Chapter 10: Active resisted strength and neurological testing Flashcards
It is used to test the integrity of contractile tissue (muscle, tendon).
Active resisted testing
What are the factors that can affect muscle and tendon activity?
- Mechanically(tearing, rupture, spasms, inflammation, etc.)
- Chemically (weak due to malnutrition, i.e. vitamins, minerals, blood supply (insufficient or absent nerve supply).
- Neurologically
Active resisted testing is also known as:
Muscle strength testing or Myotome testing
What is the percentage of resistance that the therapists should apply on the start of the testing?
Approximately 20% of their strength and then increase gradually if needed.
To determine if the muscle in question is receiving an adequate nerve supply. What should the therapist do when applying the resistance?
The resistance must be applied for at least 5 seconds in neurological testing
Strength testing are commonly performed in what position?
Neutral or mid-range position
What will happen if testing is done at the end-range?
Testing at the end-range increases your chances of injuring the client, as well as giving you false findings.
What condition usually indicates a limited movement, or pain, on passive range of motion testing ?
Soft tissue injury
What condition usually indicates a decreased strength on active resisted testing?
Compromised nerve supply or poor blood supply.
What condition indicates in an increased pain on active resisted testing?
Mechanical injury in the muscle or tendon
What chart is used to assess muscle strength?
Muscle Strength Grading Chart
What is the range of scale of strength grading chart?
The scale is from 0-5
The muscle can move the joint against full resistance. What is the grade of muscle strength?
Grade 5
The muscle can move the joint but not against gravity. What is the grade of muscle strength?
Grade 2
The muscle can contract but not enough to create movement. What is the grade of muscle strength?
Grade 1
The muscle can move the joint against gravity but not with any resistance. What is the grade of muscle strength?
Grade 3
If the muscle strength is grade 0, What is the strength of the muscle?
no contractility (the muscle cannot fire)
If the muscle strength is grade 4, What is the strength of the muscle?
The muscle can move the joint with some resistance.
The subjective nature of the strength grading chart from 4 and 5. Muscle strength testing can be done more objectively by using:
Blood pressure cuff
What is the use of blood pressure cuff in assessment of muscle strength grade 4 and 5?
The cuff is inflated to 20 mm Mg of pressure and the part being testing pushes on the cuff to see what number can be reached on the cuff.
The use of blood pressure cuff in assessment of muscle strength grade 4 and 5. True or False:
- The stronger the contraction, the more pressure they will exert on the cuff, therefore, reaching a greater pressure on the cuff.
- Active Resisted ROM testing is done again from neutral, by resisting the action of the muscle being tested, with the client in the most comfortable position as possible.
True
An examination that describes the clinical relationship between the various muscles, reflexes, and sensory areas in the lower extremity and their particular cord levels.
Neurologic Testing of lower extremeties
What are included in Neurologic Testing?
Muscles, reflexes, and sensory areas
True or False:
Since there are no individual reflexes for the T12, LI, L2, and L3 levels, their integrity can only be evaluated through muscle and sensory tests.
True
What is the main flexor of the hip?
iliopsoas
Muscle testing of iliopsoas is done on what position?
The patient sitting on the edge of the examining table with his legs dangling.
What is the first step in muscle testing of iliopsoas?
First, stabilize the clients pelvis by placing your hand over his iliac crest and ask him to actively raise his thigh from the table. ( same on the opposite iliopsoas )
What is the second step in muscle testing of iliopsoas?
Place your other hand over the distal femoral portion of the client’s knee and ask him to raise his thigh further while you resist his motion. ( same on the opposite iliopsoas )
The __________ runs in an oblique band on the upper anterior portion of the thigh, immediately below the inguinal ligament; the ___________ runs in an oblique band on the anterior thigh, immediately above the knee cap; and the __________ lies between these two bands, on the anterior aspect of the midthigh.
L1 dermatome
L3 dermatome
L2 dermatome
The nerves emanating from L1, L2, and L3 provides sensation on what areas?
Over the general area of the anterior thigh between the inguinal ligament and the knee joint.
True or False:
- Lower extremity neurologic testing L2, L3, and L4 are best evaluated by muscle and sensory tests.
- The patellar reflex, although supplied by L2, L3, and L4, is essentially an L4 reflex .
True
Muscle testing:
For this test, the patient should sit on the edge of the examining table. Stabilize the distal end of his thigh and instruct him to extend his knee, while you offer resistance to his motion. What muscle is being tested and what nerve is involve?
Quadriceps: Femoral Nerve
For the test, the patient should be either seated or supine. Instruct him to abduct his legs; after placing your hands on the medial sides of both knees, ask him to adduct his legs against your resistance. What muscle is being tested and What nerve is involve?
Hip Adductor Group: Obturator Nerve
Muscle testing: offer resistance to dorsiflexion and inversion by pushing against the dorsal and medial aspects of the head of the first metatarsal bone. What muscle is being tested and what nerve is involve?
Tibialis Anterior: deep peroneal nerve
__________ - is a deep tendon reflex, mediated through nerves emanating from the L2, L3, and L4 nerve roots, but predominantly from L4.
Patellar reflex
To test this reflex, have your patient sit on the edge of the examining table with his legs dangling free or have him sit on a chair with one leg crossed over his knee. If he is a bed patient, support his knee in a few degrees of flexion. In these positions, then to locate the tendon accurately, palpate the soft tissue depression on either side of the infrapatellar tendon. Elicit the reflex by tapping the tendon with a neurologic hammer at the level of the knee joint. What reflex is being tested?
Patellar Reflex
Sensation Testing:
On the leg, the sharp crest of the tibia is the dividing line between the _____ dermatome on the medial side and the _____ dermatome on the lateral side.
L4
L5
To this test, place your thumb on the dorsal surface of the patient’s foot so that he must dorsiflex his great toe to reach for it. Oppose this motion by pushing on the nail bed of the great toe. What muscle is being tested and what nerve is involve? .
Extensor Hallucis Longus: Deep Peroneal Nerve
To this test, have the patient lie on his side as you stabilize his pelvis with one hand. Then instruct him to abduct his leg. After he has attained full abduction, resist his motion by pushing against the lateral side of the thigh at the level of the knee joint. What muscle is being tested and what nerve is involve?
Gluteus Medius: Superior Gluteal Nerve
For this test, the patient should sit on the edge of the examining table. First, secure the calcaneus, and place the thumb of your free hand in a position that forces him to dorsiflex his toes to reach for it. Then try to oppose this extension. The toes should be virtually unyielding. What muscle is being tested and what nerve is involve?
Extensor Digitorum Longus and Brevis
Deep Peroneal Nerve
Reflex Testing: True or False
There is no easily elicited reflex supplied by the L5 neurologic level. Although the tibialis posterior muscle provides an L5 reflex, it is difficult to obtain and very slight. If, after having performed the sensory and motor tests, the integrity of the L5 level is still uncertain, test the tibialis posterior reflex.
True
To this test. Hold the forefoot in a few degrees of eversion and dorsiflexion and tap the tendon of the tibialis posterior muscle on the medial side of the foot just before it inserts into the navicular tuberosity. Normally, this should evoke a small plantar inversion response. What reflex is being tested?
Tibialis posterior reflex
True or false:
The nerves which emanate from the S2, S3, and S4 neurologic levels are the principal nerve supply for the bladder. S2, S3, and S4 also supply the intrinsic muscles of the foot.
True
What is the neurologic level of Patellar Reflex?
L4
What is the neurologic level of Achilles Reflex?
S1
In neurologic Testing of L4, what muscle is being tested?
Anterior tibialis
Sensation testing of L4 is done on what areas?
Medial leg and medial foot
In neurologic Testing of L5, what muscle is being tested?
Extensor hallucis longus
In neurologic Testing of S1, what muscle is being tested?
Peroneus longus & brevis
Sensation testing of L5 is done on what areas?
Lateral leg and dorsum of foot
Sensation testing of S1 is done on what areas?
Lateral foot
Sensation Testing: True or False
The dermatomes around the anus are arranged in three concentric rings and receive innervation from S2 (outermost ring), S3 (middle ring), and S4—S5 (innermost ring). A sharp instrument traced gently over the skin in these three areas determines whether sensation is normal or paresthetic.
True
Reflexes requiring skin stimulation and are mediated through the central nervous system (cerebral cortex). What are the superficial reflex of the lower extremity?
Abdominal, cremasteric, and anal reflexes
What are the deep tendon reflexes that are mediated through the anterior horn cell?
Patellar and Achilles tendon reflexes
The absence of any superficial reflex may indicate an _________________ , an absence which has increased significance if it is associated with exaggerated deep tendon reflexes.
Upper motor neuron lesion
True or False:
Deep tendon reflexes are prevented from excessive reaction by the inhibitory properties of the cerebral centers; therefore, an exaggerated deep tendon reflex in combination with the loss of a superficial reflex is a double.
True
