PHT 1261C Tests and Measurements Dr Kane Definitions Tone Factors affecting tone Postural Tone Hypertonia Hypotonia Dystonia Spasticity velocity dependent Clasp knife response UMN syndrome ID: 229855
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Slide1
Muscle Tone and Manual Muscle Testing
PHT 1261C Tests and Measurements
Dr. KaneSlide2
Definitions
Tone
Factors affecting tone
Postural Tone
Hypertonia
Hypotonia
Dystonia
Spasticity – velocity dependent
Clasp knife response
UMN syndrome
Clonus
Babinski Sign
Rigidity
Lead pipe
CogwheelSlide3
Definitions - continued
Hypotonia
– flaccidity
LMN syndrome
Spinal Shock/Cerebral Shock
Dystonia
Focal vs. segmental vs. posturing
Decorticate Rigidity
Decerebrate
Rigidity
OpisthotonusSlide4
Variations in Tone
Volitional Effort and movement
Stress and anxiety
Position and interaction of tonic reflexes
Medications
General Health
Environmental temperatures
State of CNS arousal or alertness
Urinary bladder status
Fever/infection
Metabolic or Electrolyte imbalancesSlide5
Examination of Tone
Initial Observation of resting posture & palpation
Common posturing – see Table 8.1 page 235
Palpation – consistency, firmness & turgor
Passive Motion Testing
Responsiveness of muscles to stretch
Vary speed for spasticity and clonus
Grading Scale
0 = no response (flaccidity)
1+ = decreased response (
hypotonia
)
2+ = Normal response
3+ = exaggerated response (mild to moderate hypertonia)
4+ = sustained response (severe hypertonia)
Active Motion Testing/Special Tests
Pendulum test
MyotonometerSlide6
Spastic Hypertonia – Modified Ashworth Scale
Gold standard subjective 5 point ordinal scale
Interrater
&
intrarater
reliability is good
Problems:
Inability to detect small changes
Limited to extremity testing only
Grades
0 = no increase in muscle tone
1 = slight increase in muscle tone; catch & release
1+ = slight increase in tome with catch & minimal resistance through rest of range
2 = marked increase in tone through most of ROM
3 – considerable increase in tone; passive motion difficult
4 = affected parts rigid in flexion or extensionSlide7
Deep Tendon Reflexes
Table 8.3 page 237 O’Sullivan
Grading Scale
0 = no response
1+ = present but depressed, low normal
2+ = Average, normal
3+ = Increased, brisker than average; possibly but not necessarily normal
4+ = very brisk, hyperactive with clonus; abnormal
Increased with UMN lesions; decreased with LMN
Reinforcement maneuversSlide8
Manual Muscle Testing
Palmer Chapter 2
Not applicable for strength testing in patients who lack voluntary or active control of muscular tension (e.g. CNS disorders)
Not appropriate for spasticity
May get inaccurate results due to gravity and activation of stretch reflex
Reliability – ½ grade
intertester
is acceptable
Follow proper procedures
Give clear instructions
Demonstrate and explain
Improved with dynamometry Slide9
Manual Muscle Testing - continued
Validity
Palpate muscle
Proper stabilization
Prevent substitution muscles or patterns
Not functionalSlide10
MMT Uses
1. Establish a basis for muscle re-
ed
and exercise;
Develop plan of care
Show progress
Shows effectiveness of treatment
Additional information before muscle transfer surgery
2. Determines how functional a patient can be.
3. Determines a pt.'s needs for supportive apparatus –
orthoses
, splints, assistive devices
4. Helps determine a diagnosis.
5. Determines pt.'s prognosisSlide11
Factors that Contribute to Effectiveness of Muscle Contraction
Length of muscle when activated
Active insufficiency
Type of contraction
Eccentric > Isometric > Concentrically
Muscle Fiber Types
Type I slow twitch – fatigue resistant
Type II fast twitch – fatigue rapidly
Must consider speed of contraction & resistance applied
Type II – require less resistance to reach “normal” grade
Speed of contraction
Increased speed = increased tension ECCENTRIC
Increased speed = decreased tension CONCENTRICSlide12
Anatomical Factors that affect Muscle Contraction
Number of motor units per muscle
Functional excursion
Cross sectional Area
Line of pull of muscle fibers
Number of joints crossed
Sensory receptors
Attachments to bone & relationship to joint axis
Age of pt.
Sex of pt.Slide13
Evaluating Skeletal Muscle Strength
Anatomical, physiological, & biomechanical knowledge of skeletal muscle positions and stabilization
Elimination of substitution motions
Skill in palpation & application of resistance
Careful direction for each movement that is easily understood by the patient
Adherence to a standard method of grading muscle strength
Experience testing many individuals with normal muscle strength & varying degrees of weaknessSlide14
Factors to Consider in MMT
Weight of limb or distal segment with minimal effect of gravity (GM)
Weight of limb plus the effects of gravity (AG)
Weight of limb plus gravity plus manual resistanceSlide15
Factors Affecting Grading of MMT
Amount of manual resistance applied (opposite torque exerted by muscle)
Ability of muscle to move through complete ROM
Evidence of presence or absence of muscle contraction by palpation & observation
Gravity and manual resistance
GM – muscle contracts parallel to gravitational force
AG – muscle contract against the downward gravitational force
Grades are dependent on: age, sex, body build, occupation, etc.Slide16
Factors affecting MMT Results
Fatigue
Joint ROM limitations
Range grade/strength grade (-20 degrees/4 (good)
Pain
Subjectivity
Positions –AG/GM
Range
Palpation
Resistance –break or make method
Stabilization
Provides support
Prevents substitution motions
Substitution
Recording measurements Slide17
Procedure For Specific MMT
Position in AG position & stabilize – see page 31
Expose body part & drape appropriately
Explain the test and demonstrate to patient
Determine available ROM
PROM or AROM; test range; possibly goniometry
Align body part to direction of muscle fibers
Stabilize proximal segment
Have patient move distal segment through test ROM or hold at end range of motion
Observe and palpate muscle belly
Apply resistance – end range or through range
Record grade & date & initial; document in SOAP