Intro to Goniometry
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Questions and Answers

What is the primary focus of validity in physical therapy measurements?

  • The ability of a measurement to be consistently repeated
  • The comparison of outcomes between different testers
  • The measurement's ability to represent the true movement of the joint (correct)
  • The statistical analysis of measurement outcomes

    • Which factor significantly affects intra-rater reliability in goniometry?

  • The type of measuring tool used
  • Consistency in tester positions during measurements (correct)
  • The presence of muscle extensibility issues
  • Variability in patient demographics

    • What is the accepted standard deviation (SD) range for inter-rater reliability in goniometry?

  • 7-8 degrees
  • 1-2 degrees
  • 5-6 degrees (correct)
  • 3-4 degrees

    • What is the minimum meaningful change in range of motion (ROM) to be considered significant after an intervention?

    <p>2 SD, approximately 10 degrees</p> Signup and view all the answers

    Which type of validity involves comparing a measurement to a gold standard like a radiograph?

    <p>Criterion-rated validity</p> Signup and view all the answers

    What is characterized by passive range of motion (PROM) being less than normal values for a joint, considering the patient's age and gender?

    <p>Hypomobility</p> Signup and view all the answers

    Which of the following is NOT a reason for hypomobility?

    <p>Increased muscle tone</p> Signup and view all the answers

    Which condition is characterized by an increase in PROM that exceeds normal values given the patient's age and gender?

    <p>Hypermobility</p> Signup and view all the answers

    Which of the following conditions is associated with joint laxity that can lead to hypermobility?

    <p>Ehlers-Danlos syndrome</p> Signup and view all the answers

    What does the Beighton Hypermobility Score assess?

    <p>The ability to perform certain movements indicating hypermobility</p> Signup and view all the answers

    What is the maximum possible total score when assessing joint hypermobility through the given criteria?

    <p>9</p> Signup and view all the answers

    Which of the following steps is NOT part of the documented goniometric procedures?

    <p>Perform on the affected side first</p> Signup and view all the answers

    In the goniometric notation system, what does a reading of '6o to 0o to 140o' indicate about range of motion?

    <p>The joint is moving into hyperextension.</p> Signup and view all the answers

    What type of information should be documented during the goniometric assessment?

    <p>Subjective measures like pain or discomfort</p> Signup and view all the answers

    Which of the following best describes protective muscle spasm during a joint assessment?

    <p>An involuntary response to pain or injury causing muscle tightening.</p> Signup and view all the answers

    What is the expected active range of motion (AROM) for the elbow joint?

    <p>0 to 140°</p> Signup and view all the answers

    Which muscle testing approach involves constant tension while the muscle length changes?

    <p>Isotonic</p> Signup and view all the answers

    Why is it important to know the expected range of motion and end feel prior to testing?

    <p>To accurately interpret the results of the test</p> Signup and view all the answers

    What does the term 'isometric' refer to in muscle testing?

    <p>Constant joint angle and muscle length during measurement</p> Signup and view all the answers

    What should be monitored when measuring joint motion to prevent compensatory actions?

    <p>Symptomatic regions during testing</p> Signup and view all the answers

    What is the purpose of resisted movement testing in manual muscle testing?

    <p>To differentiate between contractile and non-contractile sources of pain</p> Signup and view all the answers

    During the application of resistance in manual muscle testing, what is the ideal method?

    <p>Applying force perpendicular to the distal end of the segment</p> Signup and view all the answers

    Which grade in muscle strength indicates the ability to hold against maximal resistance?

    <p>5</p> Signup and view all the answers

    What does a muscle strength grade of 2 signify?

    <p>Movement through complete ROM in a gravity-minimized position</p> Signup and view all the answers

    What should be avoided during the application of resistance in manual muscle testing?

    <p>Crossing two joints while testing</p> Signup and view all the answers

    How should the patient be instructed during manual muscle testing?

    <p>To follow clear and standardized instructions</p> Signup and view all the answers

    Which grading indicates a muscle contraction that is palpable but does not result in movement?

    <p>Grade 1</p> Signup and view all the answers

    In the context of manual muscle testing, what does proximal stabilization refer to?

    <p>Stability from the region closer to the center of the body</p> Signup and view all the answers

    What does a grade of 3- in muscle strength indicate?

    <p>Movement through &lt; 1/2 ROM against gravity</p> Signup and view all the answers

    What is the significance of a break test in manual muscle testing?

    <p>To evaluate the maximal resistance during testing</p> Signup and view all the answers

    Which grading level indicates that a muscle can move through a full range of motion in a gravity-minimized position but can only achieve less than half of the range against gravity?

    <p>2+ Poor plus</p> Signup and view all the answers

    What is the significance of taking a patient through the full active/passive range of motion before testing?

    <p>To identify compensatory motion before measurement</p> Signup and view all the answers

    In muscle testing, why is it recommended to avoid crossing two joints during the application of resistance?

    <p>To maintain the integrity of muscle contraction assessment</p> Signup and view all the answers

    Which of the following actions should be considered during the muscle testing process for optimal stabilization?

    <p>Positioning the proximal segment effectively</p> Signup and view all the answers

    What does a muscle strength grade of 4 indicate about the patient's performance against resistance?

    <p>Complete movement against gravity with moderate resistance</p> Signup and view all the answers

    What type of information should be documented if a protective muscle spasm is noted during a joint assessment?

    <p>Any subjective information regarding discomfort</p> Signup and view all the answers

    During goniometric measurement, which factor is essential to ensure an accurate reading?

    <p>The goniometer should always be applied in a standard orientation</p> Signup and view all the answers

    In manual muscle testing, what does 'break test' specifically refer to?

    <p>The application of resistance until the patient fails</p> Signup and view all the answers

    Which parameter is crucial to note alongside muscle testing results for comprehensive documentation?

    <p>The presence of any abnormal joint motion</p> Signup and view all the answers

    What is a potential consequence of a joint being hypermobile during assessment?

    <p>Increased difficulty in measuring range of motion accurately</p> Signup and view all the answers

    What characterizes the end feel of an elbow extension during goniometric assessment?

    <p>Bone contacting bone</p> Signup and view all the answers

    Which process involves measuring both active and passive range of motion using appropriate devices?

    <p>Measurement of AROM and PROM</p> Signup and view all the answers

    What does a Beighton Hypermobility Score greater than 4 indicate?

    <p>Hypermobility</p> Signup and view all the answers

    In the context of goniometry, what is the primary reason for performing assessments on the contralateral side first?

    <p>To establish a baseline for comparison</p> Signup and view all the answers

    Which type of end feel is described as 'no real end-feel due to pain preventing reaching the end of the range'?

    <p>Empty</p> Signup and view all the answers

    What might be considered a common challenge during a goniometric assessment?

    <p>Difficulty in palpating anatomical landmarks</p> Signup and view all the answers

    Which type of stretch is indicated when measuring hip flexion with the knee straight?

    <p>Firm (muscular stretch)</p> Signup and view all the answers

    What does the process of contextualizing findings in goniometric assessment refer to?

    <p>Understanding the implications of results in the patient's condition</p> Signup and view all the answers

    Which of the following best explains the relationship between hypomobility and pathological conditions involving the entire joint capsule?

    <p>Hypomobility includes specific patterns of restriction in passive movements.</p> Signup and view all the answers

    What is a common cause of hypermobility related to hereditary conditions?

    <p>Ehlers-Danlos syndrome</p> Signup and view all the answers

    Which statement about the Beighton Hypermobility Score is true?

    <p>It quantifies hypermobility through specific joint movements and assessments.</p> Signup and view all the answers

    What is the significance of short structures such as muscles or ligaments in cases of hypomobility?

    <p>They can lead to restrictions in movement at the joint.</p> Signup and view all the answers

    Which of the following factors is least likely to contribute to restricted motion consistent with capsular patterns?

    <p>Normal physiological aging without other conditions</p> Signup and view all the answers

    What is the maximum score a patient can achieve when assessing joint hypermobility using the criteria outlined?

    <p>9</p> Signup and view all the answers

    Which goniometric measurement step is NOT performed on the affected side?

    <p>Perform on the contralateral side first</p> Signup and view all the answers

    What should be documented if pain is experienced during goniometric assessment?

    <p>Document any subjective information related to pain</p> Signup and view all the answers

    Which of the following best describes how to interpret a goniometric notation of '6o to 0o to 140o' for the tibiofemoral joint?

    <p>The joint starts at hyperextension and moves to flexion</p> Signup and view all the answers

    Which factor is crucial to ensuring an accurate measurement during goniometric assessments?

    <p>Consistent repositioning of the device</p> Signup and view all the answers

    What is the total active range of motion (AROM) for the humeroulnar joint in degrees?

    <p>0 to 140°</p> Signup and view all the answers

    Which type of muscle testing involves maintaining a constant joint angle and muscle length?

    <p>Isometric</p> Signup and view all the answers

    Why is it crucial to know the expected range of motion and end feel before conducting a joint assessment?

    <p>To assist in identifying any abnormal findings</p> Signup and view all the answers

    What does isokinetic muscle testing measure?

    <p>Resistance through the range of motion at a constant velocity</p> Signup and view all the answers

    Which of the following statements best describes a primary consideration when testing muscle strength?

    <p>It is important to test muscle groups rather than individual muscles to identify overall strength deficits.</p> Signup and view all the answers

    What is the primary purpose of both Active ROM (AROM) and Passive ROM (PROM) assessments?

    <p>To determine joint integrity and extensibility while accounting for pain</p> Signup and view all the answers

    Which type of end feel is associated with soft tissue approximation?

    <p>Soft end feel</p> Signup and view all the answers

    In what scenario would Passive ROM (PROM) generally exceed Active ROM (AROM)?

    <p>When the subject is relaxed and unassisted</p> Signup and view all the answers

    Which assessment provides information about the extensibility of joint structures?

    <p>Passive ROM (PROM)</p> Signup and view all the answers

    What characteristic governing the end feel is defined as being dependent on the joint tested?

    <p>Expected end feel</p> Signup and view all the answers

    Regarding goniometric data, which application is NOT explicitly included?

    <p>Diagnosing infectious diseases</p> Signup and view all the answers

    What is characterized by the integrity of articular surfaces and their related tissues during movement without assistance?

    <p>Active ROM (AROM)</p> Signup and view all the answers

    What is the role of goniometry in functional movement assessment?

    <p>It contributes to the diagnosis and treatment planning process</p> Signup and view all the answers

    What is the primary purpose of the break test in manual muscle testing?

    <p>To determine the maximum resistance a muscle can hold</p> Signup and view all the answers

    Which factor is essential when applying resistance during muscle testing?

    <p>Applying force perpendicular to the distal end of the segment</p> Signup and view all the answers

    During manual muscle testing, why is proximal stabilization crucial?

    <p>To prevent compensatory movements from affecting results</p> Signup and view all the answers

    What muscle strength grade indicates that a muscle can move through the full range of motion but only in a gravity-minimized position?

    <p>Grade 2</p> Signup and view all the answers

    What is represented by a muscle strength grade of 3+?

    <p>Movement through full range of motion under gravity with minimal resistance</p> Signup and view all the answers

    Which of the following statements about muscle strength grading is NOT correct?

    <p>Grade 0 indicates palpable muscle contraction</p> Signup and view all the answers

    What should be avoided during manual muscle testing according to best practices?

    <p>Crossing two joints during resistance application</p> Signup and view all the answers

    In the context of manual muscle testing, 'trace' strength refers to which grade?

    <p>Grade 1</p> Signup and view all the answers

    Which step is crucial to effectively manage during manual muscle testing?

    <p>Positioning both the proximal and distal segments optimally</p> Signup and view all the answers

    What defines a muscle contraction that is palpable but does not produce motion in manual muscle testing?

    <p>Grade 1</p> Signup and view all the answers

    What is the primary concern regarding the reliability of physical therapy measurements?

    <p>Results are dependent on the rater and equipment used.</p> Signup and view all the answers

    What defines construct validity in the context of physical therapy measurement?

    <p>Inferring disability based on the information obtained.</p> Signup and view all the answers

    Which statistical measure indicates the variability of measurements by different testers?

    <p>Inter-rater reliability.</p> Signup and view all the answers

    What minimum change in range of motion (ROM) after an intervention is typically considered meaningful?

    <p>10 degrees.</p> Signup and view all the answers

    Which type of validity focuses on the ability to measure accurately using anatomical landmarks?

    <p>Content validity.</p> Signup and view all the answers

    Study Notes

    Relevant Statistical Concepts

    • Reliability is the reproducibility of measurement, improved with consistent positions between measurements and testers
    • Intra-rater reliability is the consistency of measurement by a single tester, with a standard deviation of approximately 3-4 degrees
    • Inter-rater reliability is the consistency of measurement between multiple testers, with a standard deviation of approximately 5-6 degrees
    • Validity refers to the accuracy of a measurement in representing the actual joint movement
    • Content Validity ensures the knowledge of landmarks for accurate measurement
    • Criterion-Rated Validity compares the measurement to a gold standard, such as a radiograph
    • Construct Validity uses the measurement to infer disability, potentially specific to the joint
    • Meaningful Changes in ROM are considered clinically significant when they exceed 2 standard deviations, approximately 10 degrees

    Hypomobility

    • Definition: When passive range of motion (PROM) is less than normal for a joint, taking into account age and gender
    • Reasons:
      • Abnormal joint surfaces
      • Shortening of capsule, ligaments, muscles, fascia, and skin
      • Inflammation
      • Space-occupying lesion

    Capsular Patterns of Restricted Motion

    • Definition: Movement restrictions in all or most passive motions of a joint due to pathological conditions involving the entire joint capsule
    • Patterns of Restriction:
      • Not defined by a fixed number of degrees, but rather a ratio of degrees
      • Typical patterns exist, but may not be consistent
      • Does not determine the priority of interventions

    Hypermobility

    • Definition: PROM exceeding the normal values for a joint, considering age and gender
    • Causes:
      • Laxity of soft tissue structures
      • Abnormalities of joint surfaces
      • Trauma to a joint
      • Hereditary Conditions (e.g., Ehlers-Danlos syndrome, Marfan syndrome, Down syndrome)
      • Generalized hypotonia

    Beighton Hypermobility Score

    • Score: 0-9
    • Scoring Criteria:
      • 1-2 points: Passive thumb opposition to forearm
      • 1-2 points: Passive extension of the 5th metacarpophalangeal joint (MCP) beyond 90 degrees
      • 1-2 points: Hyperextension of the elbow greater than 10 degrees
      • 1-2 points: Hyperextension of the knee more than 10 degrees
      • 1 point: Ability to place palms flat on the floor with straight knees during trunk flexion

    Documenting ROM

    • 0-180° Notation System:
      • Neutral = anatomical position = 0°
      • Starting point may be beyond 0°
        • Example: tibiofemoral joint hyperextension (6° to 0° to 140°)
    • Recording Format:
      • Use 0-180° notation system
      • Include subjective information such as pain or discomfort
      • Note any protective muscle spasms, crepitus, or capsular or non-capsular patterns of restriction
      • Example: AROM elbow (humeroulnar) = 0 to 140° (R) – 20° to 0° to 140° (hyperextension, neutral, flexion)

    Goniometric Procedures

    • Initial Steps:
      • Observe posture and starting postiion
      • Perform on the contralateral side first
      • Observe active range of motion (AROM)
      • Palpate landmarks for goniometry
    • Measurements:
      • Measure AROM using an appropriate device
      • Measure PROM using an appropriate device
      • Assess end feel
      • Document objective measure, end feel, and any subjective report
    • Final Steps:
      • Perform all steps on the affected side
      • Contextualize the measurements (normal, hypermobile, hypomobile)

    Clinical Pearls for Goniometry

    • Know the expected ROM and end feel prior to testing
    • Ensure the goniometer is positioned correctly
    • Conduct the measurements efficiently

    Manual Muscle Testing

    • Approaches:
      • Isotonic: Constant tension with changing muscle length
      • Isokinetic: Resistance through ROM against a constant velocity
      • Isometric: Constant joint angle and muscle length
    • Types of Muscle Testing:
      • Muscle Strength Screening: Provides a quick overview of strength, identifying areas of deficits
      • Standardized Methods: Evaluates muscle strength using standardized methods, such as manual muscle testing (MMT)
      • Resisted Movement Testing: Differentiates between contractile and non-contractile sources of pain

    Muscle Testing Steps

    • Step 1: Patient Instructions: Clear and standardized instructions
    • Step 2: Patient Positioning:
      • Distal segment placed in desired position (gravity-resisted or gravity-eliminated)
      • Proximal segment stabilized for optimal support
      • Motion should not be restricted
      • Observe movement through full ROM
      • Ensure proper body mechanics for stabilization
    • Step 3: Application of Resistance:
      • "Break" test: Patient holds against maximal resistance for 4-5 seconds
      • Perpendicular Force: Apply force perpendicular to the distal end of the segment, considering lever-arm length
        • Resistance should be applied to the distal end of the bone to which the muscle is attached
        • Avoid crossing two joints whenever possible

    Muscle Strength Grading (0-5 Scale)

    • Grade 5: Normal: Full ROM movement against gravity with maximal resistance
    • Grade 4: Good: Full ROM movement against gravity with moderate resistance
    • Grade 3: Fair: Full ROM movement against gravity
    • Grade 2: Poor: Full ROM movement in gravity-minimized position
    • Grade 1: Trace: Slight palpable muscle contraction, but no motion
    • Grade 0: Zero: No evidence of muscle contraction

    Muscle Strength Grading (+ and -)

    • 3+ (Fair Plus): Full ROM against gravity with minimal resistance
    • 3- (Fair Minus): Full ROM in gravity-minimized position and greater than half of ROM against gravity
    • 2+ (Poor Plus): Full ROM in gravity-minimized position and less than half of ROM against gravity
    • 2- (Poor Minus): Partial ROM in gravity-minimized position

    Always Consider:

    • Proximal stabilization and landmarks
    • Center of rotation
    • Distal mobility and landmarks

    Goniometry

    • Use a goniometer to measure angles of joint motion.
    • Compare measurements with a partner to identify potential errors.
    • Challenges might arise from the patient's understanding of instructions, difficulties in palpating bony landmarks and proper goniometer placement.

    Range of Motion (ROM)

    • Active Range of Motion (AROM): Movement achieved by the patient.
    • Passive Range of Motion (PROM): Movement achieved by the examiner.
    • PROM is typically greater than AROM.
    • Hypomobile: Decreased ROM.
    • Hypermobile: Increased ROM, measured using the Beighton Hypermobility Scale (scores > 4 indicate hypermobility).

    End Feels

    • The sensation felt at the end of PROM.
    • Soft: Soft tissue approximation (e.g., knee flexion).
    • Firm: Muscular stretch (e.g., hip flexion with knee straight), capsular stretch (e.g., extension of metacarpophalangeal joints), ligamentous stretch (e.g., forearm supination).
    • Hard: Bone contacting bone (e.g., elbow extension).
    • Empty: Pain prevents reaching the end of ROM.

    Goniometric Procedures

    • Observe posture and starting position.
    • Assess the contralateral side first.
    • Observe AROM.
    • Palpate landmarks for goniometry.
    • Measure AROM using a goniometer, re-palpating landmarks if needed.
    • Measure PROM using a goniometer, re-palpating landmarks if needed.
    • Assess end feel.
    • Document objective measures, end feel, and patient's subjective report.
    • Repeat all steps on the affected side.
    • Contextualize results by comparing to expected ROM and end feel.

    Clinical Pearls for Goniometry

    • Know the expected ROM and end feel for the joint prior to testing.
    • Ensure proper goniometer placement and reading.
    • Perform measurements efficiently to minimize discomfort and potential for compensatory movements.

    Recording Goniometric Measures

    • Document subjective information, such as pain or discomfort.
    • Note protective muscle spasm, crepitus, and capsular or non-capsular patterns of restriction.
    • Record ROM in degrees, with a clear indication of whether the measurement is AROM or PROM.

    Muscle Testing

    • Step 1: Patient Instructions: Provide clear, standardized, and explicit instructions.
    • Step 2: Patient Positioning:
      • Distal segment placed in the desired position: gravity-resisted or gravity-minimized.
      • Proximal segment stabilized to minimize unwanted movement.
      • Ensure the patient's motion is not restricted.
      • Observe movement through the full ROM.
      • Maintain proper body mechanics for stabilization and resistance application.
    • Step 3: Application of Resistance: Apply maximal resistance using a "break" test (hold resistance for 4-5 seconds).
      • Apply force perpendicular to the distal end of the segment, considering lever arm length.
      • Resistance should be applied to the distal end of the bone where the muscle attaches.
      • Avoid crossing two joints whenever possible.

    Muscle Strength Grading (0-5 Scale)

    • 5 (Normal): Full ROM against gravity, holds maximal resistance.
    • 4 (Good): Full ROM against gravity, holds moderate resistance.
    • 3 (Fair): Full ROM against gravity.
    • 2 (Poor): Full ROM in gravity-minimized position.
    • 1 (Trace): Palpable muscle contraction observed, no movement.
    • 0 (Zero): No muscle contraction observed or palpated.

    Muscle Strength Grading ( + and -)

    • 3+ (Fair Plus): Full ROM against gravity, holds minimal resistance.
    • 3- (Fair Minus): Full ROM in gravity-minimized position, and through >= 1/2 ROM against gravity.
    • 2+ (Poor Plus): Full ROM in gravity-minimized position, and through < 1/2 ROM against gravity.
    • 2- (Poor Minus): Partial ROM in gravity-minimized position.

    Clinical Pearls for Muscle Testing

    • Always consider: proximal stabilization, proximal landmarks, center of rotation, distal mobility, and distal landmarks.
    • Assess AROM and PROM of the joint prior to muscle testing.

    Arthrokinematics and Osteokinematics

    • Arthrokinematics is the movement of joint surfaces and includes translatory and rotational motion.
    • Osteokinematics is the movement of the shaft of the bone and takes place in three cardinal planes.

    Goniometry

    • Goniometry is the measurement of joint angles.
    • Used to determine presence or absence of impairments, establish a diagnosis, develop treatment goals, evaluate progress, modify treatment interventions, motivate patients, research efficacy, and fabricate orthoses and adaptive equipment.

    Range of Motion Assessment

    • Examiner must have knowledge of standardized testing positions, joint anatomy, and proper goniometer alignment with anatomical bony landmarks.
    • Active ROM (AROM) - Arc of motion during unassisted voluntary joint motion. Provides information on:
      • Willingness to move
      • Coordination
      • Muscle strength
      • Joint ROM
      • Pain
    • Passive ROM (PROM) - Arc of motion without assistance from the subject. Provides information on:
      • Integrity of the articular surfaces.
      • Extensibility of the joint capsule, ligaments, muscles, fascia, and skin.
      • Pain.

    Comparing AROM and PROM

    • PROM is usually greater than AROM.
    • PROM provides information about the integrity of articular surfaces, extensibility of the joint capsule, ligaments, muscles, fascia, and skin.
    • Pain with PROM is possibly related to inert (non-contractile) tissues such as ligaments, joint capsule, bursae, fascia, and skin.

    End Feel

    • End feel is the characteristic feel detected by the examiner at the end of PROM, and is dependent on the joint being tested.
    • End Feel Categories:
      • Soft: Soft tissue approximation (Example: Knee flexion)
      • Firm: Muscular stretch (Example: Hip flexion with knee straight), capsular stretch (Example: Extension of MCPs), ligamentous stretch (Example: Forearm supination)
      • Hard: Bone contacting bone (Example: Elbow extension)
      • Empty: No real end-feel, pain prevents reaching the end of range of motion.

    Hypomobility

    • Passive ROM less than normal values for that joint, given the patient's age and gender.
    • Reasons:
      • Abnormal joint surfaces
      • Shortening of capsule, ligaments, muscles, fascia, and skin
      • Inflammation
      • Space-occupying lesion.

    Capsular Patterns of Restricted Motion

    • Pathological conditions involving the entire joint capsule cause a particular pattern of restriction involving all or most of the passive motions of the joint.
    • Not a fixed number of degrees, but proportion of degrees
    • There are typical patterns of restriction, but not always consistent
    • This also does not dictate prioritization of interventions.

    Hypermobility

    • Increase in PROM that exceeds normal values for that joint, given the patient's age and gender.
    • Causes:
      • Laxity of soft tissue structures
      • Abnormalities of joint surfaces
      • Trauma to a joint
      • Heredity conditions (Ehlers-Danlos syndrome, Marfan syndrome, Down syndrome)
      • Generalized hypotonia.

    Beighton Hypermobility Score

    • A tool to assess hypermobility. The ability to perform the following:
      • Passively oppose thumb to forearm (1-2 points)
      • Passively extend 5th MCP greater than 90 degrees (1-2 points)
      • Hyperextend elbow greater than 10 degrees (1-2 points)
      • Hyperextend knee greater than 10 degrees (1-2 points)
      • Place palms on the floor during trunk flexion (knees straight) (1 point)
      • Total Score: 0-9

    Documenting ROM

    • 0-180° notation system.
    • Neutral = anatomical position = 0°.
    • In some cases, the starting point will be beyond the '0' point (Example: The tibiofemoral joint goes into hyperextension - 6° to 0° to 140°).

    Goniometric Procedures

    • Observe Posture/Starting position
    • Perform on the contralateral side first
    • Observe AROM
    • Palpate landmarks for goniometry
    • Measure AROM using an appropriate device
    • Measure PROM using an appropriate device
    • Assess end feel
    • Document objective measures, end feel, and any subjective report
    • Perform all steps on the affected side
    • Contextualize! (Normal, Hypermobile, Hypomobile)

    Recording Goniometric Measures

    • Any subjective information (pain, discomfort) should be recorded.
    • Protective muscle spasm, crepitus, capsular or non-capsular pattern of restriction should be noted.
    • Example- "AROM elbow (humeroulnar) = 0 to 140° (R) - 20° to 0° to 140° (hyperextension, neutral, flexion)"

    Clinical Pearls for Goniometry

    • Know the expected ROM and end feel at the joint to be tested prior to testing.
    • Make sure you are able to read the goniometer without adjustment.
    • Try to do your measurements efficiently.

    Manual Muscle Testing

    • Approaches to muscle strength testing:
      • Isotonic: Constant tension, changing muscle length
      • Isokinetic: Resistance through ROM against constant velocity
      • Isometric: Constant joint angle and muscle length

    Muscle Testing

    • Muscle strength screening (MSK systems review)
      • Provides a quick overview of muscle strength
      • Used to identify areas of strength deficits
      • Testing of muscle groups
    • Standardized methods of strength assessment
      • Example: Manual muscle testing (MMT)
    • Resisted movement testing
      • Used to differentiate between contractile and non-contractile sources of pain

    Steps for Manual Muscle Testing

    • Step 1: Patient instructions - Clear, explicit
    • Step 2: Patient positioning
      • Distal segment placed in desired position (gravity-resisted or gravity-eliminated)
      • Position proximal segment for optimal stabilization
      • Motion should not be restricted
      • Observe movement through full ROM
      • Manage your own body mechanics for proper stabilization and application of resistance.
    • Step 3: Application of resistance
      • “Break” test - Patient holds against maximal resistance for 4-5 seconds.
      • Apply force perpendicular to the distal end of segment, considering lever arm length, and avoiding crossing two joints whenever possible.

    Grading Muscle Strength (0-5 Scale)

    • Grade 5 - Normal: Movement through complete ROM against gravity and able to hold against maximal resistance.
    • Grade 4 - Good: Movement through complete ROM against gravity and able to hold against moderate resistance.
    • Grade 3 - Fair: Movement through complete ROM against gravity.
    • Grade 2 - Poor: Movement through complete ROM in gravity-minimized position.
    • Grade 1 - Trace: Slight palpable muscle contraction, no motion.
    • Grade 0 - Zero: No evidence of muscle contraction (by observation or palpation).

    Muscle Strength (Plus and Minus)

    • 3+ - Fair plus: Movement through complete ROM against gravity and able to hold against minimal resistance.
    • 3 - Fair: Movement through complete ROM against gravity.
    • 3- - Fair minus: Movement through complete ROM in gravity-minimized position and through >= ½ ROM against gravity.
    • 2+ - Poor plus: Movement through complete ROM in gravity-minimized position and through < ½ ROM against gravity.
    • 2 - Poor: Movement through complete ROM in gravity-minimized position.
    • 2- - Poor minus: Movement through partial test range in gravity-minimized position.

    Manual Muscle Test 2+ Alternative

    • Moves without gravity with minimal or greater resistance.

    Manual Muscle Testing - General Considerations

    • Always consider Proximal Stabilization and Proximal landmarks, center of rotation, distal mobility, and distal landmarks.

    Relevant Statistical Concepts

    • Reliability is a key factor in physical therapy tests & measures.
      • Intra-rater reliability is improved when the same testing positions are used.
      • Inter-rater reliability is improved when all testers use consistent, well-defined testing positions.
      • Standard deviations of 3-4 degrees for intra-rater reliability and 5-6 degrees for inter-rater reliability are considered acceptable.
    • Validity refers to whether a measurement accurately represents the movement of the joint.
      • Content validity relies on knowledge of anatomical landmarks to ensure accurate measurement.
      • Criterion-rated validity compares a measurement to a gold standard, such as radiographs.
      • Construct validity assesses the ability to use information to infer disability, which may be joint-specific.

    Hypomobility

    • Passive range of motion (PROM) is less than normal values for a patient’s age and gender.
    • Possible reasons for hypomobility include abnormal joint surfaces, shortened soft tissues, inflammation, and space-occupying lesions.

    Capsular Patterns of Restricted Motion

    • Capsular patterns represent specific restrictions affecting the entire joint capsule, impacting passive range of motion.
    • Cyriax described these patterns, emphasizing that they are not fixed degrees but rather proportions.
    • Typical patterns of restriction exist, but consistency is not absolute, they do not dictate intervention prioritization.

    Hypermobility

    • Increased PROM exceeding normal values for a person’s age and gender.
    • Causes include lax soft tissues, joint surface abnormalities, trauma, and hereditary conditions like Ehlers-Danlos syndrome, Marfan syndrome, and Down syndrome.
    • Generalized hypotonia can also contribute to hypermobility.

    Beighton Hypermobility Score

    • A clinical tool for assessing hypermobility.
    • Points are assigned based on the ability to perform specific movements, such as opposing the thumb to the forearm, extending the 5th MCP joint beyond 90 degrees, hyperextending the elbow and knee, and touching the floor with palms while flexing the trunk with straight knees.
    • Total score ranges from 0 to 9.

    Documenting Goniometric Measures

    • A 0-180 degree notation system is used for goniometric measurements.
    • Neutral is defined as anatomical position, equaling 0 degrees.
    • Starting points can exceed 0 degrees in cases like hyperextension of the tibiofemoral joint, which ranges from 6 degrees to 0 degrees to 140 degrees.

    Goniometric Procedures

    • Observe posture and starting position.
    • Perform the assessment on the contralateral side first.
    • Assess Active Range of Motion (AROM).
    • Palpate landmarks and use the appropriate device for goniometry.
    • Measure AROM and PROM, re-palpating landmarks if necessary.
    • Assess end feel.
    • Document objective measures, end feel, and subjective reports.
    • Repeat all steps on the affected side.
    • Contextualize findings (normal, hypermobile, hypomobile).

    Recording Goniometric Measures

    • Subjective information, such as pain or discomfort, should be documented.
    • Protective muscle spasm, crepitus, capsular or non-capsular patterns of restriction should be noted.

    Clinical Pearls for Goniometry

    • Familiarize oneself with expected ROM and end feel before testing.
    • Ensure clear visibility of the goniometer during measurement.
    • Perform measurements efficiently to minimize discomfort and potential for compensatory movements.

    Manual Muscle Testing

    • Approaches to muscle strength testing:
      • Isotonic: Constant tension with changing muscle length.
      • Isokinetic: Resistance throughout the range of motion against constant velocity.
      • Isometric: Constant joint angle and muscle length.

    Muscle Testing Components

    • Muscle strength screening provides a quick overview of muscle strength.
    • Standardized methods for strength assessment, like Manual Muscle Testing (MMT), aim to identify muscle strength deficits and areas of weakness
    • Resisted movement testing differentiates between contractile and non-contractile sources of pain.

    Steps for Performing Manual Muscle Testing

    • Step 1: Patient Instructions:
      • Provide clear, standardized instructions.
    • Step 2: Patient Positioning:
      • Place the distal segment in the desired position depending on gravity requirements.
      • Stabilize the proximal segment to prevent unwanted movement.
      • Ensure that motion is not restricted.
      • Observe movement throughout the full range of motion.
      • Maintain appropriate body mechanics for stabilization and resistance application.
    • Step 3: Application of Resistance:
      • Use the “break” test, providing maximal resistance for 4-5 seconds.
      • Apply force perpendicular to the distal end of the segment, considering lever arm length.
      • Apply resistance to the distal end of the bone where the muscle attaches.
      • Avoid crossing two joints whenever possible.

    Grading Muscle Strength (0-5 Scale)

    • Grade 5 (Normal): Full range of motion against gravity with maximal resistance.
    • Grade 4 (Good): Full range of motion against gravity with moderate resistance.
    • Grade 3 (Fair): Full range of motion against gravity.
    • Grade 2 (Poor): Full range of motion in a gravity-minimized position.
    • Grade 1 (Trace): Slight palpable muscle contraction with no motion.
    • Grade 0 (Zero): No evidence of muscle contraction.

    Grading Muscle Strength (+ and -)

    • 3+ (Fair Plus): Full range of motion against gravity with minimal resistance.
    • 3- (Fair Minus): Full range of motion in a gravity-minimized position and through at least half the range of motion against gravity.
    • 2+ (Poor Plus): Full range of motion in a gravity-minimized position and less than half the range of motion against gravity.
    • 2- (Poor Minus): Movement through a partial range of motion in a gravity-minimized position.

    Manual Muscle Testing 2+ Alternative

    • The patient moves the body part through the required range of motion against minimal or greater resistance, without gravity.

    Key Considerations for Manual Muscle Testing

    • Proximal stabilization: Ensure the proximal segment remains stable to isolate muscle strength assessment.
    • Center of rotation: Focus on the joint's center of rotation for accurate resistance application.
    • Distal mobility: Ensure proper movement occurs at the distal end of the body part.
    • Distal landmarks: Carefully palpate landmarks to ensure accurate resistance application.

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    Related Documents

    Introduction to Goniometry & Manual Muscle Testing PDF
    Intro To Goni and MMT In-Class Presentation PDF

    Description

    This quiz focuses on statistical concepts essential for understanding measurement reliability and validity, specifically in the context of joint movement analysis. Key aspects such as intra-rater and inter-rater reliability, along with various types of validity, will be explored to enhance your comprehension of accurate measurements in this field.

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