Assessment And Clinimetrics_ Topic 1-9 (1) (2).pdf

TOPIC 2: MUSCULAR ASSESSMENT Muscular assessment Part of the physical assessment. Provides information that cannot be obtained from other assessment methods. Useful in … -Differential diagnosis -Prognosis -Neuromuscular and musculoskeletal processes. Muscular Concepts Primary muscle Main responsible...

TOPIC 2: MUSCULAR ASSESSMENT Muscular assessment Part of the physical assessment. Provides information that cannot be obtained from other assessment methods. Useful in … -Differential diagnosis -Prognosis -Neuromuscular and musculoskeletal processes. Muscular Concepts Primary muscle Main responsible for a specific movement. I.e.Agonist All muscles are primary muscles they just switch between agonist and synergist. Accessory muscle * Complement the agonist i.e. Synergist No muscle is exclusively synergist Stabilizer muscle ( Are short muscles and mono articular) Fix the assessed segment while the agonist is being tested. Hold the segment while others are in charge of movement. Stabilizers and pain work hand in hand. # Neutraliser muscle Override secondary agonists functions. -Act simultaneously with agonists -Avoid unwanted movements (synergic antagonists of the primary muscle) Method Visual inspection Atrophy/Hypertrophy Contours Motion Palpation Tone Pain/ Soreness Passive tests Tension/ Shortening Painful stretching * Resisted movements tests 1. Isometric manual testing Normal —> Energic + Painless isometric contraction Slight - Moderate MT(myotendinous injury)—> Weak (force and trembling)+ Painful isometric contraction Neurological impairment —> Weak + Painless isometric contraction 2. Isotonic manual testing Determine the maximum weight that can be lifted —> 1 rep max Requires: warming up by getting started with low weight, Position, Technique, Correct breathing (Apnea meaning no respiration). Disadvantages: speed uncontrolled and synergists take part as well. Muscle Manual testing Main procedure in Physiotherapy assessment. Proposed by Wilhelmine Wright during the Poliomyelitis epidemics Patient influences the muscular testing Real muscle strength may VARY according to… -Yearning to maximize the performance Vs Pretend greater impairment than real … -Discomfort/Pain threshold (competitive Vs wimpy) -Comprhension skills (Autism, Children, Alzheimer’s, Cognitive issues) -Motor + Proprioceptive skills (Sensory) -Lack of interest -Depression -Cultural, Social and gender habits Examiner influences the muscular testing as well… Real muscle strength may VARY according to… Q * -Knowledge + Technical skills —> ACCURACY + RELIABILITY Anatomic features: Muscle location, Fibers direction, Muscle function Palpation skills: -Identify muscle shape and volume + tone -Detect muscle contraction Notice: Muscle fatigue —> Influencing the result Joint laxity(looseness) and/ or deformity Muscle innervation DON’T touch or hold the muscle belly during test performance. -Unless while assessing pain, hypersensitivity and tone. An expert clinician never ignores patient’s comments, and knows how to interpret the terms employed. Preparing muscular testing… -Painfree + comfort position -Quiet atmosphere -Temperature —> decreased temperature means increased tone maintained -Firm support -Minimum friction (Isotonic contraction) -Appropriate height/approach -Avoid excessive postural changes “Healthy muscle” Resistance: * -Next to the distal attachment of the tested muscle -Varies at the end of AROM -Bi/ Poliarticular muscles —> half AROM amplitude. -Smooth + Progressive + Regular —> max intensity tolerated -Aligned to traction force of the tested muscle Hands- Body placement of PT Muscle Manual Testing Grades According to … -Objective factors: Patient’s ability to: -Complete the whole ROM. -Move the segment against gravity -Subjective factors: Examiners impression about: -Resistance required before getting started in testing -Max resistance the patient will tolerate Break test (Isometric) -At the end of ROM or Appropriate movement amplitude —> Resistance -Command: “Hold without letting me break that position” Make test (Isotonic —> Concentric (muscle shortening), Eccentric (muscle lengthening)) -Manual progressively increased resistance Vs the movement tested. -Command: “Hold as I’m pushing down” Exam Question !!!!! whole ROM E * full ROM ROM incomplete absence of muscle activity Validity and Reliability Both are satisfactory for clinical use. Concerning research… -Difficulties in assessing grade 4 (G) -Questionable under 3 (F) Dinamometry Dinamometer -Measures static F+R -Target muscles: Tensors Spine erectors Lower limb Muscle functional Testing I/t and A/t curves Physiological/ Physiopathological muscle behaviour +innervation Electrical muscle stimulation (EMS) Electric shock on the muscle Charts I/t ( Intensity/ time) Curve (Rectangular pulse) —> For muscular fibres A/t (Accomodation/ time) (triangular pulse) —> For nerves Healthy Injured Tensomyography Detects and analyses superficial single muscle properties. Diagnosis Continuous monitoring of the fiber condition and progression. Current —> Induced contraction —> Displacement/ Time Curve. Electromyography - Where you put surface electrodes on the muscles you want to check to see the electrical activity. Assessment of the muscle eletrical activity Electromyograph Surface we can used is Electromyography / Intramuscular EMG used by a medical doctor Isokinetic Dynamometry - Assesses muscle dynamic force in a specific ROM and at constant o speed. Advantages: -Charts: Force - ROM -Associate the obtained values Applications: -Quantify the F produced -Reestablish F after muscular injury -Training - Isokinetic foundations 1st Variable R according to speed —> Settles according to fatigue, pain and length - variations. 2nd Preset speed —> 500 degrees/second maximum -Slow (60degrees/s) -Intermediate (90-120 degrees/ s) -High (300 degrees/s) 3rd Allow both concentric and eccentric exercising 4th Very important! Position Supports setting Execution speed ROM Commands (motivation) + Stimuli —> maximum force Resting periods between contractions 5th Comparative assessments Treatment effectiveness (PRE_POST) —> Progression Compared to healthy/less affected side