{
  "resourceType": "ActivityDefinition",
  "id": "forearm-pronation-supination",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/forearm-pronation-supination",
  "version": "1",
  "name": "ForearmPronationSupination",
  "title": "Forearm Pronation/Supination with Hammer",
  "status": "draft",
  "experimental": true,
  "description": "Seated with elbow on thigh, rotate forearm using a weighted hammer or dowel. The offset weight creates torque for resisted pronation and supination.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: beginner"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "forearm-pronation-supination",
          "display": "Forearm Pronation/Supination with Hammer"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "elbow",
          "display": "Elbow"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "20903007",
          "display": "Structure of proximal radioulnar joint"
        }
      ],
      "text": "Elbow"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×10-15 reps each direction"
    }
  ],
  "usage": "Evidence: limited.",
  "note": [
    {
      "text": "Quiet elbow — only the forearm rotates",
      "authorString": "focus:internal"
    },
    {
      "text": "Tilt the hammer head all the way to the floor, then to the ceiling",
      "authorString": "focus:external"
    },
    {
      "text": "Move slowly through full range, both directions",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand on the elbow — it stays glued to the thigh",
      "authorString": "focus:tactile"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    },
    {
      "type": "citation",
      "label": "bader-forearm-rotation-emg-2018",
      "citation": "Bader J, Boland MR, Greybe D, et al.. (2018). Muscle Activity During Maximal Isometric Forearm Rotation",
      "document": {
        "url": "https://doi.org/10.1016/j.jbiomech.2017.12.011"
      }
    },
    {
      "type": "citation",
      "label": "gordon-forearm-pronation-supination-2004",
      "citation": "Gordon KD, Pardo RD, Johnson JA, King GJ, Miller TA. (2004). EMG Activity During Maximum Isometric Pronation and Supination",
      "document": {
        "url": "https://doi.org/10.1016/S0736-0266(03)00115-3"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Pronator Teres"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "29376000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Supinator"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "40678005"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Biceps Brachii"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "16225001"
          }
        }
      ]
    }
  ]
}