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PTH9111 Test 2 > Lec 23 - ROM & strength > Flashcards

Lec 23 - ROM & strength Flashcards

1
Q

study of motion of bones around an axis is known as:

A

osteokinematics

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2
Q

Arthrokinematics:

A

describes
the motion that occurs
between articular surfaces of
the two bones of a joint

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3
Q

what are some terms that describe arthrokinematic movements?

A

spin, roll and
glide

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4
Q

what are the 3 types of ROM we can test in the clinic?

A
  • active ROM (AROM)
  • Passive ROM (PROM)
  • active assisted ROM (AAROM)
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5
Q

when would we choose to use active assisted ROM in the clinic?

A

when they are not able to perform the active movements fully and we want to test how much of an impairment in muscle activity is present.

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6
Q

flexion and extension at the knee joint occurs in the ______ plane.

A

saggital

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7
Q

abduction and adduction of the hip occurs in the ______ plane

A

frontal

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8
Q

internal and external rotation occurs in the ______ plane

A

transverse

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9
Q

what should the goniometer be aligned with when conducting a ROM assessment?

A

AOR (axis of rotation)

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10
Q

what are the definitions of concave and convex with respect to the human body.

A

Convex and concave are two words that describe a line or shape, often in joint
surfaces While convex means to bend or protrude outwards, concave is the opposite and means to bend inwards

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11
Q

what are angular movements and provide some examples:

A

Movements that produce an increase or a decrease in the angle between the adjacent bones.

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12
Q

what are rotational movements and provide some examples:

A

Movements that generally occur around a longitudinal or vertical axis.

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13
Q

what patient information does assessing ROM provide?

A
  • Willingness to move,
  • Level of consciousness,
  • Ability to follow instructions, attention span,
  • Amount of movement possible at the joint
  • Movements that cause or increase pain,
  • Muscle strength (if AROM assessed).
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14
Q

T or F: PROM is usually slightly greater than AROM

A

true, due to the slight elastic stretch of tissues and in some instances due to the decreased bulk of relaxed muscles.

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15
Q

what do you need to do as a clinician before you can perform a ROM assessment?

A
  • Obtain informed consent
  • Client positioning – sitting, standing or does the patient need support?
  • Clear all contraindications and precautions,
  • Explain procedures, risk involved and
    precautions that you will undertake
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16
Q

what would be some contraindications for performing PROM or AROM?

A

if movement could disrupt the healing process or result in injury or deterioration of the condition
* interrupt the healing process immediately after injury or surgery.
* subluxation or dislocation or fracture.
* myositis ossificans (formation of bone tissue inside muscle tissue after an injury) or ectopic ossification (deposition of calcium salts in tissues)

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17
Q

what are 3 important components of a ROM assessment to keep in mind as a clinician?

A
  1. visual observation
  2. palpation
  3. posture
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18
Q

what are you watching for through visual observation during a ROM assessment?

A
  • the body part being assessed
  • facial expression
  • symmetry of compensatory motion
  • body postues and muscle contour
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19
Q

which fingers should you palpate with?

A

index and middle finger

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20
Q

what does a goniometer measure?

A

joint angles

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21
Q

what factors influence our decision on which tools we use to measure joint angles (ex. radiographs, digital images, goniometer, etc.)

A
  • degree of accuracy required,
  • the time,
  • resources available to the clinician,
  • the patient’s comfort and well-being
22
Q

what are the steps of performing a ROM test in a clinical setting?

A

1) Expose the area
2) Patient is comfortable, well supported, & movement can occur through full ROM
unrestricted
3) Stay close to the patient
4) Use firm but comfortable grip
5) Stabilize proximal to the joint
6) Place the axis of the goniometer head on the joint axis of rotation
7) Extend the stationary arm of the goniometer along the long axis of the proximal limb segment
8) Extend the moveable arm of the goniometer along the long axis of the distal limb segment
9) Record the starting position,
10) Keep or remove the goniometer,
11) To assess AROM – client moves the distal joint segment(s) through the full ROM,
To assess PROM – Therapist moves the distal joint segment(s) through the full ROM
13) Record measurement (The distance the movable arm moves away from the 0° – start position, on the protractor is recorded as the joint ROM).
14) Return limb to its starting position.

23
Q

how do you determine a patients “normal” ROM or end feels

A

by measuring the unaffected limb first

24
Q

example: the right elbow cannot be extended beyond 10° of elbow flexion due to contracture but can be flexed to 120°. how would you record the ROM

A

Recorded as right elbow flexion 10°–120°

25
Q

what are the three normal types of end-feel for PROM

A
  • soft (soft tissue)
  • firm (muscle stretch)
  • hard (bone on bone)
26
Q

what are the 4 abnormal types of end-feel for PROM

A
  1. empty
  2. firm (increased tone)
  3. hard (osteoarthritis)
  4. soft (synovitis)
27
Q

what is passive insufficiency?

A

occurs when the length of a muscle prevents full ROM at the joints it crosses over.

28
Q

describe isometric contraction

A

tension is developed but no movement occurs, muscle length does not change

29
Q

describe concentric contraction

A

tension is developed in the muscle and the origin and insertion move closer together, muscle shortens.

30
Q

describe eccentric contraction

A

tension is developed in the muscle and the origin and insertion move farther apart. muscle lengthens

31
Q

what is an isokinetic contraction

A

muscle shortens and movement occurs but the speed of the contraction remains the same throughout the entire ROM

32
Q

what is a muscle synergist?

A

a muscle that contracts and works along with the agonist to produce the desired movement.

33
Q

what are 4 things a clinician needs to do before performing a strength assessment?

A
  • Obtain informed consent,
  • Consider client positioning – sitting, standing
  • Clear all contraindications and precautions,
  • Explain procedures, risk involved and
    precautions that you will undertake
34
Q

what are some contraindications of performing a strength test?

A
  • If inflammation is present in the region.
  • In the presence of inflammatory neuromuscular disease (e.g., Guillain Barre, polymyositis, dermatomyositis).
  • Patients with severe cardiac or respiratory disease
  • In the presence of pain.
35
Q

what are some precautions of performing a strength test?

A

Take extra care when assessing muscle strength as it could worsen patient’s condition.
* Following neurosurgery or recent surgery of the abdomen,
* Intervertebral disc pathology
* In patients with a history or risk of cardiovascular problems (e.g., aneurysm, fixed
-rate pacemaker, arrhythmias, thrombophlebitis, recent embolus, marked obesity, hypertension, cardiopulmonary disease, angina pectoris, myocardial infarctions

36
Q

what is manual muscle testing?

A

THE EVALUATION OF THE FUNCTION AND
STRENGTH OF INDIVIDUAL MUSCLES AND MUSCLE GROUPS BASED ON EFFECTIVE PERFORMANCE OF A MOVEMENT IN RELATION TO THE FORCES OF GRAVITY AND MANUAL RESISTANCE

37
Q

what is the most practical method of assessing muscle strength in a clinical setting?

A

manual muscle testing (MMT)

38
Q

what is the oxford scale?

A

Isotonic (muscle movement at no specified rate) System for MMT

39
Q

what 3 factors is the oxford scale based off of?

A
  1. evidence of contraction (grade 0 or 1)
  2. gravity as resistance (ability to move the part through the full available ROM)
    - grade 2 or 3
  3. amount of manual resistance (manual = 4, maximal = 5)
40
Q

what is the grading system for the oxford scale? describe each grade

A

*nothing = no observable muscle contraction

41
Q

what are some advantages of MMT?

A
  • Convenient,
  • Quick to apply,
  • Inexpensive means of
    assessing muscle strength.
  • In weaker patients, can use equipment to measure strength
42
Q

what are some disadvantages of MMT?

A
  • reliability between therapists isnt great, therefore same therapist should perform all MMT’s when possible
  • MMT grading is limited by the strength of the examiner, especially in very strong patients when assessing grades of 5.
  • MMT is not sensitive to strength changes in the higher grades of 4 and 5
  • MMT should be supplemented with quantitative means of assessing strength (e.g., handheld dynamometry, isokinetic dynamometry, and tensiometry) for grades that are greater than 3 and more subjective in nature.
  • Training, practice, experience, and the use of strict standardized procedure are important for reliable MMT.
    Poor functional relevance
  • Non-linearity i.e. the difference between grades 3 and 4 is not necessarily the same as the difference between grades 4 and 5
  • A patient’s variability over time (due to fatigue)
  • Only assessing muscles when contracting concentrically
  • Need to assess strength throughout the full range (many patients may not have)
43
Q

when would we use isometric strength evaluation?

A

muscles with grade greater than 3 on MMT

44
Q

what is a make test in isometric strength?

A

clinician applies an external resistance that the client needs to exert against (don’t want to overpower client)

45
Q

what is a break test in isometric strength?

A

examiner exerts an external force to over- power the maximal muscular effort made by the client leading to eccentric contraction.
- therapist gradually decreased the resistance as limb approaches end or ROM

46
Q

which test, make or break requires greater force application by the examiner?

A

break test

47
Q

T or F: * If the strength is considered to be a grade 5 or normal, the make test is used

A

true

48
Q

what are some factors that can affect strength testing?

A
  • Age
  • Gender
  • Speed of Muscle contraction
  • Type of muscle contraction
  • Previous pathology
  • Surgical intervention
  • Inflammation
49
Q

describe what is meant by + or - next to a grade of muscle test

A

+ = < ½ ROM at the next higher level of resistance (half ROM against moderate resistance)
- = >1/2 ROM at the same level of resistance (half ROM against gravity)

50
Q

at what grade do we begin at for MMT?

A

usually grade 3 and then work up or down based on what we observe.

PTH9111 Test 2 (16 decks)

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