Muscle Strength and Gait Coordination

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Muscle Strength and Gait Coordination

 

Test strength by having the patient move against your resistance.

Always compare one side to the other. Grade strength on a scale from

0 to 5 " out of five " :

 

Grading Motor Strength

 

Grade Description

0/5 No muscle movement

1/5 Visible muscle movement, but no movement at the joint

2/5 Movement at the joint, but not against gravity

3/5 Movement against gravity, but not against added resistance

4/5 Movement against resistance, but less than normal

5/5 Normal strength

 

 

Test the following:

Flexion at the elbow (C5, C6, biceps)

Extension at the elbow (C6, C7, C8, triceps)

Extension at the wrist (C6, C7, C8, radial nerve)

Squeeze two of your fingers as hard as possible ( " grip, " C7, C8, T1)

[10]

Finger abduction (C8, T1, ulnar nerve)

Oppostion of the thumb (C8, T1, median nerve)

Flexion at the hip (L2, L3, L4, iliopsoas)

Adduction at the hips (L2, L3, L4, adductors)

Abduction at the hips (L4, L5, S1, gluteus medius and minimus)

Extension at the hips (S1, gluteus maximus) [12]

Extension at the knee (L2, L3, L4, quadriceps) [10]

Flexion at the knee (L4, L5, S1, S2, hamstrings)

Dorsiflexion at the ankle (L4, L5)

Plantar flexion (S1) [12]

 

Pronator Drift

Ask the patient to stand for 20-30 seconds with both arms straight

forward, palms up, and eyes closed.

 

Instruct the patient to keep the arms still while you tap them

briskly downward.

 

The patient will not be able to maintain extension and supination

(and " drift into pronation) with upper motor neuron disease.

 

 

Coordination and Gait

 

Rapid Alternating Movements

Ask the patient to strike one hand on the thigh, raise the hand, turn

it over, and then strike it back down as fast as possible.

Ask the patient to tap the distal thumb with the tip of the index

finger as fast as possible.

Ask the patient to tap your hand with the ball of each foot as fast

as possible.

 

Point-to-Point Movements

Ask the patient to touch your index finger and their nose alternately

several times. Move your finger about as the patient performs this

task.

 

Hold your finger still so that the patient can touch it with one arm

and finger outstretched. Ask the patient to move their arm and return

to your finger with their eyes closed.

Ask the patient to place one heel on the opposite knee and run it

down the shin to the big toe. Repeat with the patient's eyes closed.

 

Romberg

Be prepared to catch the patient if they are unstable.

Ask the patient to stand with the feet together and eyes closed for 5-

10 seconds without support.

 

The test is said to be positive if the patient becomes unstable

(indicating a vestibular or proprioceptive problem).

 

 

Gait

Ask the patient to:

 

Walk across the room, turn and come back

Walk heel-to-toe in a straight line

Walk on their toes in a straight line

Walk on their heels in a straight line

Hop in place on each foot

Do a shallow knee bend

Rise from a sitting position

 

 

Andrew " Guruji " LMT, MT-BC, CA

Peacefulmind.com

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