Week 3 Flashcards
Define locomotion
An individual’s capacity to move from one place to another (point A to B)
Define gait
The manner in which a person walks
(cadence, step length, stride length, speed and rhythm)
Define ambulation
the act, action, or an instance of moving about or walking
What is the foundation of movement analysis?
Gait analysis
What is the purpose of gait analysis?
1) To assess deviation from normal or less efficient pattern
2) To identify dysfunction that could lead to (functional decline, an increased fall risk, ROM and/or strength loss)
3) Identify impairments that impact gait (Poor balance, Lack of endurance or energy expenditure, Altered motor control, Reduced safety)
4) Help diagnose movement dysfunction (mechanism of gait deviation, impact of impairment on function)
5) Establish if the gait deviations could be characteristic or diagnostic of a larger clinical picture (Parkinson’s)
List important steps when assessing gait/locomotion
1) Observes patient from all directions
2) Analyze gait/locomotion characteristics with and without use of assistive, adaptive, orthotic, prosthetic or protective devices
3) Check the effects of various terrain and environments
4) Identify deviations and their effect on gait/locomotion
5) Hypothesize and verify cause(s) of deviations through specific examination (e.g. MMT, ROM, muscle tone, flexibility, pain)
What are the divisions of the gait cycle?
Stance: constitutes approximately 60% of the gait cycle and is defined as the interval in which the reference foot is in contact with the ground
Swing: comprises approximately 40% of the gait cycle and occurs when the reference limb is not in contact with the ground
What is a Double limb support/stance?
when both limbs are in contact with the ground at the same time
What is a Single limb support/stance?
It arises between the two double limb stance periods
Explain the stance phase
1) initial contact: the moment in time when the outstretched limb first hits the ground (heel strike)
2) loading response: body weight is rapidly accepted onto the outstretched limb (foot flat)
3) Midstance: body weight progresses forward over a single stable limb usually when the leg is underneath the trunk
4) terminal stance: the heel rises from the ground, the leg achieves a “trailing limb” posture, and the trunk advances well in front of the reference foot. (Heel off)
5) Pre-swing: the last phase of stance. During pre-swing, body weight transfers from the trailing limb to the contralateral lead limb, which is experiencing initial contact and loading response. (Toe off)
Explain swing phase
1) initial swing: lifting of the foot from the ground reflects the onset of the first phase of swing. (Acceleration)
2) midswing: the thigh continues to advance into flexion
3) terminal swing: further thigh flexion is curtailed; however, the knee continues to extend until it observationally appears neutral. (Deceleration)
What phases are double/single limb?
1) Initial double limb stance: initial contact, loading response
2) Single limb stance: mid stance, terminal stance
3) Terminal double limb stance: pre swing
Label the stances
1) initial contact
2) Loading response
3) mid stance
4) terminal stance
5) pre swing
List some gait variables
1) Spatial, Temporal
2) Symmetry, Planes of movement
3) Assistive Device, Level of Assistance, Environment
Describe step length and step time
1) Step length: distance between the heel contact to the point of the heel contact of the other foot
2) Step time: time to complete one step
Describe stride length and stride time
1) Stride length: stride length is the distance between the point of contact of the heel and the next contact of the same heel
2) Stride time: time to complete one stride
Describe cadence and velocity
1) Cadence: number of cycles in a period of time (steps/min)
2) Velocity: Distance covered in a period of time (m/s), gait speed
What is the normal toe out angle?
angle of the foot (5 – 13 deg)
What is closely linked to overall function?
Gait speed
List assistive device considerations of effects on pt’s mobility and stability
1) Attention and neuromotor demands
2) Interference with limb movement during balance recovery
3) Metabolic demands
4) Change in center of gravity from S2 to more anterior-superior which results in postural changes
What are the levels of the functional independence measure?
7 = Independent: safe & timely, no device
6 = Modified independence: device without supervision, more than reasonable time, or concern for safety
5 = Supervision or set up (also known as stand by assist – SBA)
4 = Minimal assistance (min A): patient performs 75% or more of effort
3 = Moderate assistance (mod A): 50 – 74% of effort
2 = Maximal assistance (max A): 25 – 49% of effort
1 = Total assistance: < 25% of effort or assist of 2 persons (also known as dependence)
List the various weight bearing statuses
1) Full weight bearing (FWB)
2) Partial weight bearing (PWB) – an established % of FWB
3) Touch down weight bearing (TDWB): Can put foot on the ground for balance but not put any weight on it
4) Toe-Touch weight bearing (TTWB): Toe can be on the ground (not commonly used)
5) Weight bearing as tolerated (WBAT): Up to the discretion of the patient
6) Non-weight bearing (NWB): Usually have foot elevated
Define balance, static balance, and dynamic balance
1) Balance: all forces acting on the body are balanced (equilibrium). COM is within stability limits and boundaries of BOS
2) Static balance: maintaining the COM within a fixed BOS
3) Dynamic balance: maintaining the COM within a moving BOS
Explain Reactive/Proactive
1) Reactive: postural control occurs in response to external forces acting on the body displacing the COM or moving the BOS (moveable platform)
2) Proactive: (anticipatory) postural control occurs in anticipation of internally generated, destabilizing forces imposed on the body’s own movements (catching a weighted ball).
What has been shown to be a greater predictor of falls than an actual hx of previous falls?
Fear of falling
Loss of balance can lead to restriction of movement, which can cause?
1) Deconditioning and debilitation
2) increased risk of falls
3) secondary problems due to sedentary lifestyle
How does the body control balance?
Sensory information from these sources
1) Vision
2) Somatosensation (surface changes, BOS changes)
3) Vestibular (gravity, acceleration, linear and angular head and eye movement)
What can you ask to determine which system is the body primarily relying on for balance in a given task?
Which system is now “inaccurate” and take it out
Ex: (eyes close = elimination of vision) (standing on a foam pad = elimination of somatosensory)
What are the balance strategies?
1) ankle strategy: involves shifting the COM forward and back by moving the body (legs and trunk) as a relatively fixed pendulum about the ankle joints
2) hip strategy: involves shifts in the COM by flexing or extending at the hips
3) stepping strategy: realigns the BOS under the COM by using rapid steps or hops in the direction of the displacing force, for example, forward or backward steps.
List some environmental aspects that can affect balance
*surface instabilities (slippery, compliant, inclines, moving surfaces, height differentials, sudden tilts)
*body perturbations (sudden pushes, pulls, or stops)
*reduced surface area (narrow short path)
*obstacle contact (uneven surfaces or loose objects)
*resistance (snow, mud, water)
*aberrant visual input (darkness, distorted input)
Falls (inpatient setting)
1) 3.3 - 11.5 falls per 1000 pt days
2) 75% unwitnessed
3) 50% elimination related
4) many due to altered mental status from medications
Falls (community setting)
1) Prevalence = 35%
2) 1 out of 5 falls results in injury (broken bones or TBI)
3) Occurs during normal daily activities
4) Underreported
How to assess fall risk?
1) # of falls in past 6 months
2) Frequency
3) Events that precede or cause the fall
4) Medications and or change in medications?
5) Change in condition (dizzy, light-headed)
6) Change in eyesight correction?
7) # of losses of balance
8) Environment
Define surface anatomy
External features of the body identified for understanding characteristics, conditions and internal structures
Define palpation
Use of touch for medical purposes
List the effects of palpation
1) non verbal communication
2) therapeutic effect of touch (reducing pain, anxiety, cortisol levels)
3) psychological implication (interpersonal connection)
4) risk of touch (cultural/personal preferences, age, sex/gender differences)
Describe the types of touch
1) Light Touch: Used to feel for superficial structures such as skin and subcutaneous fat.
oGentle, fingertips glide over the skin.
2) Moderate Pressure: Used for identifying muscles, tendons, and bony landmarks.
oFingers sink slightly deeper to assess underlying structures.
3) Deep Pressure: Used to assess deeper structures and tissues. Requires more force, using palms or thumbs.
What are the principles of palpation?
1) Slow and Deliberate Movements: Avoid rushing; accuracy improves with careful palpation.
2) Consistency: Be systematic in approach, moving from superficial to deeper layers.
3) Feedback information: Stay attuned to variations in tissue texture, resistance, and responsiveness.
4) Communication: Always communicate with the patient about discomfort or sensitivity during palpation.
What are the aspects of skin palpation?
1) Thin layer, soft, and pliable
2) Moves freely over underlying structures
3) Tenderness
4) Texture
5) Temperature
6) Moisture
What are the factors of navigating tissue under the skin?
*Subcutaneous Fat: Feels soft and spongy; varies in thickness depending on body region and individual.
*Muscle: Firm, with some elasticity. Contracted muscles feel firmer, while relaxed muscles are softer.
*Tendons: Rope-like, firmer than muscles, usually feels like taut bands.
*Ligaments: Tough, less elastic, and feels like firm, dense bands.
*Bones: Solid, hard structures beneath muscles and tendons, easily palpable in superficial regions (e.g., elbow, shin).
*Nerves: Large nerves can feel like a thick movable string, like a guitar string
*Pulses: Rhythmic beat/pulse. Can feel strong or faint depending on location and depth.
How do you interpret what you feel?
*Fat: Soft and moves easily.
*Muscle: Feels firm when contracted, or with increased tension/tone; more pliable when relaxed.
*Tendon: Firm, cord-like structures, easily felt when tensed.
*Ligament: Tough, more rigid compared to tendons.
*Bone: Hard, unyielding, clearly felt especially over superficial areas.
What are the key palpation landmarks?
1) bony prominences
2) tendons and ligaments
3) muscles
List palpation techniques
*One-Handed Palpation: Ideal for smaller, superficial structures.
*Two-Handed Palpation: Used for deeper, larger structures, providing stability and control.
*Cross-Fiber Palpation: Moving fingers perpendicular to muscle fibers to distinguish muscle and tendon.
What is the clinical significance of palpation?
*Assessment: Identifying inflammation, swelling, or abnormal lumps.
*Therapeutic Guidance: Assisting in manual therapy and treatment modalities.
*Diagnostic Support: Pinpointing areas of pain, tension, or abnormality.
Define kinematics
Study of motion without regard to the forces creating that motion.
Define Arthokinematics
Movement of joint surfaces in relation to each other
Components:
*Spin – rotary motion
*Roll – rotary motion
*Glide/Slide – translatory motion
Explain the convex/concave rules
*Concave surface moving on a Convex surface will roll and glide in the same direction (of the angular motion)
*Convex surface moving on a Concave surface will roll and glide in opposite directions
What are the grades of Arthrokinematics?
Grades 0-6
0: Ankylosed (immovable)
1: Considerable hypomobility
2: Slight hypomobility
3: Normal
4: Slight hypermobility
5: Considerable hypermobility
6: Unstable
Describe Osteokinematics
the gross movement of the shafts of bony segments (often refers to rotators motion at a joint, can happen in all planes of motion and their axes)
Describe joint range of motion
ROM
1) Arc of motion in degrees between the beginning and the end of motion in a specific plane
2) Starting position is anatomical position or neutral
3) Usually, from 0 to 180 degrees
What are the factors that can effect ROM?
Known factors:
*Age
*Gender
*Active vs Passive motion
Possible factors:
*BMI
*Occupational activities
*Recreational activities
*Testing procedures
*Type of instrument
*Experience of examiner
*Time of day
List the types of ROM
1) PROM
2) AROM
3) AAROM
Explain AROM
Arc of motion produced by the individual’s voluntary, unassisted muscle contraction.
(It tells us the pt’s willingness to move, coordination, muscle strength, and joint ROM. It also highlights any painful tissue muscle, tendon, ligaments…)
Explain PROM
Arc of motion produced by the application of an external force by the examiner. It is normally slightly greater than AROM. Can be vastly different in the presence of pain or weakness.
(It tells us the integrity of joint surfaces and extensibility of joint capsule, ligaments, muscles, tendons, fascia, and skin)
Explain AAROM
Arc of motion produced by the individual’s muscle contraction assisted by an external force.
Describe end feel
1) Tissue structures that limit motion have a characteristic “feel” detectably by the examiner
2) When analyzing PROM use slight over pressure because there is additional stretch of tissues and reduced muscle bulk when muscle is relaxed
(It protects joint structures by allowing the absorption of external force)
Explain the normal end feels
1) soft (soft tissue): Knee flexion (contact between soft tissue of posterior leg and posterior thigh)
2) Firm (muscular, capsular, ligamentous st): muscular would be when Hip flexion with the knee straight (passive tension of hamstring muscles)
3) Hard (bone on bone): Elbow extension (contact between the olecranon process of the ulna and the olecranon fossa of the humerus)
Explain abnormal end feel
1) Empty: no feel because pain prevents end full ROM (acute inflammation, bursitis, fracture)
2) soft: Occurs sooner or later in the ROM than is usual or in a joint that normally has a firm or hard end-feel. Feels boggy. (Soft tissue edema, synovitis)
3) firm: Occurs sooner or later in the ROM than is usual or in a joint that normally has a soft or hard end-feel. (increases muscular tonus and capsular, muscular, ligamentous, or facial shortening)
4) Hard: Occurs sooner or later in the ROM than is usual or in a joint that normally has a soft or firm end-feel. A bony grating or bony block is felt. (osteoarthritis, fracture, loose bone fragments in joint)
Describe hypomobility
Less than expected ROM (less than normal values)
Asymmetrical compared to other side
What can limit PROM?
1) Abnormalities in joint surface
2) Passive shortening of:
*Joint capsules
*Ligaments
*Muscles/tendons
*Fascia
*Skin
*Or inflammation of the above structures
What are capsular patterns of restricted motion?
1) Pathologies involving entire joint capsules may present predictable patterns of restricted passive motions (usually involves most or all motions of a joint)
2) Proportions of motion relative to another motion at that joint
*Joint effusion – distension of the joint capsule
*Relative capsular fibrosis – chronic low-grade capsular inflammation immobilization resolution of acute inflammation
What are non capsular pattern of restricted motion?
1) Usually involves structures other than the entire joint capsule
Ex: *Internal joint derangement
*Adhesion of part of a joint capsule
*Ligament shortening
*Muscle strain
*Muscle contracture
2) Usually involve 1-2 joint motions
What is the capsular pattern (Restricted motion) of the glenohumeral joint?
Greatest loss of lateral rotation, moderate loss of abduction, minimal loss of medial rotation
What is the capsular pattern (Restricted motion) of the elbow complex?
Loss of flexion greater than loss of extension; rotations full and painless except in advanced cases
What is the capsular pattern (Restricted motion) of the forearm?
Equal loss of supination and pronation, only occurring if elbow has marked restrictions of flexion and extension
What is the capsular pattern (Restricted motion) of the wrist?
Equal loss of flexion and extension, slight loss of ulnar and radial deviation (Cyriax)
Equal loss of all motions (Kaltenborn)
What is the capsular pattern (Restricted motion) of the carpometacarpal joint (digit 1)?
Loss of abduction (Cyriax); loss of abduction greater than extension (Kaltenborn)
What is the capsular pattern (Restricted motion) of the carpometacarpal joint (digit 2-5)?
Equal loss of all motions
What is the capsular pattern (Restricted motion) of the Metacarpophalangeal and interphalangeal joints?
Equal loss of flexion and extension (Cyriax)
What is the capsular pattern (Restricted motion) of the hip?
Greatest loss of medial rotation and flexion, some loss of abduction, slight loss of extension; little or no loss of adduction and lateral rotation (Cyriax)
Greatest loss of medial rotation, followed by less restriction of extension, abduction, flexion, and lateral rotation (Kaltenborn)
What is the capsular pattern (Restricted motion) of the knee (tibiofemoral)?
Loss of flexion greater than extension
What is the capsular pattern (Restricted motion) of the ankle (talocrural)?
Loss of plantarflexion greater than dorsiflexion
What is the capsular pattern (Restricted motion) of the subtalar joint?
Loss of inversion (varus)
What is the capsular pattern (Restricted motion) of the midtarsal joint?
Loss of inversion (adduction and medial rotation); other motions full
Define hypermobility
Ability to move actively or passively beyond normal limits
Due to:
*Laxity of soft tissue structures
*Abnormal joint surfaces
*Frequently caused by trauma
*Possible hereditary connective tissue disorders
Ex: Hypomobility syndrome, Marfan syndrome, rheumatic disease, osteogenesis imperfecta
Explain the Brighton Hypermobility Score
0-9 total sum of points. Point for R and point for L. Higher scores associated with poor proprioception and kinesthesia
Cutoff score is 4
May not be abnormal in children (65%> 4)
1) passively apples thumb to forearm
2) passively extend fifth MCP joint more than 90 degrees
3) Hyperextend elbow more than 10 degrees
4) hyperextend the knee more than 10 degrees
5) place palms on floor by flexing trunk with knees straight
What is muscle length testing?
Maximal muscle length: greatest extensibility of muscle-tendon unit
*Measured indirectly – max PROM of joint(s) crossed by the muscle
*Determine whether hypo or hypermobility is caused by antagonist muscle or other structures
What is muscle length testing categorized by?
Categorized by number of joints the muscle crosses
1)One-joint muscles
*No different than measuring joint PROM
*Use end-feel & palpation
2) 2-joint muscles
*Length usually not sufficient to allow full PROM at both joints
(Passive Insufficiency)
*To test, lengthen the muscle at both joints
*Position one joint at end range, measure PROM at the other
3) Multi-joint muscles
What is the purpose of measuring motion/position?
*Determine the presence, absence, or change in impairment
*Establish a diagnosis
*Develop a prognosis, treatment goals, and plan of care
*Evaluate progress or lack of progress toward rehabilitative goals
*Modify treatment
*Motivate the individual
*Research the effectiveness of therapeutic techniques or regimens (for example, measuring outcomes following exercises, medications, and surgical procedures)
*Fabricate orthotics and adaptive equipment
What is the patient’s body position intended to do?
*Place joint in starting position of 0°
*Permit complete ROM
*Assist stabilizing the proximal joint segment
What are the guidelines to positioning?
1.Ensure that the patient is in a comfortable, safe, and stable position.
2.Place the joint being measured in a starting position of 0 degrees.
3.Permit complete and unobstructed motion of the joint.
4.Place the muscle in a lengthened position at all joints that the muscle crosses except for the one joint that will be measured for motion when testing for muscle length.
5.Provide stabilization for the proximal joint segment(s).
What is stabilization?
Keep the patient’s body and proximal joint segment(s) from moving
*Goal is to isolate motion to the desired joint
*Avoids combined motions
*Positional Stabilization
*Manual Stabilization
What are the instruments used for measurements?
1) goniometer
2) electrogoniometer
3) visual estimation
4) tape measures
5) rulers
6) motion analysis systems
Define goniometry
The measurement of angles (created at human joints)
Goniometer – the measurement instrument
*Aligned along bones proximal and distal to the joint
*Determine joint position and total amount of motion
Explain goniometer placement
1.Palpate bony (anatomical) landmarks - axis of motion of the joint.
2.Place fulcrum (center) of the goniometer over axis of motion
3.Position stationary arm- usually lies parallel to longitudinal axis of fixed proximal segment of the joint
4.Position mobile arm – usually lies parallel to longitudinal axis of the moving distal segment
List the psychometric properties of measurements
1) Reliability: intrarate (same tool for measurement over multiple tests), interrater (different tool). Score of 1 is excellent, 0.55 fair, 0 unacceptable
2) Validity: Good to excellent validity for osteokinematics and muscle length
3) Standard error of measurement (SEM): 2.3-5 degrees
How do you document these measurements?
List each motion 0 to however many degrees measured
What are the precautions of measurements?
*Inflammation/Effusion
*Osteoporosis
*Hypermobility
*Paralysis
*Hematoma
*Hemophilia
What are the contraindications of measurements?
1) Absolute: fracture, dislocation
2) relative: immediately post op, severe injury/rupture
Describe muscle performance
Capacity of a muscle to “Do work”, i.e., perform a desired function.
What are the 3 major factors that affect muscle performance?
1) Muscle Strength
*Measurable force exerted by a muscle to overcome a resistance (in one maximal effort)
*Strength requires the ability to voluntarily produce the force necessary to perform a function.
2) Muscle Power
*Strength x speed (force x velocity)
*Work (force x distance) produced per unit of time (seconds)
3) Muscle Endurance
*Ability to produce force repeatedly
*Generate force over a sufficient (sustained) period of time
Describe muscle fatigue
Failure to generate required or expected force during sustained or repeated contractions
What are the types of muscle contraction?
*Concentric – muscle shortening – change in joint angle
*Eccentric – muscle lengthening – change in joint angle
*Isometric – no change in muscle length – no change in joint angle
What are the 3 factors that affect muscle strength?
*Physiological - muscle volume, pennation angle (fiber orientation), cross-sectional area, density/quality, and physiological adaptations to training (contractile proteins vs extracellular matrix and other “support structures”)
*Neurological – CNS and PNS signaling
*Mechanical – amount and direction of forces, axis of joint rotation, lever arm length, etc
What are the factors that affect muscle performance?
*Length-tension characteristics
*Viscoelasticity
*Velocity
*Metabolic adequacy/capacity
*Neuromuscular control/efficiency
What are the factors of impaired muscle performance?
*Weakness (paresis)
*Absence of strength (plegia)
*Loss of muscle bulk (atrophy)
*Exhaustion
*Overuse or Overwork weakness
What do you look for during muscle performance testing?
*Force production capacity
*Endurance capacity
*Diagnostic interpretation
*Functional interpretation
How is muscle performance testing used clinically?
*Direct clinical management
*Predicting functional outcomes (PT prognosis)
*Inform a diagnosis
*Establish functional STG & LTG
List the methods of examining muscle performance?
*Manual muscle testing - MMT (muscle performance)
*Hand-held dynamometry (muscle performance, endurance, fatigue)
*Instrumented isokinetic dynamometers (muscle performance, endurance, fatigue, power)
*Resistance
*Muscle timing
When is MMT valid? When is it flawed?
Valid in:
*“normal” persons who have voluntary control
*Those with weakness or paralysis due to motor unit disorders
Flawed in those with CNS disorders
*Procedures may vary
What are some considerations when performing MMT?
Motion often is the result of more than one muscle
*Primary movers will be identified
*Accessory movers need to be considered and minimized their contribution via changes in the technique (Substitution)
List MMT advantages
*No additional equipment
*Inexpensive
*Can be performed in most environments
*Effective Qualitative interpretation of mm performance
*Insight into “quality” of muscle contraction
List MMT disadvantages
*Qualitative – may lead to interrater reliability issues
*Subjective interpretation
*Subjective response by patient
What aspects to make ready prior to pt MMT (more applicable inpatient)?
*Environment
*Plinth or mat table
*Draping for comfort/modesty
*Positioning may need to deviate from standardized position for pt comfort
What do we need to know when screening a pt?
*History and system review
*Active ROM and Passive Available ROM
*Pt’s ability to follow commands
*Pt’s willingness to provide maximum force
*Any pathologies that make MMT a contra-indication?
What are the MMT tests?
(Consider gravity vector “against gravity” or “gravity reduced”)
*Break Test
*Joint ROM is screened joint is positioned pt performs isometric contraction
*Manual resistance applied in the line of pull of the desired muscle with the intent of changing the joint position
*“Hold, don’t let me move you”
*Make Test
*PT matches the pt’s resistance as the patient gradually increases force output
*“Slowly push (or pull) against me until you are pushing as hard as you can”
How are one joint muscles typically tested?
In a shortened position
How are two joint muscles typically tested?
At mid range
What does PSIS stand for (MMT technique)?
*Position: grade depends on whether you test in gravity-reduced or anti-gravity position
*Stabilization: stabilize origin or proximal joint so only the muscle being tested moves the joint and/or only the test segment moves
*“Isolation”: instruct pt in the motion and provide resistance so motion occurs in the line of pull of the intended muscle
*Substitution: avoid testing effort caused by synergistic muscles or a mm you did not intend to test
Describe how to rate “anti gravity” and “gravity reduced”?
Anti-gravity: Patient is positioned so that the segment moves vertically against Force of gravity.
*Grades 3-5
Gravity-reduced/minimized: Patient is positioned so segment moves horizontally (perpendicular to gravity vector). Gravity now only produces a friction force on the supporting surface
*Grades <3
Why do we stabilize in MMT?
*Allow movement of the test segment only (prevent substitution).
*Stabilize the segment at origin attachment.
Why do we isolate is MMT?
Intentional positioning, clear instructions, resistance, palpation
(Proper isolation positions synergists so that they cannot optimally work; often at end range with muscle fully shortened (active insufficiency))
What is a substitution in MMT?
The movement is not produced by the targeted muscle.
*Occurs when:
*Segment is poorly stabilized
*Pt is poorly positioned or allowed to deviate out of position
What is the MMT grading?
0-5 (can use +/-), for each R & L
5 Normal (N): completes full active ROM against gravity; holds test position against maximum resistance
4+ Good plus (G+)
4 Good (G): completes full active ROM against gravity; holds test position against moderate resistance
4- Good minus (G-)
3+ Fair plus (F+)
3 Fair (F): completes full active ROM against gravity; holds test position against no resistance
3- Fair minus (F-)
2+ Poor plus (P+)
2 Poor (P): completes full active ROM when gravity is minimized
2- Poor minus (P-)
1 Trace (T): can detect contractile activity visually or by palpation
0 Zero (0): no detectable muscle activity (visually or palpation)
What are some subjective and objective factors of MMT?
Subjectivity
*More at higher MMT grades
*Resistance applied by PT
*Resistance tolerated by pt
Objectivity
*Greater at lower MMT grades
*Move through full available ROM?
*Against gravity
*Gravity reduced
*Hold position against gravity?
*Able to move at all?
List the MMT procedure steps in order
1) Screen PROM
2) Screen AROM
(Full AROM against gravity & can hold?)
“Path 1”
If yes >3 then
3) apply resistance
4) grade
“Path 2”
If no <3 then
3) move to gravity reduced position
4) screen AROM
(Full AROM in gravity reduced)
If yes then
5) apply resistance
6) grade
If no then
5) grade or palpate for mm activity
6) grade
What are the absolute and relative contraindications of MMT?
Absolute
*recent fracture
*severe pain
*Severe wound or extensive op site
Relative
*moderate pain
*hysteria
*lack of motivation
*unstable joint or joint surface erosion
*neurological muscle spasm
*Inability to follow commands (motor skills, cognition)
What is a hand held dynamometer?
*Portable
*Measures force (Lbs, N, Kg)
*Require standardized or normalized positioning
*Patient
*Instrument
*Make-test procedures
What is Jamar? What is a pinch meter?
Both for grip strength
Jamar: hold one hand and squeeze gripper
Pinch meter: 3-point chuck, lateral prehension, tip pinch
What is an isokinetic dynamometer?
*Commonly seen manufacturers: Biodex, Cybex, Kin-Com, LIDO
*Stationary, electromechanical device
*Resists and measures patient’s torque (rotational force) through range
*Measure torque production of a set of muscle acting on a joint
*Can Test:
*Isometric
*Isokinetic
Isotonic
*$$$
*Typically used in research
*Tests Muscle groups together, not individual
*Measures torque, power, endurance, work, impulse, and others
What tests measure the rate of perceived exertion?
0-10 (10 being extremely hard/fatigued)
Self-report of PERCEIVED difficulty
*Visual Analog Scales
*Numerical Rating Scales
Common Measures
*BORG scale
*OMNI Exertion scale
*OMNI-RES (resistence
