Anatomy and physiology for the pediatric practitioner
After studying this chapter, the reader will be able to accomplish the following:
• Distinguish between two branches of biology: anatomy and physiology.
• Understand and describe the hierarchy of organization of the human body.
• Describe the anatomic position.
• Understand and define the descriptive and movement terminology.
• Understand the cardinal planes and axes.
• Describe the structures and functions of the organ systems of the human body.
• Provide examples of pediatric health conditions or disorders of the organ systems of the human body.
• Understand and describe the relationship among body structures, the function of body structures, and one’s successful engagement in daily occupations.
* I would like to thank Robert (Bob) Hunter for his review of this chapter as a content expert in anatomy and physiology.
The Occupational Therapy Practice Framework (OTPF) describes the domains and processes inherent to the profession of occupational therapy (OT). According to the OTPF, the term client factors refers to those components that influence actions or occupations.1 For example, a child’s neuromuscular status is considered a client factor. Client factors include both body structures and functions (Table 11-1). The term body structures refers to the parts that make up the human body. For example, the structure of the hand includes bones, muscles, tendons, nerves, and blood vessels. A child with a missing thumb would have a deficient body structure that may interfere with his occupational performance. The term body functions refers to how the body part, organ, or organ system works. In the former example, body function would include the child’s hand strength or coordination. Deficits in body functions may also result in poor occupational performance. Since body functions and body structures are essential to understanding occupational performance, this chapter provides an overview of the structures in each body system. Lastly, the author provides an overview of how body structures and body functions influence occupational performance.
TABLE 11-1
| CLIENT FACTORS | |
| CATEGORY AND DEFINITION | EXAMPLES |
| Values: Principles, standards, or qualities considered worthwhile or desirable by the client who holds them. | Honesty with self and with othersPersonal religious convictionsCommitment to family. |
| Beliefs: Cognitive content held as true. | He or she is powerless to influence othersHard work pays off. |
| Spirituality: The “personal quest for understanding answers to ultimate questions about life, about meaning, and the sacred” (Moyers & Dale, 2007, p. 28). | Daily search for purpose and meaning in one’s lifeGuiding actions from a sense of value beyond the personal acquisition of wealth or fame. |
| BODY FUNCTIONS | |
| Categories | |
| Mental Functions (affective, cognitive, perceptual) | |
| Specific Mental FunctionsHigher-level cognitiveAttentionMemoryPerceptionThoughtMental functions of sequencing complex movementEmotionalExperience of self and time | Judgment, insightAwareness, sustained, selective, attentionShort-term, long-term, and working memoryDiscrimination, spatial, and temporal relationshipsRecognition, categorization, generalization, Execution of learned movement patternsCoping, adaptingBody image, self-concept, self-esteem |
| Global Mental Functions | |
| ConsciousnessOrientationTemperament and personalityEnergy and driveSleep (physiological process) | Level of arousal, level of consciousnessOrientation to person, place, time, self, and othersEmotional stabilityMotivation, impulse control, and appetite |
| Sensory Functions and Pain | |
| Seeing and related functionsHearing functionsVestibular functionsTaste functionsSmell functionsProprioceptive functionsTouch functionsPainTemperature and pressure | Detection/registration, modulation, and integration of sensations from the body and environmentVisual awarenessSensation of securely moving against gravityAssociation of taste & smellAwareness of body position and spaceComfort with the feeling of being touched by othersLocalizing painThermal awareness |
| Neuromusculoskeletal and Movement-related Functions | |
| Functions of joints and bonesJoint mobilityJoint stabilityMuscle powerMuscle toneMuscle enduranceMotor reflexesInvoluntary movement reactionsControl of voluntary movementGait patterns | ROMPostural alignmentStrengthDegree of muscle tone (e.g., flaccidity, spasticity, fluctuating)EnduranceRighting and supportingEye–hand/foot coordination, bilateral integration,Walking patterns and impairments |
| Cardiovascular, Hematologic, Immunologic,and Respiratory System FunctionCardiovascular system functionHematological and immunological system functionRespiratory system function | |
| Blood pressure functions (hypertension, hypotension, postural hypotension), and heart rateRate, rhythm, and depth of respirationPhysical endurance, aerobic capacity, stamina, and fatigability | |
| Voice and Speech Functions | |
| Digestive, Metabolic, and Endocrine System Function | |
| Genitourinary and Reproductive Functions | |
| Skin and Related-structure Functions | |
| Protective functions of the skin–presence or absence of wounds, cuts, or abrasionsRepair function of the skin–wound healing | |
| BODY STRUCTURES | |
| Categories | |
| Structure of the nervous systemEyes, ear, and related structuresStructures involved in voice and speechStructures of the cardiovascular, immunologic, and respiratory systemsStructures related to the digestive, metabolic, and endocrine systemsStructure related to the genitourinary and reproductive systemsStructures related to movementSkin and related structures |
Moyers, P. A., & Dale, L. M. (2007). The guide to occupationaltherapy practice (2nd ed.). Bethesda, MD: AOTA Press.
Note. Some data adapted from the ICF (WHO, 2001).
World Health Organization. (2001). International classification of functioning, disability, and health (ICF).Geneva: Author.
*Adapted from Table 2 from: American Occupational Therapy Association: Occupational therapy practice framework: Domain and process, 2nd edition, Am J Occup Ther 62(6):625–703, 2008.
Anatomy is the branch of biology that studies the structures of the human body. Physiology is the branch of biology that studies the functions of the structures of the human body. The human body comprises living matter. A unifying concept in biology is that structure or shape determines function in all living matter. One’s successful engagement in chosen daily occupations may be impaired if specific client factors related to body structures and functions are impaired or abnormal.
The organization of the human body is hierarchical. Atoms are the smallest unit of matter. By definition, matter is anything that takes up space and has mass or weight. Atoms of different elements have unique masses and space requirements. The most abundant elements found in living matter are carbon, hydrogen, oxygen, nitrogen, and phosphorus. Atoms link together (bond) to form molecules. For example, two hydrogen atoms bond with one oxygen atom to form one molecule of water (H2O). Molecules come together to form cells. Cells are the smallest units of living matter. The cells found in the human body are eukaryotic cells. Eukaryotic cells have a membrane bound nucleus that contains a person’s genetic information, for example, deoxyribonucleic acid (DNA) and genes. Cells come together to form tissues. There are four basic types of tissue found in the human body. The four tissue types are epithelial, connective, muscle, and nervous (Table 11-2). Tissues come together to form organs. Organs, for example, the heart, are made of two or more types of tissues. Organs come together to form organ systems, for example, the cardiovascular system, or the circulatory system, which consists of the heart and associated vessels. Organ systems come together to form organisms. The human body has numerous organ systems that work together to allow one’s active participation in chosen daily occupations.
The OT practitioner needs to understand the interrelatedness of various organs and organ systems in the human body. Knowledge of the terminology that is used in the study of the human body’s structures and functions also is necessary. The anatomic position is used as a reference point when studying the anatomy and physiology of the human body. By definition, the term anatomic position refers to a person standing upright with the arms resting at the side of the body, palms forward, and the head and feet pointing forward. The fingers of both hands are adducted (not spread apart) (Figure 11-1). The human body has bilateral (two-sided) symmetry, that is, the right side of the body is a mirror image of the left side of the body.3,4 The human body is divided into front (anterior/ventral) and back (posterior/dorsal) cavities. Organ systems are located in specific regions of the ventral and dorsal cavities. The ventral cavity is subdivided into thoracic, abdominal, and pelvic cavities. The dorsal cavity is subdivided into cranial and spinal cavities (Figure 11-2).
Terminology, planes, and axes
In the course of their work, OT practitioners use their knowledge of terminology to examine and understand the structures and functions of the human body. The term anterior or ventral refers to the front of the body. The eyes are located in the sockets found on the anterior surface of the head. The term posterior or dorsal refers to the back of the body. The spinous processes of the vertebra are found on the posterior surface of the neck and trunk. The term superior or cephalad refers to the head, or “above.” The nose is superior to the lips. The term inferior or caudal refers to the tail/foot, or “below.” On the face, the lips are inferior to the nose. Proximal means “closer to the body,” whereas distal means “farther away from the body.” The shoulder is proximal to the hand, and the hand is distal to the elbow. Medial means “closer to the midline” or to the “midsaggittal plane of the body.” Lateral means “farther away from the midline of the body.” With a person standing in the anatomic position, the styloid process of the ulna is medial to the styloid process of the radius.
Knowledge of the three cardinal planes and their axes is important to understand the anatomy and physiology of the human body, especially when analyzing the cross-sections of structures and movements at individual joints. (1) The sagittal plane divides the body into left and right sides. If the body is divided into equal left and right parts, then the plane is called the midsaggital plane. The axis for the sagittal plane is the frontal axis, which is perpendicular to the saggital plane. (2) The frontal plane divides the human body into anterior and posterior parts. The axis for the frontal plane is the saggital axis. (3) The horizontal or transverse plane divides the body into upper and lower parts. The axis for the horizontal plane is the vertical axis. Specific movements occur in each of the three cardinal planes, and the axes are the points about which a body part rotates. For example, bending of the elbow occurs in the sagittal plane. The elbow joint rotates about the frontal axis. Understanding these concepts is crucial to the analysis and measurement of the range of motion (ROM) of joints (Figure 11-3).
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