30 chapter 4
Muscle testing
Muscle strength can be anywhere between normal and zero. Test it like this:
If the child can lift the
weight of leg all the
way, press down on it,
to check if she can hold
up as much weight as is
normal for a girl her age.
If she can, her strength is
NORMAL.
If she can just hold up
the weight of her leg, but
no added weight, she
rates FAIR.
FAIR
strength
Press down
strongly.
NORMAL
strength
If she can hold
some extra
weight, but not
as much as is
normal, she rates
GOOD.
Press down
lightly.
GOOD
strength
If she cannot hold up the
weight of her leg, have her
lie on her side and try to
straighten it. If she can, she
rates POOR.
POOR
strength
If she cannot straighten her knee at
all, put your hand over the muscles
as she tries to straighten it. If you can
feel her muscles tighten, rate her TRACE.
Muscles move,
but not leg:
TRACE
strength
No muscle
movement:
ZERO strength
Test the strength of all muscles that might be affected. Here are some of the muscle
tests that are most useful for figuring out the difficulties and needs of different
children.
Note: These tests are simple and mostly test the strength of groups of muscles.
Physical therapists know ways to test for strength of individual muscles.
Ankle and Foot
DOWN
UP
BEND IN
BEND OUT
If the child can
walk, see if she
can stand and
walk on her heels
and her toes.
NORMAL
calf
muscle
NORMAL
foot-lift
muscle
Note: Sometimes when the muscles that
normally lift the feet are weak, the child uses
his toe-lifting muscles to lift his foot.
If he lifts his
foot with his
toes bent up,
like this,
see if he can lift
it with his toes
bent down, like
this.
Also notice if the foot tips or pulls more
to one side. This may show ‘muscle
imbalance’. (See p. 78.)
EXAMPLES OF REASONS FOR TESTING
1. If strength to lift up the foot is
WEAK and strength to push down is
STRONG, tiptoe contractures may
develop—unless steps are taken to
prevent them. (See p. 383.)
2. An ankle with POOR or very uneven
strength may be helped by an ankle
brace. But if strength is FAIR, exercise
may strengthen it—and a brace may
weaken it more!
3. Lifting the foot with only
the toe muscles may lead to
a high-arch deformity.
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