Quick Reference: Chapter 3: The Musculoskeletal System and Chapter 4: The Nervous System

2000 ◽  
Vol 5 (3) ◽  
pp. 4-4
Keyword(s):  
Nervous System ◽  
Lower Extremity ◽  
Musculoskeletal System ◽  
Multistep Method ◽  
Manual Muscle Testing ◽  
Motor Deficits ◽  
Lower Extremity Weakness ◽  
Residual Symptoms ◽  
Muscle Testing ◽  
Almost All

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, divides PNS deficits into sensory and motor and includes pain in the former. This article, which regards rating sensory and motor deficits of the lower extremities, is continued from the March/April 2000 issue of The Guides Newsletter. Procedures for rating extremity neural deficits are described in Chapter 3, The Musculoskeletal System, section 3.1k for the upper extremity and sections 3.2k and 3.2l for the lower limb. Sensory deficits and dysesthesia are both disorders of sensation, but the former can be interpreted to mean diminished or absent sensation (hypesthesia or anesthesia) Dysesthesia implies abnormal sensation in the absence of a stimulus or unpleasant sensation elicited by normal touch. Sections 3.2k and 3.2d indicate that almost all partial motor loss in the lower extremity can be rated using Table 39. In addition, Section 4.4b and Table 21 indicate the multistep method used for spinal and some additional nerves and be used alternatively to rate lower extremity weakness in general. Partial motor loss in the lower extremity is rated by manual muscle testing, which is described in the AMA Guides in Section 3.2d.

scholarly journals The Role of Rehabilitation Program in Functional Recovery of Stroke: A Case Report

2020 ◽  
Vol 9 (3S) ◽  
pp. 262-265
Keyword(s):  
Lower Extremity ◽  
Functional Recovery ◽  
Stroke Patient ◽  
Neuromuscular Electrical Stimulation ◽  
Gait Training ◽  
Rehabilitation Program ◽  
Manual Muscle Testing ◽  
Outpatient Rehabilitation ◽  
Muscle Testing ◽  
Balance Exercise

Stroke is a leading cause of functional disorder and severe disability in the world. Stroke prevalence in Indonesia according to national health research (RISKESDAS) in 2007 were 0,8%, meanwhile in United State of America were 1,8-2,2%. Rehabilitation program had an important role in functional recovery of stroke patient. The purpose of rehabilitation program is to achieve functional independency, minimize disability, re-integration to home, family, and community lifes. The case is a 48 years old male with Left hemiparese due to Cerebrovascular accident intracranial hemorrhage. Initial assesments were Glasgow Coma Scale (GCS) 346, Manual Muscle Testing (MMT) 3 for left upper and lower extremity, Count Breathlessness Test (CBT) 10, Mini-Mental State Examination (MMSE) 22, Barthel Index (BI) 10. The outpatient rehabilitation program was neuromuscular electrical stimulation for left upper and lower extremity with in frequency 70-85 pps, on-time 10-15 seconds, off-time 50 seconds – 2 minutes, duration minimum 10 contraction, 3 times per week, active range of motion and isotonic strengthening exercise for upper and lower extremity, breathing exercise, sitting and standing balance exercise, gait training, occupational therapy and cognitive therapy. After 2 months of treatment the assessment was GCS 456, MMT 4 for left upper and lower extremity, CBT 21, MMSE 30, BI 95. The rehabilitation program was proved to be beneficial in improving functional recovery of stroke patient.

Multisensory stimulation to promote upper extremity motor recovery in stroke: A pilot study

2018 ◽  
Vol 81 (11) ◽  
pp. 641-648 ◽  
Author(s):  
Lawla LF Law ◽  
Kenneth NK Fong ◽  
Ray KF Li
Keyword(s):  
Upper Extremity ◽  
Cortical Excitability ◽  
Motor Recovery ◽  
Cortical Reorganization ◽  
Manual Muscle Testing ◽  
Motor Deficits ◽  
Post Intervention ◽  
Multisensory Stimulation ◽  
Muscle Testing ◽  
Preparatory Method

Introduction Occupational therapists have been using various preparatory methods as part of the treatment sessions to prepare clients for occupational performance and participation in occupation. Studies have shown sensory stimulation both activates brain areas inducing cortical reorganization and modulates motor cortical excitability for the stimulated afferents, hence re-establishing the disrupted sensorimotor loop due to stroke. This pilot investigates the potential effects of using multisensory stimulation as a preparatory method prior to conventional training (CT) on upper-extremity motor recovery and self-care function in stroke patients. Method This was a quasi-randomized controlled pilot. Twelve participants (age in years = 67.17 + /−11.29) with upper extremity motor deficits were randomly allocated to multisensory therapy (n = 6) or conventional (n = 6) groups for 12-week training. Assessments were conducted at baseline and post-intervention using Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA), Manual Muscle Testing (MMT), Functional Test for the Hemiplegic Upper Extremity (Hong Kong version FTHUE-HK) and Modified Barthel Index (MBI). Results Significant between-group differences were shown in FMA ( p = 0.003), FTHUE-HK ( p = 0.028) and MMT ( p = 0.034). Conclusion Multisensory stimulation could be used as a preparatory method prior to CT in improving upper extremity motor recovery in stroke rehabilitation. Further well-designed larger scale studies are needed to validate the potential benefits of this application.

Fampridine-SR in multiple sclerosis: a randomized, double-blind, placebo-controlled, dose-ranging study

2007 ◽  
Vol 13 (3) ◽  
pp. 357-368 ◽  
Author(s):  
A.D. Goodman ◽  
J.A. Cohen ◽  
A. Cross ◽  
T. Vollmer ◽  
M. Rizzo ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Adverse Events ◽  
Lower Extremity ◽  
Walking Speed ◽  
Manual Muscle Testing ◽  
Controlled Study ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Muscle Testing ◽  
Lower Extremity Muscle

Objective To determine the safety of sustained-release 4-aminopyridine in subjects with mutiple sclerosis (MS) and to examine dose-related efficacy up to 40 mg twice daily. Method Multicenter, randomized, double-blind, placebo-controlled, study. Following a 4-week baseline peroid, subjects were randomly assigned to receive Fampridine-SR (n=25, doses from 10 to 40 mg twice daily, increasing in 5 mg increments weekly) or placebo (n=11). A battery of assessments was performed weekly, including the MS Functional Composite (MSFC), fatigue questionnaires, and lower extremity manual muscle testing. Results The most common adverse events were dizziness, insomnia, paresthesia, asthenia, nausea, headache, and tremor. Five subjects were discontinued from Fampridine-SR because of adverse events at doses greater than 25 mg, and these included convulsions in two subjects at doses of 30 and 35 mg twice daily. Improvement were seen in lower extremity muscle strength (prospective analysis) and walking speed (post-hoc analysis) in the Fampridine-SR group compared to placebo (unadjusted p-values of 0.01 and 0.03, respectively). There were no significant differences in other MSFC measure or fatigue scores. Conclusions Future studies should employ doses up to 20 mg twice daily with lower extremity strength and walking speed as potential outcome measures. Multiple Sclerosis 2007; 13: 357-368. http://msj.sagepub.com

Tools and Resources: Cautions in Using the Guides

1999 ◽  
Vol 4 (2) ◽  
pp. 4-7
Author(s):  
Christopher R. Brigham
Keyword(s):  
Lower Extremity ◽  
Muscle Atrophy ◽  
Reflex Sympathetic Dystrophy ◽  
Limb Length Discrepancy ◽  
Manual Muscle Testing ◽  
Reference Measuring ◽  
Practical Applications ◽  
Muscle Testing ◽  
Skin Loss ◽  
Joint Ankylosis

Abstract The approach to evaluation of lower extremity impairments in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) differs from that given in previous editions. This article uses case studies to illustrate practical applications of current approaches to ankle impairment and to foot and toe impairment. Anatomic methods for rating ankle impairments include evaluations of muscle atrophy and limb length discrepancy. The Diagnosis-related estimates section provides ratings for ligamentous laxity and displaced fractures of the ankle. The arthritis section contains ratings for radiographically determined and graded diagnosis. Methods for rating ankle impairments include assessing gait derangement, range of motion, joint ankylosis, and manual muscle testing. The methods used for rating lower extremity impairments also are applicable for the foot and toes, and examiners may deploy less commonly used rating techniques such as those employed for amputations, skin loss, causalgia and reflex sympathetic dystrophy, and vascular disorders. The examiner must understand the applicable rating methods used, estimate percentages via each, and decide which methods best describe the impairment(s) without overlooking or duplicating ratings. The examiner also should report the rating options considered, the reasons for selecting the method(s) used, the method by which the percentage was calculated, and the rationale for any variance from the AMA Guides. [A companion Quick Reference, Measuring Impairments of the Hand and Digits, appears on pp 5-6 of this issue of The Guides Newsletter.]

Internal Consistency of Manual Muscle Testing Scores

1997 ◽  
Vol 85 (2) ◽  
pp. 736-738 ◽  
Author(s):  
Richard W. Bohannon
Keyword(s):  
Muscle Strength ◽  
Lower Extremity ◽  
Home Care ◽  
Internal Consistency ◽  
Test Scores ◽  
Manual Muscle Testing ◽  
Limb Muscle ◽  
Manual Muscle Test ◽  
Muscle Testing

The internal consistencies of manual muscle test scores of the actions of three upper and three lower extremity muscles were examined among 37 home care patients. The correlations between scores of specific pairs of actions ranged from .01 to .88. Cronbach alphas ranged from .59 to .88. Manual scores of limb muscle strength, therefore, appear to possess suitable internal consistency.

Impairment Tutorial: Impairment of the Lower Extremity

1997 ◽  
Vol 2 (1) ◽  
pp. 2-4
Author(s):  
William S. Shaw
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Limb Length Discrepancy ◽  
Manual Muscle Testing ◽  
Fourth Edition ◽  
Muscle Testing ◽  
Whole Person ◽  
Skin Loss ◽  
Testing Range ◽  
Specific Section

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, introduces a new system of rating lower extremity impairments that allows use of more than one method for arriving at a rating. Such flexibility allows the rater greater leeway to assess each patient's unique status but requires the clinician to clearly understand the diagnosis, pathoanatomy, and expected sequelae of a condition. For example, diminished muscle function can be evaluated in four ways (gait, atrophy, weakness, and peripheral nerve injury), but impairments should be estimated under only one of these criteria. Tables in the AMA Guides give impairment values for the whole person, as well as for the lower extremity and the part, where applicable. Impairments can be calculated in several broad categories, including the following: limb length discrepancy; gait derangement; unilateral atrophy; manual muscle testing; range of motion measurements and ankylosis; arthritis; amputations; skin loss; diagnosis-based estimates; peripheral nerve; vascular disorders; and causalgia and reflex sympathetic dystrophy. Each category includes general guidelines that help raters decide when to use that specific section. In addition to clarifying and discussing the categories, the article provides references to specific sections and tables in the AMA Guides, Fourth Edition.

Provocative Walking Test of Strength for Diagnosis, Management, and Outcome Assessment of Symptomatic Lumbar Spinal Stenosis

2019 ◽  
Vol 33 (12) ◽  
pp. 1003-1007
Author(s):  
Bruce H. Dobkin
Keyword(s):  
Physical Therapy ◽  
Lower Extremity ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Outcome Measurement ◽  
Medical Council ◽  
Lower Extremity Weakness ◽  
Walking Test ◽  
Muscle Testing ◽  
Lumbar Spinal

Background. Clinical care and randomized trials of rehabilitation or surgery for symptomatic lumbar spinal stenosis with neurogenic claudication (LSS) are complicated by the lack of standard criteria for diagnosis and outcome measurement. Objective. To evaluate whether manual muscle testing (MMT) can detect transient lower-extremity weakness provoked by walking in patients with likely LSS. Methods. A total of 19 patients with symptoms and MRI findings suggestive of LSS were tested for a decline in lower-extremity strength, using the British Medical Council scale of MMT, by comparing strength at rest to a change in strength within 60 s of completing a 400-foot walk. They were retested after reclining supine for another 2 minutes. This examination was repeated following decompressive lumbar surgery. Results. All patients developed bilateral weakness in the distribution of their LSS, but always including the hip extensors and knee flexors, when tested immediately after the provocative walking test. Most patients were not aware of weakness or change in gait during the walking task. They recovered to baseline strength after resting supine. The patients did not improve with physical therapy. When examined within 8 weeks after decompressive laminectomy, no one developed weakness during the 400-foot walk, and daily lower-extremity pain had resolved. Conclusions. A careful repetitive motor examination can detect transient paraparesis in patients with definite LSS. This finding supports the diagnosis and the functional severity of LSS while providing an objective outcome measurement for physical therapy and surgical interventions that goes beyond symptoms of pain.

Questions and Answers

2000 ◽  
Vol 5 (2) ◽  
pp. 3-3
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Nervous System ◽  
Peripheral Nervous System ◽  
Spinal Nerve ◽  
Sensory Loss ◽  
Residual Symptoms ◽  
Additional Information ◽  
Questions And Answers ◽  
Motor Nerves ◽  
Symptoms And Signs ◽  
Limited Motion

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) describes procedures for rating upper extremity neural deficits in Chapter 3, The Musculoskeletal System, section 3.1k; Chapter 4, The Nervous System, section 4.4 provides additional information and an example. The AMA Guides also divides PNS deficits into sensory and motor and includes pain within the former. The impairment estimates take into account typical manifestations such as limited motion, atrophy, and reflex, trophic, and vasomotor deficits. Lesions of the peripheral nervous system may result in diminished sensation (anesthesia or hypesthesia), abnormal sensation (dysesthesia or paresthesia), or increased sensation (hyperesthesia). Lesions of motor nerves can result in weakness or paralysis of the muscles innervated. Spinal nerve deficits are identified by sensory loss or pain in the dermatome or weakness in the myotome supplied. The steps in estimating brachial plexus impairment are similar to those for spinal and peripheral nerves. Evaluators should take care not to rate the same impairment twice, eg, rating weakness resulting from a peripheral nerve injury and the joss of joint motion due to that weakness.

scholarly journals Impact of structured physical therapy intervention on functional recovery in a patient with CAPOS syndrome: a case report

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Shailesh Gardas ◽  
Aishwarya Mahajan
Keyword(s):  
Functional Performance ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Measurement Scale ◽  
Manual Muscle Testing ◽  
Trunk Control ◽  
Control Measurement ◽  
Muscle Testing ◽  
Post Test ◽  
Capos Syndrome

Abstract Background CAPOS syndrome (cerebellar ataxia, areflexia, pescavus, optic atrophy, and sensorineural hearing loss) is a rare congenital autosomal dominant disorder. The resulting neurological sequelae of impairments are progressive in nature and may interfere with functional independence, performing activities of daily living (ADL’s), and subsequently, affecting the quality of life (QOL). Since it is an extremely rare disorder, there is a severe dearth in the literature about how specific physiotherapy interventions may affect their functional status. Therefore, our objective was to investigate the effects of proprioceptive neuromuscular facilitation (PNF) and Frenkel’s coordination exercises on functional recovery in a patient with CAPOS syndrome. Case presentation We herein present a case of a 25-year-old Indian male with complaints of generalized body weakness, difficulty visualizing distant objects, nystagmus, progressive sensorineural deafness, and ataxia. He was rehabilitated with a structured/customized physiotherapy protocol consisting of PNF approach and coordination exercises for 4 weeks, 6 days/week, 60 min daily. An improvement in overall functional performance of patient as per post-intervention scores of manual muscle testing, trunk control measurement scale, functional independence measure (components of self-care, transfers, and locomotion), and decline in severity of ataxia on scale for assessment and rating of ataxia scale was observed. Conclusion PNF and Frenkel’s exercises resulted in an improvement in overall functional performance of the patient. Improvement was observed in post-test scores of Manual Muscle Testing (MMT), Trunk Control Measurement Scale (TCMS), and Functional Independence Measure (FIM) for the components of self-care, transfers, and locomotion. Additionally, results also showed a decline in severity of ataxia on post-test scores of scale for the assessment and rating of ataxia (SARA) scale (i.e., from severe to moderate).

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