Download Range of Motion, Strength, and Tone Assessment in Physical Therapy and more Schemes and Mind Maps French in PDF only on Docsity!
- ICF domain a. ROM, Strength, Tone – Body structure/Function impairment
- Testing Observsations will allow for proper documentation of IMPAIRMENTS a. Qualitative and quantitative
- Hx/Task Analysis a. What observations would lead you to investigate: i. ROM, Strength and Tone 4. ROM a. ICF i. Body structure function b. Factors affecting ROM i. Boney ii. Muscular
- Contracture
- Strength
- TONE iii. Pain c. Measuring ROM i. When to measure ROM? 1. General screen is always a good idea 2. Observation of deficit a. Tasks and movement analysis b. Clues in hx ii. Tests and Measures: Goniometry
- AROM, AAROM, PROM d. Movement system diagnoses related to ROM impairment i. ROM is not an identified MSDx classification **ii. You would select the MSDx that impacts A/PROM most:
- Force production**
- **Hypokinesia
- Strength** a. Define it: i. Ability of a muscle to volitionally contract against a given resistance b. Paresis vs Plegia i. Weakness (paresis) vs. Paralysis (complete muscle loss) c. Tests and measures i. 1 RM 1. Would this type of strength assessment be useful with neurologic patient population? - NO 2. Are there more appropriate measures of strength for these patients? – YES ii. MMT iii. HHD
- Strength measured on a continuous scale (ratio data) – lbs,kg
- Demonstrated to be better than MMT at detecting mild to moderate weakness and changes in muscle strength
- Normative and Psychometric Data
- How to HHD a. The same as MMT but use the Dynamometer b. Repeat 3 times–take the average iv. Pinch or hand grip v. Isokinetic testing (biodex/cydex) (how you can produce force at different speeds)
- Constant Speed: Variable Resistance
- Biodex or Cybex
- Multiple Variables Tested a. Peak Torque (most common) - highest amount of force b. Total Work – ability to maintain torque throughout ROM and reps i. For neurologic patients – this would be most functional c. Average Power – total work/time
- Compares results between limbs (if available) d. Functional Measures of LE Strength – can do movement observation at same time i. 5x - sit to stand
- Assessment that provides a method to quantify functional lower extremity strength.
- Also provides an opportunity for movement observation of a common functional task.
Strength Tests and Measures: MMT and HHD
- Break test
- “Hold, don’t let me move you.”
- What type of contraction is produced?
- Eccentric contraction – highest force - Make test - “Push as hard as you can.” - What type of contraction is produced? - We want to do make test – more accurate measure of ms strength
- Which produces highest force? → BREAK
- How do we reduce measurement error?
- Strength and weakness of each type?
- Additional considerations
- Method of applying resistance (make versus break)
- Patient’s body position in relationship to gravity
- Joint-angle
- Dynamometer placement on the patient (leverarm)
6. Tone: Hypotonicity a. Decreased/lack of resistance to passive movement b. Causes: i. LMN ii. Dorsal Rhizotomy iii. SCI – Spinal Shock: period immediately after SCI, absence of muscle tone due to inflammation
- Intervention: lower body temp to minimize inflammation iv. Variable duration v. Acute CVA
- Flaccidity in Brunnstrom stage 1 a. Sulcus Sign of affected arm indicates hemiparetic sling vi. Cerebellar Disease vii. Genetic Syndromes c. Tests and Measures: Hypotonicity i. PROM ii. Document with Classyfying words
- Low tone
- Flaccidity – more extreme form d. Tone: Hypertonicity i. Resistance to passive movement of a limb **ii. Spasticity
- Velocity dependent** 2. Generally on one side of the joint
- Caused by/physiology: limited descending inhibition of stretch reflex a. Cortex (corticospinal/pyramidal tracts) b. Brainstem/Spinal Cord (med/lat vestibulospinal or dorsal reticulopsinal tracts)
- Common seen in: a. SCI, CVA, TBI, MS iii. Clinical Presentation of Spasticity
- Increased resistance a. when moved fast and normal when slow
- Catch and letting go a. Move slow -- normal and catch when turn up speed
- Clonus a. Rhythmic oscillation between activation and relaxation mediated by stretch reflex (typical in gastroc/soleus) iv. Chronic Spasticity Cycle (skin checks necessary for positioning)
v. Tests and Measures: Hypertonicity- Spasticity
- General Positive Signs and Symptoms a. Flexor (or extensor) spasms during movements b. Clasp knife phenomenon. c. Babinski sign d. Exaggerated cutaneous withdrawal (flexor, pain) reflexes 2. Deep Tendon Reflexes a. 0: absent b. 1+: trace or seen only with reinforcement c. 2+: normal d. 3+: brisk e. 4+: nonsustained clonus f. 5+: sustained clonus
g. Biceps (C5, C6) h. Brachioradialis (C6) i. Triceps (C7) j. Patellar (L4) k. Achilles (S1)
3. Modified Ashworth Scale (MAS) a. General: i. Supine Positioning ii. Move muscle from shortened to lengthened in one second (“one-one thousand”) b. Flexor Testing: i. Passively move joint in maximally flexed position ii. Over one second (one thousand one) move joint to fully extended position c. Extensor Testing: i. Passively move joint in maximally extended position ii. Over one second (one thousand one) move joint to fully flexed position d. Grading:
i. Tardieu and Modified Scales
e. What is the importance of the spasticity angle? i. Tells you availability of ROM you have to FUNCTION/move in f. Grading
0 – no muscle reaction 1– weak resistance 2– catch and release 3 – fatiguable clonus under 10 sec 4 – nonfatoguable clonus greater than 10 sec g. Population tested i. CP, CVA, peds and adult
5. Pendulum test a. Specific Quadriceps Test i. Clonus – lots of swings ii. No clonus – less swings as you drop leg b. Populations: CVA, SCI i. Research ii. Generally used with c. Electrogoniometer, video, motion capture software d. Grading i. Cycles 1. Normal : 6-
- spastic : < 6-7 unless clonus evoked ii. Qualitative
- Normal : smooth
- spastic : catch, may have quicker cycles iii. Relaxtion Index
- Clonus drop a. Test for soleus and gastroc b. SCI population c. Data collected: motion capture for angle, duration of clonus, number of beats, EMG data d. Grading i. >10 sec = non - fatiguing
Spasticity of which muscle group is being tested?
- Hamstring testing in SL
- 1 = catch at end of ROM How would this impact movement?
- Knee extension affected which can affect:
- initial contact (flat foot) What if they had gastroc spasticity?
- May not get to Terminal stance = shorter step length
e. Hypertonicity: Rigidity i. Not velocity Dependent* ii. Generally resistance on both sides of the joint*** iii. Clinical Presentation
- Lead-Pipe - resistance throughout range
- Cogwheel - stop and go iv. Physiology: Limited descending inhibition
- Issues with dopaminergic neurons and basal ganglia v. Common Causes
- Parkinson's Disease
- Segmental/Generalized: multiple parts/joints
- Duration
- Minutes, hours, permanent
- Causes:
- Inherited/Genetic
- Neurodegenerative disease
- Metabolic disease - Athetoid vs. Ataxia
- Slow writhing vs poorly coordinated
Hyperkinetics: Chorea (huntington's disease)
- Characterization
- Brief, unpredictable, non-stereotyped movement
- fidgety, clumsy
- may worsen with stress
- Subsides with sleep
- Cause:
- Dysregulation of BG causing increased Cortical Excitation from Thalamus
Hyperkinetics: Synergy
- Pathological vs. Non-Pathological
- Non-Pathological – throwing
- Pathological - UE flexion /LE extension
- Common Causes:
- Characteristics: - Coupled movements or paired muscular activity which is inappropriate for the function/task
- Brunnstrom stages of stroke recovery
- Description of synergistic movements post CVA
- UE flexion and LE extension – most common
Synergy: Brunnstrom Stages (CVA Recovery) – DO NOT WRITE GOALS ON THIS
- Stage 1 (initial stage): - no voluntary movement in affected limb, flaccidity. - Stage 2: basic limb synergies (effort = synergistic pattern) - some components appear as weak associated reactions (flexion first). Spasticity developing, no voluntary movement - Synergy present - Associated reactions -brain trying to selectively control movements but it can’t
