MUSCLE STRENGTH.pptx ahh settings Srikah

Gyan

1. Definition Ability of the muscle to exert force Refers to ability of person to generate maximal force using a muscle or group of muscles Muscle endurance – ability to maintain repeated contraction or force generated for prolonged period of time

2. Types of muscle contraction Isotonic contractions are those which cause the muscle to change length as it contracts and causes movement of a body part. 2 types of Isotonic contraction: Concentric Concentric contractions are those which cause the muscle to shorten as it contracts

3. An example is bending the elbow from straight to fully flexed, causing a concentric contraction of the Biceps Brachii muscle

4. Eccentric Eccentric contractions are the opposite of concentric and occur when the muscle lengthens as it contracts Eg This occurs when lowering the dumbbell down in a bicep curl exercise

5. Isometric Contractions Isometric contractions occur when there is no change in the length of the contracting muscle Eg when you grip something, such as a tennis racket

6. Isokinetic Contractions Isokinetic contractions are similar to Isotonic in that the muscle changes length during the contraction, where they differ is that isokinetic contractions produce movements of a constant speed Eg breaststroke in swimming, where the water provides a constant, even resistance to the movement of adduction

7. Manual muscle testing Procedure for : Evaluation of the function & strength of individual muscles and muscles group based on effective performance of movement in relation to Forces of gravity Manual resistance through the available ROM

8. Muscle tone The resistance of muscle to passive elongation or stretching It is state of muscle tension inside a muscle or muscle group when it is at rest

9. Range of motion arc of motion that occurs at a joint or a series of joints

10. Why evaluation ? Facilitate diagnosis - neuromuscular conditions (e.g., spinal cord injury, peripheral nerve injury) Establish a baseline & assess intervention effectiveness Determine whether weakness is limiting performance

11. Determine need for compensatory measures or assistive devices on a temporary or long-term basis Identify muscle imbalances that require strengthening Determine appropriate orthotic intervention to prevent deformity

12. Long handle reachers

13. Swivel Spoon with Built Up Handle

14. Universal cuff

15. Wrist support with universal cuff

16. Functional position – resting hand splint

17. The examiner should test passive ROM prior to performing a manual muscle test of muscle strength because the grading of manual muscle tests is based on completion of the joint ROM

18. Evaluation Evaluated by manual resistance, isokinetics exercises ,pinch meters, and dynamometers Hand strength - hand dynamometer pinch strength - pinch meter

19. What OT assess MMT – both upper & lower limb Generally grasps & pinches are tested

20. Unlike active ROM, passive ROM does not depend on the subject’s muscle strength and coordination

21. Limitation Inability to measure the patient’s muscle endurance (number of times the muscle can contract at maximum level) Muscle coordination (smooth, rhythmic interactions of muscle function) Motor performance capabilities (use of the muscles for functional activities)

22. The manual muscle test cannot be used accurately with patients who have spasticity

23. In stroke muscles are often hypertonic Muscle tone & ability to perform movements - influenced by primitive reflexes & position of the head & body in space. Movements tend to occur in gross synergistic patterns (several muscles and joints working together), which makes isolating muscle action & joint movement impossible for most patients

24. Videos

25. Factors affecting Muscle strength As a person ages, skeletal muscle strength decreases as a result of changes in fiber type & motor unit distribution It is generally assumed that the increased connective tissue results in decreased ROM & increased muscle stiffness

26. Conditions Myasthenia gravis – autoimmune disease causing muscle weakness

27. Principles of MMT lists both manual muscle testing (MMT) and dynamometry as appropriate measures of muscle strength  Resistance applied at the end of the tested range is termed a 'break test' Resistance applied throughout the range is termed a 'make test’

28. BASIC RULES OF PROCEDURE THAT APPLY TO MUSCLE STRENGTH TESTING Explain the procedure and demonstrate the desired movement.eg next slide Place the subject in a position that offers the best fixation of the body as a whole (usually supine, prone, or side-lying) Stabilize part proximal to tested part or, as in the case of the hand, adjacent to the tested part.

29. "I'm going to test the strength of one of the muscles that bends your elbow“ "This is the movement pattern I want you to do. Do it first on your uninvolved side."

30. Place the part to be tested in precise antigravity test position, whenever appropriate, to help elicit the desired muscle action & aid in grading Use test movements in the horizontal plane when testing muscles that are too weak to function against gravity

31. Apply pressure directly opposite the line of pull of the muscle or the muscle segment being tested Use a long lever whenever possible, unless contraindicated

32. Evaluation evaluated in several ways most precise method, is a test of individual muscles assess the strength of groups of muscles that perform specific functions at individual joints

33. third way to evaluate muscle strength is by observing the performance of ordinary activities Apply uniform pressure; avoid localized pressure that can cause discomfort

34. Clinical practice Explaining client about procedure ,take cultural aspect into account If possible Remove clothing or restriction around joint (not general rule ) Positioning Make client comfortable

35. Check if available passive ROM is available – instructions clear Do not keep changing position often – check muscles in one position & then change other Respect pain Record appropriately

36. Start with grade 3 Spasticity – voluntary control assessment Pain, swelling ,T/C/D

37. Check bilaterally /unilaterally Consider weakness – avoid too many repetitions Tone increased – individual MMT can’t be done

38. Diff - muscle tone ,muscle strength Scales used

39. Limitation of grading scale Muscle being tested may have no clinical relevance There may be individual variation in reporting Only assesses muscles which are contracting in a concentric manner The scale may not be applicable in all patients

40. References Introduction to occupational therapy ,4 th edition , Jane Clifford O'Brien Joint structure & function ,4 th edition ,Cynthia c .norkin Willard & Spackman’s occupational therapy ,11 th edition , Elizabeth Blesedell Crepeau ..

41. Muscles testing & function with posture & pain,5 th edition, Florence Peterson Kendall ,Elizabeth Kendall McCreary Essential of medical physiology ,6 th edition ,k Sembulingam