Rehabilitation Sciences 3060A/B Final: Manual Muscle Testing, Sensory Testing

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Rehabilitation Sciences
Rehabilitation Sciences 3060A/B
Thomas Overend

RS 3060 SCI Neurological level of the SCI, manual muscle testing and sensory testing The neurological level of the SCI is the most distal uninvolved nerve root with normal function. What is (1) normal muscle function and (2) normal sensory function? (1) Normal muscle function means normal as defined by manual muscle testing. Manual muscle testing was first developed in the early 1900s. While there are measurement issues related to reliability of testing, it is still used clinically to obtain a quick estimate of someones muscle function. Manual muscle testing involves ascertaining the answers to 3 questions to determine a grade: o Can the person move the limb through the joints available range of motion? o Can the limb be moved through this range against gravity? o Can the person resist manually applied resistance? A fair+ or 3+ manual muscle grade means the answer to all three questions is yes. This grade defines normal muscle function when determining the level of the lesion because it usually reflects an adequate amount of strength for functional use of the muscle or limb. (2) Normal sensory function means normal as defined by the response to specific clinical tests of sensation. Examples of these tests are outlined below as they pertain to Anterior Cord Syndrome. Tests that determine the integrity of the Spinothalamic Tract Pain: sharp vs. dull safety pin or paper clip: sharp end vs. rounded, blunt part is placed on the skin normal means the two feelings can be correctly identified without looking Temperature: warm vs. cold 2 test tubes: 1 containing warm water, 1 with crushed ice normal means the two temperature states can be correctly identified without looking Tests that determine the integrity of the Posterior Column Proprioception: joint position sense awareness that joint is at rest asked to describe joint position (e.g. initial, mid, end of range as defined prior to testing) normal means the position can be correctly identified verbally or demonstrated with the other limb when applicable Kinesthesia (body position): awareness of movement in all directions asked during the movement to describe the direction of movement (e.g. updown) normal means the direction can be correctly identified verbally or demonstrated with the other limb when applicable Vibration: use tuning fork asked to discriminate between a vibrating and nonvibrating tuning fork normal means the person can identify when the tuning fork is vibrating and when it is not
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