ROM and Strength Assessment

Question 1

define kinematics and osteokinematics
what terms are used to describe movements in osteokinematics

Answer 1

kinematics: study of the geometry of motion without reference to cause of the motion (position, displacement, velocity, acceleration)
osteokinematics: study of motion of bones around an axis (referenced relative to sagittal, frontal or transverse planes)
flexion, extension, abduction, adduction, IR, ER

Question 2

define ROM
what can ROM be used to measure

Answer 2

the extent of movement of a joint measured in degrees of a circle
progress the patient makes and effectiveness of interventions

Question 3

define arthrokinematics
what is active asisted ROM
T or F: there can be rotational movements in the sagittal and frontal planes

Answer 3

describes the motion that occurs between two articular surfaces of the two bones of a joint
when partial assistance is applied to the joint to achieve motion
T, forwards somersault (sagittal) or cartwheel (frontal)

Question 4

how must the axis of rotation be determined
why is it determined this way
the AOR is within the ___ joint member and ___ to the plane of motion

Answer 4

experimentally
because the AOR maybe located within the joint or outside two bones composing a joint
convex, perpendicular

Question 5

when assessing ROM the goniometer should be aligned with what
define concave and convex

Answer 5

the axis of rotation
concave: to bend inwards
convex: bend or protrude outwards

Question 6

define angular movements
circumduction is a combination of what movements
define rotational movements

Answer 6

movements that produce an increase or a decrease in the angle between the adjacent bones
flexion, extension, abduction, adduction
movements that occur around a longitudinal or vertical axis

Question 7

what information about the patient does assessing ROM give us

Answer 7

willingness to move, level of consciousness
ability to follow instructions/attention span
amount of movement possible at the joint
movements that cause/increase pain
muscle strength (AROM)

Question 8

is AROM or PROM greater and why

Answer 8

PROM is greater than AROM because there is slight elastic stretch of tissues and decreased bulk of relaxed muscles

Question 9

what are the contraindications of assessing ROM

Answer 9

if movement could disrupt the healing process or result in injury or deterioration of the condition
if motion to the part will cause further damage or interrupt the healing process immediately after injury/surgery
if a subluxation, dislocation or fracture is suspected
if myositis ossificans (formation of bone tissue inside muscle tissue) is suspected or present
if ectopic ossification (deposition of calcium salts in tissue) is suspected or present

Question 10

what are the precautions of assessing ROM

Answer 10

if movement to the part might aggravate the condition
in painful conditions or in the presence of an inflammatory process in a joint
in patients taking medications for pain or muscle relaxants (may not be able to respond appropriately)
osteoporosis or hypermobile joints
regions of hematoma
in assessing joints if bony ankylosis (stiffness) is suspected
disruption of soft tissue after an injury
in the region of a recently healed fracture
after prolonged immobilization of a part

Question 11

what should you do when communicating about assessing ROM

Answer 11

explain the rationale and component parts of the assessment process, keep things simple and concise, ask for consent and explain risks, encourage them to ask questions, understand the need to expose regions of the body, communicate changes in signs and symptoms during and after the assessment

Question 12

what is the prerequisite knowledge for measuring ROM
what are the prerequisite skills for measuring ROM

Answer 12

normal ROM, proper stabilization, substitution patterns, normal end feels, landmarks for placing AOR, factors that can alter ROM, goniometric application
position/stabilize athlete and joint, identify end ROM, palpate correct landmarks, apply/read goniometer correctly, check for proper alignment

Question 13

why should the body part being assessed be exposed
what information do you gain from a visual observation of ROM

Answer 13

for adequate visual information
pain via facial expression, symmetrical or compensatory motion in functional activities, body posture, muscle contours

Question 14

what is palpation used to assess
which fingers should you palpate with

Answer 14

bony and soft tissue contours, bony landmarks, soft tissue consistency, skin temperature and texture
index and middle fingers

Question 15

the instruments chosen to assess ROM depends on what 4 factors
what is the most frequently used instrument to measure ROM

Answer 15

degree of accuracy required, the time, resources available to the clinician, patient’s comfort and well being
goniometer

Question 16

a goniometer measures between what degrees of motion
what are the two arms of the goniometer called
the size of the goniometer used is determined by what
how should you describe the ROM when you record it

Answer 16

180 or 360
stationary and moveable
the size of the joint being assessed
full, normal (N), within normal limits (WNL)

Question 17

what should you do before measuring ROM in the affected limb
where should you place the axis, stationary arm and movable arm of the goniometer

Answer 17

measure ROM in the uninvolved limb to determine normal ROM and normal end feel
axis: over the axis of movement of the joint
stationary: parallel to the longitudinal axis of the proximal joint
movable: parallel to the longitudinal axis of the moving distal joint segment

Question 18

what is end feel
what is normal end feel characterized by
what is abnormal end feel characterized by

Answer 18

the sensation transmitted to the therapist’s hand at the extreme end of the PROM indicating the structures that limit the joint movement
full PROM at the joint and the normal anatomy of the joint stops movement
a decreased or increased PROM or other structures other than the normal anatomy stop joint movement

Question 19

what are the 3 types of normal firm end feel
what is normal soft end feel called
what is normal hard end feel called

Answer 19

muscular stretch, ligamentous stretch, capsular stretch
soft tissue approximation
bone contacting bone

Question 20

what are the 4 types of abnormal end feel
what are the 3 types of normal end feel

Answer 20

empty, firm, hard, soft
soft, firm, hard

Question 21

what is passive insufficiency
give an example of passive insufficiency

Answer 21

when the length of a muscle prevents full ROM at the joints it crosses over
hip flexion with knee straight limited by length of hamstring muscles when knee joint held in extension

Question 22

define strength

Answer 22

the maximal amount of tension or force a muscle can voluntarily exert in one maximal effort, when type of muscle contraction, limb velocity and joint angle are specified

Question 23

define isotonic and isokinetic contractions
what occurs in the agonist and antagonist muscles during an isometric contraction

Answer 23

isotonic: muscle shortens or lengthens and movement of a limb takes place
isokinetic: muscle shortens or lengthens and movement takes place but the speed of contraction remains the same the entire ROM (with a machine)

Question 24

what is a synergist muscle
what are the 3 ways in which we can assess strength

Answer 24

a muscle that contracts and works along with the agonist to produce the desired movement
observation of ability to complete functional activities, manual muscle testing, handheld dynamometry

Question 25

the instruments chosen to assess strength depends on what
what are the 3 types of manual muscle tests
what are the 2 types of handheld dynamometry tests

Answer 25

the degree of accuracy required in the measurement time and resources available to the clinician
make or break test, oxford scale, ASIA motor examination
make test, break test

Question 26

what is the most accurate and valid tool to assess strength
what are the contraindications to strength testing
what are the precautions to strength testing

Answer 26

isokinetic dynamometer (takes too long tho)
inflammation in region, presence of inflammatory neuromuscular disease, severe cardiac or respiratory disease, pain
take care that it doesn’t worsen the patient’s condition, follow neurosurgery or recent abdomen surgery, intervertebral disc pathology, patients with a history or risk of CV problems

Question 27

the oxford scale for MMT is based on what 3 factors
describe the MMT findings for grades 0-5 on the oxford scale

Answer 27

evidence of contraction, gravity as resistance, amount of manual resistance
0: nothing
1: flicker/palpable contraction, no limb movement (trace)
2: full ROM with gravity eliminated (poor)
3: full ROM against gravity (fair)
4: full ROM against gravity and moderate resistance (good)
5: full ROM against gravity and maximum resistance (normal)

Question 28

what are the + and - used to indicate when grading MMT
what are the advantages of MMT

Answer 28

whether or not they can do full ROM (+) or less than half ROM (-)
convenient, quick to apply, inexpensive, no equipment required

Question 29

what are the disadvantages of MMT

Answer 29

intratester reliability is better than intertester reliability
limited by the strength of the examiner
not sensitive to strength changes in the higher grades of 4 and 5
training, practice, experience and use of strict standardized procedure are important for reliable MMT
poor functional relevance, non-linearity
patient variability over time (fatigue)
need to assess strength throughout full ROM and some patients may not have full ROM due to their pathology

Question 30

MMT should be supplemented with what when assessing strength for grades that are greater than 3
isometric strength evaluations are applied to muscles with a grade greater than __

Answer 30

quantitative means of assessing strength (handheld dynamometry)
3

Question 31

what is a make test
what is a break test

Answer 31

make: client exerts a 5s maximal muscular force against an external resistance, the external resistance shouldn’t over power the muscle contraction
break: examiner exerts an external force to overpower the maximal muscular effort made by the client (eccentric contraction)
therapist gradually decreases the resistance as the limb segment falls towards the muscles outer range

Question 32

when is the make test used
does the make or the break test require greater force application by the examiner

Answer 32

if the strength is considered to be a grade 5 or normal
the break test

Question 33

what are the factors that can affect strength testing

Answer 33

age, gender, speed of muscle contraction
type of muscle contraction, previous pathology
surgical intervention, inflammation