Intro To Goni and MMT In-Class Presentation PDF

FOUNDATIONS OF EXAMS: INTRO TO GONIOMETRY AND MMT 9/18/24  GONIOMETRY!!  You and your partner will work together to measure 3 angles:  How far your lap top opens (please do not break it….it is not a contest to see how far your can get it to open).  Three dots on the p...

FOUNDATIONS OF EXAMS: INTRO TO GONIOMETRY AND MMT 9/18/24  GONIOMETRY!!  You and your partner will work together to measure 3 angles:  How far your lap top opens (please do not break it….it is not a contest to see how far your can get it to open).  Three dots on the paper in front of you  The degrees of rotation of a door handle  RULES:  MUST use goniometer! (No other measuring tool allowed) THEN: - Find another pair, and compare measurements. - What were some of your challenges? Did all of your angles measure up to the same? What do you feel went well? PARTS OF THE GONIOMETER https://www.fab-ent.com/evaluation/range-of-motion/baseline-plastic- goniometers/ LET’S REVIEW!  What is AROM?  What is PROM?  Which will be greater?  Hypomobile?  Hypermobile?  Beighton Hypermobility Scale- 5 components; scores >4 indicates hypermobility  END FEEL?  Characteristic feel detected by the examiner at the end of PROM – dependent on joint being tested End Feel Description Example Soft Soft tissue Knee flexion approximation Firm Muscular stretch Hip flexion with knee straight Capsular stretch Ext of MCPs Ligamentous stretch Forearm supination Hard Bone contacting bone Elbow extension Empty No real end-feel pain prevents reaching end of range of motion.  GONIOMETRIC PROCEDURES Observe Posture/Starting position First, perform on the CONTRALATERAL side Observe AROM Palpate landmarks for goniometery Measure AROM using an appropriate device (re- palpating if need be!) Measure PROM using an appropriate device (re- palpating if need be!) Assess end feel Document objective measure, end feel, any subjective report Now perform all steps on the affected side Contextualize! (Normal, Hypermobile, Hypomobile) CLINICAL PEARLS 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 – Ex: the goniometer is often applied backwards or upside down prior to measurement Try to do your measurements efficiently – Involved joint may be symptomatic – Testing position may be uncomfortable – Abnormal joint motion can create compensatory actions  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  e.g. AROM elbow (humeroulnar) = 0 to 140° (R)  20° to 0° to 140° (hyperextension, neutral, flexion)  MUSCLE TESTING  STEP 1: Patient instructions  Standardized, clear, explicit  STEP 2: Patient positioning  Distal segment placed in desired position  Gravity-resisted  “Gravity-eliminated” (gravity minimized/lessened)  Position proximal segment for optimal stabilization  Motion should not be restricted  Observe movement through full ROM  Be sure you manage your own body mechanics for proper stabilization & application of resistance  MUSCLE TESTING  STEP 3: Application of Resistance “Break” test  Patient holds against maximal resistance for 4-5 seconds Apply force perpendicular to distal end of segment  Consider lever arm length  Apply resistance to distal end of bone to which muscle being tested is attached  Avoid crossing 2 joints whenever possible  GRADING MUSCLE STRENGTH (0-5 SCALE) Grade Descriptio Definition n 5 Normal Movement through complete ROM against gravity & able to hold against maximal resistance 4 Good Movement through complete ROM against gravity & able to hold against moderate resistance 3 Fair Movement through complete ROM against gravity 2 Poor Movement through complete ROM in gravity-minimized position 1 Trace Slight palpable muscle contraction, no motion 0 Zero No evidence of muscle contraction (by observation or palpation)  GRADING MUSCLE STRENGTH (+ AND -) Grade Descriptio Definition n 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 Movement through complete ROM in gravity-minimized position & through >= minus ½ ROM against gravity 2+ Poor plus Movement through complete ROM in gravity-minimized position & through < ½ ROM against gravity 2 Poor Movement through complete ROM in gravity-minimized position 2- Poor Movement through partial test range in gravity-minimized position CLINICAL PEARLS  Always consider:  Proximal Stabilization and Proximal landmarks  Center of rotation  Distal mobility and distal landmarks  Remember to take your patient through the full A/PROM of the joint in order to see what is available prior to testing. (This will help you grade them)