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Clinical skills > muscle strength, length and power > Flashcards

muscle strength, length and power Flashcards

1
Q

what four outcomes does myogenic or muscular system assessment cover?

A
  • muscle bulk/ girth
  • muscle length
  • muscle power
  • muscle strength
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1
Q

what is muscle bulk? how is it measured?

A
  • muscle building; indicative of strength
  • measured using tape measure
  • compare to healthy limb
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2
Q

what does muscle bulk result in?

A
  • swelling of limb
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3
Q

what are the problems of measuring muscle bulk?

A
  • subjective measure
  • intramuscular fat
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4
Q

what is muscle length ?

A
  • ability of a muscle crossing a joint/ joints to lengthen
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5
Q

what muscles are more likely to be injured and why?

A
  • tight muscles
  • can lead to muscle imbalance and altered biomechanics
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6
Q

what factors does muscle length also calculate?

A
  • force and tension
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7
Q

what is muscle strength?

A
  • maximal force a muscle or muscle group can generate at a specific or determined velocity
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8
Q

what does muscle strength provide?

A
  • provides stability and mobility for functional movement within MSK system
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9
Q

what is leg muscle power?

A
  • ability to exert force with lower extremities quickly
  • lower leg power is an early indicator of poor function
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10
Q

what is power ?

A
  • combination of strength and speed
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11
Q

what does power relate to? - give some examples

A
  • relates to functional assessment
  • chair rise
  • return to play
  • single leg jump
  • leg press
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12
Q

what are the limitations of subjective assessments?

A
  • visual, observation of contours e.g., thigh, upper arm
  • measuring limb girth with tape measure
  • underestimates muscle loss, quadriceps cross sectional area by 22-33%
  • little differentiation of anatomical structures : muscle, bone, subcutaneous fat, perimuscular fascia
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13
Q

what are the four objective assessments of muscle function?

A
  • dynamometer (grip strength test)
  • force platforms (dynamic strength)
  • peak force, leg power, jump height
  • sensitivity, normative data to compare
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14
Q

what are the four psychometric properties?

A
  • reliability
  • validity
  • consistency
  • sensitivity
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15
Q

what is reliability ?

A
  • different clinician should be able to use the same tool on the same patient to receive the same outcome
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16
Q

what is validity?

A
  • measurement should test what it’s meant to be testing e.g., dynamometer measures strength
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17
Q

what is consistency?

A
  • same results all the time
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18
Q

what is sensitivity?

A
  • if there’s a change to function/ outcome can the measurement highlight this
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19
Q

what are the four physiological considerations for strength?

A
  • muscle fibre types
  • neural factors
  • connective tissue integrity
  • age
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20
Q

what factors of muscle fibre types influence strength?

A
  • fast/ slow
  • regeneration of ATP
  • response to training
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21
Q

what neural factors influence strength?

A
  • tension developing capacity
  • motor unit recruitment
  • firing frequency of motor units
22
Q

what connective tissue integrity factors influence strength?

A
  • brain signals
23
Q

how does age influence strength?

A
  • muscle mass
  • fibres
  • functional motor units
  • CSA
  • power
24
Q

what other factors determine strength?

A
  • morphological and neural factors
25
Q

what are the seven morphological and neural factors of strength?

A
  • contractions
  • muscle architecture; pennation angle, echogenicity
  • CSA
  • mechanical properties e.g., stiffness of structure
  • motor unit recruitment, rate coding and motor unit synchronisation
  • neuromuscular inhibition
  • speed of contraction
26
Q

what is strength influenced by?

A
  • pathologies (neurological deficits)
  • physical activity
27
Q

what is strength impaired by?

A
  • injury
  • infection
  • major surgery
  • medical conditions
  • muscle control
28
Q

what is strength predictive of?

A
  • quality of life
  • mortality
  • hospital length stay
  • hospital readmission
29
Q

what are the 10 correlates of strength?

A
  • age
  • sex
  • muscle fat ratio
  • muscle size
  • CSA
  • pennation angle
  • mechanical properties: tone, elasticity, stiffness
  • PA
  • co- morbidity
  • medication
30
Q

what are the four associations between disease and muscle function?

A
  • osteoarthritis
  • diabetes mellitus
  • cardiovascular disease
  • association with lower leg power compared to age - matched older adults
31
Q

what is resistance training effective for?

A
  • improving body fat mass
  • muscle strength
  • performance
32
Q

what is isometric contraction?

A
  • static
  • variable resistance
  • no change in muscle length
  • no movement
33
Q

what is isotonic contraction? what are the two types?

A
  • uniform tension
  • change in muscle length
  • eccentric and concentric
34
Q

what is eccentric contraction? - give an example

A
  • muscle lengthens with movement
    e.g., elbow extension
35
Q

what is concentric contraction? - give an example

A
  • muscle shortens with movement
    e.g., elbow flexion
36
Q

what should the techniques be? what does it determine?

A
  • techniques safe, simple, reliable, consistent, valid and reproducible
  • determines loss in muscle strength
37
Q

what should you consider and what does this influence?

A
  • consider factors that influence muscle strength
  • good understanding influences clinical reasoning skills
  • consider positioning> key to visualise muscle
38
Q

are objective assessments effective?

A
  • no ;
    low reliability and validity
39
Q

is dynamometry effective?

A

+ less subjective
+ quantifiable outcome
+ sensitivity to change
- not available

40
Q

is the MCR scale effective?

A

+ quick
+ simple grading scale
+ good inter-rater reliability
- subjective

41
Q

what factors affect strength and length outcomes? (10)

A
  • pain
  • fatigue
  • ROM
  • mechanical properties
  • emotions; mental health
  • occupation
  • hobbies
  • age and maternity
  • handedness
  • physical activity levels
42
Q

what does manual muscle testing determine?

A
  • extent and degree of muscle weakness from disease, injury or disuse
43
Q

what is the MRC scale?

A
  • modified medical research council
44
Q

how would you apply manual muscle testing?

A
  • plan therapy
  • evaluate function and strength of muscle/ muscle groups
  • consider action, individual muscles or group of muscles
45
Q

what are other testing scales?

A
  • Kendall muscle testing scale
  • Daniels and worthingmans manual muscle testing scale
46
Q

how many grades are in the oxford grading scale?

A

5

47
Q

describe 0-5 of the oxford grading scale

A

0= no contraction
1= flicker/ trace of contraction (limited ROM)
2= muscle activation with gravity minimised
3= muscle activation against gravity
4= muscle activation against some/ minimal resistance
5= muscle activation against examiner’s full resistance

48
Q

what are the limitations of the oxford grading scale?

A
  • non- linearity: difference between grades 3 and 4 isn’t necessarily the same as diff of 4 and 5
  • patient’s variability over time e.g., due to fatigue
  • inter- rater reliability
  • only assesses muscles when contracting concentrically
  • difficulty of applying scale to all patients
  • strength rarely assessed as many patients do not possess full range due to respective pathology
49
Q

what has been made to overcome the oxford rating scale limitations?

A
  • modified versions of oxford scale
  • tests inner, middle and outer range
50
Q

what are the common pathologies?

A
  • stroke
  • cerebral palsy
  • spinal cord injury
  • multiple sclerosis
  • Parkinson’s disease
  • arthritis
  • metabolic syndromes
  • muscular dystrophy
  • motor neuron disease
  • COPD
  • heart failure
51
Q

what are the cautions ?

A
  • unhealed fracture
  • dislocation or unstable joint
  • situations where active ROM are contraindicated e.g., post operative protocols
  • if pain limits participation
  • severe inflammation
  • severe osteoporosis
  • haemophilia
  • cognitive concerns/ decreased ability to complete test
52
Q

what are the contradictions?

A
  • abdominal surgery or hernia
  • bony ankylosis
  • haematoma
  • cardiovascular disease
  • pulmonary disease
  • prolonged immobilisation
  • cases where fatigue may be harmful or exacerbate persons conditions e.g., COPD, MS

Clinical skills (13 decks)

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