1348494369.482Measurement in Physical Therapy New

Measurement In Physical Therapy Course Coordinator: FUZAIL AHMAD RHPT-241, BPT -IVTH Semester Department Of Physical Therapy College Of Applied Medical Sciences

Examination Pattern

Long Essay type Question (Ans not less than 2 page) 10x2=20

Short notes (Minimum 1 page ans) 5x5=25

MCQ 50x1=55

Total Marks 100


Resistance

Its a force that acts in opposition to a contracting muscle.

Maximal Resistance

Its the maximum resistance, which a patient can overcome to performing full range of

motion.

Minimal Resistance

Its the minimum resistance, which a patient can overcome to performing full range of

motion.

Manual Muscle Testing

It is the procedure of manually testing the strength of a muscle using manual muscle testing

scale.

Break Test

It is the procedure most commonly used in manual muscle testing today. Manual resistance is

applied to a limb or other body part after it has completed its range of movement. Manual

resistance should always be applied in the direction of the "line of pull" of the participating

muscle or muscles. At the end of the available range, or at a point in the range where the

muscle is most challenged, the patient is asked to hold the part at that point and not allow the

examiner to "break" the hold with manual resistance.

Active Resistance Test

An alternative to the break test is the application of manual resistance against an actively

contracting muscle or muscle group (i.e., against the direction of the movement as if to

prevent that movement). This may be called an "active resistance" test. During the motion,

the examiner gradually increases the amount of manual resistance until it reaches the

maximal level the subject can tolerate and motion ceases. This kind of manual muscle test

requires considerable skill and experience to perform and is so often equivocal that its use is

not recommended.


Range of Motion: Joint range of motion is the motion available at any single joint and is

influenced by the associated bony structure and the physiologic characteristics of the

connective tissue surrounding the joint. Important connective tissue that limits joint range of

motion includes ligaments and joint capsule.

Universal Goniometer

It is devise used for measuring the joint range of motion. The universal goniometer is made

of either metal or clear plastic and consists of a central protractor portion on which are

mounted two arms of varying lengths. The protractor portion of the goniometer may be either

a full circle or a half circle, both of which are calibrated in degrees. One of the two arms of

the goniometer is an extension of the protractor (the stationary arm), while the other arm is

riveted to, and can move independently of, the protractor (the moving/movable arm). The

central rivet, which attaches the moving arm to the protractor, functions as the axis, or

fulcrum, of the goniometer.

PROCEDURES FOR MEASURING JOINT RANGE OF MOTION

1. Determine the type of measurement to be performed (AROM or PROM).

2. Explain the purpose of the procedure to the patient.

3. Position the patient in the preferred patient position for the measurement.

4. Stabilize the proximal joint segment.

5. Instruct the patient in the specific motion that will be measured while moving the

patient's distant joint segment passively through the ROM. Determine the patient's

end-feel at the end of the PROM.

6. Return the patient's distal joint segment to the starting position.

7. Palpate bony landmarks for measurement device alignment.

8. Align the measurement device with the appropriate bony landmarks.

9. Read the scale of the measurement device and note the reading.


10. Have the patient move actively, or move the patient passively, through the available

ROM.

11. Re-palpate the bony landmarks and readjust the alignment of the measurement device

as necessary.

12. Read the scale of the measurement device and note the reading.

13. Record the patient's ROM. The record should include, at a minimum:

a. Patient's name and identifying information

b. Date measurement was taken

c. Identification of person taking measurement

d. Type of motion measured (AROM or PROM) and device used

e. Any alteration from preferred patient position

f. Readings taken from measurement device at beginning and end of ROM.

PRINCIPLES OF MANUAL MUSCLE TESTING

1. Knowledge of the location and anatomical features of the muscles in a test. In

addition to knowing the muscle attachments, the examiner should be able to visualize

the location of the tendon and its muscle in relationship to other tendons and muscles

and other structures in the same area

2. Knowledge of the direction of muscle fibers and their "line of pull" in each muscle.

3. Knowledge of the function of the participating muscles (e.g., synergists, prime

movers, accessories).

4. Consistent use of a standardized method for each different test.

5. Consistent use of proper positioning and stabilization techniques for each test

procedure.


6. Ability to identify patterns of substitution in a given test and how they can be detected

based on a knowledge of which other muscles can be substituted for the one(s) being

tested.

7. Ability to detect contractile activity during both contraction and relaxation, especially

in minimally active muscle.

8. Sensitivity to differences in contour and bulk of the muscles being tested in contrast to

the contra lateral side or to normal expectations based on such factors as body size,

occupation, or leisure activities.

9. Awareness of any deviation from normal values for range of motion and the presence

of any joint laxity or deformity.

10. Understanding that the muscle belly must not be grasped at any time during a manual

muscle test except specifically to assess tenderness or pain and muscle mass.

11. Ability to modify test procedures when necessary while not compromising the test

result and understanding the influence of the modification on the result.

12. Knowledge of the effect of fatigue on the test results, especially muscles tested late in

a long testing session, and sensitivity to fatigue in certain diagnostic conditions such

as myasthenia gravis or Eaton-Lambert syndrome.

13. The patient with open wounds or other conditions requiring gloves, which may blunt

palpation skills.

PROCEDURE FOR MUSCLE TESTING

1. The examiner and the patient must work in harmony if the test session is to be

successful.

2. This means that some basic principles and inviolable procedures should be second

nature to the examiner.


3. The patient should be as free as possible from discomfort or pain for the duration of

each test. It may be necessary to allow some patients to move or be positioned

differently between tests.

4. The environment for testing should be quiet and none distracting. The temperature

should be comfortable for the partially disrobed subject.

5. The plinth or mat table for testing must be firm to help stabilize the part being tested.

The ideal is a hard surface, minimally padded or not padded at all. The hard surface

will not allow the trunk or limbs to "sink in." Friction of the surface material should

be kept to a minimum. When the patient is reasonably mobile a plinth is fine, but its

width should not be so narrow that the patient is terrified of falling or sliding off.

When the patient is severely paretic, a mat table is the more practical choice. The

height of the table should be adjustable to allow the examiner to use proper leverage

and body mechanics.

6. Patient position should be carefully organized so that position changes in a test

sequence are minimized. The patient's position must permit adequate stabilization of

the part or parts being tested by virtue of body weight or with help provided by the

examiner.

MATERIALS NEEDED FOR THE MANUAL MUSCLE TESTING

1. Muscle test documentation forms

2. Pen, pencil, or computer terminal

3. Pillows, towels, pads, and wedges for positioning

4. Sheets or other draping linen

5. Interpreter (if needed)

6. Assistance for turning, moving, or stabilizing the patient


NECK

Extension

ROM: 0-450

MMT-Position of Patient

Grade IV & V: Prone with head off end of table, arms at side

Grade III: Prone with head off end of table and supported by therapist, arms at side

Grade II, I & 0: Supine with head on table, arms at side.

Flexion

ROM: 0-450

Flexor Muscles: Sternocliedomastoid, Longus Coli & Scalenus Anterior

Manual Muscle Testing:- Position of Patient:

Supine with head on table with arms at sides.

Rotation

ROM: 0-550

Sternocleidomastoid, Trapezius & Levator Scapulae

Manual Muscle Testing- Position of Patient:

Grade V, IV & III: Supine with cervical spine in neutral & head supported on table

with face turned as far to one side as possible.

Grade II, I & 0: Sitting. Trunk and head may be supported against a high-back chair.

Head posture neutral.


TRUNK

Lumbar Extension

ROM: 0-250


Grade V & IV: Prone with head and upper trunk extending off the table from about

the nipple line

Grade III, II, I & 0: Prone with arms at sides.

Trunk Flexion

ROM: 0-800

Trunk Flexors: Rectus Abdominis, Obliquus externus abdominis & Obliquus

internus abdominis.

Manual Muscle Testing-Position of Patient:

Grade V: Supine with hands clasped behind head

Grade IV: Supine with arms crossed over chest

Grade III: Supine with arms outstretched in full extension above plane of body

Grade II: Supine with arms at sides. Knees flexed.

Trunk Rotation

ROM: 0-450

Trunk Rotators: Obliquus externus abdominis & Obliquus internus abdominis.


Grade V: Supine with hands clasped behind head.

Grade IV: Supine with arms crossed over chest.

Grade III: Supine with arms outstretched above plane of body.

Grade II: Supine with arms outstretched above plane of body.

Grade I & 0: Supine with arms at sides. Hips flexed with feet flat on table.


UPPER EXTREMITY

SCAPULAR MOVEMENT

Scapular Abduction and Upward Rotation

ROM: Not available

Muscles: Serratus anterior & Pectoralis minor

Manual Muscle Testing-Position of Patient:

Grade V, IV & III: Short sitting with arm forward flexed to about 130 and then

protracted in that plane as far as it can move.

Grade II: Short sitting with arm flexed above 90 and supported by examiner.

Grade II & 0: Short sitting with arm forward flexed to above 90 (supported by

therapist).

Scapular Elevation

Elevator muscles: Trapezius( Upper fibres), Levator scapulae, Rhomboidus major &

Rhomboidus minor


Position of Patient: Short sitting over end or side of table. Hands relaxed in lap.

Scapular Adduction

Adductors muscles: Trapezius (Medial fibres), & Rhomboidus major


Prone with shoulder at edge of table abducted to 90, elbow is flexed to a right angle

& head may be turned to either side for comfort.

Scapular Depression And Adduction

Muscles: Trapezius, Lattisimus dorsi, Pectoralis major & Pectoralis minor.



Prone with test arm over head to about 145 of abduction. Forearm is in mid position

with the thumb pointing toward the ceiling. Head may be turned to either side for

comfort.

Scapular Adduction And Downward Rotation

Muscle: Rhomboids major, Rhomboids minor & Levator scapulae


Grade V. IV & III: Prone with shoulder internally rotated and the arm

adducted across the back with the elbow flexed and hand resting on the back.

Head may be turned to either side for comfort.

Grade II, I & 0: Short sitting with shoulder internally rotated and arm

extended and adducted behind back.

SHOULDER JOINT

Shoulder Flexion

ROM: 0-1200

Flexor Muscles: Deltoid-Upper fibres & Coracobrachialis


Grade V & IV: Short sitting with arms at sides, elbow slightly flexed, and

forearm pronated.

Grade III: Short sitting, arm at side with elbow slightly flexed and forearm

pronated.

Grade II, I & 0: Short sitting with arm at side and elbow slightly flexed.

Goniometry


Starting position for measurement of shoulder flexion: Supine with

shoulder in 0 degrees flexion, elbow fully extended, forearm in neutral

rotation with palm facing trunk

Bony landmarks for goniometer alignment: Lateral aspect of acromion

process, lateral midline of thorax, lateral humeral epicondyle.

Shoulder Extension

ROM: 0-450

Extensor Muscle: Latissimus dorsi, Teres major, Posterior Deltoid


Position of Patient: Prone with arms at sides and shoulder internally rotated

(palm up)

Goniometry

Patient position: Prone with shoulder in 0 degrees flexion, elbow fully

extended, forearm in neutral rotation with palm facing trunk.


process, lateral midline of thorax, lateral humeral epicondyle.

Shoulder Abduction

ROM: 0-1800

Abductor Muscle: Middle Deltoid and Supraspinatus


Grade V, IV & III: Short sitting with arm at side and elbow slightly flexed.

Grade II: Short sitting with arm at side and slight elbow flexion.

Goniometry

Patient position: Supine with arm at side, upper extremity in anatomical

position.


Bony landmarks for goniometer alignment: Midline of sternum, medial

humeral epicondyle.

Shoulder External Rotation

ROM: 0-600

External Rotator Muscle: Infraspinatus and Teres minor


Grade V, IV & III: Prone with head turned toward test side. Shoulder

abducted to 90 with arm fully supported on table; forearm hanging vertically

over edge of table. Place a folded towel under the arm at the edge of the table

if it has a sharp edge.

Grade II, I & 0: Prone with head turned to test side, trunk at edge of table.

The entire limb hangs down loosely from the shoulder in neutral rotation,

palm facing table

Goniometry

Patient position: Supine with shoulder abducted to 90 degrees, elbow flexed

to 90 degrees, forearm pronated, folded towel under humerus.

Bony landmarks for goniometer alignment: Olecranon and styloid

processes of ulna

Internal Rotation

ROM: 0-800

Internal Rotator Muscle: Subscapularis, Pectoralis Major, Teres Major & Lattisimus

dorsi.


Grade V, IV & III: Prone with head turned toward test side. Shoulder is

abducted to 90 with folded towel placed under distal arm and forearm


hanging vertically over edge of table. Short sitting is a common alternate

position.

Grade II, I & 0: Prone with head turned toward test side. Patient must be near

the edge of the table on test side so that entire arm can hang down freely over

the edge. Arm is in neutral with palm facing the table.

Goniometry



Bony landmarks for goniometer alignment: Olecranon and styloid

processes of ulna

ELBOW JOINT

Elbow Flexion

ROM: 0-1500

Elbow Flexor Muscle: Biceps, Brachialis, and Brachioradialis

Manual Muscle Testing- Position of Patient

Grade V, IV & III: Short sitting with arms at sides. Forearm is supinated

(biceps), pronated (brachialis), and in midposition (brachioradialis).

Grade II: Short sitting with arm abducted to 90 and supported by examiner.

Forearm is supinated (biceps), pronated (brachialis), and in midposition

(brachioradialis).

Grade I & 0: Supine. Elbow is flexed to about 45 with forearm supinated

(for biceps), pronated (for brachialis), and in midposition (for brachioradialis).

Goniometry



process, lateral humeral epicondyle, radial styloid process.



Elbow Extension:

ROM: 150-00

Elbow Flexor Muscle: Triceps Brachei & Anconeous


Grade V, IV & III: Prone on table. The patient starts the test with the arm in

90 of abduction and the forearm flexed and hanging vertically over the side

of the table.

Grade II, I & 0: The arm is abducted to 90 with the shoulder in neutral

rotation and the elbow flexed to about 45. The entire limb is horizontal to the

floor.

Goniometry

Bony landmarks for goniometer alignment: lateral aspect of acromion

process, lateral humeral epicondyle, radial styloid process

Patient position: Supine with upper extremity in anatomical position (see

Note), elbow extended as far as possible, folded towel under distal humerus,

proximal to humeral condyles.

Supination

ROM: 0-800

Elbow Flexor Muscle: Supinator & Biceps Bracheii


Grade V, IV & III: Short sitting; arm at side and elbow flexed to 90;

forearm in pronation.


Grade II, I & 0: Short sitting with shoulder flexed between 45 and 90 and

elbow flexed to 90. Forearm in neutral.

Goniometry

Bony landmarks for goniometer alignment: Anterior midline of humerus

and ulnar styloid process

Patient position: Seated or standing with shoulder completely adducted,

elbow flexed to 90 degrees, forearm in neutral rotation

Pronation

ROM: 0-800

Elbow Flexor Muscle: Pronator Teres & Pronator Quadratus


Grade V, IV & III: Short sitting; arm at side and elbow flexed to 90;

forearm in pronation.

Grade II, I & 0: Short sitting with shoulder flexed between 45 and 90 and

elbow flexed to 90. Forearm in neutral.

Goniometry

Bony landmarks for goniometer alignment: Anterior midline of humerus

and ulnar styloid process.

Patient position: Seated or standing with shoulder completely adducted,

elbow flexed to 90 degrees, forearm in neutral rotation.

WRIST JOINT

Wrist Flexion

ROM: 0-800


Elbow Flexor Muscle: Flexor carpi Ulnaris & Flexor Carpi Radialis


Grade V, IV & III: Short sitting. Forearm is supported on its dorsal surface

on a table. To start, forearm is supinated. Wrist is in neutral position or

slightly extended.

Grade II, I & 0: Short sitting with elbow supported on table, forearm in mid

position with hand resting on ulnar side.

Goniometry

Bony landmarks for goniometer alignment: Olecranon process of ulna,

triquetrum, lateral midline of 5th metacarpal.

Patient position: Seated, with shoulder abducted 90 degrees; elbow flexed 90

degrees; forearm pronated; arm and forearm supported on table; hand off table

with wrist in neutral position

Wrist Extension

ROM: 0-800

Elbow Flexor Muscle: Extensor carpi radialis longus, Extensor carpi radialis brevis, and

Extensor carpi ulnaris.


Grade V, IV & III: Short sitting. Elbow is flexed, forearm is fully pronated,

and both are supported on the table.

Grade II, I & 0: Short sitting with elbow supported on table, forearm in mid

position with hand resting on ulnar side.

Goniometry

Bony landmarks for goniometer alignment: Olecranon process of ulna,

triquetrum, lateral midline of 5th metacarpal


Patient position: Seated, with shoulder abducted 90 degrees; elbow flexed 90

degrees; forearm pronated; arm and forearm supported on table; hand off table

with wrist in neutral position


LOWER EXTRIMITY

HIP JOINT

Flexion

Hip flexors: Illacus & Psoas Major

Manual Muscle Testing: Body Position

Grade III, IV & V: Sitting with hip & knee flexed to 900

Grade II: Side lying

Goniometric Measurement

Body Position : Supine

ROM: 0 to 1200

Bony landmarks for goniometer alignment

Fixed arm: lteral midline of pelvis/trunk

Fulcrum: Greater Trochanter

Movable arm: Lateral femoral epicondyle

Extension

Hip Extensors: Gluteus Maximus, Biceps Femoris, Semimembrenous &

Semitendinosus


Grade III, IV & V: Prone lying




ROM: 0 to 200


Fixed arm: lateral midline of pelvis/trunk


Fulcrum: Greater Trochanter

Movable arm: Lateral femoral epicondyle

Abduction

Abductors: Gluteus Medius, Gluteus Minimus & Tensor Faciae Latae(TFL)


Grade III, IV & V: Side lying

Grade II: Supine lying



Range of motion: 0-450



Fulcrum: ASIS

Movable arm: Midline of patella

Adduction

Adductors: Adductor longus, Adductor Magnus, Adductor Brevis, Pectinius

& Gracilis


Grade III, IV & V: Side lying with upper leg abducted.

Grade II: Supine



Body Position : Supine with contra lateral hip abducted



Fulcrum: ASIS


Movable arm : Midline of patella

Internal rotation

Internal Rotators: Gluteus Medius, Gluteus Minimus & Tensor Faciae Latae

Manual Muscle Testing (Body position)

Grade III, IV & V: Short Sitting (with hip & knee flexed at 900)

Grade II: Supine



Body Position : Seated, with hip and knee flexed to 90 degrees,


Fixed arm: Tibial Crest

Fulcrum: Midpoint of Patella

Movable arm: Tibial Crest

External Rotation

External rotators: Obturator internus & Externus, Superior & Inferior

Gemellus, Quadratus Femoris , Piriformis & Gluteus Maximus


Grade III, IV & V: Short Sitting (with hip & knee flexed at 900)

Grade II: Supine



Body Position : Seated, with hip and knee flexed to 90 degrees,


Fixed arm: Tibial Crest

Fulcrum: Midpoint of Patella

Movable arm: Tibial Crest


KNEE JOINT

Flexion

Knee Flexors: Hamstring (Semimembrenous, Semitendinosus & Biceps

Femoris)


Grade III, IV & V: Position of Patient: Prone with limbs straight and

toes hanging over the edge of the table.




Body Position : Starting position for measurement of knee flexion.

Towel roll under ipsilateral ankle to promote full knee extension.


Fixed arm: Greater trochanter

Fulcrum: Lateral femoral epicondyle

Movable arm : Lateral malleolus

Extension

Knee Extensors: Quadriceps (Vastus medialis, vastus lateralis, vastus

intermedius & Rectus femoris)


Grade III, IV & V: Short sitting with hip & knee flexed at 900


ANKLE JOINT

Plantar flexion

Ankle Plantar flexors: Gastronomies & Solius



Position of Patient: Patient stands on limb to be tested with knee

extended.

Grade 5: Patient successfully completes a minimum of 25 heel rises

through full range of motion without a rest between rises and without

fatigue.

Grade 4: Heel rises between 24 and 10 with no rest between repetitions

and without fatigue.

Grade 3 (Fair): Patient completes between nine and one heel rises

correctly with no rest or fatigue.1

Grade 2: Side lying with feet clearing the end of table.



Body Position : Long sitting with knee in extension & ankle in neutral

position (900)


Fixed arm: Fibular head

Fulcrum: Lateral malleolus

Movable arm : Lateral midline of 5th metatarsal

Dorsiflexion

Ankle Dorsiflexors: Tibialis Anterior, Extensor Hallucis Longus, Extensor

digitorum Longus & Peroneus Tertius


Grade III, IV & V: Short sitting with knee & ankle flexed at 900





Body Position : Long sitting with knee in extension & ankle in neutral

position (900)


Fixed arm: Fibular head.

Fulcrum: Lateral malleolus

Movable arm: Lateral midline of 5th metatarsal

Inversion

Ankle Invertors: Tibialis posterior


Grade III, IV & V: Short sitting with hi & knee flexed at 900

Resistance: Antero-medial border of foot

Grade II: Long sitting with knee in extension & ankle in neutral

position (900)

Eversion

Ankle Evertors: Peroneous longus &Peroneous brevis


Grade III, IV & V: Short sitting with hi & knee flexed at 900

Resistance: Antero-Lateral border of foot

Grade II: Long sitting with knee in extension & ankle in neutral

position (900)


Tape Measurement

Trunk FlexionThoracolumbar Spine

Patient position: Standing, feet shoulders' width apart

Bony landmarks for tape measure alignment: Midline of spine in line with PSIS,

spinous process of C7 vertebra.

Trunk Lateral Flexion

Patient position: Standing, feet shoulders' width apart; palm of hand against thigh

At maximal lateral flexion, distance from tip of middle finger to floor is measured

Trunk FlexionLumbar Spine



15 cm above base line mark.

Trunk Extension



15 cm above base line mark

Trunk Rotation

Patient position: Sitting erect, arms crossed and hands on opposite shoulders

Bony landmarks for tape measure alignment: lateral tip of ipsilateral acromion,

Greater trochanter of contralateral femur.

Chest Expansion

Maximum Expansion 2 to 6 cms

Locations for measuring the expansion

a. T1 or at the level of Axilla

b. T4 or at the level of Nipples


c. T10 or at the level of Xiphisternum

Limb length Measurement

True length: From Greater trochanter to lateral malliolus

Apparent length: From Umbilicus/ASIS to lateral malliolus

Limb Girth Measurement

Its the measurement of thigh circumference at 15 cms above the patella.

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1348494369.482Measurement in Physical Therapy New