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clinical physio > muscle strength testing > Flashcards

muscle strength testing Flashcards

1
Q

Correlates of strength

A

Age
Sex
Muscle fat ratio
Muscle size
mechanical properties, tone, elasticity, stiffness
Physical activities
Co-morbidity
Medication
Cross-sectional area
Pennation angle

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2
Q

Physiological considerations of strength

A

Muscle fibre types
Neural factors
Connective tissue integrity (brain signals)
Age: muscle mass, fibres, functional motor units, cross sectional area

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3
Q

key things to note down

A

muscle being tested
Amendments in positioning to complete test
grade
Symptoms that may influence strength outcome

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4
Q

two joint muscles in lower limb and what they do

A

Long head bicep femoris, semitend, semimem = hip extension + knee flexion
Rec fem = hip flexion + knee extension
Gastroc = knee flexion + ankle plantar flexion

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5
Q

ways to assess strength

A

Manual eg oxford scale
Functional assessment
Dynamometers
Muscle bulk/girth, indicative of strength or swelling but significant limitations

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6
Q

contras and cautions

A

Unhealed fracture
Dislocation or unstable joint
where active RoM or resistance are contra (e.g. post- op protocols etc)
Pain
Severe inflammation
Severe osteoporosis (CI), any degree of osteoporosis is a caution
Haemophilia
Cognitive concerns
Abdominal Surgery or Hernia
Bony Ankylosis
Haematoma
CV Disease
Pulmonary Disease
Prolonged Immobilisation
where fatigue may be harmful or exacerbate condition ( e.g. lower motor neuron disease)

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7
Q

how many parts to oxford grading scale

A

0-5

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8
Q

what is grade 0

A

no contraction

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9
Q

what is grade 1

A

Flicker or trace of contraction

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10
Q

what is grade 2

A

Full range of active movement with gravity minimised

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11
Q

what is grade 3

A

Full range of active movement against gravity

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11
Q

what is grade 4

A

Full range of active movement against gravity with minimal resistance

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12
Q

what is grade 5

A

Full range of motion against gravity with maximal resistance/ normal strength

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13
Q

how to perform grading/testing

A

test unaffected side first
ensure appropriate comfortable position
Determine if they can move through full RoM against gravity
If cant move through any part of RoM against gravity, reposition to eliminate gravity (movement in horizontal plane)
May need to support limb on friction free surface or manually
If can do grade 3 assess against resistance
If they can hold resistance for 5+s or overcome = grade 5
If not = grade 4

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14
Q

general points about grading/testing

A

Apply resistance slowly and gradually at distal end
Don’t apply resistance directly to a joint
When testing through RoM, start in full outer RoM and go all the way through to full inner RoM
Isolate muscle or group being tested
substitute movements

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15
Q

what range to perform test and why

A

mid range for optimal contraction force
inner (short) and outer (long) have less force

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16
Q

what to do pre test

A

unaffected limb first
discuss how you’ll do the same on affected
set expectations
painful part last
cautions and contras

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17
Q

to remember during test

A

consent
clearly communicate why
explain + demonstrate passive
discuss exposure

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18
Q

how to do isometric tetsing

A

Start mid range
Identify position, mid range for max force
Consider variation in strength through RoM
consistency, re-assessment routine, data collection, clinical notes

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19
Q

what may happen if not adequately stabilised

A

substitute movements at other joints

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20
Q

where to stabilise

A

gravity and weight provide initial stabilisation
Stabilisation proximal joints as resistant placed distally

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21
Q

where to apply resistance for one joint muscle

A

at end of range for consistency

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22
Q

where to apply resistance for two joint muscle

A

mid range, length tension more favourable

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23
Q

what to do if you cant distinguish between Grade 5 and 4

A

put patient at a mechanical disadvantage

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24
Q

how to apply resistance

A

slowly and gradually at the distal end
applied opposite to line of pull of the muscle

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25
Q

position for hip extension grade 0 and 1

A

prone

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26
Q

position for hip extension grade 2

A

side lying

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27
Q

position for hip extension grade 3, 4 and 5

A

prone

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28
Q

position for hip flexion grade 0 and 1

A

supine

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29
Q

position for hip flexion grade 2

A

side lying

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30
Q

position for hip flexion grade 3, 4 and 5

A

supine (msk says sitting)

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31
Q

position for hip abduction grade 0 and 1

A

supine

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32
Q

position for hip abduction grade 2

A

supine

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33
Q

position for hip abduction grade 3, 4 and 5

A

side lying or standing

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34
Q

position for hip adduction grade 0 and 1

A

supine

35
Q

position for hip adduction grade 2

A

supine

36
Q

position for hip adduction grade 3, 4 and 5

A

side lying or standing

37
Q

position for hip external rotation grade 0 and 1

A

prone

38
Q

position for hip external rotation grade 2

A

supine

39
Q

position for hip external rotation grade 3, 4 and 5

A

sitting, hip and knees 90

40
Q

position for hip internal rotation grade 0, 1and 2

A

supine

41
Q

position for hip internal rotation grade 3, 4 and 5

A

sitting, hip and knee 90

42
Q

position for knee flexion grade 0 and 1

A

prone

43
Q

position for knee flexion grade 2

A

side lying

44
Q

position for knee flexion grade 3, 4 and 5

A

prone or standing

45
Q

how to isolate bicep femoris when testing knee flexion

A

externally rotate ankle

46
Q

how to isolate semitendinosus/semimembranosus when testing knee flexion

A

internally rotate ankle

47
Q

position for knee extension grade 0 and 1

A

supine

48
Q

position for knee extension grade 2

A

side lying

49
Q

position for knee extension grade 3, 4 and 5

A

sitting

50
Q

position for ankle plantarflexion grade 0 and 1

A

prone

51
Q

position for ankle plantarflexion grade 2

A

side lying

52
Q

position for ankle plantarflexion grade 3, 4 and 5

A

prone or standing
1 calf raise = 3
3-5 = 4
5+ = 5

53
Q

how to isolate soleus when testing ankle plantarflexion

A

knee flexion

54
Q

position for ankle dorsiflexion grade 0 and 1

A

supine

55
Q

position for ankle dorsiflexion grade 2

A

side lying

56
Q

position for ankle dorsiflexion grade 3, 4 and 5

A

supine or sitting

57
Q

position for ankle in and eversion grade 0, 1 and 2

A

supine

58
Q

position for ankle in and eversion grade 3, 4 and 5

A

side lying

59
Q

how to test ankle dorsiflexion

A

grip calcaneus one hand
grip mid foot with other hand
push down on their foot
tell them don’t let me push your foot down so they are pushing foot up against hand

60
Q

position for shoulder extension grade 0 and 1

A

prone

61
Q

position for shoulder extension grade 2

A

side lying

62
Q

position for shoulder extension grade 3, 4 and 5

A

prone

63
Q

position for shoulder flexion grade 0 and 1

A

supine

64
Q

position for shoulder flexion grade 2

A

side lying

65
Q

position for shoulder flexion grade 3, 4 and 5

A

supine

66
Q

position for shoulder add and abduction grade 0, 1 and 2

A

supine

67
Q

position for shoulder add and abduction grade 3, 4 and 5

A

side lying or standing

68
Q

position for shoulder external rotation grade 0 and 1

A

prone

69
Q

position for shoulder external rotation grade 2

A

supine

70
Q

position for shoulder external rotation grade 3, 4 and 5

A

sitting, hip and knees 90

71
Q

position for shoulder internal rotation grade 0, 1 and 2

A

supine

72
Q

position for shoulder internal rotation grade 3, 4 and 5

A

sitting, hip and knee 90

73
Q

position for elbow extension grade 0 and 1

A

prone

74
Q

position for elbow extension grade 2

A

side lying or sitting

75
Q

position for elbow extension grade 3, 4 and 5

A

prone or sitting

76
Q

position for elbow flexion grade 0 and 1

A

supine

77
Q

position for elbow flexion grade 2

A

side lying or sitting

78
Q

position for elbow flexion grade 3, 4 and 5

A

supine or sitting

79
Q

position for elbow pro and supination grade 0, 1 and 2

A

supine or sitting
difficult to eliminate gravity

80
Q

position for elbow pro and supination grade 3, 4 and 5

A

supine or sitting
difficult to complete against gravity

81
Q

position for wrist flexion and extension grade 0,1 and 2

A

supine or sitting
2 - forearm in mid position

82
Q

position for wrist flexion grade 3, 4 and 5

A

supine or sitting
forearm supinated

83
Q

position for wrist extension grade 3, 4 and 5

A

supine or sitting
forearm pronated

84
Q

position for ulnar and radial deviation grade 0, 1 and 2

A

supine or sitting
2 - forearm pronated

85
Q

position for radial deviation grade 3, 4 and 5

A

supine or sitting
forearm in mid position

86
Q

position for ulnar deviation grade 3, 4 and 5

A

supine or sitting
forearm pronated

clinical physio (4 decks)

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