Muscle Performance and ROM Measures

Question 1

What is used to measure

Answer 1

Universal Goniometer

Visual examination - if expert

Question 2

Placement of goniometer

Answer 2

anatomical landmarks and palpation
Axis of rotation
Distal arm (moving)
Proximal arm (stationary)

Question 3

Contradictions/Precautions with goniometry

Answer 3

Acute dislocations/fractures
Immediately following surgery
Willingness to move issues
Disease (infection, thrombosis)

Question 4

Which comes first active or passive? then what?

Answer 4

Active
Passive
Resistance

Question 5

Active ROM - what to look at

Answer 5

Pain
Coordination
Attention span
Muscle strength
Stabilization (core)
Ability to follow commands

Question 6

Passive ROM - what to feel for

Answer 6

Joint structure - know which are involved
Pain/tenderness
End feel - take joint to end ROM, to whatever is limiting the motion

Question 7

Primary Sources of Error with Goniometry

Answer 7

Reading goniometer wrong
Rounding off
Expectation of what reading should be
Inexperience
Lack of stabilization

Question 8

Acceptable readings indicating improvement

Answer 8

Intratester 3-4 degree (Me on multiple occasions)

Intertester 5 degree (Me and then another PT)

Question 9

Procedure

Answer 9

1. Patient Position/Comfort
2. Visually Examine
3. Palpate
4. Joint Motion
5. Measure

Question 10

Procedure - Step 1

Answer 10

Patient Position/Comfort
Explain procedure
Position for correct measurement
Suport body part
Pt. Modesty
Environment

Question 11

Procedure - Step 2

Answer 11

Visually Examine
Look at joint you will move
Color
Contour
Scars
Skin Condition

Question 12

Procedure - Step 3

Answer 12

Palpate
Joint structures
Anatomical landmarks
Restrictive tissue

Question 13

Procedure - Step 4

Answer 13

Active
Active assisted if needed
Passive to end feel
Limit substitutions 
Compare sides (start with unaffected)

Question 14

Procedure - Step 5

Answer 14

Measure
Position goniometer
Fulcrum on joint axis
Moving arm on body part that is going to move
Stationary arm on body part that is stabilized

Question 15

Procedure - Step 6

Answer 15

Recording

0-180 method (0 as starting point)

Question 16

What to mention when recording data

Answer 16

If used something other than universal goniometer
Record body part and side you measured
AROM vs PROM
If tested in standard position or not

Question 17

Define Muscle Performance

Answer 17

The capacity of a muscle or group of muscles to generate force

Question 18

Define Strength

Answer 18

The maximal force that is generated at a given velocity

Question 19

Define Power

Answer 19

The product of strength and speed

Question 20

Define Endurance

Answer 20

Ability of a muscle to sustain or repeat contraction over time

Question 21

What is a muscle test

Answer 21

Clinical measurement to assist in determining muscle performance

Question 22

Type of muscle tests

Answer 22

Isokinetic devices
MMT
GMT
Functional muscle testing
1 repetition max

Question 23

Gross Muscle Testing

Answer 23

Use of manual resistance to test a group of muscles
Screening test only - can only say strong vs. weak
Normal vs. Impaired

Question 24

Manual Muscle Testing

Answer 24

Testing the strength of one muscle by manual resistance
Inc advantage of specific muscle
Or decrease activity of other muscles
Able to delineate levels of strength 
Use of muscle grades

Question 25

Factors involved in ability of a muscle to generate force

Answer 25

``` Muscle size Fiber arrangement and type Neural elements Anatomical relationship to joint axis Contraction type "Normal" function of muscle Condition of musculotendinous junction ```

Question 26

Concepts that MUST be remembered for muscle testing

Answer 26

``` Positioning Stabilization Resistance Role of palpation Part of grading Testing the correct muscle Control of substitutions ```

Question 27

Positioning with muscle testng

Answer 27

Where is gravity Muscle length (shortened vs lengthened) Action of muscle Composition of muscle

Question 28

Stabilization with muscle testing

Answer 28

Intrinsic is performed by body itself Extrinsic is imposed on the subject by outside elements Major factor in control of substitutions

Question 29

Resistance with muscle testing

Answer 29

Must be practiced Must be controlled Applied in the direction of the resolution of the force generated across the joint Distance of application is a significant consideration

Question 30

Types of MMT

Answer 30

Break and Make (both isometric resistance) Break = Command = Hold or Do not let me move you Make = Push against me. Try and move me

Question 31

Contradictions and Precautions to MMT

Answer 31

``` Dislocations and fractures Immediately following surgery Disease (infection, osteoporosis) Spasticity Acute inflammatory Pain and fatigue ```

Question 32

How to - muscle testing

Answer 32

``` Patient/Body part position Determine available ROM Stabilization Placement of body part Manual Resistance - Isometric Hold Gradual build up of force 3 to 6 sec max resistance ```

Question 33

Placement for muscle testing

Answer 33

Mid-range in primary place where the muscles act

Question 34

Communication

Answer 34

``` Seek permission Explain procedure to patient Take them through movement Ask for a "hold" DO NOT ask patient to push into your hand --> that would be make and we want break! ```

Question 35

In order to give a muscle grade...

Answer 35

Rules MUST be followed | Otherwise, can only give weak or strong compared to opposite side

Question 36

ROM | GMT vs. MMT

Answer 36

``` GMT = Yes MMT = Yes ```

Question 37

Body Position | GMT vs. MMT

Answer 37

``` GMT = not important MMT = critical ```

Question 38

Palpation | GMT vs. MMT

Answer 38

``` GMT = Not important MMT = Important ```

Question 39

Stabilization | GMT vs. MMT

Answer 39

``` GMT = Important MMT = Critical ```

Question 40

Side Tested | GMT vs. MMT

Answer 40

``` GMT = Both sides at once or one side at a time MMT = One side at a time ```

Question 41

Normal Bone to Bone End Feel

Answer 41

A hard, painless sensation with no give | Ex: elbow extension

Question 42

Normal Soft Tissue Approximation End Feel

Answer 42

A mushy, forgiving sensation that stops further motion | Elbow or knee flexion = EX

Question 43

Normal Tissue Stretch End Feel

Answer 43

The most common type of normal end feel, felt when the primary restraints for further movement are a ligament or capsule. May be further divided into elastic (a spring) or capsular (no spring) wrist flexion = soft knee extension = hard

Question 44

Abnormal Bone to Bone End Feel

Answer 44

Similar to feel of normal, but this is painful and occurs before the normal expected ROM Ex ' elbow flexion in presence of excess bone

Question 45

Abnormal Springy Block End Feel

Answer 45

A forgiving feeling, similar to tissue stretch but often is painful and felt before the normal end ROM is achieved Ex = knee extension in presence of meniscus tear

Question 46

Abnormal Capsular End Feel

Answer 46

Feels similar to capsular tissue stretch end feel, but can invoke pain and occurs before the normal end ROM is achieved or where end feel is not expected Ex: frozen shoulder

Question 47

Abnormal Muscle Spasm End Feel

Answer 47

Involves a brief, involuntary muscle spasm that occurs in response to pain Ex: cervical lateral flexion following whiplash

Question 48

Abnormal Empty End Feel

Answer 48

Involved no sensation of resistance felt by the examiner, but the patient indicated the motion must stop due to intense pain Ex: bursitis