UE Reaching

Question 1

Eye-head-hand Coordination Series of Events

Answer 1

Typically…
Eyes reach target first
Then head
Then hand

Question 2

Eye-head-hand Coordination

Answer 2

-entire reach is guided by vision
-need to “vaguely” know the target or object location in order to plan/execute reach direction and distance (peripheral vision)
-last part of the reach is vision dependent (foval vision)
“Foviate” your eyes on the object
Must know the object characteristics in order to successfully grasp the object

Question 3

Eye-head-hand Coordination: Encourage…

Answer 3

Encourage our patients to find target with their eyes first in order to locate and facilitate an accurate reach

Question 4

Smooth pursuit

Answer 4

Track a slow moving object smoothly
Can only be done to a certain speed -> saccades
CN 3, 4, and 6

Question 5

Saccades

Answer 5

• rapid eye movements

- Don’t process on what’s in between-just focusing on each vocation

Question 6

Cerebellar trauma (or stroke) Issues

Answer 6

• Gaze-evoked nstagmus
• disrupted smooth pursuit
• Ocular dysmetria when performing saccades

Question 7

Gaze-evoked nystagmus

Answer 7

• Slow nystagmus in same direction of the spin
• Fast nystagmus in opposite direction of spin
• **Caused by a quick saccade! Just looking at target, their eyes cannot focus

Question 8

Disrupted Smooth Pursuit

Answer 8

Cannot keep tracking an object

Question 9

Ocular Dysmetria when performing saccades

Answer 9

• Dysmetric= poor measurements
• Hypometric- falling short of object, undershooting
• Hypermetric- falling past object, overshooting
• Can’t pick up object until eyes target object

Question 10

Dorsal pathway (superior) “spatial vision”

Answer 10

• parietal lobe
• processing of spatial relationships between you/objects
• Have pt move objects around in space to work on the “spatial vision”

Question 11

Ventral pathway (interior) “object vision”

Answer 11

• temporal lobe

- processing physical qualities of an object

Question 12

Transport

Answer 12

• primarily the proximal joints moving the hand where it needs to be
• Scapula, shoulder, elbow and forearm if within arm length reach (trunk stable)
• if reach is beyond arm’s length include trunk:
• Sitting: includes the trunk (trunk dynamic)
• Standing: may include the trunk and LEs (e.g. hip or ankle strategy)

Question 13

Reaching from the Sitting Position: Within Arm’s Length

Answer 13

Stable Trunk:

Facilitation of abdominal and lumber co-contraction for reach within arm’s length (to avoid falling)

Question 14

Reaching from the Sitting Position: Beyond Arm’s Length

Answer 14

Dynamic trunk

• Facilitate weight shift from centered to over ischial tuberosity, same side as reach (diagonal is lateral and anterior)
• Facilitate Pelvic Tilt (posterior -> anterior) & Lumbar (flexion -> extension)
• Facilitation of trunk lateral elongation (reach side) and contraction/lateral flexion (contralateral side)

Question 15

Dynamic trunk reach

Answer 15

The more angular (on a diagonal) the reach, the more you observe the previous patterns. Plus encourage a “high” reach by placing an object.

Question 16

Reaching from the Sitting Position: Scapula

Answer 16

-Scapular protraction (upward rotation/ER) (abduction, external rotation, elevation)-reach forward
-Scapular retraction (downward rotation/IR)
(adduction, internal rotation, depression) –come back

Question 17

Reaching from the Standing Position: Within Arm’s Length

Answer 17

Trunk & body fairly stable:
Facilitation of abdominal and lumber co-contraction for reach within arm’s length…need to stabilize more for heavier objects

Question 18

Reaching from the Standing Position: Beyond Arm’s Length [Trunk and Ankle]

Answer 18

• Dynamic trunk and body & LEs
• Facilitate weight shift to ipsilateral foot and trunk elongation
• Ankle strategy – relative DF to weight shift (rocking)– just a little beyond’s arms length

Question 19

Reaching from the Standing Position: Beyond Arm’s Length [Hip]

Answer 19

• Dynamic trunk and body & LEs
• Facilitate trunk/hip flexion & relative ankle plantarflexion
• COM of pelvis must shift posterior
• COM of chest must shift anterior, elevate and lateral (ipsilateral)

Question 20

Reaching from the Standing Position: Beyond Arm’s Length [Stepping]

Answer 20

-Facilitate through pelvis to encourage step
(diagonal lateral and anterior shift)
-Facilitate through upper (chest) & lower trunk elongation

Question 21

UE Reaching: Scapula, Shoulder and Elbow

Answer 21

-Facilitate scapula protraction,
shoulder elevation and elbow extension
-you could say forearm is pronating and wrist moves into flexion

Question 22

Grasp

Answer 22

• primarily the distal joints of the wrist and hand performing manipulation
• Fine motor control
• Some reference the forearm as part of transport and some state the forearm is part of manipulation or grasp

Question 23

Spatial Trajectory

Answer 23

• Reaching is a multi-joint movement accomplished by a straight line trajectory
• Essentially a straight line from start to target locations

Question 24

Spatial Trajectory: Force and Direction

Answer 24

• had variability in trajectory and end point
• Pt needs to accurately plan and execute the movement
• Essentially straight spatial hand path or trajectory
• Effector - index finger – reach and point
• try to figure out if pt has problem with force OR direction and help you configure a strate

Question 25

Spatial Trajectory: Effector

Answer 25

can differ [what pt can get on target] Pointing – tip of index finger Grasp – tips of thumb and index fingers Punch – knuckles

Question 26

Joints involved in Transport Changes with Movement Direction : Simple

Answer 26

- relatively single joint movement | - “relatively a simple movement”

Question 27

Joints involved in Transport Changes with Movement Direction : Horizontal

Answer 27

- relatively two-joint movement | - Horizontal adduction and elbow extension (opposite coming back)

Question 28

Joints involved in Transport Changes with Movement Direction : Straight line across page

Answer 28

- joint reversal movement | - Horizontal adduction and elbow flexion then extends [joint reversal]

Question 29

Spatial Trajectory: Purpose

Answer 29

An individual must correctly plan and execute both the proper direction and distance of the trajectory

Question 30

Spatial Trajectory: Accuracy

Answer 30

-Direction versus Distance (force) Error -distance error > direction error [Distance = force] [Direction = multi-joint] -increased both types of error with distance -This is done on a moradum, where the elbow and shoulder are free to move BUT the motion is restricted to a 2D movement

Question 31

Constant error (CE)

Answer 31

distance from the mean end point location to the center of the target

Question 32

Variable error (VE)

Answer 32

- a measure of error dispersion - one standard deviation in the X & Y directions - “The Scatter” of the 6 dots - How variable are they in their reaches/end point

Question 33

Speed-Accuracy Tradeoff

Answer 33

- Increase movement speed, decrease accuracy | - Decrease movement speed, increase accuracy

Question 34

Fitt's Law

Answer 34

MT = a + b log2 (2A/W) A = amplitude (distance start to target) --As A increases, MT will increase bc it takes more time to each the target [directly related] W = width of target --as W decreases, the MT increases to hit target [inversely proportioned] MT=movement time (varies with distance of A and with W)

Question 35

Transport: Clearance

Answer 35

- Movements around obstacle - Forces curvilinear trajectories - Minimum clearance – closest approach to obstacle - Move fast over obstacle, increase minimum clearance - Move slow over obstacle, decreases minimum clearance

Question 36

Hand Grasp

Answer 36

- Spatial hand path or trajectory - Maximum aperture – 60-80% of reach distance or time - Maximum aperture is relative to object width - pre-shaping as reach - finalize shape at end of reach

Question 37

Maximum Aperture

Answer 37

- Width of fingers spread apart - Maximum aperture is 2.5 – 3 times larger than object width - Finger start to match shape of object at end of reach trajectory - When they “mold” around the object as you touch the object

Question 38

Grip Force

Answer 38

- Must match grip force to object weight (grip to load ratio) - Must match grip force to texture of object (grip to texture ratio)

Question 39

In-hand Manipulation

Answer 39

- Translation - move object to fingers, to palm and back - Shifting - moving a “pen” closer and further from tip - Rotation - rotating and stabilizing an object

Question 40

Clinical Application: Grasp

Answer 40

``` Vary: size and shape of object weight and texture of object orientation of object use of object “slipperiness” fragility of object vary functional use stationary versus moving objects/person (taxonomy) ```

Question 41

Interlimb Timing Constraints and Phase Characteristics

Answer 41

The two hands are temporally and spatial linked -Ex 1: finger abduction-adduction -Ex 2: tap two hands at different rates -example three: spatial/timing constraints Draw simultaneously

Question 42

In Clients post-CVA or TBI...

Answer 42

- use non-involved UE to impose temporal and spatial constraints upon involved UE - Perform bi-manual movements (rolling pin, etc.), mirrored movements, & reciprocal movements - This will train both the movement pattern (muscles sequencing) and timing

Question 43

Take Home Message: UE Reaching

Answer 43

- Do not use a haphazard approach when setting up tasks for your patient(s) to perform - Methodically plan to expose your clients to a wide variety of functional tasks in multiple environments