Week 2, D&G: Ch. 13 (Motor Function Assessment: ROM)

intrarater reliability

one therapist consistently measuring the same joint angle over multiple trials

manual muscle testing (MMT)

procedure for the evaluation of the strength of muscles depending on the performance of a movement in relation to the forces of gravity and manual resistance

cardiorespiratory endurance

the ability of the circulatory and respiratory system to supply oxygen during a time period while performing a task

muscular endurance

the ability of the muscle to perform multiple repetitions of a contraction without fatigue

muscular strength

the ability to perform activities that require high levels of muscular force - a key component of muscular fitness

passive range of motion (PROM)

the amount of motion at a given joint when the joint is moved by an outside force

active range of motion (AROM)

the amount of motion that a given joint achieved when the client contracts the muscles that control the desired motion

static muscle endurance assessments

the amount of time a contraction can be held

Endurance Measurement: the talk test

the client should be able to continue talking in full sentences during engagement in therapeutic tasks

maximum voluntary contraction (MVC)

the greatest amount of tension a muscle can generate and hold only for a moment, such as in muscle training

break test

the muscle to be tested is positioned at its greatest mechanical advantage and then an external force is applied as the client is asked to hold the position -isometric hold

dynamic muscle endurance assessments

the number of repetitions per unit of time

end-feel

the resistance in the joint that the therapist feels at the end range of the passive limits of motion

underlying causes that can affect motor function

- bony blocks to motion - capsular tightness around the joint - tightness of the muscle-tendon unit - edema - contractures - extensive scar tissue

symptoms of muscle fatigue

- cramping - burning - tremor (which are secondary to the accumulation of lactic acid)

client-related factors that can affect accuracy and reliability of ROM measurements

- pain - fear of pain - fatigue - feelings of stress or tension

the basic instructions to follow when performing a functional screening of ROM and strength of the upper extremity

- the client should be seated, if possible - the client should perform the motions bilaterally, if possible. If not, the unimpaired or least impaired side should move first to set a baseline for normal for this person - observe for complete movements, symmetry of movements, and timing of movements - demonstrate the movements if the client has a language barrier or cognitive deficits - to estimate the amount of active movement and strength, give instructions to the client

environmental factors that can affect accuracy and reliability of ROM measurements

- time of day - temperature of the room - type of goniometer used - training and experience of the tester

3 types of pinch

- tip pinch - lateral pinch (key pinch) - palmar pinch (three-jaw chuck)

Measuring Edema: process of volumetric measurement

- use a water vessel that is large enough to allow submersion of the whole hand - when the limb is placed in the vessel, water is displaced and spills out into a collection beaker via a spout at the top and is then measured with a graduated cylinder - an edematous limb displaces more water than a limb without swelling, so a lower reading is considered an improvement - not appropriate for hands with open wounds or other skin conditions, percutaneous pinning or external fixation devices, healing skin grafts, suspicion of infection, or are immediately post-operative

3 general principles to follow when positioning a goniometer over a joint

1) place the access of the goniometer over the axis of motion 2) position the stationary arm parallel to the longitudinal axis of the body segment proximal to the joint being measured 3) position the movable arm parallel to the longitudinal axis of the body segment distal to the joint being measured

What is considered to be the 0° (zero start) position when measuring ROM?

Anatomical position - alternatively, if a given starting position is different from anatomical position, it is defined as 0°

T/F : it is not important to match the size of the goniometer to the size of the joint

F - the goniometer size should match the size of the joint

T/F : PROM measurements are more reliable than AROM measurements

F - PROM measurements have the potential to be less reliable because of the variability of the applied force

T/F : it is normal to have slightly more PROM than AROM

T

muscular fitness

a combination of muscular strength and muscular endurance

weakness

a lack or reduction of the power in a muscle or muscle group

When would it be appropriate for a therapist to perform manual muscle testing (MMT) with a client?

during the screening, if the therapist determines any patterns such as weakness in one specific nerve distribution

dynamometer

a measure of applied force converted to a moment of force by multiplying by the perpendicular distance from the force to the axis of the lever - the use of a handheld dynamometer includes placing it perpendicular to the limb segment with the joint in a gravity-eliminated position and then asking the client to build a maximum contraction against the dynamometer for a 1-2 second period and to hold it against the dynamometer for 4-5 seconds

Measuring Edema: process of circumferential measurement

a millimeter tape is used to measure the circumference of a body part not easily submerged (as required by volumetric measurement) or when the edema is very localized (such as to a single digit, making measurement of the entire hand is unnecessary) - the figure-of-eight technique is typically used to measure the whole hand and may be especially appropriate and volumetry is contraindicated - the figure-of-eight technique is easier to use, more time efficient, and cost-effective, particularly in the ICU setting, than volumetry

the Baltimore Therapeutic Equipment (BTE) work simulator

a piece of equipment that can be set up to simulate a variety of work and daily tasks, such as digging with a shovel, turning a knob, climbing a ladder or rope, and using a steering wheel (among other things) - the therapist can see on the equipment if the client is decreasing in speed and showing fatigue

bone-to-bone hard end-feel

a stop and movement as the bony services meet - normal for elbow and knee extension

soft tissue approximation

a stop and movement due to soft tissue - normal in elbow and knee flexion

spasm end-feel

a tissue response with a harsh movement in the opposite direction; passive movement stresses a fracture or inflamed joint (always abnormal)

electrogoniometer

a tool that can offer continuous, dynamic joint measurement of ROM once positioned and calibrated - may be particularly helpful in work- and industry-type settings where repetitive work tasks and ergonomic impact are being assessed - requires calibration by the therapist

goniometer

common instrument used for measuring limb joint motion, which has a protractor, and axis, and two arms

Measuring Edema: process of perometer

in optoelectronic automated method of measuring upper extremity edema that has been shown to be quick, hygienic, and a less operator-dependent method of limb volume assessment - uses infrared beams to rapidly and automatically estimate limb volume - the volume of any part of the limb can be measured, the shape of the limb or limb segment can be displayed, and accurate calculations of change in volume can be made in seconds

capsular end-feel

is a movement that is somewhat firm or leathery but has some give - normal for shoulder external rotation and hip internal rotation

Why are clients asked to talk (e.g., sing, count) while doing an isometric contraction?

isometric holding increases blood pressure and stresses the cardio pulmonary system, which is especially true if the person holds his or her breath while holding the contraction - talking while doing it isometric contraction precludes breath holding

muscle strength should be assessed appropriately with MMT for deficits from ________ motor neuron injury [upper/lower]

lower motor neuron

volumetric

measurement that documents changes in the mass of a body part by use of water displacement

functional capacity evaluation (FCE)

measures a client's occupational performance to participate in work or in the worker role - assesses the clients impairments (such as endurance), occupational performance overall, and the role performance of the work to which the client wants to return

interrater reliability

multiple therapists consistently measuring the same joint angle

empty end-feel

no "feel," but rather the client asks to stop because of pain (always abnormal)

Endurance Measurement: the Borg (15-point) scale of perceived exertion

ranges from 6 (no exertion at all) to 20 (maximal exertion) and allows the person to assign one of the consecutive set of numbers with a corresponding descriptor of amount of exertion to the ongoing activity - Ex: 11 equals fairly light, 17 equals very hard - although subjective, multiplying the rating of exertion by 10 can provide a rough estimate of heart rate - perceived exertion for a given level of oxygen uptake is higher for arm work than for leg work

within normal limits (WNL)

represents capacities that fall in the range of what has been determined to be normal depending on mean average ranges

within functional limits (WFL)

represents capacities that may be less than normal limits, but sufficient for the client to participate in meaningful occupations to their own satisfaction

springy end-feel

some hard rebound at the end ROM (always abnormal)

tone should be assessed for deficits resulting from _______ motor neuron injuries [upper/lower]

upper motor neuron - a manual muscle test following an upper motor neuron insult would yield inconclusive results because of changes in tone, not necessarily in muscle strength. Therefore, MMT is inappropriate following a neurological event with resultant changes in tone