Manual muscle testing is used by occupational therapists to evaluate muscles' ability to generate force and assess impairments. It involves instructing a patient to hold a limb against the therapist's opposing resistance through a range of motion. Grades from 0 to 5 are used to rate strength based on whether movement can be completed against gravity and additional pressure. While useful, manual muscle testing relies on a therapist's strength; dynamometry provides more objective strength measurements but requires expensive equipment. Both types of testing only approximate muscle function during daily activities.
Key points of control illustrations by examplesSara Sheikh
you can get a fair idea WHAT key points of control are and how can be they used to control a patient.... though it is demonstrated on children, it can be used with adults also, if beneficial.
Understanding the various theories of motor control- reflex-hierarchal theory, ecological theory, dynamic systems theory and it's clinical application; also forming the basis of neurological rehabilitation techniques like Task-orient approach, Constraint induced movement therapy (CIMT), NDT (Neurodevelopmental Facilitation).
Key points of control illustrations by examplesSara Sheikh
you can get a fair idea WHAT key points of control are and how can be they used to control a patient.... though it is demonstrated on children, it can be used with adults also, if beneficial.
Understanding the various theories of motor control- reflex-hierarchal theory, ecological theory, dynamic systems theory and it's clinical application; also forming the basis of neurological rehabilitation techniques like Task-orient approach, Constraint induced movement therapy (CIMT), NDT (Neurodevelopmental Facilitation).
Neurodevelopmental Treatment and Cerebral Palseyda5884
Description of my Critically Appraised Topic on the effectiveness of Neurodevelopmental treatment with children who have cerebral palsy when compared to alternative therapies.
Neurodevelopmental Treatment and Cerebral Palseyda5884
Description of my Critically Appraised Topic on the effectiveness of Neurodevelopmental treatment with children who have cerebral palsy when compared to alternative therapies.
Master of Surgery - MS.
Doctor of Medicine - MD.
Bachelor of Ayurvedic Medicine and Surgery - BAMS.
Bachelor of Homeopathic Medicine and Surgery - BHMS.
Bachelor of Physiotherapy - BPT.
Bachelor of Unani Medicine and Surgery - BUMS
uscle strength is a common area evaluated when patient first come to rehabilitation. Most practitioners use manual muscle testing devices like hand held dynamometers to get results for muscle strength.
Manual Muscle Testing (MMT) is a clinical assessment technique used by healthcare professionals to evaluate the strength and function of individual muscles or muscle groups. It involves the systematic application of resistance while the patient contracts specific muscles, allowing the examiner to assess the muscle's ability to generate force and produce movement. Here's a detailed overview:
1. **Purpose**: MMT is used to:
- Identify muscle weakness or imbalance.
- Assess the extent and location of neuromuscular dysfunction.
- Monitor changes in muscle strength over time.
- Guide treatment planning and rehabilitation interventions.
2. **Procedure**:
- **Patient Positioning**: The patient is positioned appropriately to isolate and activate the muscle being tested.
- **Instruction**: Clear instructions are provided to the patient regarding the desired movement and level of effort.
- **Stabilization**: Adjacent joints or body segments may be stabilized to prevent compensatory movements.
- **Resistance Application**: The examiner applies resistance, typically manually, in the direction opposite to the muscle's action, gradually increasing it while the patient contracts the muscle.
- **Observation**: The examiner observes the quality of muscle contraction, noting factors such as initiation, strength, endurance, and any signs of fatigue or compensation.
- **Grading**: Muscle strength is graded on a scale ranging from 0 to 5:
- 0: No contraction detected.
- 1: Muscle flicker, but no movement.
- 2: Movement occurs, but not against gravity.
- 3: Movement against gravity, but not against resistance.
- 4: Movement against some resistance, but not full strength.
- 5: Full strength, normal movement against full resistance.
3. **Applications**:
- **Clinical Diagnosis**: MMT helps identify muscle weakness or dysfunction associated with various conditions, such as neuromuscular disorders, orthopedic injuries, and neurological impairments.
- **Treatment Planning**: Assessment findings from MMT guide the selection of appropriate therapeutic interventions, including strengthening exercises, manual therapy techniques, and functional training.
- **Rehabilitation Monitoring**: Serial MMT evaluations track changes in muscle strength and function during the rehabilitation process, informing progression and adjusting treatment goals as needed.
4. **Considerations**:
- **Reliability and Validity**: MMT results may vary based on factors such as examiner experience, patient cooperation, and testing conditions. Standardized protocols and repeated assessments can enhance reliability.
- **Limitations**: MMT may not be suitable for assessing deep muscles or muscles affected by pain, and results may be influenced by factors such as fatigue, motivation, and neurological impairment.
- **Clinical Judgment**: Interpretation of MMT findings requires clinical judgment,.
A chronicle on muscle strengthening:
MMT is a procedure for the evaluation of strength of individual
muscle or muscles group, based upon the effective performance of a movement in relation to the forces of gravity or manual resistance through the available ROM.
The manual muscle testing procedure was described in this power point, indications, contraindications, limitations of MMT was included. the MMT grading system (scale) was explained well in this PPT.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
2. Manual muscle testing
- Manual muscle testing is used in rehabilitation and recovery to
evaluate contractile units, including muscles and tendons, and their
ability to generate forces.
- When used as part of rehabilitation, muscle testing is an important
evaluative tool to assess impairments and deficits in muscle
performance, including strength, power, or endurance.
- Impairments in muscle function may result from a number of
issues including musculoskeletal injuries, cardiovascular,
pulmonary, or neuromuscular disease or disorders.
- Identifying impairment in specific muscles or muscle groups is an
important part in determining the course of a rehabilitation
regimen which may include therapeutic exercise, manual therapy,
bracing, or functional movement training.
3. - Manual Muscle Testing (MMT) is a method of valuable diagnostic
evaluation used by occupational therapist with establishing
effective treatment and tracking progress throughout a specific
regimen.
- Modern methods for doing kinesiological testing have adopted
standardly accepted procedures and grading systems that allow
occupational therapist to understand and communicate muscle
testing findings.
- Muscle testing can be performed using manual strength testing,
functional tests, and dynamometry.
- With manual muscle testing, the patient is instructed to hold the
corresponding limb or appropriate body part to be tested at the end
of its available range while the practitioner provides opposing
manual resistance.
4. PROTOCOLS FOR ACCURATE MANUAL MUSCLE TESTING RESULTS
- Make sure to communicate with the patient all the components of
the test and the results you are looking to obtain from the test.
- Work with the non-dominant (or non-injured) side first and keep
consistent when applying pressure.
- Remind your patient to breathe naturally during the test, because
breath holding can increase a forced result.
- Make sure the patient is dressed in loose clothing and has full
range of movement.
- Place the patient in an adequately supported position, so they are
able to completely concentrate their effort on the body part being
test.
5. PROTOCOLS FOR ACCURATE MANUAL MUSCLE TESTING RESULTS
- Always test first in an antigravity position. If muscles are too weak
to function against gravity, they are then tested in the horizontal
plane.
- Resistance needs to be applied directly opposite the “line of pull” of
the muscles being tested.
- Plan out the test first, testing all the muscles that should be
examined in one position before changing to another. This reduces
any inefficiency during testing and makes the most of treatment
time.
- Always provide adequate stabilization to unrelated joint/s so as to
avoid unnecessary compensation. For example, stabilization of the
shoulder will prevent extra movements when the patient is resisting
elbow bending (flexion).
6. PROTOCOLS FOR ACCURATE MANUAL MUSCLE TESTING RESULTS
- Always test both sides in order to compare strength or muscle grade
of both limbs to get the most accurate picture of strength and/or
impairment.
- What to Avoid When Performing Manual Muscle Testing
Avoid doing jerking movements when applying resistance to your
patient’s during testing
Discontinue testing if patient complains of pain or discomfort
Do not leave patient unattended
7. - Traditional grading uses either descriptive terms “zero,” “trace,”
“poor,” “fair,” “good,” and “normal,” or uses a numerical scale
from 0 through 5.
- A grade is determined by a patient’s ability to move the tested body
part through its full range of motion (against gravity) and whether
they can hold in the test position.
- This ability earns a grade of fair, or 3, and is the most objective
observation made during testing due to the consistency of gravity.
- However, a poor grade, or 2, is given when a patient is able to move
throughout the full range of motion, only when gravity has been
removed.
- Trace grades, or 1, is given when a patient is unable to move
throughout the range of motion, however a slight contraction is
noticeable upon palpitation. When there is no evidence of even a
slight contraction, a grade of zero is given.
8.
9. Manual Muscle Test Grades
Grade 5 (Normal; 100%) :
- This grade means the patient is able to comfortably withstand
pressure in the test position.
- Patient is also able to complete the whole range of motion
(movement) against gravity while the practitioner applies maximum
resistance at the end-range of movement.
10. Manual Muscle Test Grades
Grade 4 (Good;75%) :
- This grade means the testing subject is able to successfully perform
the test with moderate to strong pressure.
- Patient is also able to complete the whole range of motion
(movement) against gravity while the practitioner applies moderate
resistance at the end-range of movement.
- Don’t forget to consider both sides to evaluate whether you are
applying adequate force on the tested limb.
Grade 3+ (Fair+) :
- The patient can complete the motion against gravity with minimal
resistance applied by the examiner at end-range.
11. Manual Muscle Test Grades
Grade 2+ (Poor +) :
- This grade is given when a patient is able to move through 50% of
motion or less in an anti-gravity position or is able to hold position
against resistance in a position without gravity.
- For example, when a gravity is eliminated, such as performing the
motion in side-lying, if the patient is able to perform the movement
at full range of motion with ease, but then gives way immediately
with the application of resistance, then the grade is a 2+.
12. Manual Muscle Test Grades
Grade 3 (Fair;50%) :
- This is considered the mid-range grade, in which a patient can
perform the movement without any additional pressure.
-
- With Grade 3, the patient can only complete the range of motion
against gravity.
- If the practitioner applies force, the patient is unable to complete the
test.
- For example, when testing the strength of the left knee extensors
(quadriceps femoris/quads). If the patient is able to straighten their
leg fully from a seated position, without force but then gives way
upon the application of force, the grade is considered a 3.
13. Manual Muscle Test Grades
Grade 2+ (Poor +) :
- This grade is given when a patient is able to move through 50% of
motion or less in an anti-gravity position or is able to hold position
against resistance in a position without gravity.
- For example, when a gravity is eliminated, such as performing the
motion in side-lying, if the patient is able to perform the movement
at full range of motion with ease, but then gives way immediately
with the application of resistance, then the grade is a 2+.
14. Manual Muscle Test Grades
Grade 2 (Poor;25%) :
- In this grade, a patient is able to complete movement completely in a
horizontal plane.
- In this grade, patients are unable to perform movements against
gravity, but can move once the pull of gravity is eliminated, as long
as resistance is not applied.
- Grade 2 - (Poor -)This grade indicates a patient can only complete
movement partially in a horizontal plane.
- In this grade, movement is dependent on the elimination of gravity,
but can only be completed partially, even without resistance
15. Manual Muscle Test Grades
Grade 1 (Trace) :
- This grade indicates that no visible movement of the tested body part
is detected except a slight contraction.
- In this grade, the patient is not able to move the body part at all,
even without resistance or gravity.
- Upon, closer examination with palpation, the therapist will be able
to detect a slight muscle contraction.
- Grade 0 (Zero; No trace)This grade indicates a complete lack of
contraction. Either by visual examination or even with physical
therapist's palpation (touch).
16. - While manual muscle testing is an essential component in
rehabilitation, it can have its downsides. For example, testing results
may be hampered by a practitioner’s ability to provide adequate
resistance.
- Isokinetic dynamometry uses a measurement device, like a
handheld dynamometer, to evaluate the force of the patient’s
contraction of a particular muscle group.
- These types of measurement devices increase efficiency because they
are able to apply maximal resistance at all points in the body part’s
range of motion at a specified speed, while being able to objectively
assess strength, power and endurance.
17. - These tests offer a more complete picture for rehabilitation
purposes.
- In order to look at peak torques, strength is assessed using a slower
velocity.
- Power is assessed using a fast velocity setting in order to look at the
amount of force performed during a specified amount of time.
- When testing for endurance, the practitioner assesses the patient’s
ability to maintain force output during several repetitions during
higher velocities.
18. - Advantages of isokinetic testing include the ability to maximally load
the muscle throughout its range of motion; stabilization of proximal
body parts to prevent substitute motions; measurement of concentric
and eccentric loading; and objectivity.
- As in manual muscle testing, however, isokinetic testing does not
necessarily provide an accurate picture of how a muscle will
function during actual activities of daily living or sports.
- In addition, unlike manual muscle testing, it requires expensive
equipment and space.
19. - Advantages of isokinetic testing include the ability to maximally load
the muscle throughout its range of motion; stabilization of proximal
body parts to prevent substitute motions; measurement of concentric
and eccentric loading; and objectivity.
- As in manual muscle testing, however, isokinetic testing does not
necessarily provide an accurate picture of how a muscle will
function during actual activities of daily living or sports.
- In addition, unlike manual muscle testing, it requires expensive
equipment and space.