Muscle Performance

Question 1

Why might muscle strength testing be different with an infant or child than with an adult?

Answer 1

*Musculoskeletal system development
*Age norms?
*Ability to generate consistent force
*Cooperation, ability to follow directions, attention span

Question 2

Are muscle power and endurance measurable in infants or children?

Answer 2

• For endurance: use functional tests
• For power: only when child large enough to use isokinetic system

Question 3

Methods of muscle strength testings

Answer 3

• Functional Strength Testing
• Manual Muscle Testing
• Hand Held Dynamometer
• Isokinetics

Question 4

Functional movement assessment for infants:

Answer 4

• Body, arm, leg movements against gravity
• Reflexes and postural responses (ATNR or MORO reflex in 3 mo old or lateral head righting reaction)

Question 5

Functional movement assessment tasks for toddlers/preschoolers

Answer 5

• Tip toes
• Get up from floor
• Jump
• Stand on one foot

Question 6

Standardized pediatric examination

Answer 6

BOT-2

Question 7

Physical fitness test

Answer 7

• Flexed arm hang
• Push up
• Sit up/curl up

Question 8

Pediatric modifications to MMT

Answer 8

• Observation/ movement activation/ palpation method
• Standardized MMT
• Modified MMT

Question 9

Who should you use observation/ movement activation/ palpation method?

Answer 9

• Infants, toddlers, children under 4 yo
• 4-6 yo who have trouble following directions or staying on task
• Children with cognitive impairments

Question 10

Procedure for observation/ movement activation/ palpation method

Answer 10

• Observe posture and active movement
• Activate movement (tickle, tap, stroke muscle, position child, facilitate movement)
• Palpate

Question 11

How to grade observation

Answer 11

• Present/Absent
• Apparently normal/weak/absent
• Describe any associated movement characteristics (compensations, synergies, etc)

Question 12

Who should you use standard MMT with?

Answer 12

Children over 4, who can attend to tasks and follow directions

Question 13

Grading standard MMT

Answer 13

0-3: same as adult
4,5: subjective, no norms, how much resistance?

Question 14

Is intra-rater or inter-rater reliability better in standard MMT

Answer 14

intra-rater

Question 15

Who should you use Modified MMT with?

Answer 15

• Children 4 yo and older
• Children who move with substitution patterns or synergistic movement patterns

Question 16

Confusion sign

Answer 16

idk what it is

Question 17

Modified MMT procedure

Answer 17

Use resistance only to point of substitution or synergy

Question 18

Grading for modified MMT

Answer 18

*Standard 0-5 grading for non synergistic/ substitution movements
* Remember 4-5 grades have decreased reliability/ validity with children
*In-synergy or with substitution
3-: Moves through entire ROM against gravity
2-: Moves through entire ROM gravity eliminated
1+: Initiates movement in gravity eliminated position

Question 19

What is the most reliable and precise method of testing muscle strength in children?

Answer 19

Dynamometer

Question 20

What is strength correlated with?

Answer 20

weight, age, height, etc

Question 21

What are the greatest predictors of strength?

Answer 21

body mass and age

Question 22

What has the most influence on strength in young children

Answer 22

height

Question 23

Test/Retest reliability for dynamometry

Answer 23

Varies by muscle group

Question 24

Sensitivity/Specificity for Dynamometry

Answer 24

Varies per muscle group

Question 25

Reliability systematic review for dynamometry with children with CP

Answer 25

* Inconclusive results * Within session reliability + for lower extremity * Between session reliability: + for some lower extremity muscle groups, but – for others * Interrater reliability: - for all lower extremity muscle groups

Question 26

Procedure for Dynamometry

Answer 26

*** MAKE TEST * Less chance for injury * Easier to control/more comfortable * Sustain contraction for 5 sec * Stabilize when measuring at hip/knee * Make sure child understands instructions * Take two measures and report MEAN * Mean of 2 trials versus maximum contraction

Question 27

How to perform dynamometry

Answer 27

* Dynamometer placement, * PT position, * Patient position, * Be careful not to resist child’s isometric contraction

Question 28

Standard Positions for dynamometry

Answer 28

* Hip flexion sitting and supine * Hip extension in supine * Knee extension and flexion in sitting * Dorsiflexion in sitting

Question 29

Who are isokinetics systems useful for?

Answer 29

Children who can fit isokinetic system (at least 6 years of age) - Norms avail based on large sample 6-13 yo

Question 30

Reliability for Isokinetic Systems

Answer 30

* 0.96 ICC for test-retest reliability – 10-13 year olds, knee flexion/extension * Improves with training * Need good fit of equipment

Question 31

One of the major impairments of CP

Answer 31

- inadequate force generation * Impact of abnormal muscle tone, synergy, and substitution * Poor selective control of isolated muscle groups --> leads to poor reliability with some muscle groups * Strength of spastic muscles versus antagonist muscle

Question 32

Who is the most difficult group of children to test muscle strength reliably?

Answer 32

Children with CP

Question 33

Recommendations for measuring muscle strength in children with CP

Answer 33

* Use dynamometer or functional testing * Detectable strength changes with dynamometry are large * Functional testing – age-appropriate functional testing * Test all muscle groups * Spastic muscles (out of synergy, in isolated movement) * Antagonist to spastic muscles

Question 34

How to test muscle endurance for children with CP

Answer 34

Distance can walk, wheelchair without substitution/ compensation/ synergy

Question 35

When do you test muscle strength in children with myelomeningocele

Answer 35

- Newborn (pre-surgical) - Approximately 10 days post surgical closure - At regular intervals through adolescence and into adulthood

Question 36

Presurgical Newborn testing for myelomeningocele

Answer 36

* Procedure * Limited positions possible * Observe movements * Palpate * Muscles tested * Head/neck * Trunk – above and below lesion * Use of data * Document pre-surgical muscle activity, help determine level of lesion

Question 37

10 days post surgical testing for myelomeningocele

Answer 37

*Procedure * Positioning precautions * Observe, palpate, activate (as allowed) *Muscles tested * Same as in newborn *Use of data * Help identify level of lesion * Intervention planning * Prediction of functional outcome

Question 38

Muscle Strength Testing throughout childhood for children with myelomeningocele

Answer 38

*Test at regular intervals * Helps detect any negative changes (i.e. from tethered cord) *Include neck, upper extremities, trunk *Test at regular intervals (often as part of Myelomeningocele Clinic) * Every 3-6 mo through infancy * Every 6 mo. Through young childhood * Annually through adolescence/adulthood

Question 39

Clinical Suggestions - Muscle strength testing in myelomeningocele

Answer 39

- Important to test individual, specific muscles - Standardize procedure

Question 40

Recommended methods of muscle strength testing in myelomeningocele

Answer 40

- MMT - Dynamometer - Functional Testing (muscle endurance)

Question 41

MMT in Myelomeningocele

Answer 41

* MMT – most commonly used * May not detect until > 50% deficit * Limited test-retest, inter-rater reliability * Need to have > 1 grade change to reflect true change in strength * Predictive of later muscle strength * Consider standard training and standard recording sheets

Question 42

Dynamometry in myelomeningocele

Answer 42

* Good reliability (0.73-0.99) * Standardize procedure – position, command, feedback/ reinforcement, application of R, body mechanics of examiner * Recommend 3 trials – report MEAN * Watch for substitutions

Question 43

Minimum detectable change for dynamometry in myelomeningocele

Answer 43

15 N