring in-depth evaluation.
• The purpose of the observational procedure is to:
1. Identify the deficit components of tasks already identified as
dysfunctional or at risk for dysfunction through questioning.
2. Hypothesize about the underlying cause of the performance deficit.
3. Identify the most likely interventions for managing the deficit.
4. Ascertain the clients’ potential for improving their task performance

37. Parameters of Task Performance for
Description and Measurement
• The parameters of task performance that Occupational Therapists are
most interested in evaluating are:
Value
Independence
Safety
Quality (ie, efficiency, adequacy, or acceptability)

38. Value
• When evaluating the meaning of task performance and task
performance dysfunctions to clients, data about the value that they
place on different tasks is essential.
• Value reflects the importance or significance of a task to the client.
• As an evaluation parameter, value is usually used in reference to the
independent performance of tasks. (Eg. the ability to move indoors
independently might be valued most by clients with stroke)
• Our actions as humans are influenced by our values; ascertaining the
relative value that ADL and home management tasks have for clients
is useful for establishing intervention priorities and for negotiating
target intervention outcomes with them.

39. Independence
• The most common parameter used to measure disability is the level
of independence clients exhibit when performing a task.
• When task performance is not totally independent, a more refined
measurement scale may be used to quantify the extent of
independence. Eg. 75% independent, 50% independent, or 25%
independent.
• Alternatively, the reference point used to measure disability may be
the effort exerted by care-givers, rather than by client. Eg. caregivers
may provide no, minimal, moderate, or maximal assistance of one or
more persons.

40. Cont.
• When assistance is required to complete an activity, the type of help
needed may be added to the rating scale.
• Three (3) general types of assistance are recognized and are rank
ordered from least to most assistive as follows:
1. Assistive technology/devices
2. Non-physical assistance
3. Physical assistance

41. Assistive technology/devices
• Assistive technology or devices /adaptive equipment/technical aid
qualifies as the least assistive type of help because it enables activity
performance to be adaptive, but independent.
• Clients who can feed themselves using utensils with elongated handle
fit this definition.
• Students should mention some other client situations that best fit the
definition above.

42. Non-physical assistance
• Non-physical help takes into account an array of techniques,
including:
Task setup/stimulus control: this involves preparing task materials
and environment for task performance. Eg. opening milk tin and sugar
packets.
Supervision: this means that the caregiver is available to monitor
task performance and to intervene if problems arise.
Standby assistance: this is similar to supervision, except that the
caregiver must be in close proximity to the client at all times. Eg.
walking alongside a client using a walker.

43. Cont.
Verbal guidance: this implies using words, either orally or in writing,
to instruct clients about task performance or prompt them to initiate
or continue it. Eg. reminding clients to brush their teeth.
Nonverbal guidance: involves the use of demonstration, which is also
called modeling/gestures to instruct clients about activity
performance or prompt them to initiate or continue it. Eg. tapping on
a client’s foot to draw attention to the need to put socks on.
Encouragement: the intention is to motivate clients, rather than to
teach them. Eg. “You are doing a great job, keep it up”

44. Physical assistance
• This includes physically guiding clients to do a task or part of a task
and doing it for them. Both of these techniques require direct “hands-
on” contact with clients.
• When physical assistance is used the only expectation for clients is
that they cooperate with caregiving. Eg. positioning a client’s hand on
a walker or lifting a client from a chair.
• In conclusion, perceived self-efficacy (clients’ beliefs about their
ability to perform tasks independently) is a key facet of independent
task performance. For instance, if the distance between the bed and a
wheelchair looks like a canyon to clients and they believe that they
can not execute a transfer successfully, it is likely that they will not
perform the task.

45. Safety
• Safety refers to the extent to which clients are at risk when engaged
in tasks.
• It is applied to the way in which clients interact with objects and their
environments to perform tasks.
• Safety is not a quality of the environment per se, but rather of the
person-task-environment transaction.
• For example, an electrical cord traversing a sink suggest that clients,
or others in the home, have unsafe daily-living habits.

46. Quality (ie, efficiency, adequacy, or acceptability)
• Adequacy of task performance refers to the quality of the action used
to execute tasks as well as the quality of the outcome or product of
that action.
• When dressing, for example, movement may be efficient or
inefficient.
• When dressing is completed, the individual may look neat or
disheveled

47. Descriptions of specific instruments for
functional assessments
1. ARNADOTTIR OT-ADL NEUROBEHAVIOURAL EVALUATION (A-ONE)
• The A-One evaluation has a dual purpose, namely:
 to assess independence in selected ADL (dressing, grooming &
hygiene, transfer & mobility, feeding and communication) and the
types of assistance needed to complete them.
 to identify the types and severity of neurobehavioral impairment.
• The ADL and neurobehavioral impairments are rated on a 5-point
ordinal scale, ranging from 0 to 4. The high point of the functional
scale connotes independence, whereas the low point connotes an
inability to perform task.

48. Cont.
• Data for Part I (about the ADL) are gathered through informal
observation.
• Part II ( about neurobehavioral impairment) relies on the
practitioner’s clinical reasoning about the underlying cause or causes
of task performance deficits.
• In addition, this instrument appears to have the capability of
detecting ADL improvement.

49. 2. ASSESSMENT OF LIVING SKILLS AND
RESOURCES (ALSAR)
• The ALSAR was developed to assess IADL as well as to identify needs,
assign risk, and prioritize intervention.
• A unique feature of this instrument is the consideration of IADL skills
in relation to the resources available to mitigate skill deficits.
• Conceptually, IADL deficits must not be interpreted solely in terms of
skills, but rather, from the perspective of the environmental resources
available to compensate for these deficits.
• The ALSAR is an interview measure and questions are provided to
assist in data gathering.

50. *The skill and resources are combined to obtain a risk score for
each IADL.
* Risk is designated as
-low (combined score of 0 or 1)
-moderate (combined score of 3)
-high (combined score of 4)
SKILLS RESOURCE RATE
Independent Consistently available 0
Partially independent Inconsistently available 1
Dependent Not available 2

51. 3. ASSESSMENT OF MOTOR AND PROCESS SKILLS (AMPS)
• The AMPS is used to examine the relation between motor and
process skills/task performance to establish the current level of
competences.
• It is useful for treatment planning and has been used with children,
adolescents, and adults with a variety of underlying impairments.
• Clients’ normal routines are identified through interview.
• Subsequently, the practitioners suggests five or six tasks for clients to
perform, ask them to select from these options, observe and rate
their performance.

52. Cont.
• Each motor and process skill item is rated on a 4-point ordinal score,
ranging from 1 to 4.
 1 – deficit is severe enough to result in damage
 2 – danger
 3 – task breakdown
 4 - there is no evidence of a deficit that affect performance
• AMPS item scores are then transformed from ordinal to an interval
scale to make it possible to predict a client’s performance on the
other calibrated task.

53. 4. FUNCTIONAL INDEPENDENCE MEASURE (FIM)
• The FIM measures disability associated with physical impairments.
• It is a mechanism for standardizing data collection for clients entering
medical rehabilitation.
• FIM was devised to provide a more comprehensive measure of
disability by including communication and cognitive function.
• The FIM requires observation of task performance and rating by
trained observers, who may be practitioners, clients’ family members.

54. Cont.
• The type and amount of assistance required to perform tasks is used
to measure disability severity and care burden.
7-point scale 4-point scale
1 Total assistance with clients exerting less
than 24% effort
1 Dependence (1,2)
2 Complete dependence with clients exerting
25% plus effort
2 Modified dependence (3,4,5)
3 Moderate assistance with clients exerting
50% plus effort
3 Modified independence (6)
4 Minimal assistance with clients exerting
75% plus effort
4 Independence (7)
5 Supervision
6 Modified independence(some delay, device
usage)
7 Complete independence

55. 5. KLEIN-BELL ACTIVITIES OF DAILY LIVING SCALE
(KLEIN-BELL)
• The Klein-Bell scale was designed to measure ADL independence in
children and adults.
• It is useful for determining current status, change in status, and the
subtasks to focus on during intervention.
• The Klein-Bell scale is an observational instrument.
• Task analysis is used to identify critical and observable subtask are
scored as follows:

56. Cont.
 1 - able to perform
 2 - unable
 3 - not applicable
• The total points achieved within each task are added to give an
overall independence score.
• These scores can range from 0 to 313, but are expressed as
percentages of the total points possible.

57. 6. KOHLMAN EVALUATION OF LIVING SKILLS (KELS)
• The KELS was designed to aid in discharge planning for clients with
psychiatric diagnoses.
• It evaluates the ability to live independently and safely in the
community.
• It has also been used with geriatric clients and those with mental
retardation, brain injury, and cognitive impairment.
• The KELS combines interview and performance-based methods and
tends to emphasis the knowledge component of tasks.

58. Cont.
• 18 tasks are included on the KELS and are grouped into five
categories, namely:
 self-care
 safety and health
 money management
 transportation and telephone
 work and leisure
• Task performance is scored as:
 0 signifying independence
 1 or ½ signifying needs assistance

59. 7. MILWAUKEE EVALUATION OF DAILY LIVING SKILLS (MEDLS)
• The MEDLS was designed to establish baseline behaviors necessary to
develop treatment objectives and guide intervention relative to daily
living skills for clients with chronic mental health problems.
• MEDLS subtest/tasks can be administered individually or in
combination.
• A screening form is used to ascertain the specific items to be
examined for each client as well as obtaining information from clients
and their families.

60. Cont.
• Each subtest/task is scored according to the number of skills
completed.
• No summary score is calculated for the MEDLS because the
administration of subtests varies from client to client.
• Subtests have a specified time for completion and when this is
exceeded, the practitioner makes a clinical judgement about the
cause of the delay.

61. 8. PERFORMANCE ASSESSMENT OF SELF-CARE SKILLS (PASS)
• The PASS was designed to evaluate healthy, older adults as well as
those with osteoarthritis, dementia, depression, cardiopulmonary
disease, schizophrenia, mental retardation, and low vision.
• It can be used to assess baseline status and change over time
following intervention or age – associated or disease- related
changes.
• Additionally, it provides data useful for planning intervention or the
support needed at discharge. It is also a performance-based
observational tool
• Measurement parameters are rated on a 4-point ordinal scale with 0
representing dysfunction and 3 representing function.

62. RANGE OF MOTION (ROM)
• ROM is the arc of motion through which a joint passes.
• Passive range of motion (PROM) is the arc of motion through which
the joint passes when moved by an outside force.
• Active range of motion (AROM) is the arc of motion through which
the joint passes when moved by muscles acting on the joint.
• Joint structure and the integrity of surrounding tissues determine the
directions and limits of motion for any given joint.

63. Purpose of evaluating ROM
• The occupational therapist evaluates ROM to:
1. Determine limitations that affect function
2. Determine limitations that may produce deformity
3. Determine additional range needed for function
4. Keep a record of progress or regression
5. Determine appropriate treatment goals
6. Determine the need for splints, assistive devices, or both
7. Select appropriate treatment modalities, positioning techniques, and other strategies
to decrease limitations.

64. Goniometric Measurement Tools
• A goniometer is the instrument used to measure joint ROM.
• Goniometers can be metal or plastic and comes in several sizes.
• Goniometer comprises of the following parts:
i. Protractor
ii. Stationary bar
iii. Movable bar
iv. Axis/Hinge joint

65. Goniometer

66. Goniometer parts cont…
• Protractor: A half-circled, attached to the stationary bar, printed with a
scale of degrees from zero to 180 degrees in each direction which permits
measurement of motion in both directions without reversing the tool.
• Stationary bar: The stationary arm is structurally a part of the body and
therefore cannot move independently of the body
• Movable bar: The moving arm is attached to the fulcrum in the center of
the body by a rivet or screw-like device that allows the moving arm to
move freely on the body of the device
• Axis/Hinge joint: Where the two arms are riveted together. It must move
freely, yet be tight enough to remain where it was set when the
goniometer is removed from the body.

67. Functions of Goniometric
• Most clinics use this 180-degree system where:
1. 0 degree is the starting position for all motions.
2. Anatomic position is the starting position.
3. 180 degrees is the superimposed as a semi-circle on the body in the
plane in which the motion will occur.
4. The axis of the joint is the axis of the semi-circle/arc of motion.
5. All joint motions begin at 0 degrees and increase toward 180
degrees.
• Other measurement systems used include the 360-degree system
where 180 degree is a starting position and motion occurs toward
zero degrees.

68. General Principles of Goniometry
• Formal joint measurement is not necessary with every client,
especially when limited ROM is not anticipated.
• Typical diagnoses that may necessitate closer attention include
arthritis, fractures, cerebrovascular accident (CVA), and spinal cord
injury.
• AROM can be visually observed during ADL or by having the client
move through various positions.
• All joints can be put briefly through various PROM. However, joints
should not be forced beyond the point of resistance.

69. Cont…
• Normal ROM varies from one person to the next, however, one could
also measure the uninvolved extremity as a normal comparison.
• A medical history should be noted for any previous joint injury or
secondary diagnosis affecting ROM.
• ROM can be limited by pain.
• Before evaluation, the therapist needs to know the average normal
ROM, how the joint moves, and how to position himself/herself, the
client, and the joints for measurement.

70. Cont.
• The term goniometry is derived from two Greek words, gonia
meaning angle and metron, meaning measure. Thus, a goniometer is
an instrument used to measure angles.
• Within the field of occupational therapy, goniometry is used to
measure the total amount of available motion at a specific joint.
• Goniometry can be used to measure both active and passive range of
motion.
• The two most common types of instruments used to measure joint
angles are the bubble inclinometer and the traditional goniometer.

71. The bubble inclinometer
• It has a 360° rotating dial with fluid
indicator
• It aid in measuring angles of slope
with respect to its gravity by creating
an artificial horizon.
• It is also known as a tilt sensor, tilt
indicator, slope meter, slope gauge,
gradient meter, gradiometer, level
gauge & level meter.

72. Procedure for using bubble inclinometer
• Place the bubble inclinometer near the joint to be measured
• Turn the bubble inclinometer dial until the scale reads 0
• Take the joint through it's range of motion
• Read the range traveled directly from the bubble inclinometer dial
NB: Some neck and back measurement protocols require the
simultaneous use of 2 inclinometers.

73. Bubble inclinometer vrs Traditional goniometer
• The bubble inclinometer, which has a 360° rotating dial and scale with
fluid indicator can be used for
flexion and extension;
abduction and adduction; and
rotation in the neck, shoulder, elbow, wrist, hip, knee, ankle, and
the spine.
• The traditional goniometer, which can be used for
flexion and extension;
abduction and adduction; and
rotation in the shoulder, elbow, wrist, hip, knee, and ankle

74. Flexion and Extension

75. Flexion and Extension

76. Flexion and Extension
• In anatomy, flexion and extension are two opposing movements that
muscles can perform about a joint.
• Flexion is a motion in which the angle of the joint involved decreases,
as in bending the elbow so that the forearm is brought toward the
upper arm.
• Extension is a movement that increases the angle of the joint, as in
straightening the elbow.
• Both occur in a single, front-to-back plane of motion known as the
sagittal plane

77. Abduction and Adduction

78. Abduction and Adduction
• Abduction and adduction refer to motions that move a structure
away from or towards the centre of the body.
• Abduction refers to a motion that pulls a structure or part away from
the midline of the body.
• Adduction refers to a motion that pulls a structure or part toward the
midline of the body.
• Both motions occur in a single plane of movement known as the
frontal plane.

79. Pronation and Supination
• Pronation and supination are a pair
of unique movements possible only
in the forearms and hands, allowing
the human body to flip the palm
either face up or face down.
• The muscles, bones, and joints of
the human forearm are specifically
arranged to permit these unique and
important rotations of the hands.

80. Cont.
A. FOOT PRONATION
B. NEUTRAL FOOT
C. FOOT SUPINATION

81. Cont.

82. Ulnar Deviation and Radial Deviation
• Ulnar deviation (ulnar flexion)
It is the movement of bending the wrist to the little finger, or ulnar
bone, side.
• Radial deviation (radial flexion)
It is the movement of bending the wrist to the thumb, or radial bone,
side.
NB: Students should identify and explain three (3) sets of distinct
movements the wrist is capable of doing.

83. Inversion and Eversion of the foot
Inversion and eversion refer to movements that tilt the sole
of the foot away from (eversion) or towards (inversion) the
midline of the body

84. ROM Evaluation Procedure
1. Position client comfortably.
2. Explain and demonstrate to client what you are doing and why.
3. Stabilize joint proximal to joint being measured.
4. Observe available movement by having client move joint or
examiner move joint passively to get a sense of joint mobility.
5. Place goniometer axis over joint axis in starting position.
6. Record the number of degrees at starting position.
7. Hold the body part securely above and below the joint being
measured. Gently move the joint through the available PROM.
8. Return limb to resting position
9. Record the number of degrees at the final position.
10. Date and sign.

85. Advantages and Disadvantages of Goniometers
• Goniometers are portable
• They are simple enough to be mass produced in a short amount of time.
• They are inexpensive and have many different purposes, ranging from
those found in the medical industry to applications in physical science.
• However, they are limited by the materials that they can be constructed
from.
• They must also be used in conjunction with a surface medium in order to
provide any significant results.

86. Active ranges of motion of the larger joints
JOINT ACTION DEGREES OF MOTION
Shoulder Flexion 0 – 180
Extension 0 – 40
Abduction 0 – 180
Internal rotation 0 - 80
External rotation 0 - 90
Elbow Flexion 0 - 150

87. Cont.
JOINT ACTION DEGREES OF MOTION
Forearm Pronation 0 - 80
Supination 0 - 80
Wrist Flexion 0 - 60
Extension 0 - 60
Radial deviation 0 - 20
Ulnar deviation 0 - 30

88. Cont.
JOINT ACTION DEGREES OF MOTION
Hip Flexion 0 - 100
Extension 0 - 30
Abduction 0 - 40
Adduction 0 - 20
Internal rotation 0 - 40
External rotation 0 - 50

89. Cont.
JOINT ACTION DEGREES OF MOTION
Knee Flexion 0 - 150
Ankle Plantarflexion 0 - 40
Dorsiflexion 0 - 20
Foot Inversion 0 - 30
Eversion 0 - 20

90. Group Presentations
• Group 1 –
• Group 2 –
• Group 3 –
• Group 4 –
• Group 5 –

91. The End.
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