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Functional Anatomy
Department of Rehabilitation Sciences
The Hong Kong Polytechnic University
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Aims
Apply anatomy knowledge
in a functional perspective.in the understanding of
pathological conditions
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Functional Anatomyof Lower Limbs
Examples
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Functions of lower limbs
Support Locomotion
bipedal
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Body weight is transferred from:
Weight bearing
bones – strong joints – stable
base – wide & adaptable
Support - skeletal system
ADAM
h e a d > V C
h i p > f e
m u r
t i b i a > t a l u s >
c a l &
M T
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Support FunctionBalance:
Related to falling eg, ‘keeping one’s balance’
Body dynamics:
Inertial forces acting on the bodyCharacteristics of the body segments
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Support Function
Posture
Orientation of body/body segment
Usually measured with referenceto the vertical
Good
Posture
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Maintaining Balance
Complicated Activity . . .Requires integrity ofMusculoskeletal System
Postural musclesNervous System
Reflex loops
Somatosensory inputVestibular
Vision
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Support Locomotion
Initial
Static
Semi-static position
Final
Dynamic movement
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Eye muscles
Gaze stabilization
Postural muscles
Balance control
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Falls of elderly
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Hip Joint Range required in sitting
Depends on posture, chair height & depth, activit ies
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Sit to standKinematics Hip
from flex to ext.
about 800-1000 flex is required.
Knee
from flex to ext
range depends on height of
seat
Ankle from plantarflexion
to neutral
Muscular Actions Gluteus max.
Hamstrings
Quadriceps
Note positions
of joints
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Sit to stand: Two main phases . . .Phase 1
Forward rotation of trunk over stationary thigh base of support = chair; controlled eccentrically by hip
extensors therefore hip flexion occurs.Phase 2
Raising of the COM above feet
new base of support = feet; Hip & knee extension;Ankle plantarflexes to neutral.
P
H
A
S
E
2
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How does a person with functionalimpairment of lower limbs stand up?
Push up w/ UL;
Lat dorsi + triceps
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How does a person with progressivemuscular dystrophy rise to a standingposition?
Gowers’ sign: arms push body to (B), using arms to
‘walk’ to (C), then climb up on legs to erect position (D).
Shands’
Walk back to C
C
L
I
M
B
A to B
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How does impaired function inlower limbs affect the ADL?
Toileting
Dressing
Note hip ROM
Getting intoBath tub
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Locomotion – Walking, Running . .Functional kinetic chain
Interrelated systems
Compensation takesplace when one
system / structure isimpaired
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Walking (Locomotion)
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Locomotion Function
Challenges
Controlling foot trajectory.
Evidence that the average toe
clearance above the groundduring swing phase:
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Functional Impairment due to Nerve / Muscles /
Tendon Injuries to ankle dorsiflexor . . . .
Unable to control foot
Slapping noise compensation
Unable to hold foot up
Dragging of Toes
foot-strike to mid support forward swing phase
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High steppage gait
Go to media clip
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Up/down stairs
Joint range required ?
Muscles required ?
Nerve required ?
Plantar FlexorsIliopsoasQuadriceps
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Functional impairment due to Nerve /Muscle / Bone injury to hip region . . .
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Trendelenburg Sign on single leg standing
& Gait 3 factors for normal fx: • normal fx glut med & min
• hip joint located
• femoral neck intact
(R) CDH
Abductors:
• maintain / raise
pelvis level to
enable the other
leg to swing
forwards
Weight of leg drags
the pelvis down
(L)
Another patient
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Trendelenburg gait
Go to media clip
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Injuries to other structures . . .
Anterior cruciate ligament (ACL)
injury is quite common (Miyasaka et al. 1991)
Operative & Non-operative procedure (Johnson et al. 1992)
Go to media clip
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Anterior Cruciate Ligament: action
Primal
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Anterior Cruciate Ligament: testing
PrimalNote excessive
movement. Go to Clip
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Anterior Cruciate Ligament:
grafting
Wilk & Andrews 1992Intensive Rehab is required
Go to media clip
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ADAM
Rehabilitation
Surgery: grafting why the exercise on the right
is not suitable for early phaseof rehab?
Function: prevent forward
displacement of tibia
early phase: graft not secured
very large anterior displacement
by the strong quadriceps muscle,
may damage the healing graft.
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Foot Conditions
Hallus Valgus & Bunion
Flat Foot
Foot Pronation
Fallen arch
Foot Supination
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Foot conditions
correction by realignment
Normal Pronation
Orthotics:
(insole)
(special shoes)
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Loss of function - supportBone & Joint
Muscles & ligaments
Go to media clip
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How can we help? Artificial system
e.g. replacement, wheelchair, brace, crutches
Compensatory system -
strengthening ex.
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Functional Anatomy
Upper LimbExamples
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Stability vs Mobility
articular surfaces
shape, size, & arrangement
ligament & capsule
muscle tone around the joint
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How can we help?
Right deltoid atrophy from axil lary n. paralysis
following dislocation of shoulder (Shands’ p212).
Ball bearing or Rocker Feeder
Places arm in posit ion for feeding
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Conditions Affecting the Hand:
Rheumatoid arthritis,osteoarthritis
Industrial Accident
Lost digits
Congenital Conditions
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How can we help?
Exercise,
Special Aids,Splints
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Functions of handIntegration of systems
Grasping mechanism STRENGTH
PRECISION
Sensory
Expression
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Factors influencing grip
Shape of objectSize of object
Physical factors
weight, texture, temp.
Intended activity
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The End
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