Testing Protocol: Grip and Pinch
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- Claud Nichols
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1 Testing Protocol: Grip and Pinch OF POWER GRIP or upright - test arm at side with elbow flexed 90 - palm facing inward Adjust handle to appropriate rung, where grip is comfortable and the thumb overlaps the fingernail of middle finger. In front of and to the side of patient. Have patient squeeze, hold and release. Patient should not feel grip move nor see gauge. muscle strength testing functional capacity evaluation hand grip lateral pinch LATERAL (KEY) PINCH CHUCK PINCH 16 chuck pinch PULP PINCH (RIGHT/LEFT ON EACH FINGER) or upright - test arm at side with elbow flexed 90 - palm facing inward or upright - test arm at side with elbow flexed 90 - palm facing down or upright - test arm at side with elbow flexed 90 - palm facing down - test finger on button DISTRIBUTED BY: pulp pinch PINCH GAUGE Pinch gauge between flexed PIP joint of index finger and thumb. Pinch gauge between thumb and the index and middle fingers. Pinch gauge between thumb and test finger (make sure other fingers do not interfere). OF In front of patient, to the side, stabilizing pinch gauge. In front of patient, to the side, stabilizing pinch gauge. In front of patient, to the side, stabilizing pinch gauge. lateral pinch Have patient squeeze, hold and release. Have patient squeeze, hold and release. Have patient squeeze, hold and release. A simple, easy-to-use, ergonomically designed instrument that objectively measures push, pull and lift forces for manual muscle testing, functional capacity evaluation and job task evaluation at a remarkably affordable price. Because the instrument is lightweight, small and portable, you can perform precise, objective evaluations in your office, at the client s location, or in the field. Ergonomically designed dynamometer is easy to grasp while testing small forces. The easy-to-attach single or dual grip handle can be used when measuring larger forces. Can be used with functional lift platform to perform lifting evaluations. u muscle strength measurement This hand-held dynamometer lets you objectively measure manual muscle strength. u job task analysis Measure actual push, pull and lift forces needed to perform a particular task (function). u functional capacity evaluation Quantitatively evaluate an individual s push, pull or lift capacity to perform a given task (function). job task evaluation DISTRIBUTED BY: FABRICATION ENTERPRISES INCORPORATED, Post Office Box 1500, White Plains, New York USA TEL: FAX: WEB: Info@FabricationEnterprises.com ver 5/04
2 Table of Contents m Introduction to Manual Muscle Testing (MMT) 3 m Baseline push-pull dynamometers for manual muscle testing 4 Test Protocol: Elbow 5 Test Protocol: Forearm 5 Test Protocol: Wrist 6 Test Protocol: Shoulder 7 Test Protocol: Hip 8 Test Protocol: Ankle 9 Test Protocol: Knee 10 Test Protocol: Cervical (neck) 11 Test Protocol: Lumbar 12 m Baseline Lift (Back-Leg-Chest) dynamometer - and - Baseline push-pull dynamometer with lifting accessories 13 Test Protocol: Physical Capacity (lift) Test m Baseline grip and pinch dynamometers 15 Test Protocol: Hand and Finger 16 Baseline grip and pinch strength dynamometers dial 200 Pound The 200 pound Baseline hand dynamometer has become the standard tool used by therapists all across the world. The regular sized head is the industry standard and our most popular size. But...The new HiRes large head makes for easier reading. Comes standard with case. 200 lb. regular head standard 200 lb. HiRes large head HiRes large head 300 lb. HiRes large head HiRes large head 300 lb. digital head digital LCD sys. digital 300 Pound The 300 lb. (135 kg) digital hand dynamometer uses the same hydraulic system but has the added advantage of an easy-toread LCD display. Features an electronic zero calibration system, a power management system that assures at least 1000 hours of use without changing the 2 "AAA" batteries, a low battery light, and an automatic shut off. Push button console includes a button to zero the last maximum reading stored in memory, a maximum button to display the highest reading since the last press of the maximum clear button, and a lb./kg. toggle button to change the measurement reading. Hydraulic Hand Dynamometer The Baseline hand dynamometer gives accurate grip strength readings without the subject being able to "feel" the handle move. Results are consistent with published Baseline and Jamar studies. The internationally accepted design assures reliability, user convenience and measurement repeatability. The five position adjustable handle can accommodate any hand size. The maximum reading remains until the unit is reset. The strength reading can be viewed as pounds or kilograms. Each dynamometer comes in a molded carrying case. The unit is made in the USA and has a 1-year warrantee. CE certified. Hydraulic Pinch Gauge The Baseline hydraulic pinch gauge uses the improved hydraulic system of the hand dynamometer to assure convenience, product reliability and measurement accuracy and repeatability. The therapist can support the pinch gauge during testing. This yields a more accurate result for all pinch tests (tip, key and palmer). The results are consistent with the published Baseline and Jamar studies. The maximum reading remains until the unit is reset. The strength reading can be viewed as pounds or kilograms. Each dynamometer comes in a rugged carrying case. The unit is made in the USA and has a 1-year warrantee. CE certified. DISTRIBUTED BY: 2 Baseline Mechanical Pinch Gauges Measure tip, key and palmer pinch strength in both pounds and kilograms. Measurements are accurate and repeatable. Results are consistent with published Markowitz studies. Indicator remains at the maximum reading until reset. Comes with hard shelled, padded protective case. orthopaedic & sports medicine lb. with case, blue lb. with case, red weak and damaged hand lb. with case, gold lb.with case, silver digital dial Baseline Hydraulic Pinch Gauges The 50 pound hydraulic pinch gauge offers accurate and repeatable pinch strength measurements. The HiRes large head offers a bigger viewing dial and more measurement gradations. 50 lb. regular head standard 50 lb. HiRes large head HiRes large head 100 lb. HiRes large head HiRes large 100 lb. digital head digital LCD system 15
3 Testing Protocol: Lift Tests (Physical Capacity Tests) arm lift high far lift high near lift torso lift hydraulic push-pull with base Introduction to Manual Muscle Testing (MMT) General Testing Concepts This instruction manual contains some standard test protocols to demonstrate the types of tests that can be performed using various Baseline dynamometers. Refer to appropriate textbooks and manual muscle testing resources and guides for patient conditions suitable for dynamometry testing, further testing methods and protocols, and for evaluation of test data. Reasons for Muscle testing: Screening: measurement of the subject's strength against a know norm (i.e., grip strength of fireman) or against a benchmark value needed to perform a given task (i.e., ability to lift a box) leg lift floor lift Comparative: to measure the subject's strength dominant side vs. non-dominant side (right hand against left hand) to ascertain extent of "impairment." To measure the subject's strength over time to ascertain the effectiveness of a treatment protocol. ARM LIFT (cervical/upper HIGH FAR LIFT (cervical/upper HIGH NEAR LIFT (cervical/upper 14 TORSO LIFT (lumbar/lower LEG LIFT (lumbar/lower FLOOR LIFT (lumbar/lower - Stand on base with feet shoulder width apart - relax knees - elbows at 90 - palms facing up feet shoulder width apart - relax knees - elbows at 90, palms up - shoulders flexed to feet shoulder width apart - relax knees - elbows at, palms up - shoulders flexed to feet shoulder width apart - relax knees - arms straight, palms down - torso bent at hips feet wider than shoulder width apart and knees bent - shoulders/head up - arms straight, palms down feet wider than shoulder width apart and knees bent - feet flat - torso straight, palms down Set correct start position by adjusting chain length and ensuring chain is perpendicular Set correct start position by adjusting chain length and ensuring chain is perpendicular Chain length same as with high far lift. Ensure chain is perpendicular Set correct start position by adjusting chain length and ensuring chain is perpendicular Chain length same as with torso lift. Ensure chain is perpendicular to base, and bar is gripped at mid to lower thigh height. Remove chain, and attach handle grip bar directly to gauge. Ensure gauge is aligned perpendicular OF Patient should pull Patient should pull Patient should pull Patient should pull Patient should use his legs to pull Patient should use his legs to pull Muscle testing methodology: Positioning the subject: The angle of the joint during the test has a direct effect on the strength measurement result. If the objective is to simulate a given activity, then the joint angle should be as close as possible to the angle required by the activity to be performed. Stabilizing the subject: The subject's body should be stabilized to ensure that the muscle or muscle group being tested is isolated. Testing methodology: Break test: The tester firmly holds the dynamometer and applies force against the subject's body until it begins to move. The reading represents the muscle strength "break" point at which the subject could not overcome the tester's force. Make test: The subject initiates and exerts a force against the dynamometer (that is firmly held by the tester) until it begins to move. The reading represents the muscle strength "make" point at which the subject overcomes the tester's force of resistance. Instrument test: The subject gradually (no sudden, jerky or abrupt movements) exerts force against the instrument until the strength or pain threshold in reached. The final result is not dependent upon the tester's resistance, only upon the instrument. Consistent results: Regardless of the test, the subject should be made to perform the test three (3) times. If the individual readings are inconsistent, wait a few minutes and repeat the test. If possible, test the uninjured side first. 3
4 Baseline Push-Pull Dynamometer The heavy-duty dynamometer features the hydraulic system that is used in the industry accepted Baseline and Jamar hand dynamometers and pinch gauges. Hydraulic system ensures accurate readings. Much lighter (1½ lb. vs. 6lb.) and easier to use than spring push-pull dynamometers that are in common use today. Baseline Lift (Back-Leg-Chest) Dynamometer digital or analog comes in carrying case Dial continuously shows instantaneous force and holds the maximum force reading. This maximum reading should be manually recorded prior to resetting for the next test. Available with either an analog (dial) or a digital (LCD) readout. Choose either 50 lb., 100 lb., 250 lb., or 500 lb. force capacity unit. Comes with 3 push pads (padded curved, padded straight, and 1cm 2 circular), 1 pull hook and 1 snap-lock hook. Comes in cushioned carrying case with muscle test manual. 1 year warranty. CE certified. Baseline back-leg-chest dynamometer Measure strength of back, leg and chest. Base provides sure footing. Chain length is adjusted to accommodate for height differences or to vary the point of force application. Shows pounds and kilograms. Pointer remains at maximum until reset. Comes with specified base large base, 660 lb. adult regular base, 660 lb. adult regular base, 330 lb. adolescent regular base, 165 lb. child back-leg-chest hardware accessories Complete with 5 foot chain, snap hook and threaded oval. functional lift bases regular bases (15x15 ) large base (24x24 ) Baseline push-pull dynamometers with lifting accessories use without handle use with functional lift platform base use with dual grip handle push-pull dynamometers analog (Dial) readout lb./22.5 kg lb./45 kg lb./115 kg lb./225 kg. Digital (LCD) readout lb./22.5 kg lb./45 kg lb./115 kg lb./225 kg. MORE BASELINE PRODUCTS ON THE WEB: DISTRIBUTED BY: optional accessories handles single grip dual grip functional lift bases regular (15 x15 ) large (24 x24 ) WalSlide TM wall anchor slides and locks to any position along 6 system adjustable anchor hardware chain (per foot) snap oval (pair) threaded oval (pair) Dial (analog) hydraulic lb./22.5 kg lb./45 kg lb./115 kg lb./225 kg. Baseline push-pull handles Handle system screws onto pushpull dynamometer body. Allows for a variety of tests. Fits Baseline hydraulic and electronic push-pull dynamometers Single Grip Handle Digital (LCD) hydraulic lb./22.5 kg lb./45 kg lb./115 kg lb./225 kg. Baseline pull accessories Attachments can be used for a variety of tests Medium Hook Small Hook Oval Snap Hook curved push pad straight push pad small circular tip large circular tip electronic lb/22.5kg lb/45kg lb/112.5kg lb/225kg back-leg-chest hardware accessories chains/straps chain (ft) ovals snap oval (pair) threaded oval (pair) 13
5 Testing Protocol: Lumbar Testing Protocol: Elbow and Forearm lumbar flexion elbow flexion elbow extension lateral flexion forearm rotator lumbar flexion - knees bent - feet flat - arms resting at side On the sternum at the center of the chest. OF Above and to side of patient. Break test - patient s arms are relaxed and head + shoulders lifted off table, exert force to push down head. - shoulder flexed - elbow flexed - palm up On the inside of the arm just above the wrist of the arm being tested. OF Hand not holding dynamometer stabilizing underneath the upper arm of patient. downward 12 LATERAL (RIGHT) - prone - arms resting at side on table - back laterally flexed to right - arms resting in lap At the inferior angle of the scapulae on the center of the back between the shoulder blades. Under the arm of the rib cage (right side). Above and to side of patient. In front of and to side of patient with nondynamometer hand isolating the left hip. Break test - patient s arms are relaxed and head and chest lifted off table, exert force to push down body. patient lean right with buttocks on table, exert force to push patient inward. FOREARM ROTATOR - shoulder flexed - elbow flexed - palm up - shoulder flexed - elbow flexed - palm in On the outside of the arm just above the wrist of the arm being tested. On the outside of rod held by hand. Hand not holding dynamometer stabilizing on the front of the upper arm of patient. Hand not holding dynamometer stabilizing on the front of the upper arm of patient. upward. force on rod to push arm inward. 5
6 Testing Protocol: Wrist Testing Protocol: Cervical (neck) wrist flexion wrist extension flexion lateral flexion rotation extension ulnar deviation radial deviation OF 6 ULNAR DEVIATION RADIAL DEVIATION with arm stabilized on table edge. - palm in, wrist flexed and fingers relaxed. with arm stabilized on table edge. - palm down, wrist extended and fingers relaxed. with arm stabilized on table edge. - palm down, wrist flexed towards the ulna. with arm stabilized on table edge. - palm down, wrist flexed towards the radius. On the palm of the hand being tested just below the bend of the fingers. On the back of the hand being tested just below the bend of the fingers. On the outside of the hand being tested just below the bend of the little finger. On the inside of the hand being tested just below the bend of the index finger. OF In front of patient, stabilizing patient s forearm against table. In front of patient, stabilizing patient s forearm against table. In front of patient, stabilizing patient s forearm against table. In front of patient, stabilizing patient s forearm against table. force to push hand out force to push hand down force to push hand in force to push hand out LATERAL (RIGHT) (RIGHT) - chin tucked - knees bent & feet flat - prone - arms at sides - chin tucked - head turned to left - chin tucked - knees bent & feet flat - prone - head turned to right - arms at side - chin tucked On forehead. On back of head (occipital). On right temple. Above and behind the ear on the right temporal area. Aside the patient. Aside the patient. Aside the patient. Aside the patient. patient lift head while keeping chin tucked. Exert force to push head patient lift head while keeping chin tucked. Exert force to push head patient lift and keep head turned and chin tucked. Exert force to push head patient lift and keep head turned and chin tucked. Exert force to push head 11
7 Testing Protocol: Knee Testing Protocol: Shoulder shoulder flexion shoulder extension shoulder adduction shoulder abduction internal rotation external rotation upper trapezius knee flexion knee extension OF OF - shoulder flexed to 90 - elbow straight Slightly above elbow of test arm. At patients side, opposite hand on shoulder of test arm. - prone - test leg flexed 90 - non-test leg straight On the back of leg above ankle. Aside patient. Nondynamometer hand stabilizes thigh. - prone w/ head to side - arms at sides w/ arm being tested extended & straight Slightly above elbow of test arm. To the side of test arm, opposite hand stabilizes test shoulder. - sitting with legs over the table edge - test leg extended On the front of leg above ankle. In front of patient. hand under knee of test leg. ADDUCTION - standing - arm being tested out to side 8-10 from body Slightly above elbow on inside of test arm. To the front-side of patient, with opposite hand on patient's hip. out. ABDUCTION - arm out to side at 90 - elbow flexed 90 - palm facing down Slightly above elbow of test arm. Behind and to the side of patient with the opposite hand on test shoulder. INTERNAL - arms at sides with 90 elbow flexion Slightly above wrist on inside of test arm. In front of patient with other hand stabilizing the outside of elbow. out. EXTERNAL - arms at sides with 90 elbow flexion Slightly above wrist on outside of test arm. In front of patient with other hand stabilizing the inside of elbow. in. UPPER TRAPEZIUS - arms at sides - test shoulder shrugged On top of test shoulder. Behind patient, stabilizing non testside shoulder. force to push shoulder 10 7
8 Testing Protocol: Hip Testing Protocol: Ankle hip flexion hip extension hip abduction plantar flexion dorsi flexion hip abduction internal rotation external rotation OF - Supine with knees bent and feet flat - hip of test leg flexed to about 90 Slightly above knee of test leg. To the side of test leg. ADDUCTION - prone w/ arms at side - test leg is bent at knee with hip extended and knee off table - lye on side w/ test (bottom) leg touching table, in line with trunk. - top leg in step position to allow Slightly above knee on back of test leg. Slightly above knee on inside of test leg. To the side of test leg. To the side of patient. Break test - patient lifts lower leg off table, then exert out. PLANTAR- inversion - prone with feet of end of table - foot in neutral position On ball of test foot. eversion OF hand stabilizes lower leg against table. force to push down foot. ABDUCTION - lye on side w/ test leg on top, in line with trunk. - bottom leg bent to stabilize body. Slightly above knee on outside of test leg. To the side of patient. Break test - patient lifts upper leg off table, then exert DORSI- - test leg straight - ankle in neutral position On top of foot positioned below toe. hand stabilizes lower leg against table. force to push down foot. INTERNAL w/ legs over edge of table - knees bent 90 - hip rotated in Slightly above ankle on outside of test leg. In front of patient with non-testing hand on inside of patient s knee. in. INVERSION - test leg straight - ankle inverted On inside of foot positioned below toe. hand stabilizes lower leg against table. force to push out foot. EXTERNAL w/ legs over edge of table - knees bent 90 - hip rotated out Slightly above ankle on inside of test leg. In front of patient with non-testing hand on outside of patient s knee. in. EVERSION - test leg straight - ankle everted On outside of foot positioned below toe. hand stabilizes lower leg against table. force to push in foot. 8 9
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