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Peds Neuro > Muscle Performance > Flashcards

Muscle Performance Flashcards

1
Q

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

A

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

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2
Q

Are muscle power and endurance measurable in infants or children?

A
  • For endurance: use functional tests
  • For power: only when child large enough to use isokinetic system
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3
Q

Methods of muscle strength testings

A
  • Functional Strength Testing
  • Manual Muscle Testing
  • Hand Held Dynamometer
  • Isokinetics
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4
Q

Functional movement assessment for infants:

A
  • Body, arm, leg movements against gravity
  • Reflexes and postural responses (ATNR or MORO reflex in 3 mo old or lateral head righting reaction)
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5
Q

Functional movement assessment tasks for toddlers/preschoolers

A
  • Tip toes
  • Get up from floor
  • Jump
  • Stand on one foot
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6
Q

Standardized pediatric examination

A

BOT-2

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7
Q

Physical fitness test

A
  • Flexed arm hang
  • Push up
  • Sit up/curl up
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8
Q

Pediatric modifications to MMT

A
  • Observation/ movement activation/ palpation method
  • Standardized MMT
  • Modified MMT
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9
Q

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

A
  • Infants, toddlers, children under 4 yo
  • 4-6 yo who have trouble following directions or staying on task
  • Children with cognitive impairments
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10
Q

Procedure for observation/ movement activation/ palpation method

A
  • Observe posture and active movement
  • Activate movement (tickle, tap, stroke muscle, position child, facilitate movement)
  • Palpate
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11
Q

How to grade observation

A
  • Present/Absent
  • Apparently normal/weak/absent
  • Describe any associated movement characteristics (compensations, synergies, etc)
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12
Q

Who should you use standard MMT with?

A

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

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13
Q

Grading standard MMT

A

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

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14
Q

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

A

intra-rater

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15
Q

Who should you use Modified MMT with?

A
  • Children 4 yo and older
  • Children who move with substitution patterns or synergistic movement patterns
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16
Q

Confusion sign

A

idk what it is

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17
Q

Modified MMT procedure

A

Use resistance only to point of substitution or synergy

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18
Q

Grading for modified MMT

A

*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

19
Q

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

A

Dynamometer

20
Q

What is strength correlated with?

A

weight, age, height, etc

21
Q

What are the greatest predictors of strength?

A

body mass and age

22
Q

What has the most influence on strength in young children

A

height

23
Q

Test/Retest reliability for dynamometry

A

Varies by muscle group

24
Q

Sensitivity/Specificity for Dynamometry

A

Varies per muscle group

25
Q

Reliability systematic review for dynamometry with children with CP

A
  • 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
26
Q

Procedure for Dynamometry

A

*** 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

27
Q

How to perform dynamometry

A
  • Dynamometer placement,
  • PT position,
  • Patient position,
  • Be careful not to resist child’s isometric contraction
28
Q

Standard Positions for dynamometry

A
  • Hip flexion sitting and supine
  • Hip extension in supine
  • Knee extension and flexion in sitting
  • Dorsiflexion in sitting
29
Q

Who are isokinetics systems useful for?

A

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

30
Q

Reliability for Isokinetic Systems

A
  • 0.96 ICC for test-retest reliability – 10-13 year olds, knee flexion/extension
  • Improves with training
  • Need good fit of equipment
31
Q

One of the major impairments of CP

A
  • 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
32
Q

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

A

Children with CP

33
Q

Recommendations for measuring muscle strength in children with CP

A
  • 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
34
Q

How to test muscle endurance for children with CP

A

Distance can walk, wheelchair without substitution/ compensation/ synergy

35
Q

When do you test muscle strength in children with myelomeningocele

A
  • Newborn (pre-surgical)
  • Approximately 10 days post surgical closure
  • At regular intervals through adolescence and into adulthood
36
Q

Presurgical Newborn testing for myelomeningocele

A
  • 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
37
Q

10 days post surgical testing for myelomeningocele

A

*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

38
Q

Muscle Strength Testing throughout childhood for children with myelomeningocele

A

*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

39
Q

Clinical Suggestions - Muscle strength testing in myelomeningocele

A
  • Important to test individual, specific muscles
  • Standardize procedure
40
Q

Recommended methods of muscle strength testing in myelomeningocele

A
  • MMT
  • Dynamometer
  • Functional Testing (muscle endurance)
41
Q

MMT in Myelomeningocele

A
  • 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
42
Q

Dynamometry in myelomeningocele

A
  • 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
43
Q

Minimum detectable change for dynamometry in myelomeningocele

A

15 N

Peds Neuro (19 decks)

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