Protocol Isometric Strength Testing Encals-Books Pdf

Protocol Isometric Strength Testing ENCALS
03 Jul 2020 | 0 views | 0 downloads | 10 Pages | 651.68 KB

Share Pdf : Protocol Isometric Strength Testing Encals

Download and Preview : Protocol Isometric Strength Testing Encals


Report CopyRight/DMCA Form For : Protocol Isometric Strength Testing Encals



Transcription

1 Introduction, The necessity for standardized muscle strength testing as an evaluation method in ALS effect studies. ALS leads to progressive muscle weakness that spreads throughout the entire body This muscle weakness. is for a large part responsible for functional loss over time To understand the effect of new therapies on. functional level it is therefore essential to include muscle strength in trial designs However the. measurement of muscle strength yields various problems such as lack of standardization and low intra. and inter rater reliability Consequently the data is often of poor quality leading to suboptimal reliability. of test outcomes An example of these problems is outlined in the following case. Mr Jones 62 has had a dropping foot for two years He is experiencing increasing difficulty in climbing. the stairs Two months ago he was diagnosed with ALS Mr Jones is participating in a trial His isometric. muscle strength will therefore be assessed monthly. At the time of the first trial measurement Mr Jones is sitting in a chair The evaluator notes that the arm. of the chair is in the way and so she cannot grip the right elbow while measuring elbow flexion She. therefore allows Mr Jones to rest his elbow on the chair During the test the evaluator stands in front of. the patient Later the evaluator notes that she is not able to break the power of the knee extension with. gentle force To resolve this she pushes against the lower leg using her full body weight without noticing. that she has actually pushed the hip down on the chair and the knee was still extended during the test. One month later Mr Jones visits the same evaluator for his monthly muscle strength test This time the. evaluator positions the elbow away from the body slightly so that she can grip the elbow to test the. flexural strength She performs the test while standing alongside rather than in front of the patient After. the previous monitoring visit Mr Jones experienced pain in his knee He therefore now chooses to exert. submaximal power On this occasion the evaluator succeeds in gently breaking through the power of the. extensor muscles of the knee Test scores show that the measured strength in the knee extensors is much. lower than it was the previous month, In our daily practice the approach used for measurement of isometric muscle strength often varies. However in order to compare the results it is important that every muscle strength measurement is. carried out in exactly the same way by each of the investigators Had the measurement in the above case. been standardized the execution of the measurements would have been as follows. The strength of arms and legs is measured on a treatment table while Mr Jones is lying down Thus Mr. Jones body acts as a fixation for the strength test and the evaluator has both hands free to perform the. test This makes it much easier to break through the exerted force using gentle pressure When testing the. flexural strength of the elbow the evaluator stands in axis of the movement according to the protocol and. exerts a pulling movement to extend it, To test the strength of the knee the evaluator asks Mr Jones to sit on edge of the bed Because the. treatment table is at a high setting the feet do not touch the floor and the lower legs can dangle in. relaxed fashion When testing the extension force of the knee the evaluator can exert resistance in the. direction of knee flexion by pushing with two hands Because of the sitting position on the treatment. table the possibility of the muscles around the patient s hip affecting the strength test of the knee. extensor muscles is minimised The test results are now much more reliable because there is less. variability This means that isometric strength testing is of huge added value for the desired effect. evaluation, TRICALS Protocol Isometric Strength Testing Version February 2018 Contact info tricals org. Why do we test isometric strength with a HDD and not with the MRC scale. The use of the MRC scale is debatable because of the subjectivity What is normal strength for a man of. 39 or a woman of 62 Furthermore the MRC score is not sensitive This is problematic for the detection of. small changes Regarding this issue the non linear nature of the scale is also a stumbling block see. Figure 2 Because of these factors the reliability of the MRC scale for an effect study is low. Figure 2 Comparison between the Medical Research Council MRC scale upper line and the dynamometer scale. lower line in the case of the elbow flexors of a man Clearly the ability of the MRC scale to grade a large range of. force application is inadequate in particular in the range 3 to 5. A portable and inexpensive way of solving these problems is by using a Hand Held Dynamometer HHD. to test isometric muscle strength This device can provide a reliable and objective representation of the. strength provided that the test is performed in a standardized way by all evaluators We make the quality. of the measurements as high as possible by instructing all the investigators to test isometric muscle. strength in the same way with the same instrument This is not only beneficial to our patients but it also. contributes to the quality and usefulness of the research data. This course introduces you to the standardized test procedures so that you can then apply them yourself. Practicing the protocol is essential in order to meet the requirements of an accredited evaluator. 2 Conditions for measuring isometric strength, Break method.
For this protocol the so called break method is used This means that the evaluator not only offers. resistance in the opposite direction to the force exerted by the subject but also gently breaks through the. power exerted by the patient This form of testing is aggravating for the muscles and joints of the patient. It is therefore recommended that movement is gentle and only pushes slightly through the power. exerted by the patient to limit the load on the tested muscle as much as possible Make sure that the. tested body part never touches the ground before the end of the test The ground offers extra resistance. and so touching it would result in an overestimation of the observed power. If breaking through the exerted power of the subject was not possible it is very important to note this. on the designated place on the score form, Starting position of the subject. The strength measurements are carried out on a treatment table The body itself can serve as fixation. strength for strength measurements This fixation strength is highest in the supine position Therefore this. position greatly improves the reproducibility of the data The head of the treatment table is usually set at. a 45 degree upward incline A small pillow can be placed under the head neck region for extra comfort In. general it is recommended that treatment table paper or mattress covers are removed in order to create. as much friction as possible at the table surface, An exception in starting position is only made for knee extension and flexion For these tests the patient. sits on the treatment table in upright position with the lower legs hanging down relaxed While testing. compensatory movements in the trunk of the patient should be avoided if possible. TRICALS Protocol Isometric Strength Testing Version February 2018 Contact info tricals org. It is important to adhere to the starting positions specified in the protocol see Technique Section 3 You. also have the option of checking the corners of limbs with a goniometer Shoes and any orthotics are. taken off during muscle strength testing, Starting position of the evaluator. It is possible that an evaluator has difficulty breaking through the power of the patient This happens. when the subject is stronger than the assessor In order to provide as much resistance as possible the. evaluator always stands in the groove of motion and therefore is always exerting a pushing or pulling. movement It is important to not only use the arms but also the trunk to provide sufficient resistance for a. Placement of the HDD, The exact location of the HDD has a large influence on the final test score The higher the leverage the. lower the force being measured Always place the HHD just proximal to the articulation of the joint If the. HHD is positioned too far distally this may cause a movement in the joint or result in an improper test of. the muscle group These factors have a considerable adverse influence on the strength score. Duration of contraction, To give the subject the opportunity to exert maximum strength but to prevent unnecessary overexertion.
the isometric contraction is sustained for 2 seconds followed by a break. Encouragements, The subject should be encouraged to push against the HHD with all of his her strength The effect of. encouragement on maximal strength has been proven The encouragement has therefore been. standardized During muscle strength measurement the evaluator says in an encouraging voice level. contract 1 second followed by maximum 1 second followed by a gentle break. Number of repetitions, Each measurement is repeated twice Both scores are written down If the value of the second. measurement deviates by more than 15 from the first measurement the measurement is repeated a. third time The value of the third measurement is also included on the test form. Handgrip strength, The Jamar dynamometer is used to measure hand grip strength Hand grip strength is measured and. recorded in pounds For this protocol the standard grip setting is at the second notch and should not be. 3 Technique see Appendix 1 for supportive images, Shoulder Flexion. Subject in supine position Shoulder flexion 90 degrees relative to the trunk Elbow extended the forearm. is in neutral position thumb is pointing towards the ceiling HHD is placed proximal to the humeral. epicondyles i e just above the elbow joint Movement evaluator pull. Elbow Flexion, Subject in supine position Elbow is flexed to 90 degrees the forearm is in neutral position thumb is.
pointing towards the ceiling Important during the test the upper arm and elbow rest on the mattress of. TRICALS Protocol Isometric Strength Testing Version February 2018 Contact info tricals org. the treatment table HHD is placed on the distal radius just proximal to the wrist joint Movement. evaluator pull, Elbow Extension, Subject in supine position Elbow is flexed to 90 degrees the forearm is in neutral position thumb is. pointing towards the ceiling Important during the test the upper arm and elbow rest on the mattress of. the treatment table HHD is placed on the distal ulna just proximal to the wrist joint Movement evaluator. Wrist Extension, Subject in supine position Elbow is flexed to 90 degrees the forearm is in neutral position thumb is. pointing towards the ceiling and the back of the hand lies in the extension of the forearm Important. during the test the upper arm and elbow rest on the mattress of the treatment table The fingers are bent. into a fist if possible The evaluator grasps the palmar side of the forearm with the contralateral hand The. HHD is placed just below MTP 2 3 and 4 on the back of the hand Movement evaluator push. First Dorsal Interosseous, Pay attention The finger pad has to be installed to test this muscle group Subject in supine position. Forearm in pronation the back of the hand is pointing upwards During the test the upper arm and elbow. rest on the mattress of the treatment table Using his contralateral hand the hand not holding the HHD. the evaluator fixes the ulnar side of the subject s hand just below MTC 5 The subject is asked to spread. the fingers maximally The HHD is placed on the lateral side of the index finger just proximal to the PIP. joint of the index finger Movement evaluator push, Hip Flexion. Subject in supine position Raise knee until hip is flexed 90 degrees relative to the trunk The knee of the. raised leg hangs loosely in flexion Important the foot does not touch the treatment table HHD is placed. suprapatellar to the flexed knee at the end of the upper leg towards the knee Movement evaluator push. Ankle Dorsiflexion, Subject in supine position The ankle is in neutral dorsiflexion 0 degrees foot perpendicular to the lower.
leg HHD is placed just proximal to the metatarsal joints Movement evaluator pull. Knee Extension, Subject is sitting on the edge of the treatment table the back of the knees just not touching the edge. The height of the treatment table is set so that the feet float at least 20 centimetres above the ground. The subject should not move the trunk forwards or backwards during the test The hands can lean on the. treatment table next to the thighs but must not hold on to the treatment table The backs of the knees do. not touch the edge of the table The knees are in 90 degrees of flexion the lower legs hang down relaxed. HHD is placed on the ventral side of the lower leg just proximal to the malleoli Movement evaluator. Knee Flexion, Subject is sitting on the edge of the treatment table in the same position as during the knee extension. test HHD is placed on the dorsal side of the lower leg just proximal to the malleoli right on the Achilles. tendon Movement evaluator pull, TRICALS Protocol Isometric Strength Testing Version February 2018 Contact info tricals org. Grip strength, Subject in sitting position on the edge of the treatment table The subject s feet are touching the ground. Grip strength is measured with a Jamar grip dynamometer The standard grip setting is at the second. His isometric muscle strength will therefore be assessed monthly At the time of the first trial measurement Mr Jones is sitting in a chair The evaluator notes that the arm of the chair is in the way and so she cannot grip the right elbow while measuring elbow flexion She therefore allows Mr Jones to rest his elbow on the chair During the test the evaluator stands in front of the

Related Books

815 04 Introduction to R UTC

815 04 Introduction to R UTC

An Introduction to R ML01 Spring 2019 This Week z The R programming language Syntax and constructs Variable initializations Function declarations z Introduction to R Graphics Functionality Some useful functions The R Project z Environment for statistical computing and graphics Free software z Associated with simple programming language Similar to S and S

How to Create a Simple to Use Wiki Based on DokuWiki in a

How to Create a Simple to Use Wiki Based on DokuWiki in a

How to Create a Simple to Use Wiki Based on DokuWiki in a vCloud Environment 14 Installation 10 Click Add New When your server is created it will be in a powered off state To access your DokuWiki vApp select the power button and browse to the external IP address listed in the server details The default

Instructor CSIS 499

Instructor CSIS 499

managing complete secured cyber systems Prerequisites CSCI 230 Outcomes After completing CSIS 499 students will be able to 1 Examine the architecture of a cyber system to discover vulnerabilities 2 Use or develop tools for pen testing and vulnerability assessment 3 Discover different types of network intrusions based on their key features

Hacking for Beginners DynaCorps

Hacking for Beginners DynaCorps

This is a form of ethical hacking where the hacker assists his client e g a business to improve the latter s digital defenses These days businesses and other organizations are more than willing to pay just to protect themselves from malicious attacks What makes penetration testing different from malicious hacking is the permission from the target Thus pen testing is still

Instructor CSIS 641 College of Charleston

Instructor CSIS 641 College of Charleston

security issues ethical and legal aspects of cybersecurity and disaster recovery Special emphasis will be given to designing deploying and managing complete secured cyber systems Prerequisites CSCI 631 Outcomes After completing CSIS 641 students will be able to 1 Examine the architecture of a cyber system to discover vulnerabilities 2 Develop and use already existent tools for pen

Hacking Secret Ciphers with Python

Hacking Secret Ciphers with Python

Hacking Secret Ciphers with Python is licensed under a Creative Commons Attribution Noncommercial Share Alike 3 0 United States License You are free To Share to copy distribute display and perform the work To Remix to make derivative works Under the following conditions Attribution You must attribute the work in the manner specified by the author or licensor but not in

CERTIFIED ETHICAL HACKER EC Council

CERTIFIED ETHICAL HACKER EC Council

The Certified Ethical Hacker C EH v10 program is a trusted and respected ethical hacking training Program that any information security professional will need Since its inception in 2003 the Certified Ethical Hacker has been the absolute choice of the industry globally It is a respected certification in the industry and is listed as a baseline certification on the United States Department

OWNER S MANUAL Microsoft

OWNER S MANUAL Microsoft

OWNER S MANUAL INTRODUCTION OVERVIEW WARNING IMPORTANT SAFETY INSTRUCTIONS 1 Read these instructions 2 Keep these instructions 3 Heed all warnings 4 Follow all instructions 5 Do not use this apparatus near water 6 Clean only with dry cloth 7 Do not install near any heat sources such as radiators heat registers stoves or other apparatus including amplifiers that produce

VonJimMarshall

VonJimMarshall

VonJimMarshall Ichm chtedirpers nlichdaf rdanken dassdudichf r unserenneuen JVM Ampentschiedenhast SeitderGr ndungderFirmaMarshallAmplificationim

OWNER S MANUAL Marshall Amps

OWNER S MANUAL Marshall Amps

OWNER S MANUAL CODE is a new generation of Marshall amplifier Fully programmable CODE combines authentic modelling of classic and contemporary Marshall tones with professional quality FX CODE preamp power amp and speaker cabinet models have been developed in collaboration with audio software pioneers Softube to create Marshall Softube MST modelling Featuring Bluetooth amp USB