Skip to main content

MUSCLE POWER GRADING

 INTRODUCTION:

An assessment of muscle strength is typically performed as part of a patient's objective assessment and is an important component of the physical exam that can reveal information about neurologic deficits. It is used to evaluate weakness and can be effective in differentiating true weakness from imbalance or poor endurance. It may be referred to as motor testing, muscle strength grading, manual muscle testing, or any other synonyms. Muscle strength can be assessed by a number of methods-manually, functionally, or mechanically. Strength depends on the combination of morphological and neural factors including muscle cross-sectional area and architecture, musculotendinous stiffness, motor unit recruitment, rate coding, motor unit synchronization, and neuromuscular inhibition.


FUNCTION:

The function of muscle strength testing is to evaluate the complaint of weakness, often when there is a suspected neurologic disease or muscle imbalance/weakness. It is an important part of the assessment in many client groups including

  • patients with stroke, brain injury, spinal cord injury, neuropathy, amyotrophic lateral sclerosis, and a host of other neurologic problems.
  • rehabilitation after sporting injuries eg ACL repair
  • after fractures and joint replacements eg TKR
  • gait and balance problems in the older adult
  • falls risk assessment

TYPES OF MUSCLE POWER GRADING:
so many types of muscle power grading tests used in physiotherapy field. 

MRC GRADING:
ScoreDescription
0No contraction
1Flicker or trace of contraction
2Active movement, with gravity eliminated
3Active movement against gravity
4Active movement against gravity and resistance
5Normal power

OXFORD SCALE:
he most commonly accepted method of evaluating muscle strength is the Oxford Scale (AKA Medical Research Council Manual Muscle Testing scale). This method involves testing key muscles from the upper and lower extremities against the examiner’s resistance and grading the patient’s strength on a 0 to 5 scale accordingly:
  1. Flicker of movement
  2. Through full range actively with gravity counterbalanced
  3. Through full range actively against gravity
  4. Through full range actively against some resistance
  5. Through full range actively against strong resistance

Commonly tested muscles include the shoulder abductors, elbow flexors, elbow extensors, wrist extensors, finger flexors, hand intrinsics, hip flexors, knee extensors, dorsiflexors, great toe extensor, and plantar flexors. These muscle groups are commonly chosen, so that important spinal nerve roots are assessed systematically eg testing the strength of the elbow flexors, elbow extensors, wrist extensors, finger flexors, and hand intrinsics allow for a methodical evaluation of the C5 to T1 nerve roots.

DYNAMOMETER:

Distal strength can be semiquantitatively measured with a handgrip ergometer (or with an inflated BP cuff squeezed by the patient) to record grip strength. Requires specialized equipment, most commonly dynamometers. Dynamometry is a more precise measurement of the force that a muscle can exert and can allow for differences in strength to be recorded over time. Expensive versions exist as do cheap versions as found on internet searches.

FUNCTIONAL TESTING:

Often provides a better picture of the relationship between strength and disability. As the patient does various maneuvers,deficiencies are noted and quantified as much as possible (eg 30 seconds sit to stand testTUG.).

  • Rising from a chair or stepping onto a chair tests proximal leg strength, walking on the heels and on tiptoe tests distal strength.
  • Pushing with the arms to get out of a chair indicates quadriceps weakness.
  • Swinging the body to move the arms indicates shoulder girdle weakness.
  • Rising from the supine position by turning prone, kneeling, and using the hands to climb up the thighs and slowly push erect (Gowers sign and seen in Duchenne gait) suggests pelvic girdle weakness.


CLINICAL SIGNIFICANCE: Muscle strength testing can help diagnose many problems in which weakness plays a role. Careful technique is important for ensuring valid and reproducible results.
  • The Manual muscle power testing Scale is commonly accepted and does not require special equipment, and demonstrates reasonable interrater reliability. More precise methods of measurement, such as hand-grip dynamometry, are less subjective and provide a quantifiable measurement that can be tracked over time. However, a cross-sectional study (2020) shows a lower correlation between the handgrip strength and standard strength measures of the lower limbs (hip, knee, and ankle extensor/flexor muscles), and functional capacity in older women.
  • Functional assessment of strength focuses on how independently patients are able to perform their activities of daily living and whether strength is a limiting factor.
  • Effect of Protein supplements on muscle-For untrained individuals, consuming supplemental protein likely has no impact on lean mass and muscle strength during the initial weeks of resistance training. Protein supplementation may accelerate gains in both aerobic and anaerobic power as the frequency, duration, volume of resistance training increase.

THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND WEBSITES..

THANK YOU,

SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER

Comments

Popular posts from this blog

முதுகு வலி மற்றும் முதுகு தண்டுவட வலி உள்ளவர்களுக்கு கடைபிடிக்க வேண்டிய சில வழிமுறைகள்....

  முதுகு வலி மற்றும் முதுகு தண்டுவட வலி உள்ளவர்களுக்கு கடைபிடிக்க வேண்டிய சில வழிமுறைகள் ....     பொதுவாக முதுகு வலி என்பது இன்றைய காலகட்டத்தில் பல பேருக்கு மிக அதிகமாகவே காணப்படுகிறது. இவ்வாறு வலி இருக்கும் பொழுது என்ன மாதிரியான வழிமுறைகளை கடைப்பிடிக்க வேண்டும் என்பதை கீழே விரிவாக பார்க்கலாம்.   பொதுவாக முதுகு வலி ஆரம்பிக்கும் பொழுது அவற்றை உதாசீனப்படுத்தாமல் அருகில் உள்ள மருத்துவரை அணுகி ஆலோசனை பெறுவது மிகவும் முக்கியம். மேலும் முதுகு வலி ஏற்படும் பொழுது அவற்றுக்கு தேவையான மருத்துவம்(medical management), இயன்முறை மருத்துவம்(physiotherapy treatment), பயிற்சிகள்(exercises) அல்லது அறுவை சிகிச்சை(surgery) மற்றும் புனர்வாழ்வு சிகிச்சைகள்(Rehabilitation) போன்றவை தேவைப்படலாம். மேலே கண்ட மருத்துவத்தில் ஏதாவது ஒன்றை எடுத்துக் கொள்ளும் பட்சத்தில் மேலும் முதுகு வலி வராமல் பாதுகாத்துக் கொள்ளவும், நமது அன்றாட வேலைகளை தொடர்ந்து செய்யவும், மருத்துவ உபகரணங்களை பயன்படுத்திக் கொள்ளவும்...

BRONCHIECTASIS

INTRODUCTION: Bronchiectasis means abnormal dilatation of the bronchi due to chronic airway inflammation and infection. It is usually acquired, but may result from an underlying genetic or congenital defect of airway defences. CAUSES: Congenital • Cystic fibrosis • Primary ciliary dyskinesia • Kartagener’s syndrome (sinusitis and transposition of the viscera) • Primary hypogammaglobulinaemia Acquired • Pneumonia (complicating whooping cough or measles) • Inhaled foreign body • Suppurative pneumonia • Pulmonary TB • Allergic bronchopulmonary aspergillosis complicating asthma • Bronchial tumours CLINICAL FEATURES: ● Chronic cough productive of purulent sputum.  ● Pleuritic pain. ● Haemoptysis.  ● Halitosis. Acute exacerbations may cause fever and increase these symptoms. Examination reveals coarse crackles caused by sputum in bronchiectatic spaces. Diminished breath sounds may indicate lobar collapse. Bronchial breathing due to scarring may be heard in advanced disease. INVESTIG...

PARKINSON'S DISEASE

  Parkinson's EtiologyParkinson's disease (PD) is a neurodegenerative disorder that mostly presents in later life with generalized slowing of movements (bradykinesia) and at least one other symptom of resting tremor or rigidity. Other associated features are a loss of smell, sleep dysfunction, mood disorders, excess salivation, constipation, and excessive periodic limb movements in sleep (REM behavior disorder). PD is a disorder of the basal ganglia, which is composed of many other nuclei. The striatum receives excitatory and inhibitory input from several parts of the cortex. The key pathology is the loss of dopaminergic neurons that lead to the symptom .  It is the seconds most common neuro-degenerative condition in the world after Alzheimer's. The condition is caused by the slow deterioration of the nerve cells in the brain, which create dopamine. Dopamine is a natural substance found in the brain that plays a major role in our brains and bodies by messag...

லம்பார் ஸ்பாண்டிலோஸிஸ்(lumbar spondylosis)

  முன்னுரை ல ம்பார் ஸ்பாண்டிலோஸிஸ்(lumbar spondylosis) எனப்படும் மருத்துவ பிரச்சினைகள் என்பது முதுகுப் பகுதியில் ஏற்படும் நீண்ட நாள் முதுகு வலி. இவ்வாறு ஏற்படும் முதுகு வலி முதுகு முள்ளெலும்பு பகுதியில்(vertebral coloum) உள்ள தட்டு அழுத்தப் படுவதினால்(disk compression) அல்லது முள்ளெலும்பு பகுதியின பிரதான பகுதி சற்று இடம் நகர்வதால(displacement) முதுகு வலி ஏற்படுவதற்கு வாய்ப்புகள் உள்ளதாக கூறப்படுகின்றன. சில சமயங்களில் முதுகு தண்டு மற்றும் எலும்பு பகுதிகள் தொடர்சிதைவு(degeneration) ஆகும் போதும், முதுகெலும்பு தட்டு பகுதி, முதுகெலும்பு மூட்டு(facet joints) பகுதி தொடர்ந்து பிரச்சனைக்கு உள்ளாக்கப்படும் பொழுதும் முதுகு வலி ஏற்படுகிறது. ஸ்பாணடிலோஸிஸ் என்பதை முதுகு எலும்பு தேய்மானம்(osteoarthritis)  எ ன்று கூறலாம். இவ்வாறு முதுகு எலும்பு தேய்மானம்,  ல ம்பார்(lumbar vertebrae)  எனப்படும் கீழ் முதுகு எலும்பு பகுதிகள், மேல் முதுகு எலும்பு பகுதிகள்(thoracic vertebrae), மற்றும் கழுத்து முதுகெலும்பு(cervical vertebrae) பகுதிகள் போன்றவற்றை பாதிக்கலாம். பொதுவாக ஸ்பாண்டிலோசிஸ் எனப்படு...

CARDIAC ARREST AND RESUSCITATION

INTRODUCTION: The leading causes of sudden death before old age, in people over the age of 44, are ventricular fibrillation from asymptomatic ischaemic heart disease or non-traumatic accidents such as drowning and poisoning. In people under the age of 38, the commonest causes are traumatic, due to accident or violence. In such instances death may be prevented if airway obstruction can be reversed, apnoea or hypoventilation avoided, blood loss prevented or corrected and the person not allowed to be pulseless or hypoxic for more than 2 or 3 minutes. If, however, there is circulatory arrest for more than a few minutes, or if blood loss or severe hypoxia remain uncorrected, irreversible brain damage may result. Immediate resuscitation is capable of preventing death and brain damage. The techniques required may be used anywhere, with or without equipment, and by anyone, from the lay public to medical specialists, provided they have been appropriately trained. Resuscitation may be divided in...

CARDIAC REHABILITATION

  Introduction “Cardiac Rehabilitation is the process by which patients with cardiac disease, in partnership with a multidisciplinary team of health professionals are encouraged to support and achieve and maintain optimal physical and psychosocial health. The involvement of partners, other family members and carers is also important”. Cardiac rehabilitation is an accepted form of management for people with cardiac disease. Initially, rehabilitation was offered mainly to people recovering from a myocardial infraction (MI), but now encompasses a wide range of cardiac problems. To achieve the goals of cardiac rehabilitation a multidisciplinary team approach is required. The multidisciplinary team members include: Cardiologist/Physician and co-coordinator to lead cardiac rehabilitation Clinical Nurse Specialist Physiotherapist Clinical nutritionist/Dietitian Occupational Therapist Pharmacist Psychologist Smoking cessation counsellor/nurse Social worker Vocational counsellor Clerical Ad...

RELAXED POSITIONS FOR BREATHLESS PATIENTS

Relaxation positions for the breathless patient  If patients can be taught how to control their breathing during an attack of dyspnoea, this can be of great benefit to them. The patient should be put into a relaxed position, and encouraged to do ‘diaphragmatic’ breathing at his own rate. The rate of breathing does not matter at this stage; it is the pattern of breathing that is important. As the patient gains control of his breathing he should be encouraged to slow down his respiratory rate. Any of the following positions will assist relaxation of the upper chest while encouraging controlled diaphragmatic breathing. They can be adapted to various situations in everyday life. HIGH SIDE LYING  Five or six pillows are used to raise the patient’s shoulders while lying on his side. One pillow should be placed between the waist and axilla, to keep the spine straight and prevent slipping down the bed. The top pillow must be above the shoulders, so that only the head and neck are supp...