1. Manual Muscle Testing An evaluation system for diagnosis of disease or dysfunction of the musculo- skeletal and nervous systems

2. Purpose Measures the capability of muscles or groups to provide support and movement Measures the capability of muscles or groups to provide support and movement Diagnostic tool Diagnostic tool Postural balance Postural balance Gait impairment Gait impairment Range of motion Range of motion Uses little equipment Uses little equipment Obtains information not defined by other procedures Obtains information not defined by other procedures

3. Precautions Do No Harm (use gentleness) Do No Harm (use gentleness) Know ROM limits Know ROM limits Follow procedure Follow procedure Record Record Promptly Promptly Accurately Accurately

4. To Get Standardized Results Proper training and education Proper training and education Knowledge base of anatomy, physiology and neurology of muscle function Knowledge base of anatomy, physiology and neurology of muscle function Follow precise testing protocol Follow precise testing protocol Practice, Practice, Practice Practice, Practice, Practice A skill developed and maintained with number of cases A skill developed and maintained with number of cases

5. Validity and Accuracy Coordinate the muscle testing findings with other standard diagnostic procedures Coordinate the muscle testing findings with other standard diagnostic procedures The amount of pressure used to test may vary between persons performing the test. The amount of pressure used to test may vary between persons performing the test. The amount of strength loss must be greater than approximately 20to 30% to be dependably measurable The amount of strength loss must be greater than approximately 20to 30% to be dependably measurable Comparison of both sides is a better indicator of loss Comparison of both sides is a better indicator of loss

6. Muscles 3 Types: Skeletal, Smooth, Cardiac 3 Types: Skeletal, Smooth, Cardiac Skeletal around 40% of muscle composition Skeletal around 40% of muscle composition Generally voluntarily controlled Generally voluntarily controlled Composed of fibers Composed of fibers Work in groups Work in groups Movement depends on how the muscles are attached Movement depends on how the muscles are attached

7. Structure of Muscle http://en.wikibooks.org/wiki/Anatomy_and_Physiology_of_Animals/Muscles

8. How Do Muscles Cause Movement Origin- where the muscle is attached to the bone; this bone will move very little Origin- where the muscle is attached to the bone; this bone will move very little Insertion- muscle attachment to bone with most motion Insertion- muscle attachment to bone with most motion Belly of muscle- part of muscle that enlarges on contraction Belly of muscle- part of muscle that enlarges on contraction

9. Muscle Groups Quadriceps Hamstrings Calf Low back Abdominals Pectoralis major Rhomboids Trapezius Latisimus dorsi Deltoids Biceps Triceps

10. Conduct Strength Testing Correct positioning is essential (Start in extended anatomical position) Correct positioning is essential (Start in extended anatomical position) Place muscle to be tested in a supported position directly opposed to gravity Place muscle to be tested in a supported position directly opposed to gravity Exert uniform force directly on the line opposing movement Exert uniform force directly on the line opposing movement

11. Testing of Bicep & Tricep Support humerus where gravity is against the bicep and tricep, client in anatomical position Support humerus where gravity is against the bicep and tricep, client in anatomical position Move elbow through full ROM (Passive ROM) Move elbow through full ROM (Passive ROM) Flexion Flexion Extension Extension Internal rotation Internal rotation External rotation External rotation

12. Maneuver to Assess Muscle Strength With arm in full extension, pull downward on forearm while client attempts to flex. With arm in full extension, pull downward on forearm while client attempts to flex. With arm flexed, apply pressure against forearm, ask client to straighten arm. With arm flexed, apply pressure against forearm, ask client to straighten arm. When performing muscle tests, be sure to evaluate for asymmetry of the muscle groups (i.e. atrophy on one side and not the other) and landmarks prior to testing. When performing muscle tests, be sure to evaluate for asymmetry of the muscle groups (i.e. atrophy on one side and not the other) and landmarks prior to testing.

13. Use the following scale to rate strength: 0-No movement, no contraction of the muscle 0-No movement, no contraction of the muscle 1- Trace, evidence of muscle contraction but no joint movement 1- Trace, evidence of muscle contraction but no joint movement 2- Poor, complete range of motion with gravity eliminated 2- Poor, complete range of motion with gravity eliminated 3-Fair, complete range of motion against gravity 3-Fair, complete range of motion against gravity 4- Good, complete range of motion against gravity with moderate resistance 4- Good, complete range of motion against gravity with moderate resistance 5-Normal, complete range of motion against gravity with maximal resistance without evidence of fatigue 5-Normal, complete range of motion against gravity with maximal resistance without evidence of fatigue

14. Other Test Results Weakness – defined as a strength below fair in non weight bearing muscles; below fair + in weight bearing muscles Weakness – defined as a strength below fair in non weight bearing muscles; below fair + in weight bearing muscles Contracture – degree of shortness in muscle, so it cannot move through ROM Contracture – degree of shortness in muscle, so it cannot move through ROM Substitution – weak muscles are supported by other muscles to move Substitution – weak muscles are supported by other muscles to move

15. Active ROM Instruct client to move the elbow through ROM Instruct client to move the elbow through ROM Flexion Flexion Extension Extension Internal rotation Internal rotation External rotation External rotation Normal ROM is measured by goniometer Normal ROM is measured by goniometer Elbow flexion 0-160 Elbow flexion 0-160 Elbow extension 145-0 Elbow extension 145-0 Elbow pronation (rotation inward) 0-90 Elbow pronation (rotation inward) 0-90 Elbow supination (rotation outward) 0-90 Elbow supination (rotation outward) 0-90

16. Strength Test Example Gastrocnemius (Ankle plantar flexion) Gastrocnemius (Ankle plantar flexion) Patient Standing Patient Standing Rises on toes, pushing weight upward Rises on toes, pushing weight upward

17. Case Study to Follow Take patient hx to determine diagnosis Take patient hx to determine diagnosis Assessment of muscle strength Assessment of muscle strength Set objectives Set objectives Implement a plan Implement a plan Evaluate progress Evaluate progress

18. Case Study Drop Foot Drop Foot weakness of muscles that are involved in flexing the ankle and toes. weakness of muscles that are involved in flexing the ankle and toes.

19. Clinical Muscle Evaluation Typical podiatric ankle strength evaluation consists of plantar flexion, dorsiflexion, eversion and inversion testing Typical podiatric ankle strength evaluation consists of plantar flexion, dorsiflexion, eversion and inversion testing

20. Dorsiflection Testing Tibialis Anterior Tibialis Anterior Support leg above ankle Support leg above ankle Apply pressure against medial side, dorsal surface of the foot, in the direction of plantar flexion of the ankle joint and eversion of the foot. Test dorsiflection directly. Apply pressure against medial side, dorsal surface of the foot, in the direction of plantar flexion of the ankle joint and eversion of the foot. Test dorsiflection directly.

21. Dorsiflection Testing Extensor Hallucis Longus Extensor Hallucis Longus Stabilize foot in slight plantar flexion Stabilize foot in slight plantar flexion Pressure applied against dorsal surface of distal and proximal phalanges of the great toe in direction of flexion. Test big toe extension. Pressure applied against dorsal surface of distal and proximal phalanges of the great toe in direction of flexion. Test big toe extension.

22. Dorsiflection Testing Extensor Digitorum Longus Extensor Digitorum Longus Stabilize foot in slight plantar flexion Stabilize foot in slight plantar flexion Apply pressure against dorsal surface of the toes in the direction of flexion. Test extension of toes. Apply pressure against dorsal surface of the toes in the direction of flexion. Test extension of toes.

23. Summary Manual Muscle Testing is clinical tool used to evaluate patient Manual Muscle Testing is clinical tool used to evaluate patient Need information in order to develop orthotic treatment plan Need information in order to develop orthotic treatment plan

24. END Questions? Questions?

25. Conditions A list of conditions treatable with Applied Kinesiology A list of conditions treatable with Applied Kinesiology A list of conditions treatable with A list of conditions treatable with

26. All about muscles http://www.emporia.edu/ksn/v42n1- january1996/shape.htm http://www.emporia.edu/ksn/v42n1- january1996/shape.htmwww.emporia.edu/ksn/v42n1- january1996/shape.htmwww.emporia.edu/ksn/v42n1- january1996/shape.htm

27. This power point is based on information found on the Illinois Institute of Technology web site where students developed resources to be used in education in Latin America. I modified the original power point to be used by high school students in the Healthcare Science classroom. This power point is based on information found on the Illinois Institute of Technology web site where students developed resources to be used in education in Latin America. I modified the original power point to be used by high school students in the Healthcare Science classroom. Pat Rape Pat Rape

28. http://www.lhup.edu/yingram/jennifer/webpa ge/homepage2.htm http://www.lhup.edu/yingram/jennifer/webpa ge/homepage2.htm http://www.lhup.edu/yingram/jennifer/webpa ge/homepage2.htm http://www.lhup.edu/yingram/jennifer/webpa ge/homepage2.htm http://www.iit.edu/~ipro309s08/links.html http://www.iit.edu/~ipro309s08/links.html http://www.iit.edu/~ipro309s08/links.html http://www.bulowbiotech.com/intromov.html http://www.bulowbiotech.com/intromov.html

29. Careers http://francistuttle.com/classes/ctp/details.aspx?PRGID=13 http://francistuttle.com/classes/ctp/details.aspx?PRGID=13 http://francistuttle.com/classes/ctp/details.aspx?PRGID=13 Orthotic & Prosthetic (O & P) Technicians assist the disabled by fabricating the orthopedic braces (orthoses) and artificial limbs (prostheses) necessary for their rehabilitation. O & P Technicians are trained and skilled to provide comprehensive O & P technical support services and possess the knowledge to interact with clinical prosthetists and orthotists. You will acquire knowledge in polymer processes, strength of materials and applied biomechanical principles to develop and totally customize an orthosis or prosthesis. Providing O & P care involves the application of clinical and technical processes to meet patient rehabilitation objectives. Orthotic & Prosthetic (O & P) Technicians assist the disabled by fabricating the orthopedic braces (orthoses) and artificial limbs (prostheses) necessary for their rehabilitation. O & P Technicians are trained and skilled to provide comprehensive O & P technical support services and possess the knowledge to interact with clinical prosthetists and orthotists. You will acquire knowledge in polymer processes, strength of materials and applied biomechanical principles to develop and totally customize an orthosis or prosthesis. Providing O & P care involves the application of clinical and technical processes to meet patient rehabilitation objectives.