The Biomechanical Model

The Biomechanical model

Introduction
• Occupational therapist uses the biomechanical frame of reference in
orthopedic cases, burn cases and patients with limited range of motion and
strength. The Biomechanical frame of reference is based on Joint range of
motion, Muscle strength, and Endurance with the intact central nervous
system.
History
• This model has been present in some form throughout the history of
occupational therapy. At one time it was called kinetic occupational
therapy.
• The biomechanical model is a remediation and bottom up approach.

Focus
• The musculoskeletal capacities on which functional movement depends

• Strength
• Range of motion
• Endurance
Clients
• This model targets a specific group of clients, that is people who have problems with
movement which in turn affects their ability to perform daily occupations. This includes:
• Orthopedic problems such as fractures and arthritis, hand and upper limb injuries, burns,
lower motor neuron lesions such as spinal cord injuries, cardiac conditions.
• This model is not suitable for people who have movement problems resulting from an
upper motor neuron lesion such as head injury.
• It is used for people who are likely to regain functional movement, strength and
endurance, or who can benefit from prevention.
• It is applicable across the lifespan, perhaps with the exception of the very elderly.
Interdisciplinary base
• Kinetics ‫لحركة‬..‫ببتا‬..‫ليس‬..‫لقوة ا‬..‫ا‬and kinematics‫ا‬.‫فسه‬..‫لحركة ن‬..‫فاصيلا‬...‫ ت‬, anatomy and physiology

especially of the musculoskeletal and cardiovascular systems.
• Theory
• The theory of this model is concerned with the biomechanical basis of the stability and
movement required to perform occupations
• Knowledge of structure and function of each joint, the factors involved in stability and
movement, the factors involved in the production of muscle tension and the capacity to
sustain muscle activity over time (endurance).
Assessment
• ROM – use of goniometer

• Strength – manual muscle testing
• Endurance – stress testing for example
Function – Dysfunction continuum
• This part of biomechanical frame of reference focuses on concern areas or problem
areas. Concern areas of this frame of reference are –
1. Structural stability,
2. Passive Range of motion,
3. Low level endurance
4. Edema control,
5. Strength,
6. High level endurance.
Function – Dysfunction continuum
• These areas should be focused by an occupational therapist while
assuming biomechanical frames of reference in the treatment plan.
• Structural stability assumed as a primary concerned area after that only,
therapist can stress peripheral structures (muscle stretching). In a fracture
case, bone and soft tissue healing, consider as structural stability.
• And, high level Endurance should take care of at the end of treatment
planning. Low level endurance training can be initiated along with low
resistance activities to boost repetition.
Behaviors Indicative of Function –
Dysfunction (Guide for Evaluation)
• In Biomechanical evaluation OT uses different tools for assessment like
Goniometer for Joint range of motion, Volumetry for edema, and manual
muscle testing for strength.
• Along with these formal tests, OT also does clinical observation, including
Skin’s appearance, End feel during range of motion and grip strength.
• Low level and high level endurance can be assessed by using cardiac step
chart and metabolic equivalents chart (MET). After the formal and
informal assessment, OT set the objectives and goals for the patient.
Intervention
• Focus on:
• Preventing deformity and maintaining existing capacity for movement
• Restoration of capacity
• Compensation for limited motion
• Kielhofner includes compensation for limited motion as a focus of the biomechanical model.
Other authors, for example Rybski place compensation in the rehabilitation model.
Compensation will be discussed more fully under the rehabilitation model.
• The intervention methods in the biomechanical model are clearly specified.

Techniques to prevent deformity and maintain existing capacity
• Active/passive ranging
• Stretching
• Compression
• Positioning (for example, for a client with burns)
• Splinting
• Education re body mechanics (for example for a client who has to lift or do
repetitive work)
• Resisted exercise
Techniques to improve/restore capacity
• Graded exercise
• Graded activities (activity analysis is used with the biomechanical model)
• Simulated tasks, for example work tasks
• Techniques to compensate for lack of or reduced function

• Assistive devices
• Environmental modifications
• Modification of tasks
Biomechanical Goals, and Functional outcomes.
• For Example, a patient who is a writer fell down on his hand and the
radius bone got fractured (right side).
General Deficit / Present problem Loss of joint range of motion
Supination of forearm 70 degrees

Biomechanical Goals Pronation of forearm 70 degrees
Wrist extension 70 degrees
Ability to hold a pen and write with

Functional Outcome
wrist extended and forearm pronated.
In the above example, the patient doesn’t care about 10-15 degree improvement in
wrist extension; he must be more concerned about his writing abilities for the long
duration.
Biomechanical Goals, and Functional outcomes.
• intervention create links between biomechanical goals and therapeutic
activities.
Supination of forearm 70 degrees
Pronation of forearm 70 degrees
Measurable Biomechanical Goals
Wrist extension 70 degrees
It consists of heat, manual stretch and

splinting. Which increases elasticity of the
General Treatment Method skin, elongates collagen fibers and position
of the joints in functional position
Involve him/her in writing task.

Functional Activities
In the above example, both of these, general & functional activities, helps OT to
achieve better client oriented result.
In the biomechanical frames of reference, it’s easy to develop measurable
biomechanical goals because this frame of reference uses quantitative evaluation data
such as degree of range of motion.
Limitations
• Traditionally the biomechanical model has focused on performance components.

• The research provides little evidence to support the belief that improvement in strength, endurance
and range of motion will transfer to occupational performance.
• In itself it is not a client centered approach. The client is a passive recipient of the therapy. The
model is reductionist rather than holistic – that is, it focuses on part of the person rather than the
whole person.
• Not occupation centered. The use of this model may influence therapists to focus on non-
occupational aspects of therapy.
• The model focuses only on physical performance and does not include volition, context,
motivation, psychological and social aspects.
Research
• The model has been well researched from the perspective of the kinetic and kinematic aspects.
Research focusing on the model as it relates to occupational performance is less common but
some studies have been done. For example, a study that examined muscle action and kinematic
patterns in the performance of different tasks (Wu, Trombly & Lin, 1994).
• Another area of study focuses on how meaning and purpose affects improvement in movement
capacity. For example a study by Kirchner (1984) compared perceived exertion when doing
purposeful tasks and when doing non purposeful tasks.
• Such research may eventually influence how this model is used in occupational therapy.
• A recent study in Australia by McEneany, McKenna & Summerville (2002) examined treatment
choice by occupational therapists working in adult physical dysfunction settings and found a
trend towards treatments that are functional, client focused and that address occupational
dysfunction.

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The Biomechanical model

• The biomechanical model is a remediation and bottom up approach.

• The musculoskeletal capacities on which functional movement depends

• Kinetics ‫لحركة‬..‫ببتا‬..‫ليس‬..‫لقوة ا‬..‫ا‬and kinematics‫ا‬.‫فسه‬..‫لحركة ن‬..‫فاصيلا‬...‫ ت‬, anatomy and physiology

• ROM – use of goniometer

• The intervention methods in the biomechanical model are clearly specified.

• Techniques to compensate for lack of or reduced function

General Deficit / Present problem Loss of joint range of motion

Supination of forearm 70 degrees

Ability to hold a pen and write with

It consists of heat, manual stretch and

Involve him/her in writing task.

• Traditionally the biomechanical model has focused on performance components.

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