FUNCTIONAL ASSESSMENT

OF MUSCLE
By:-Harsh Mali

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 Introduction(1/2)

• The traditional techniques used for quantification

of strength are assessed in linear movements
involving single muscle groups and may be
inadequate as indicators of functional performance.

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 Introduction(2/2)
• Brown et al. Proposed that strength and function
are best assessed by performance of specific
task that combines key muscle groups.

• This techniques focuses on assessment of

muscle strength and endurance from the
perspective of function.

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 Definitions(1/2)
• Function:-Performance that support physical,
social, psychological well-being And
meaningful living and is determined to be
essential by the individual.

• Strength-force output capacity:-Maximum

force or tension generated by single muscle or
related muscle group.

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 Definitions(2/2)

• Functional strength:- capacity to generate a

force output adequate to complete a specific
task.

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 Three components
• Upper body test

• Lower body tests

• Gross body tests

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UPPER BODY TESTS

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 Sweep Curl(1/4)
• Assessment of functional strength of elbow
flexors and shoulder musculature( pactoralis
major, subscapularis, latissimus dorsi , teres
major.

• Equipment – straight wooden chair with a

seat height of 43 to 44 cm placed against a wall,
barbell weights of 0.45 kg, 1.35 kg, and 2.25 kg.
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 Sweep Curl(2/4)

• Patient position – sitting in middle of chair

feet flat on floor hips and knee flexed 90°
• begin test with patient holding a 2.25-kg weight
in hand on the side being tested with the elbow
extended, palm facing forward, and arm at side.

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 Sweep Curl(3/4)

• Examiner position – at side being tested.

• Command – now bend your elbow and touch

your opposite shoulder. Repeat that action five
times.

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Sweep Curl(4/4)

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 Grades(1/2)
• Grade 5 – Patient completes five repetitions
without difficulty.
• Grade 4 – Patient completes four repetitions.
• Grade 3 – Patient completes five repetitions
using small amount of weight.

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 Grades(2/2)
• Grade 2 – Patient completes less than five
repetition but is able to initiate the movement
through partial range without allowing the arm
to drop back to side.
• Grade 1 – examiner palpates a contraction of
the biceps and shoulder muscles.
• Grade 0 – no contraction is observed or
palpated by the examiner.
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 Sitting Up Lift(1/4)

• Assessment of functional strength of upper trunk

extensors, shoulder flexors, and scapular
rotators.

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 Sitting Up Lift(2/4)
• Equipment – Chair and square wooden block
held by examiner at patient's arm length in front
and centre of patient.
• Patient position – sitting on chair hip and
knee flexed 90°
• Begin test with patient’s hand resting on the
thighs.

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 Sitting Up Lift(3/4)
• Examiner position – to side close enough to
position the block in front and centre of patient
and prevent loss of balance in forward direction.

• Command – now reach up and take the block

with both hands and place it in your lap.

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Sitting Up Lift(4/4)

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 Grades(1/2)

• Grade 5 – patient completes five repetition

without difficulty.
• Grade 4 – patient completes four repetition
but movement uncoordinated.
• Grade 3 – patient completes three of the five
repetitions but requires added time and
movement is poorly controlled.

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 Grades(1/2)

• Grade 2 – patient is able to initiate the

movement through partial range without
allowing the arm drop back to the thighs.
• Grade 1 – examiner palpates a contraction of
the biceps and shoulder muscles.
• Grade 0 – no contraction is observed od
palpated.

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 Sitting Down Lift(1/4)

• Assessment of functional strength of upper trunk

flexors(down movements) And
extensors(movement back to upright).

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 Sitting Down Lift(2/4)

• Equipment – chair and square wooden block.

• Patient position – sitting on chair hip and

knee flexed 90° shoulder level upright hands
resting on lap holding the block with both
hands.

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 Sitting Down Lift(3/4)
• Examiner position – to side close enough to
prevent a loss of balance in forward direction.

• Command – now take the block with both

hands and place it on the floor in front of you
and leave it there

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Sitting Down Lift(4/4)

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 Grades(1/2)
• Grades 5 – patient completes five repetition
without difficulty.
• Grade 4 – patient completes four repetitions
but movement uncoordinated.
• Grade 3 – patient completes three of the five
repetitions but requires added time and
movement poorly controlled.

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 Grades(1/2)

• Grade 2 – patient is able to initiate the movement

through partial range without dropping the object
or losing balance.
• Grade 1 – examiner observes movement in
forward direction but patient unable to initiate
placement of the block without loss of balance.
• Grade 0 – no contraction is observed or palpated.

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 Diagonal Up
Lift(1/4)

• Assessment of concentric and eccentric

functional strength of trunk, shoulder abductor
and flexors, and scapular rotators.

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 Diagonal Up Lift(2/4)

• Equipment – chair placed next to a shelf

approximately 168 m high and 0.45-kg, 1.35-kg,
and 2.25-kg weights.
• Visual target on chair by sticky labels or
colourful tape in diagonal reach pattern.

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 Diagonal Up Lift(3/4)
• Patient position – standing close to and facing
chair with arms at sides.
• Examiner position – in back of patent with
hands on each side of pelvis to prevent loss of
balance.
• Command – now reach with your right hand to
pick up the weight and place it on the shelf and
leave it there.

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Diagonal Up Lift(4/4)

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 Grades(1/2)
• Grade 5 – patient completes lift of 2.25 kg
without difficulty.
• Grade 4 – patient completes lift of 1.35 kg but
movement jerky and slowed.
• Grade 3 – patient completes more than one-
half lift of 0.45 kg but with added time, And
movement is poorly controlled

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 Grades(2/2)

• Grade 2 – patient completes less than one half

of the lift against gravity (no weight).
• Grade 1 – patient is unable to complete task,
slight contraction is palpated or observed.
• Grade 0 – patient is unable to complete task no
contraction is palpated or observed.

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 Diagonal Down Lift(1/3)

• Assessment of concentric and eccentric

functional strength of the trunk, shoulder
flexors, horizontal adductors, and scapular
rotators.

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 Diagonal Down Lift(2/3)

• Equipment – same as above

• Patient position – Same as above
• Examiner position – same as above
• Command – now reach with your right hand
to pick up the weight and place on the marker on
the chair and leave it there.

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Diagonal Down Lift(3/3)

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 Grades(1/2)
• Grade 5 – patient completes test with 2.25 kg
without difficulty.
• Grade 4 – patient completes test with 1.35 kg
but movement jerky and with decreased speed.
• Grade 3 – patient completes more than one
half of the test with 0.45 kg but with poorly
controlled downward movement.

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 Grades(1/2)

• Grade 2 – examiner passively moves patient’s

arm to reach position and release; patient’s arm
fall back to side.
• Grade 1 and 0 – test not recommended

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 Long Sit(1/4)
• Assessment of concentric and isometric neck
flexors.
• Equipment – mat or firm surface
• Patient position – supine with arms at the
sides and the hands resting on each side of the
pelvis.

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 Long Sit(2/4)

• Examiner position – Walk stand at the side

of the mat or surface.
• Command – now sit up and hold your head
upright.

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Long Sit(3/4)

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Long Sit(4/4)

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 Grades(1/2)
• Grade 5 - patient is able to initiate and maintain
neck flexion through five repetition of movement.
• Grade 4 – patient is able to initiate and maintain
neck flexion through three repetitions of the
movement.
• Grade 3 – patient is able to initiate and maintain
neck flexion through one repetition of movement.

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 Grades(2/2)

• Grade 2 – patient is able to lift head from

surface but is unable to maintain through test
range against gravity.
• Grade 1 – contraction is observed or palpated
but patient is unable to lift head from surface.
• Grade 0 – no movement or contraction occurs;
patient’s head remains supported by the surface.

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 Prone Roll(1/4)

• Assessment of concentric and isometric

functional strength of neck extensors.
• Equipment – mat or firm surface
• Patient position – prone forehead resting on
surface shoulder is abducted 90° and elbow
flexed approximately 90 to 100°

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 Prone Roll(2/4)

• Examiner position
– at side of the mat or
surface observe
movement and prevent
the head falling too
rapidly and for safety
during patient’s roll.

• Command – now lift your head and roll to

your side. Harsh Rami 44
Prone Roll(3/4)

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Prone Roll(4/4)

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 Grades(1/2)

• Grade 5 – patient is able to initiate and maintain

neck extension through five repetitions of
movement.
• Grade 4 - patient is able to initiate and maintain
neck extension through three repetition of
movement.
• Grade 3 – patient is able to initiate and maintain
neck extension through one repetition of the
movement.
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 Grades(1/2)

• Grade 2 – patient is able to lift head from

surface but is unable to maintain through test
range against gravity.
• Grade 1 – contraction is observed or palpated
but no movement.
• Grade 0 – no movement or contraction occurs;
the head remains supported by surface.

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 Supine To Side Roll(1/4)
• Assessment of functional strength of neck rotators.
• Equipment – mat or firm surface.
• Patient position – supine with head turned away
from the side being tested, shoulder abducted 90°
and dorsum of forearm resting on table.
• Examiner position – on the side of the mat towards
patient rolling to observe and to provide safety.

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 Supine To Side Roll(2/4)

• Command:- Now
turn your head and
roll onto right side
and then back.

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Supine To Side Roll(3/4)

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Supine To Side Roll(4/4)

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 Grades(1/2)
• Grade 5 - patient is able to complete five
repetitions.
• Grade 4 – patient is able to complete three
repetitions.
• Grade 3 – patient is able to complete one
repetition.

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 Grades(2/2)
• Grade 2 - patient is able to complete less than
one half of the roll against gravity.
• Grade 1 – contraction is observed or palpated
but patient is unable to roll.
• Grade 0 – no movement or contraction occurs;
the patient remains supine.

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Lower body tests

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 Repeated Chair Rise(1/4)

• Assessment of functional strength of knee

extensors and gross lower body muscle group.
• Equipment – Chair and stop watch.
• Patient position - sitting in middle of chair.
• Examiner position – at side of the patient.

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 Repeated Chair Rise(2/4)

• Command – rise from the chair without using

your arm, come to full standing, and then sit back
into chair.
• Repeat full stand to sit as many times as you can
do in 30 seconds without stopping.
• Scoring recommendations - the score is the
total number of successfully completed rise in 30
seconds.
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Repeated Chair Rise(3/4)

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 Repeated Chair Rise(4/4)

Chair 60-64 65-69 70-74 75-79 80-84 85-89 90-94

stand
women 14 13 12 12 11 10 8

men 16 15 14 14 12 11 9

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 Step Test(1/4)

• Assessment of functional strength of gross

lower body muscle groups.
• Equipment – step approximately 10 to 15
cm high placed on nonskid surface with “X”
markers for foot placement

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 Step Test(2/4)

• Patient position - standing in double limb

stance facing step.
• Examiner position – to side or back of
patient enough to prevent loss of balance, but
without touching or restricting the stepping
movements.

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 Step Test(3/4)

• Command – now
begin stepping up
and back five times
with each foot.

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Step Test(4/4)

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 Grades(1/2)
• Grade 5 – patient completes task without
difficulty.
• Grad e 4 - patient completes task but
movement may be slowed.
• Grade 3 – patient completes task but
movement is slowed and more labored.

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 Grades(2/2)

• Grade 2 – patient initiate movement but is

unable to complete task safely and requires
moderate assistance to prevent fall.

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 For Grade 2 And Below
• Equipment – standard mat, plinth, pillow, and
towel.
• Patient position – supine on the mat and
towel roll under each knee.
• Examiner position – standing beside the mat
near the patient’s lower extremity.

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• Command – now
begin bending and
straightening your
knee alternately,
repeating five times
with each leg .

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 Grades(1/2)

• Grade 2 – patient bend knee to place the foot

flat on mat surface at least three of five attempts
on each limb.
• Grade 1- examiner observes and palpates a
contraction of hip and knee flexors.
• Grade 0 – no contraction is observed or
palpated by examiner.

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 Stair Climbing(1/3)
• Assessment of functional concentric strength of
lower extremities.
• Equipment – at least three steps of standard
height.
• Patient position – standing facing the stairs.
hands may be on handrails.

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 Stair Climbing(2/3)

• Examiner position – examiner side and

behind the patient during the movement for
safety and prevent loss of balance.
• Command – now climb up and down the
stairs.

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Stair Climbing(3/3)

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 Grades(1/2)
• Grade 5 – patient ascends and descends at
least 3 steps without difficulty.
• Grade 4 – patient ascends and descends at
least 3 steps but slower and hesitant.
• Grade 3 – same as grade 4 and 5 except
movement is more slower and increased
dependence on handrails.

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 Grades(2/2)

• Grade 2 - patient will able to initiate

movement but be unable to complete task.
• Grade1 and 0 – not recommended.

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 Side Step Stair Climbing(1/2)
• Assessment of functional concentric strength of
hip abductors
• Same as above except patient is standing in
sideways.

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Side Step Stair Climbing(2/2)

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 Sitting Leg Cross(1/3)
• Assessment of functional strength of lower trunk
flexors.
• Equipment – chair.
• Patient position – seated on chair.
• Examiner position – o the side near enough
to prevent loss of balance.

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 Sitting Leg Cross(2/3)

• Command – now
cross your legs with
your right knee over
the left and then
return to the starting
position.

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Sitting Leg Cross(3/3)

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 Grades(1/2)
• Grade 5 – patient is able to complete five
reputations.
• Grade 4 – patient is able to complete three
repetitions.
• Grade 3 – patient is able to complete one
repetition.

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 Grades(2/2)

• Grade 2 – patient is able to complete less then

one half of the movement against gravity.
• Grade 1 – contraction is observed or palpated
by the examiner but patient is unable to initiate
lifting foot from floor.
• Grade 0 – no movement or contraction occurs.

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 Lateral Hip Scoot(1/3)
• Assessment of functional strength of lower
trunk rotators.
• Equipments – chair.
• Patient position – seated on chair.
• Examiner position – to the side enough to
observe movement and prevent a loss of
balance.

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 Lateral Hip Scoot(2/3)

• Command – now
scoot to the front of
the chair one hip at a
time once achieved
say now scoot back
in chair one hip at a
time.

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Lateral Hip Scoot(3/3)

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 Grades(1/2)

• Grade 5 – patient is able to complete forward

and backward movement.
• Grade 4 - patient is able to complete forward
and backward movement but slowed.
• Grade 3 - patient is able to complete forward
and backward movement but with excessive
trunk lean to utilize momentum.

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 Grades(2/2)

• Grade 2 – patient is able to complete less then

one half of the forward task.
• Grade 1 – contraction is observed or palpated
by the examiner but the patient is unable to
initiate movement.
• Grade 0 – no movement or contraction occurs.

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 Hip Hike(1/3)

• Assessment of functional strength of ipsilateral

lower trunk, lateral flexors, and contralateral hip
abductors.
• Equipment – low stool placed on nonskid
surface and beside a support surface (plinth or
wall)
.

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 Hip Hike(2/3)
• Patient position – standing on low stool
with the side being tested in non-weight-
bearing, the pelvis is level in horizontal plane.
patient may place one hand on support surface
• Examiner position – examiner is to the side
and back of patient in close proximity.
• Command – now bring your hip up toward
the shoulder and back down five times.

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Hip Hike(3/3)

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 Grades(1/2)
• Grade 5 – patient is able to complete five
repetitions.
• Grade 4 – patient is able to complete three
repetitions.
• Grade 3 – patient is able to maintain the pelvis
level but is unable to laterally flex the trunk.

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 For Grade 3 And Below
• Patient position – standing facing wall with
feet approximately 15 to 20cm from wall and
shoulder width apart.
• The pelvis is level in horizontal plane.
• The patient hands may placed on the wall for
stability as needed.

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• Examiner position – examiner is to side and
back of patient in close proximity to patient in
case of loss of balance.
• Command – instruct patient as follow “when
I say to bring your right hip up toward your right
shoulder. Do not rotate your hips from their
position”

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 Grades(1/2)
• Grade 2 – patient is able to initiate lateral
trunk flexion, but unable to clear foot from
floor(heel may come up)
• Grade 1 – contraction is observed or palpated.
• Grade 0 – no movement or contraction occurs.

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 Forward Stepping(1/2)

• Assessment of functional strength, lower

extremities.
• Patient position – standing at one end of the
3-m course.
• Examiner position – to the side and back of
the patient .

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 Forward Stepping(2/2)

• Command – walk
forward to the end of
the course, turn
around, and come
back to starting
position.

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 Grades(1/2)
• Grade 5 – patient is able to complete 3-m
course in forward stepping direction.
• Grade 4 – patient is able to complete 3-m
course in forward stepping direction but slowed.
• Grade 3 - patient is able to complete 3-m
course in forward stepping direction but slowed.
Inconsistent in steps, and hesitating in stepping.

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 Grades(2/2)

• Grade 2 - patient is able to complete less then

one half of the 3-m course without assistance.
• Grade 1 – contraction is observed or palpated
by examiner but patient is unable to safely
initiate forward stepping of the swing limb.
• Grade 0 – no movement or contraction occurs
in advancing limb.

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 Backward Stepping(1/2)
• Assessment of functional strength of lower trunk
extensors.
• Same as above except patient walks in
backwards.
• Grading same as above.

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Backward Stepping(2/2)

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Gross Body Movements

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 Floor Sit(1/3)
• Assessment of functional strength of gross upper
and lower muscle groups.
• Equipment – chair and mat.
• Patient position – sitting on chair.
• Examiner position – to the side near enough
to prevent a loss of balance in forward direction.

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 Floor Sit(2/3)

• Command – come
forward and down to
sit on the floor. You
may get down to the
floor in any safe way
you choose.

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Floor Sit(3/3)

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 Grades(1/2)
• Grade 5 – patient completes the task safely
without loss of balance
• Grade 4 - patient completes the task but
movement is labored and less controlled.
• Grade 3 - patient completes the task but uses
chair for support until sitting on floor.

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 Grades(1/2)

• Grade 2 – patient initiate movement bus is

unable to complete task safely and requires
assistance to prevent fall.
• Grade 1 – patient is unable to safely complete
the task beyond forward movement in chair.
• Grade 0 – patient is deemed unsafe to attempt
task.

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 Floor Rise(1/3)
• Assessment of whole-body movement and
functional strength of upper and lower
extremities in complex rotational pattern.
• Equipment – chair and mat.
• Patient position – sitting on the floor mat.
• Examiner position – to the side or back near
enough for safety.

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 Floor Rise(2/3)

• Command – now
rise from the floor
and get into chair.

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Floor Rise(3/3)

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 Grades(1/3)

• Grade 5 – patient completes the task safely

without loss of balance
• Grade 4 - patient completes the task but
movement is labored and less controlled.
• Grade 3 – patient completes the task but
pushes down on chair to rise from floor.

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 Grades(2/3)

• Following grade needs maximal assistance to

place patient into chair.
• Grade 2 – patient initiate movement but is
unable to complete task safely and requires
moderate assistance to prevent fall.
• Grade 1 – patient is unable to complete
movement need maximal assistance for
completion of task .

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 Grades(3/3)

• Grade 0 – patient requires maximal assistance

for completion of task.

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 Supine To Side Sit(1/3)
• Assessment of functional strength of whole-
body transitional movement against gravity.
• Equipment – mat or firm surface.
• Patient position – supine with the arm resting
on side.
• Examiner position – on the side of the mat
toward patient is moving.

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 Supine To Side Sit(2/3)

• Command – sit up
to side and stay
there.

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Supine To Side Sit(3/3)

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 Grades(1/2)

• Grade 5 – patient is able to complete fie

repetitions.
• Grade 4 – patient is able to complete three
repetitions.
• Grade 3 – patient is able to complete one
repetition.

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 Grades(2/2)

• Grade 2 – patient is able to complete less then

half of the movement against gravity.
• Grade 1 – contraction is observed or palpated
by the examiner but patient is unable to initiate
roll.
• Grade 0 – no movement or contraction occurs.

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 Reference
• Muscle and sensory testing by Nancy Berryman
Reese
• Functional Fitness Normative Scores for
Community-Residing Older Adults, Ages (
Volume 7 Issue 2, April 1999)

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THANK YOU

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