Objective Measurements In Physical Therapy Lecture PDF

Objective measurements in Physical Therapy  Objectives By the end of this lecture you would be able to: Identify objective assessment of pain Identify objective assessment of ROM Identify objective assessment of muscle stregnth Define isokinetik device and its uses ...

Objective measurements in Physical Therapy  Objectives By the end of this lecture you would be able to: Identify objective assessment of pain Identify objective assessment of ROM Identify objective assessment of muscle stregnth Define isokinetik device and its uses  Pain Assessment Pressure ALgometer What is a pressure Algometer? Algometers are devices that can be used to identify the pressure and/or force eliciting a pressure-pain threshold. It has been noted in pressure-pain threshold studies that the rate at which manual force is applied should be consistent to provide the greatest reliability. Pressure ALgometer uses manual pressure to test pain sensitivity in deeper structures. It's a valid tool that's been widely used.The algometer's tip was positioned on the trigger area, and pressure was increased at a rate of 1 kg per second.When the patient expressed discomfort and verified it verbally, the pressure measurement was recorded as kg/cm2, The technique was done three times at 60-second intervals Assessment of ROM Cable tensiometer  Hand-Held Dynamometer what is Hand-Held Dynamometer ? It is a small device that the examiner holds against the patient's limb as the patient exerts a maximal force. How does a handheld dynamometer work? A handheld dynamometer, takes the force a patient generates and transmits it through a transducer, quantifies the force, and then presents the data in a digital format. Health professionals can use this muscle strength testing equipment to measure muscle strength efficiently and effectively across the board.  Hand-Held Dynamometer Measuring hand strength and manual muscle testing helps identify deficits after local injury as well as providing information on a patient’s overall strength and health. The best way to measure hand strength or manual muscle testing is with the use of a hand held dynamometer Also a hand dynamometer are perfect for practitioners to use to: Identify deficits as a result of chronic conditions or injury Establish a baseline of strength Track progress throughout a rehabilitation program Iso Kinetic Dynamometer Isokinetic dynamometer is Isokinetic is a Latin word means “same movement”. It is the dynamic movement at a preset constant controlled velocity. Isokinetic dynamometry, originally described by Hislop & Perrine (1967), is a relatively recent tool used in physiotherapy departments in measurements and training. Benefits of Isokinetic The advantage of an isokinetic dynamometer is that the controlled speed of movement allows the exertion of muscle force throughout the entire range of movement, The Isokinetic Dynamometer An isokinetic dynamometer is consisted of a chair and dynamometer which are both capable of rotating about 360° in the transverse plane. Additionally, the dynamometer is also able to rotate vertically. This latter feature enables the patient to be positioned in a number of ways. Specialized attachments allow the unit to be placed alongside a chair or bench in order to measure muscle performance Iso Kinetic Dynamometer Isokinetic assess the muscle performance values. A specific muscle group can be assessed for the following values, to name a few: Peak Torque - highest muscular force output similar to a one repetition maximum effort in isotonic Work - a more functional value of muscle performance, as work is torque sustained over distance in the active case, and torque sustained over time in an Isometric test. Power - This is how effectively the muscle can perform work over time. Modes of Operation in The Isokinetic Dynamometer Modern machines are capable of testing and exercising muscles in a wide range of exercise modes: passive, isometric, isotonic and isokinetic. Passive Mode When operating in the passive mode, the velocity remains constant and no voluntary force is required by the patient to initiate the movement. it is a useful mode in which to start to familiarise the patient with the machine.  Isometric Mode During isometric exercise, the muscle contracts without shortening or lengthening. As the force of contraction increases, there is an increase in the tension generated by the muscle, but there is no change in muscle length and there is no visible joint movement. Isometric exercise is also called “static” exercise. The isometric mode on the dynamometer allows the physiotherapist to programme a series of isometric hold angles throughout the patient's available range of motion. For example, the quadriceps muscle may be weak towards the inner range. Strength here is essential for a normal gait. It may also be weak at 90° of knee flexion. The physiotherapist is able to test the quadriceps at these specific angles by presetting these as hold angles before starting the test. The machine passively moves the patient's limb to the first preset angle (90°) of knee flexion and instructs the patient, via a screen prompt, to contract the quadriceps isometrically for a predetermined time, e.g. 5 seconds. The machine then instructs the patient to relax, and the limb is allowed to reposition or is moved passively to the next hold angle in inner range and the process repeated. Force is displayed on a print out. The protocol Isokinetic testing can be used to provide valid, reliable, objective measure of a muscle’s performance time after time. Following the guidelines established by Kevin Wilk can further assist these measures. The goal of these parameters is to improve the reproducibility of the test results. The parameters are as follows: Patient Education As with other modalities in the clinic, a patient will be less apprehensive and respond more favorably to treatment if they understand the procedure. Educate your patient verbally about Isokinetics; and allow them a few practice sessions, if possible. This will make them more comfortable, and will produce better results as there is a learning curve associated with new movements. Wilk has shown that a patient educated through practice sessions is 80% more likely to give maximal effort of a test, while an patient who is not comfortable with the activity will only give 60% effort. The protocol Test Order It is important to remember that a patient likes consistency. To make your results more reproducible between test sessions and patients ,your patient should perform the tests in the same order every time. The key to a good test session is consistency. By keeping the same order every time, it will reduce the clinicians time in administering the test. This will also make your patient more comfortable with your skills as a tester. Axis Rotation This is important to allow for safe movement of the joint, and allows for isolation of muscle groups. Should there be any unnatural movement of the joint it will cause poor biomechanics, which in turn can cause joint surface irritation and substitution of the muscles being tested. The protocol Stabilization Stabilization is important to prevent accessory movements of the segments. Accessory, or compensatory, movements may allow the patient to obtain higher torque values. It is recommended to use the straps provided on the chair to help stabilize the patient. Make sure that they are snug, but not too tight, as this may cause ischemia or change the length tension relationship of the muscles being tested (much like a chopats strap does for the patellar tendon) and ultimately affect the test results. Position It may be necessary to recline the seat to reduce the pre-stretch effect of tight hamstrings. Positioning will vary with each body part tested. Remember to be consistent when administering multiple tests to the same patient. The protocol Verbal Coaching Research has been done in terms of how a patient is affected by verbal coaching. A patient will respond to any verbal encouragement that is given. If the clinician is not consistent or another clinician administers a test without verbal coaching, this may effect the test results. Visual Feedback As with verbal encouragement, visual feedback is another variable that could affect the outcome of the test results. During a training session, it is helpful to have the biofeedback that may provide motivation for the patient. = The protocol Angular Velocities Choosing angular velocities are important. Traditionally, slow speeds have been considered "strength speeds" (60º/sec to 120º/sec) and fast speeds (180º/sec to 300º/sec) have been considered "endurance speeds." This is a fairly true assumption, however, ADLs are comprised of variable speeds and muscular strength needs to be assessed as such. Peak Torque, work, and power can be assessed at any speed chosen. Calibration Calibration of the system is necessary to ensure the validity of the test. The Biodex dynamometer need to be calibrated,. Calibration verification should be done at least once a month. The protocol Planes of Motion Tested When isolating a particular joint, it is important to remember the biomechanics patterns and movement specific to that joint. For example, to isolate the quadriceps and hamstrings, flexion and extension occur in a sagittal plane. This ensures a safe movement pattern and isolation of these muscles. G.E.T. Gravity Effect Torque This is essentially the torque produced by of the limb and the attachment. For patterns effected by gravity, it is necessary to measure GET. This is done by the dynamometer, recorded by the software, and added to movements against gravity, and subtracted to movements assisted by gravity. The protocol Test Repetitions Repetitions should be kept consistent between test sessions. By increasing the number of repetitions, the patient may experience fatigue or discomfort during the test. At least three (3) repetitions are needed for the Biodex Software to calculate the test data, provided the patient meets Isokinetic Speed. Standard isokinetic knee testing is as follows: 60 deg/sec...........5 reps 180 deg/sec.........10 reps 300 deg/sec.........15 reps Factors affecting isokinetic measurement: A number of factors will influence how this is carried out, such as: * Diagnosis. * Age of patient. * Muscle group(s) to be tested. * System calibration. * Acceleration. * Gravity effect. * Optimal biological-mechanical alignment. * Stabilization. * Test protocol. 45