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NMSKI > Assessment of Muscle Strength > Flashcards

Assessment of Muscle Strength Flashcards

1
Q

causes of muscle weakness

A

Lesion or pathology affecting the nerve which innervates the muscle

  1. Any lesion, injury or pathology of the muscle tissue
  2. Disuse
  3. Immobilisation
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2
Q

example of upper motor neuron lesion CNS

A

stroke

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3
Q

example of lower motor neuron lesion PNS

A

peripheral nerve lesion

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4
Q

effects of immobilisation on muscle

A 
Decrease;
Muscle fibre size
Size and number of mitochondria
total muscle weight
Stores of glycogen and ATP
Protein synthesis
Muscle tension produced 
all leading to atrophy
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5
Q

Strength

A
  • Ability to generate force
  • Capacity to exert force
  • Ability to do work against resistance
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6
Q

factors of strength to make movement

A

Combined contractile forces of the muscles causing movement
• The ability to co-ordinate the agonists, antagonists and
stabiliser muscles
• The mechanical advantages of the levers

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7
Q

assessment of strength

A

cross sectional area - CT/MRI/ Tape measure
manual muscle testing - Oxford scale how much force a muscle can make
Objective measurement - isokinetics - endurance how long can you maintain force/strain gauge, dynamometry
functional assessment - 1RM

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8
Q

Use of assessing cross sectional area

A

detect muscular atrophy
MEASURED WHHEN MUSCLE IS RELAXED
predictor of mortality in some diseases e.g. COPD

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9
Q

Manual Muscle Testing - MMT 0

A

No contraction

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10
Q

MMT 1

A

Flicker or trace of contraction

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11
Q

MMT 2

A

Full range of active movement with gravity eliminated

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12
Q

MMT 3

A

Full range of active movement against gravity

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13
Q

MMT 4

A

Full range of active movement against gravity and resistance

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14
Q

MMT 5

A

Normal

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15
Q

Where would you position your hands to

examine the strength of the bicep muscle?

A

wrist and back of elbow

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16
Q

principles of manual resistance

A
  1. Stabilise the proximal segment (non-moving part, muscle origin)
  2. Resist the distal (moving) segment
  3. Give yourself mechanical advantage: consider the length of the lever and where your resistance is coming from
  4. Respond to the patient’s effort: increase your resistance gradually
17
Q

Assessment of Strength of Deltoid Muscle

A

shoulder abduction and pressing against elbow and put hand on opposite shoulder.

18
Q

limits of oxford scale

A 
Grade 4 is not sensitive to change in strength (amount of resistance is not measured)
Grade 5 (“normal strength”) is subjective
19
Q

reason to use oxford scale

A
  1. Quick
  2. No equipment needed
  3. Allows assessor to get a “feel” for the muscle and observe
    movement through range
  4. Sensitive from grade 0 to the start point of grade 4
  5. Assessor can adjust resistance intuitively (for example, in
    trying to reproduce pain)
  6. Useful as a screening tool for strength deficits
20
Q

benefits of using handheld dynamometry

A

Suitable for assessing strength of individuals who score Grade 4 or 5 on the Oxford Scale
• More sensitive than MMT
• Allows measurement of Maximal Isometric
Torque = Maximum Voluntary Isometric Contraction (MVIC)

21
Q

limitations of dynamometry

A

Requires training
• If patient is very strong the tester may not be able to fully resist the patient’s effort (needs to be a “break” test)
• Isometric testing only

22
Q

purpose of hand grip dynamometry

A

Useful predictor of physical function in aging adults

• Hand grip is fundamental to ADLs

23
Q

advantages of strain gauges

A
  • Sensitive
  • Objective
  • Reliable
  • Can assess a large number of muscles
24
Q

disadvantages of strain gauges

A

Time consuming
• Requires training
• Only measures isometric force

25
Q

benefits of isokinetic evaluation

A

Mechanical measurement of muscle performance
• Objective
• Quantitative
• Isometric / concentric / eccentric
• Muscle works at constant velocity: Isokinetic
• Resistance is variable depending on muscle ability to generate force & to keep pace with selected speed

26
Q

positive of isokinetic testing

A
  • Objective, sensitive, accurate
  • Controls for speed
  • Calculates agonist: antagonist ratios
  • Tests isometric, concentric and eccentric strength
27
Q

negatives of isokinetic testing

A
  • Isokinetic machines are expensive and bulky
  • Takes a long time to test
  • Limited to a small number of muscle groups
  • Open-chain movement only
  • Not very functional
28
Q

1 repetition maximum - 1R,

A

the maximal weight that can be lifted once using a proper lifting technique.

29
Q

why use 1RM

A
  1. Allows dynamic movement (concentric and eccentric)
  2. Functional and meaningful
  3. No expensive equipment
  4. Specific to exercise prescription
  5. Research shows it to be very reliable (Grgic et al, 2020)
  6. Motivating for patient
30
Q

Calculating 1 RM

A

determining the maximum weight that the patient can lift, without failure or compensatory body movements, with good technique. (If you do this, try to get to the 1-RM within 5 attempts.)

31
Q

Functional strength testing

A

Performance of a compound movement, such as sit to stand, heel raise, pull up or push up

32
Q

functional strength testing detects

A

• Speed of performance (= POWER)
• Absolute repetition number (concentric / eccentric) (=
ENDURANCE)
• Sustained maximal duration trials (isometric) (= ENDURANCE)

33
Q

endurance

A

Ability to undergo prolonged activity or to resist stresses set up as a result of prolonged activity

34
Q

muscular endurance

A

The ability of a muscle to sustain an isometric contraction or to
continue a dynamic contraction

35
Q

cardiovascular endurance

A

The capacity of the individual to maintain strenuous activity of a
number of muscle groups or of the whole body for a prolonged
period

36
Q

fatigue

A

Subjective feeling of discomfort, tiredness
• Increased perception of effort
• Decrease in maximal power produced by a muscle

37
Q

What is the relationship of fatigue to task failure in PNS?

A

Impairment of physiological processes that enable contractile proteins to generate a force
Accumulation of metabolic by-products (H+, Pi, AMP)
ATP used faster than it can be provided

38
Q

What is the relationship of fatigue to task failure in CNS?

A

Mechanisms in the CNS which result in decreased voluntary activation
• The “central governor theory”

NMSKI (38 decks)

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