MUSCLE TESTING
MUSCLE TESTING
Manual
muscle tests are used to determine the extent and degree of muscular weakness
resulting from disease, injuring or disuse. The records obtained from the tests
provide a basis for planning therapeutic procedures and for periodic retesting,
which can be utilized in evaluating these procedures. Muscle testing is
therefore an important tool for all members for the health team dealing with
the physical residual of disability.
The public and the health professions
are demanding a total approach to patient treatment. The emphasis is changing
from “Sick Care” to “Health Care” through the pursuit of
comprehensive, continuous and coordinated care. Consequently physicians,
physical therapists, occupational therapists, nurses and their supporting
personnel have need for varying levels of knowledge and ability in muscle
testing in their concern for preventing disability, habilitating those who have
never known normal function, restoring those with disability to optional
function and maintaining the functions obtained. Physical educators, although
less concerned with the treatment of muscle impairment, are definitely
concerned with the optional development of the body and the prevention of
disability. They must, therefore, be familiar with the details of muscle
functions, testing for fair, good and normal function is an excellent device
for teaching kinesiology to this group.
VALIDITY AND RELIABILITY IN TESTING
Careful observation, palpation and
correct positioning are essential for validity in testing. The patient should
the asked to attempt to move the part through the range of motion, if he is
able to do so. The examiner should observe and note dissimilarities in the size
and contour of the muscle or group of muscles being tested and the counterpart
on the opposite side of the body. The contractile tissue and tendon (or
tendons) should be palpated, as a lack of tension helps to indentify
substitution by muscles other by the prime movers. Substitution usually can be
eliminated by careful positioning; if this is impossible a notation should be
made on the record. A classic example of complete substitution can occur in
patients with muscular dystrophy when the prime mover may be nonfunctioning and
secondary muscles perform the movement.
In considering the interpretation of a
test grade its is probably unnecessary to point out the existence of variation
in length and bulk of the body parts, variations in shape of like parts in
different persons, age and sex differences persons, age and sex differences in
strength, and the ever-present psychological considerations of cooperation
and willingness to put maximal effort
that operate particular in every small children. In view of these and other
factors such as fatigue, it would be an error to assume that invariably muscles
or muscle groups with the same grade have suffered an equal degree of involvement.
A factor that has been widely
disregarded, not only in muscles testing but also therapeutic exercise in
general, is the considerable variation in the force that a muscle can normally
exert at various point through the range of motion of the moving segment.
Consideration of such “strength curves” shows that the test point in manual
resistance tests is often near the weakest portion of the range. As long as the
test is always done in the same manner, this willnot affect its reliability,
but it may have implication for functional interpretation of the grade.
NECK FLEXION
Normal
and Good
v Backlying
, shoulders relaxed.
v Stabilize
lower thorax.
v Patient
flexes cervical spine through range of motion.
v Patient
is given on forehead
Note:
The
accessory muscles flex the head and stabilize the cervical spine as the
sternocleidomastoideus muscles flex the neck. if the accessory muscles are
weak, the contraction of strong sternoccieddomastoideus muscles will increase
rather than decrease the convexity of the cervical spine , the head can be
raised but will be rotated posteriorly, chin up.
Normal and Good
Ø Facelying
with neck in flexion
Ø Stabilize
upper thoracic area and scapulae
Ø Patient
extends cervical spine through range of motion.
Ø Resistance
is given on occiput.
Note:
If
there is considerable weakness of neck extensors or discomfort in this
position, all tests may be given with head resting on bed or table.
Extensors muscles on right may be
tested by rotation of head to right with extension and vice versa.
Trunk Flexion
Normal and Good
ü Backlying
with hands behind neck.
ü Stabilize
lower limbs.
ü Patients
flexes thorax through range of motion.
A “curl-up” is emphasized, and
flexion is possible until scapulae are raised from bed or table.
Note:
If
abdominals are weak, the reverse action of the hip flexors may cause lumber
lordosis. If so, the patient’s hips and knees should be flexed (feet flat on
bed/ tables). This allows “slacks” in the hip flexors. However, if the extensor
muscles of the lumbar spine are weak, contraction of the abdominal muscles can
cause posterior rotation of the pelvis. If this occurs, tension in the hip
flexors would be useful in stabilize the pelvis.
·
If hip flexors are weak, stabilize the
pelvis.
NOTE: In
all tests, observe the umbilicus cranial movement indicates a stronger
contraction of upper segments of muscle, and caudal movement indicates a
stronger contraction of lower segments.
·
Tests for neck flexion should precede
those for trunk flexion.
Patient flexes thorax on pelvis
through range of motion
Normal and Good
§ Backlying
with hands behind neck
§ Stabilize
lower limbs
§ Patient
rotates and flexes thorax to one side. Repeat to opposite side.
§ Tests
for left obliges externus abdominis and right obliques internus abdominis.
Rotation to left is brought about by opposite muscles.
Note: In
all tests, observe any deviation of umbilicus, which will move towards strongest
quadrant if there is a difference in strength of opposing oblique muscles.
§ Flaring
of rib cage denotes weakness of external obligues.
§ If
hip flexion muscles are weak, stabilize pelvis.
§ A
good grade is given if scapula on forward shoulders is raised from bed/table
and other partially raised.
Normal and Good
v Facelying
v Stabilize
pelvis
v With
arms and shoulders clears of table/bed to prevent their use in extending
trucks, patients extends is raised from table/bed.
v Resistance
is given on caudal portion of thoracic area.
Note: Tests
for neck extensions should precede those for trunks extension.
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