Force Production Deficit

Question 1

What does it mean?

Answer 1

Muscle weakness - may be muscle, NMJ, peripheral n., or CNS dysfunction

Question 2

Is presentation variable?

Answer 2

Yes - may be localized to one joint, segmental (generalized to an extremity or body region), or r/t fatigue (of skeletal muscle and not necessarily CP endurance)

Question 3

Is movement fractionated?

Answer 3

Yes, if they can move 2/2 weakness

Question 4

Key tests and signs: strength

Answer 4

< 3+/5 to 4/5 t/o
Focal weakness at one primary joint
Deterioration in ROM of speed of movement with repetition

Question 5

Key tests and signs: STS

Answer 5

Failure during initiation phase, typically requiring assistance or accommodation
Extension of knees before hips during first half of execution

Question 6

Key tests and signs: gait

Answer 6

May need manual assistance or AD to WB and maintain upright posture
Deviations often significant
When severe, cannot ambulate

Question 7

Key tests and signs: reach and grasp

Answer 7

Difficulty or failure with reach > 60 deg of shoulder flexion or with sustaining reach position
Unable to maintain force for gripping objects, especially during transport

Question 8

Key tests and signs: postural control

Answer 8

Unable to stand unsupported or loss of support moment at hip and knee during SLS
Limited improvement in performance with practice; may worsen with repeated trials
When severe, may not be able to sit unsupported

Question 9

Associated signs: movement

Answer 9

Fractionated, if they can do it

Question 10

Associated signs: muscle tone

Answer 10

Normal, mild, or flaccid

Question 11

Associated signs: sensation

Answer 11

Normal or no more than mild loss of joint position sense at ankle, loss of sharp/dull sensation or numbness

Question 12

Associated signs: nonequilibrium coordination

Answer 12

When severe, may be unable to test 2/2 weakness

When milder, likely to be slow but accurate

Question 13

Associated signs: postural control

Answer 13

In early stages of recovery, unable to sit or perhaps stand unsupported; would fall w/o support

Question 14

Differential movement dx:

Answer 14

Movement pattern coordination deficit

Hypokinesia

Question 15

Expected outcome: good potential for recovery

Answer 15

Stable with standing ADLs
I ambulation in home and community (in familiar environments)
Ambulate w/o AD, or with cane at most (may need AFO)
Ascend/descend stairs reciprocally; may need railing for balance and support
Gait speed at least 60-80% of normal for age
Able to use hand in all functional tasks
W/ NS problems, may reach plateau in improvement in strength and notice ongoing difficulties w/ MSK fatigue, power, and speed

Question 16

Expected outcome: poor potential for recovery

Answer 16

Varies with degree of involvement
In all but most severe forms, improved I w/ functional activities using compensatory strategies, but may still require assistance
Use of WC, at least for distances; degree of I r/t involved extremities
When less severe, can ambulate short distances w/ AD, bracing, or physical assistance at very slow speeds
Able to use and as an arrest w/ activity in less involved cases
When more severe, requires 24-hr care

Question 17

Associated medical dx: good prognosis for recovery

Answer 17

Generalized debilitation
Disuse atrophy
Peripheral n contusion 
GBS
CVA (mild)
TBI
MS (remitting)

Question 18

Associated medical dx: poor prognosis for recovery

Answer 18

CVA
TBI
MS (chronic progressive)
Chronic inflammatory diffuse polyneuropathy
Myopathies
MD
SCI (low complete paraplegia)
Poliomyelitis/postpolio syndrome
CP