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• Children with CP are weak. Motor function and strength are directly
related. Manual muscle testing (MMT) is the typical method for
measuring muscle strength In child with CP.
Last , observe the limb/ joint while asking the patient to move
the same joint on contralateral side.
• By using this process for evaluation, the consistency and
completeness of tone abnormality documentation improve.
ASHWORTH SCALE:
1. No increase in tone
2. Slight increase in tone
3. More marked increase in tone
4. Considerable increase in tone
5. Affected part rigid
MODIFIED ASHWORTH SCALE
• GRADE 0 – No increase in muscle tone
1 – Slight increase in muscle tone manifested by catch and
release or by minimal resistance at the end of ROM when
affected part is moved in flexion or extension.
1+ – Slight increase in the muscle tone manifest by a catch
followed by minimal resistance through out reminder of
the ROM
2 – More marked increase in muscle tone through most of the
ROM but affected part easily moved.
3 – Considerable increase in muscle tone, passive movement
difficult.
4 – Affected part rigid in flexion or extension.
• On other hand dystonic hypertonia shows an increase muscle
activity when at rest, has a tendency to return to a fixed posture,
increase resistance with the movement of contralateral limb and
change with the change in behavior or posture.
• Perry and colleagues have shown that when these test are performed
with electromyography, both mono articular and bi articular muscle
crossing the joint contract.
• Because of the origin and insertion points, the causes of limited hip
abduction ROM can be distinguished by measuring hip abduction in
various position of hip and knee with the patient in supine.
The one joint adductors ( adductor longus, brevis , magnus) are
isolated with the knee flexed. In this position, the gracilis is relaxed.
(cont..)
• With the knee in full extension the length of 2 joint gracilis in a
position of maximum stretch.
KNEE
• In child with CP capsular contracture causes knee flexion contracture.
It is must to differentiate between true knee joint contracture and
hamstring contracture.
1) Thigh foot angle : most reliable method and also most commonly
used. However hind and mid foot mobility is necessary to properly
align the foot in line with talus primarily because it is difficult to
standardize foot alignment , and foot deformities are common in
child with CP.
FOOT
• Pronation and supination are terms used to describe the tri planar
motion in the foot and ankle. These 2 are pure rotation movement
around an oblique axis.
• Because every foot has its own neutral subtalarjoint (STJ) position,
the use of non weight bearing STJ neutral position provides
consistency in positioning the foot in order to assess and identify
patient specific structural abnormalities and their resultant
compensation In weight bearing.
• STJN is defined as the position from which the STJ can maximally
pronated and supinated and there for position from which STJ can
function optimally. STJN is found through palpation at the articulation
b/n the head of talus and the navicular. Congruency of the
talonavicular joint is the position of foot at which neither medial nor
the lateral head of talus protudes and examiner feels symmetry of
the navicular on the head of talus. From this starting point, the
patient rear foot and fore foot relation are evaluated.
EVALUATION OF REAR FOOT POSITION IN STJN
• Once the foot is placed in STJN position, rear foot position in relation
to lower one third of leg is assessed.
• If the plane of fore foot in relation to rear foot shows shows the
medial side of foot to be higher than lateral side (forefoot inverted)
this position is described as fore foot VARUS deformity.
• Deviation of fore foot in the transverse plane towards the mid line
are referred to ADDUCTION and away from mid line as ABDUCTION.
COMPENSATION
• COMPENSATION is a change in the structural alignment or position of
foot to neutralize the effect of an abnormal force, resulting in a
deviation in structural alignment or position of another part.