PREPARATIONS

Prof. Dr. Ibrahim Hamoda

 1- Plinth
• The plinth for testing must be firm to help

stabilize the part being tested. The ideal is a

hard surface, minimally padded or not padded

at all. The hard surface will not allow the trunk

or limbs to "sink in. " Friction of the surface

material should be kept to a minimum.

• When the patient is reasonably

mobile a plinth is fine, but its width

should not be so narrow that the

patient is terrified of falling or sliding

off.

• When the patient is severely paretic, a

mat table is the more practical

choice.

• The height of the table should be

adjustable to allow the examiner to

 2- Materials needed
• Muscle test documentation forms
• Pen, pencil, or computer terminal
• Pillows, towels, pads, and wedges for positioning
• Sheets or other draping linen
• Goniometer
• Interpreter (if needed)
• Assistance for turning, moving, or stabilizing the
patient
• Emergency call system (if no assistant is available)
• Reference material
• EXPLANATION & INSTRUCTION:

• The therapist demonstrate and or

explains briefly the movement to be
performed and or passively moves
the patient’s limb through the test
movement.
• ASSESSMENT OF NORMAL MUSCLE STRENGHT:

• Always assess and record the strength of the unaffected side limb to

determined the patient’s normal strength.

 PROPERLY POSITINED THE PATIENT:

• The patient is positioned to isolate the muscle (or) muscles group to be

tested
• gravity eliminated or Against gravity positioned.
 Stabilization:
• PROXIMAL HAND – At Origin of
muscle & proximal joint giving
stabilization.
• DISTAL HAND – Distally offering resistance
or Assistance depend upon performance.
• The plinth or mat table for testing must be
firm to
• help stabilize the part being tested.
 Stabilization:

The site of attachment of the muscle origin should be stabilized,

so the muscle has a fixed point from which to pull.
Substitutions and trick movements are avoided by making use
of the following methods:
a) The patient's normal muscles

b) The patient's body weight: It is used to help fix the proximal parts (shoulder or
pelvic girdles) during movement of the distal ones.
C) The patient’s position:

D) External forces: They may be applied manually by the therapist or mechanically by devices such as belts

and sandbags.

E) Substitution and trick movements: When muscles are weak or paralyzed, other muscles may take over

or gravity may be used to perform movements normally carried out by the weak muscles.
 CONVENTIONAL METHODS:

• Manual grading of muscle strength is based on three factors:

• Evidence of contraction: No palpable or observable muscle contraction
(grade 0) or a palpable or observable muscle contraction with no joint
motion (grade 1).
• Gravity as a resistance: The ability to move the part through the full
available range of motion with gravity eliminated (grade 2) or against
gravity (grade 3).
• Amount of manual resistance: The ability to move the part through
the full available range of motion against gravity and against moderate
manual resistance (grade 4) or maximal manual resistance (grade 5).
 Adding (+) or (-) to the whole grades:

This is needed to denote variation in the range of motion.

Movement through less than half of the available range of motion is denoted
by a “+” (outer range), while movement through greater than half of the
available range of motion is denoted by “-“ (inner range).
CONVENTIONAL GRADING
 NUMERALS LETTERS DESCRIPTION

Against gravity tests: The patient is able to move through:

5 N (normal) The full available ROM against gravity and against maximal manual resistance, with hold at the
end of the ROM (for about 3 seconds).

4 G (good) The full available ROM against gravity and against moderate manual resistance.

4- G - (good -) Greater than one half of the available ROM against gravity and against moderate manual
resistance.

3+ F + (fair +) Less than one half of the available ROM against gravity and against minimal manual resistance.

3 F (fair) The full available ROM against gravity.

3- F - (fair -) Greater than one half of the available ROM against gravity.

2+ P + (poor +) Less than one half of the available ROM against gravity.

Gravity eliminated tests: The patient is able to actively move through:

2 P (poor) The full available ROM with gravity eliminated.

2- P - (poor -) Greater than one half the available ROM with gravity eliminated.

1+ T + (trace +) Less than one half of the available ROM with gravity eliminated.

1 T (trace) None of the available ROM with gravity eliminated and there is palpable or observable flicker
contraction.

0 0 (zero) None of the available ROM with gravity eliminated and there is no palpable or observable muscle
contraction.
 SCREENING TEST:

• A screen test is a method used to

control muscle strength assessment,
avoid unnecessary testing and
avoid fatiguing and / or discouraging
the patient.
The therapist may screen the patient through the information gained from:

• The previous assessment of the patient's active range of motion.

• Reading the patient's chart or previous muscle test result.

• Observing the patient while performing functional activities. For example, shaking the patients
hand may indicate the strength of grasp (finger flexors).

• All muscle testing procedures must begin at a particular grade; this is usually grade “fair”. The
patient is instructed to actively move the body part through full range of motion against gravity.
Based upon the results of this initial test, the muscle test is either stopped or proceeds.

• Ask patient to stand on toes and raise hands as max as he can

 FACTORS AFFECTING STRENGTH:

• 1). Age:

• A decrease in strength occurs with increasing age due to deterioration

in muscle mass. Muscle fibers decrease in size and number; there is an
increase in connective tissue and fat and the respiratory capacity of
the muscle decreases.
 FACTORS AFFECTING STRENGTH:

2). Sex:
Males are generally stronger than
females.
 FACTORS AFFECTING STRENGTH:

3) Type of muscle contraction:

More tension can be developed during an eccentric contraction
than during an isometric contraction. The concentric contraction
has the smallest tension capability.
4) Muscle size:
The larger the cross-sectional area of a muscle, the greater the
strength of this muscle will be. When testing a muscle that is
small, the therapist would expect less tension to be developed
rather than if testing a large, thick muscle.
 FACTORS AFFECTING STRENGTH:

5) Speed of muscle contraction:

When a muscle contracts concentrically, the force of contraction
decreases as the speed of contraction increases. The patient is
instructed to perform each movement during muscle test at a
moderate speed.
6) Previous training effect:

Strength performance depends up on the ability of the nervous

system to activate the muscle mass. Strength may increase as
one becomes familiar with the test situation. The therapist must
instruct the patient well, giving him an opportunity to move or be
passively moved through the test movement at least once before
muscle strength is assessed.
7). Joint position:
It depends on the angle of muscle pull and the length-tension
relationship.
The tension developed within a muscle depends upon the initial
length of the muscle. Regardless of the type of muscle
contraction, a muscle contracts with more force when it is
stretched than when it is shortened.
8). Fatigue:
As the patient fatigues, muscle strength decreases. The therapist
determines the strength of muscle using as few repetitions as
possible to avoid fatigue.

The patient's level of motivation, level of pain, body type, occupation

and dominance are other factors that may affect strength.
 BREAK TEST:

 Resistance applied at the end of tested range is

termed as BREAK TEST.
 For one joint muscle resistance is applied at End of
ROM.
 For two joint muscle resistance is applied at Mid
Range.
 The isometric hold (break test) shows the muscle to
have a higher grade than the make test
INDICATIONS OF BREAK TEST:

1. When movement is contraindicated

2. When there is pain in movement
3. When must we assess the quality of strength and
not the quantity?.
 MAKE TEST:

Resistance is applied throughout the test is called

MAKE TEST.
 INSTRUMENTATION:

• Instrument chosen to assess muscle strength depends on the degree of

accuracy required in the measurement.
 HAND HELD
DYNAMOMETER
:

This Device operate on

principle of compression.
Application of external force
to the dynamometer
compress a steel spring and
moves a pointer.
PINCH GAUGE:

pinchis a strength
measurement using pinch
dynamometer.
 CABLE
TENSIOMETER
:
Force during knee extension
increased force on cable
depresses a riser over which
cable passes, this deflects the
pointer and indicates amount
of force applied.
KINEO SYSTEM AND ISOKINETIC
Thank YOU