Range of motion and mmt

Question 1

What is joint ROM dependent on?

Answer 1

• the structure of the joint, the amount of bulk near the joint, and the elasticity of supporting structures (tendons, ligaments, capsules, and muscles)

Question 2

Describe normal range of motion (NROM)?

Answer 2

• the amount if motion through which a joint passes as it moves within a specific plane.
• varie sdue to age, sex, body type, occupation, ect.. BUT aveages and norms have been established

Question 3

Describe Passive range of motion (PROM)?

Answer 3

• the amount of motion through which a joint passes through when moved by an outside force, (therapist)
• passive ROM is slighly more than active bc there is an additional amount of available range that is not under volunatry control
• the additional ROM helps protect joint structure bc it allows the joint to give and absorb extrinsic forces
• PROM gives therapists insight into elasticity and extensibilitu of the joint structures (tendons, ligaments, muscles, and capsules)

Question 4

Describe Active range of motion? (AROM)

Answer 4

• the amount of motion through which a joint passes when under voluntary control of the subject.
• this gives insight about client’s joint range, muscle strength, and coordination
• BUT if the client has muscle weakness the OT could het inaccurate info about the client’s joint felxibility if they cannot voluntarily move the joint through full avalailable ROM

Question 5

Describe functional range of motion? (FROM)?

Answer 5

• the amount of range that is necessary to have at any particular joint to perform activities of daily living withiout the use of adapted equipment and/or excessive compensatory body movements
• subject may have less than the normal range of motion and still be functional.
• But if range falls below functional level their compendatory strategies might cause more harm than good

Question 6

What is the purpose of measuring a joint ROM?

Answer 6

1. assess general integrity and flexibility of the joint
2. Determine any limitations which are interfering with the client’s ability to function or which are producing disabling deformity
3. to determine what ranges need to be increased to enhance client’s functioning or reduce deformity
4. to keep an on-going record of changes in ROM to help determine effectivenss of treatmnet techniques

Question 7

What knowledge do you need to do joint ROM?

Answer 7

1. properly position client in recommended or alternative positions
2. stabilize the client and joint
3. differentiate between and palpate bony landmarks
4. position the goniometer correctlt in line with anatomical landmarks and reference points
5. move the client’s part through appropriat ROM
6. determine when the end ROM has been reached (end-feel)
7. Read the goniometer correctly
8. Record measurments

Question 8

Procedure for measuing joint ROM

Answer 8

1. Explian and demonstrates to the clients the ROM procedure
2. Make the client comfortable and relaxed
3. Remove any clothing that may obstruct the viewing of the joint
4. Place client in recomended position
5. Stabilize the proximal joint segment
6. Move the distal joint segment through available ROM to get an “end feel”
7. Return the distal segmnet to the starting position (0 degrees)
8. Place the axis of the goniometer over the axis of the joint. Align the stationary bar along the proximal bony segment, align the moving bar along the distal segment. Be sure the goni is lined up with appropriate anatomical landmarks
9. Read the starting position
10. Move the distal segment through full available ROM
11. Read the goniometer and record

Question 9

What should you do if the client has painful joints?

Answer 9

• watch client’s face for indications of pain
• go to the point of pain
• release slowly and carefully
• pain may be reduced if client is encourgaed to pull with the examiner. but the arc of motion should always be passively completed by the examiner

Question 10

What is manual muscle testing?

Answer 10

the means of objectively grading the maximum contraction of a muscle or muscle group

Question 11

What is the purpose of measuing muscle strength?

Answer 11

1. to determine extent to which muscle power is available
2. identify muscle weakness which interferes with client’s function
3. prevent deformities from occuring by locating possible problem areas due to muscle imbalance
4. Aid the therapist in:
   - establishing a baseline for treatment
   - assessing the needs for and practicality of adpative devices
   - determining the level of activities the client is capable of performing
   - evaluating the effectiveness of treatment techniques

Question 12

What are the indications for mmt?

Answer 12

Indications: a mmt can be given to all of the clients who have:
* lower motor neuron disease (which cause flaccid paralysis, polio, guillian-barre syndrome)
* spinal cord injuries (quadriplegics and paraplegics will often demonstrate a lower motor neuron clinical picture above the level of the lesion)
* Neurological diseases that cause primary muscle weakness (MS, ALS, Myasthenia Gravis, Muscular dystrophy)

Question 13

What are the contraindications for mmt?

Answer 13

Contraindications: mmt will NOT be used for clients who primarily demonstrate an upper motor neuron lesion (diseases that result in spacticity, hyperactive deep reflexes, pathological reflexes, such as
* cerebral palsy
* CVA (if the client still moves in a syngergist pattern of motion)
* Spinal cord injuries (quadriplegics and paraplegics in most cases will demonstrate an upper motor neuron clinical pattern below the level of the lesion)
* Parkinson’s disease

Question 14

What types of disabilities may be tested within limitations taken into consideration?

Answer 14

1. arthritis- joint pain may inhibit client from moving part of accepting maximum resistance
2. parkinson’s disease- during early stages, prior to or in absence of rigiditu
3. CVA- as synergy patterns break up, the client may demonstrate isolated muscle control in various joints if spasticity is not an inhibiting factor
4. Cerebral palsy- if hypertonicity or hypotonicitu are not severe and incoordination not a problem, a form of muscle testing may be administered with appropriate adaptations

Question 15

What are the limitations to a muscle test?

Answer 15

• does not show endurance of muscle and muscles ability to do work
• does not show ability of client to combine muscles into smooth harmonious movement
• does not show picture of gross or partial muscle control
• does not show ability of client to use muscle power for function (motivation to use muscles, and muscle sense–> control and coordination
• does not show how much joint range the individual is working through

Question 16

What skills are needed for a muscle tester?

Answer 16

1. must know how to position part being tested
2. must know how to stabilize to rule out subsitution and to give the muscle being tested a firm base of origin
3. must know what substitution patterns are possible and how to observe for them
4. must know how to palpate a muscle contraction
5. must know how and where to apply resistance
6. must know how to determine “normal” in muscle power
7. must have knowledge of origins, insertion, direction of muscl efiberes and position of muscle in layers

Question 17

How to position a client for an isolated muscle/muscle group test?

Answer 17

• client should be positioned comfortably, and in an appropraite position to test (explain what you do and why)
• have the muscles uncovered for max accuracy
• remove any obstavles (bed, chair, ect) that might limit the free motion of the joint at which the muscle is acting upon
• For maximum comfort to the client, grade all muscles possible in a given position (upright, prone, suprine, sidelying) before changing the position of client

Question 18

How to properly stabilize client for mmt?

Answer 18

• remember that when a muscle contracts, it pulls on the origin and the insertion. Manual stabilization thus is needed to isolate the desired action to a specific joint
• To obtain max muscle contraction, supporting muscles around the point of origin will provide the tension that is needed to stabilize the stationary segment. The examiner when stabilizing a part (in order to rule out the substitution/compensatory action of the muscle(s) other than the one being tested) must be sure to provide stabilization that is usually performed by fixator muscles

Question 19

What occurs duing observation?

Answer 19

Obsevation:
* patient must be clearly instrcuted on what is expected of movement
* examiner must distinguish between substitution patterns and the client not undestanding what they are supposed to do
* If substitution patterns are noted, the therapist should point them out to the client and the client should be given the opportunity to try again
* if the client has a poor “muscle sense” the therapoist may have to actually move the part for them until the clinet can “feel” what is desired

Question 20

What occurs duing palpation?

Answer 20

• as the muscle contracts the examiner palapates the msucle belly in order to confim muscle activity
• if the muscle is not readily accessible for palpation, it might be easier to palpate the muscle tendon as it tarvels to the point of insertion

Question 21

a

How to provide resistance properly?

Answer 21

• the amount of resistace that can be received by a muscle and still be considered “normal” varies from client to client” (such as age, sex, lifetyles)
• The clinet should be allowed to move the part through the complete range of motion first
• Resistance is applied at the end of the range of motion. The client is instrcuted to “hold” while the therapist maxes sure that maximu, contraction of the muscle has been established before applying resistance
• Pressure should be applied in as direct of a line as possible, opposite the line of pull of the muscle or muscle groups being tested
• Therapist should apply pressure at distal end of the segment upon which the muscle inserts
• If the client experiences any pain or discomfort the resistance should be discontinued immediately

Question 22

Describe the muscle grades of a 0 through P(2)

Answer 22

• 0: zero, no contraction of the muscle, no movement of the part
• T(1): trace, slight contraction can be palpated but no movement of the part
• P- (2-): Poor minus; part moves through incomplete rom WITH gravity minimized
• P(2): poor; part moves through complete rom WITh gravity minimized

Question 23

Describe muscle grades p+(2+), F-(3-), and F(3)?

Answer 23

• P+(2+): poor plus; part moves through complete ROM WITH gravity minimized, and WITH slight resistance
• F-(3-): fair minus: part moves through incomplete ROM against gravity
• F(3): fair; part moves through complete rom against gravity

Question 24

Describe mucle grades of G(4) and N(5)?

Answer 24

• G(4): good; part moves through complete rom against gravity and moderate resistance
• N(5): normal; part moves through complete rom against gravity and normal resistance

Question 25

What is the relationship between a mmt and passive rom test?

Answer 25

• a passive rom test indicates the amount of movement available at the joint when moved by an outside source, it does NOT indicate the muscle strength available at the joint
• Muscle grades are first established by the ability of a specifc muscle or muscle group to move a part through full range of motion available at a joint and secondly by the amount of resistance a muscle can take
• It is not necessary for a joint to have “normal” rom in order to have good musculature. It is possible or a joint to be limited in rom and still have normal musculature
• As long as the muscle is strong enough to carry a part through its full existing rom, no matter how little; the muscle grade will be “poor” (if gravity is minimized) or fair and above (if moving against gravity)
• It is necessary to have an OT administer a passive ROM test prior to the administration of a muscle test in order to determine the client’s exisiting or available ROM at. a joint. The therapist can establish a specific muscle grade based on the clients’s ability to move through or within an established rom

Question 26

What is the procedure for a functional muscle test?

Answer 26

1. A detailed examination takes time and may be fatiguing to the client
2. a screening procedure may be utilized instead of mmt or prior to it
3. a screeninig device will readily give the therapist information on the clients ability to move and perform basic movements
4. the screening procedure is quick to administer, requires little positioning of the client and if the client can perform the movements, will assure the therapist of the prescense of Fair or above muscle strength in key muscle groups

Question 27

What is the interpretation of a good to normal muscle?

Question 28

What is the interpretation of a fair plus (F+)?

Question 29

What is the interpretation of a Fair (F)?

Question 30

What is the interpretation of a Poor (P)?

Question 31

What is the interpretation of a Zero to trace?

Question 32

What are the treatment priorities?