1q.

Factors affecting joint range of motion

Ans. Factors affecting joint range of motion –
1. Soft tissue tightness
2. Adhesion
3. Inflammation or injury around a joint
4. Muscle bulk
5. Gender
6. Age
7. Nervous system
8. Cartilagenous or bony degeneration
Soft tissue tightness-
 Joint soft tissues like muscle, ligament, capsule,Cartilage, synovial membrane spasm or
tightness causes the reduction of range of motion of The joint.
 The soft tissue tightness may be due To the prolonged immobilization of the joint,Injury
around the joint or any joint diseases Like osteoarthritis, rheumatoid arthritis,
Adhesion- Adhesion formation of the joint reduces the ROM of the joint.
Inflammation or injury around a joints- As the Result of the pain patient may avoid performing
The full range of movement.
Muscle bulk- Increasing the muscle bulk may cause the reduction of the active and passive range
of motion.
Gender-
Generally,Female will be having the more flexible increased range of motion than the male.
In females above 25 years, Rom Of hip extension is less than that of males..
Age-
 ROM is more in infants and children due to non-fusion of bones
 Rom reduces with age, as the person reaches adulthood.
 Rom again slightly increases in old age due to loss of muscle bulk.
Nervous system-
 Spasticity of the muscle, Which is the result of the UMN lesion, will be Reducing the range
of motion and the joint said To be hypomobile.
 The LMN lesion, which Causes the flaccidity, will result in hypermobile Joint.
Cartilaginous or bony degeneration causes pain during movement, therefore reducing overall
ROM.
2q. General procedure of Goniometry
Ans. Goniometry is the procedure used to measure the ROM of a specific joint.
Procedure-
• Patient’s clothes are removed where the Joint measurement to be taken.
• Position the patient in the relaxed manner
 the joint to be measured should be free From any obstructions like pillow, couch, etc.
• Measuring joint has to be in 0º position.
• Total procedure should be explained to the Patient.
• Therapist has to stand near to the patient And facing the joint, which has to be Measured.
• Axis or the fulcrum of the goniometer is Placed over the axis of the joint to be Measured.
• Stable arm is fixed with the proximal segment of the joint.
• Movable arm is fixed with the distal segment Of the joint.
• Therapist has to move the distal segment Of the joint with the movable arm of the Goniometer
to measure the joint range.
 The complete range of motion of the joint Has to be permitted.

3q. Goniometry for shoulder flexion

Ans. • Position of the patient: Supine lying.
• Axis: Greater tuberosity of the humerus is Taken as the axis.
• Movable arm: Movable arm is placed over The midline of the lateral aspect of arm and Is
holding by the therapist’s right hand.
• Stable arm: It is placed straight line to the Movable arm and is kept in the air without The
patient’s body contact and is holding by The therapist’s left hand.

4q. Goniometry fir knee flexion

Ans. Flexion-
• Position of the patient: Prone lying.
• Axis: Lateral joint line is taken as the axis.
• Movable arm: It is placed over the midline Of the lateral aspect of the leg and is holding By the
therapist’s right hand.
• Stable arm: It is placed over the midline of The lateral aspect of the thigh and is holding By the
therapist’s left hand

5q. Explain the parts and types of goniometer and it’s limitations.
Ans. Refer pg 40,41…..laxmi narayan

6q. Explain grades of MMT.

ANS. Muscle grading is done to determine the Strength or weakness of a muscle or a muscle
group.

Accuracy in grading depends on many factors:

 the Stable position of the patient,
 the fixation of the part Proximal to the part being tested,
 the precision of the Test position
 the direction and amount of pressure.
 The amount of pressure varies with the age and the size Of the patient, the part being
tested and the leverage.
 If One extremity is unaffected, the examiner may use the Strength in the unaffected
extremity as an index for the Patient’s normal strength when testing the affected Extremity
7q. Mmt for knee extensors.
And. Patient: Sitting, with the knees over the side of the table And holding on to the table.
Fixation: The examiner may hold the thigh firmly down
On the table. Or…….. the examiner may put a hand under the distal End of the thigh to cushion
that part against table pressure.
Test: Full extension of the knee joint, without rotation Of the thigh.
Pressure: Against the leg, above the ankle, in the direction of flexion.

8q. Mmt for hip abductors.

Ans.Patient: Side-lying, with the underneath leg flexed at The hip and knee and the pelvis rotated
slightly forward
Fixation: The muscles of the trunk and the examiner Stabilize the pelvis.
Test -
 Abduction of The hip, with slight extension and slight external rotation.
 The knee is maintained in extension.

Pressure:
 Against the leg, near the ankle, in the direction of adduction and slight flexion;
 do not apply pressure against the rotation component.
 The pressure is applied against the leg for the purpose of obtaining a long Lever
9q. Explain break and active resistance test.
 Ans. A break test is a Muscle strength test to determine the maximal effort exerted by a
subject who is performing an isometric contraction as the examiner applies a gradual
buildup of Pressure to the point that the effort by the subject is Overcome.
 It is used in determining grades of fair+ Through good-h
10q. Explain the measurement of vital parameters -Heart rate, Respiratory rate, body
temperature(
Ans. Heart rate can be measured by the assessment of radial pulse rate.
Normal heart rate- 60-100 beats/minute
Respiratory rate it should be checked and counted when the patient’s thorax expands, in 1
minute.
Normal respiratory rate- 12-18 beats per minute

Normal body temperature- 36.1-37.2 °C

11q. Explain superficial sensation testing.

Ans. Superficial senses consist mainly 4 types of senses-
1. Fine touch
2. Crude touch
3. Temperature
4. Pain
Fine touch testing –
 Ask the subject to close his eyes.
 Supply proper instructions to the subject (To raise his finger or say “yes” when he feels the
sensation of touch)
 With the help of cotton wool, elicit sensation dermatome wise on both sides of the body.
 Note down your observation.
Crude touch testing –
• Ask the subject to close his eyes.
• Supply proper instructions to the subject (To raise his finger or say “yes” when he feels the
sensation of touch)
 Elicit pressure sensation by pressing with your finger tip on the skin of different
dermatomes.
 Note down your observation.
Superficial pain testing-
 Explain properly that you will be eliciting pain.
 With a help of a pin, lightly prick the skin of different parts of the body and ask the subject
if he feels pain.
 Elicit pain from all the dermatomes of both sides of the body.
 Record your observation.
Temperature testing-
 Take 2 test tubes containing warm and cold water separately.
 Place the test tubes randomly on the skin of the subject to say whether he feels warm or
cold.
 Examine the sensation on the dermatomes of both side and note your observation.
Abnormalities of sensation-
 Anesthesia- Loss of all sensations
 Hypoasthesia- Decreased sensations
 Hyperasthesia- increased sensations (Exaggerated response)
 parasthesia- Touch sensation produces pain sensation
 Dissociated anaesthesia – Sensation of pain and temperature is lost, with preservation of
touch sensation.
 Analgesia- Loss of pain sensation
 Hypoalgesia- Partial loss of pain sensation
 Hyperalgesia – Exaggerated pain sensation
12q. Explain Sterognosis and testing.
Ans. Supply instructions to subject to identify the object when asked to handle it.
 Ask the subject to close his eyes
 Place a familiar object in one hand of the subject and ask him to recognize it by palpating
the object
 Repeat the procedure with 4-5 familiar object
 Repeat the procedure in the opposite hand.
13q. Explain the principles of passive movement
Ans. Principles of passive movement involve-
1. Relaxation
2. Fixation
3. Support
4. Traction
5. Range
6. Speed and duration
7. Sequence
Relaxation-
 Patient has to be positioned in relaxed manner Before starting the treatment procedure.
 The therapist’ Position also plays an important role to treat The patient.
  The therapist has to adopt the walk Standing position while treating the patient.
Fixation – The bone which lies proximal to the joint is fixed to ensure that the movement is
localised to that joint.
Support- Full support is given to the part which has to be moved. The physiotherapist stance
must be firm and comfortable when standing, his/her feet are apart and placed in line of
movement.
Traction- The proximal bone at the joint is fixed and the distal bone is distracted along the long
axis of the joint.
Movement - The pattern of movement has to be the natural and free movement of the joint
Range of motion – ROM is as full as the condition of the joint permits without eliciting pain or
spasm in the surround muscles
Speed and duration – The speed of movement of movement must be uniform, fairly slow and
rhytmical
14q. Effects of immobilization
And. Immobilization may be caused due to plaster Cast, bedrest, and fear of pain.
Due to the non -mobility of the joint causes many changes over The joint structures.

Normally, after immobilization, contracture develops in the surrounding Soft tissues, so that after
the immobilization of Joint, it is impossible to attain normal range of Motion
15q. Write about the indications and contraindications of passive movements.
Ans. INDICATIONS-
• The patients who cannot perform active movements.
• The patients who cannot perform full range of movements.
• For the prolonged bed-ridden patients mainly to prevent DVT, maintain the muscle property
and increase the venous drainage as well as lymphatic drainage.
• To break adhesion formation through that joint range can be increased.
• Unconscious patients.
• For relaxation.
• Edematous limb.
CONTRAINDICATIONS
• Recent fractures
• Recent dislocations
• DVT
• Malignant tumor
• Psoriatic arthritis
• Recently injuries and inflammation
• Precaution must be taken for the flial joints
• Hemarthrosis
• Early burns
• Immediately after any joint surgery or repair
• Hemophilic joints
• Patients with external appliances
• Patients with POP plaster cast.

16q. Define passive movement, its types and effects in detail

Ans.
The movement, which is performed with the help of the external force whenever the muscles fail
to perform the movement by its own.
Types of Passive Movements
1. Relaxed passive movement
2. Passive manual mobilization
• Mobilization of the joints
• Manipulation of the joints and soft tissues
• Stretching of the soft tissues.
Effects of passive movements-
 Maintains the muscle properties
• Increases the ROM
• Increases the venous and lymphatic drainage
• Breaks the adhesion formations in the joints
• Prevents the DVT
• Induces the relaxation.

17q. Explain deep sensation testing

Ans. Deep sensations mainly involve –
1. Proprioception
2. Vibration
Proprioception testing –
 Supply proper instructions to the subject
 Ask him to close his eyes
 Move his finger or hand, up or down and ask the subject to recognize the movement by
imitating the same movement in the opposite limb
 Repeat the same procedure in all joints
Vibration-
 Supply proper instructions
 Make the tuning fork vibrate by hitting the blades of fork again the thigh
 Place the foot of vibrating tuning fork on a bony prominence (Ex- lateral malleolus)
  Ask the subject to raise his finger when he senses to feel the vibration
 Immediately place the tuning fork on the corresponding bony prominence of your body
and note whether can still perceive the vibration
 Note if the examiner perceives the vibration after the subject ceases to sense it, the sense
of subject is impaired
 Elicit vibration sense on all the bony prominence of the body

Proprioception abnormalities -
 Loss of sensation of joint movement, sense of position of different parts of the body and
sense of vibration.
This loss of proprioception can be seen in –
1. Tabes dorsalis
2. Sub acute combined degeneration of spinal cord

18q. Explain any 2 functional tests

Ans. Functional abilities include h Dressing, eating, bathing, transfering, rising from a chair,
climbing stairs, lifting.

Functional tests include-

1. Chair stand test
2. TUG
3. Gait speed
4. Stair climb
Chair stand test
Aim – To test the lower limb strength using chair stand test.
Objective- The 30 secs sit to stand test is for leg strength and endurance of older adults.
Procedure -
1. The 30 secs chair test is administered using a folding chair without arms, with seat heights
of 17 inches.
2. The chair is placed against the wall to prevent it from moving
 3. The participant is seated on the chair, back straight, feet shoulder width apart and placed in
floor at an angle slightly back from knees, with one foot slightly in front of other2 to
maintain balance
4. Arms are crossed at wrists and held against the chest
5. Demonstrate the task both slowly and quickly
6. Have the patient practice a repetition or 2 before completing the test.
7. The participant in encouraged to complete as many full stands as possible within 30 secs,
including fully sitting between stands
8. While monitoring the participants performance, ensure proper form
9. The tester silently counts the completion of each correct stands.
10.Any incorrect standing or sitting done should nit be counted and the therapist may
encourage the participant while the test is being done.
TUG test
Aim – To determine fall risk and measure prognosis of balance, sit to stand and walking.

Materials required-
1. 1 chair with arm rest
2. Stop watch
3. Tape (3 meter mark)
Procedure –
1. Patients wear their regular foot wear snd can use walking aid if needed
2. Patient starts in seated position
3. Patient stands up on therapists command. Walk 3 meter, turn around, walk back to chair
and sit down
4. The time stops when patient is seated
5. Be sure to document assistive device used
Observation –
1. Slow tentative pace, loss of balance, short strides, little to no arm swinging , shuffling, not
using assistive device properly
2. These changes may signify neurological problems that require further evaluation
19q. Explain BMI and it’s normative values.
Ans. Body mass index (BMI) is used to assess weight relative to the height.
 This technique compares an individual's weight (in kilograms) to their height (in meters
squared)
  It is used to determine body composition and stages of obesity.
 It can also be used to achieve an optimal weight.
Formula - BMI= weight (Kg) /Height (m^2)
BMI
Underweight <18.5
Normal 18.5-24.9
Over weight 25- 29.9

Obesity- Class I 30-34.9

Class II 35-39.9
Class III >40

20q. Write the procedures of skin fold measurement and explain any 2 folds measurement in
detail
Ans. This estimate is based on the principle that the amount of subcutaneous gat is proportional
to the total amount of body fat.

Procedure
 Firmly grasp a skinfold and the subcutaneous fat between the thumb and the index finger
of your left hand and lift up away from the body
 The subject has to relax the area if skinfold measurement, before taking measurement
 Grasp the skinfold site with your 2 fingers, both 8cm apart
 Hold the calliper in your right hand with the scale facing up
 Place the contact surfaces of the calliper 1 CM below your fingers
 Release the scissors grip of the calliper claws and continue to record the reading on the
calliper scale.
 Measure each skin fold site atleast 2 times.
 Rotate through the measurement sites to allow time for the skin to regain it’s normal
thickness and texture.
 Sum the mean/average of each skinfold site to determine the body fat percentage with the
specific skinfold formula.
Standardised skinfold sites include-
1. Abdomen
2. Triceps
3. Biceps
4. Chest
5. Medial calf
6. Midaxillary line
7. Subscapular
8. Supra iliac
9. Thigh
Abdomen- Vertical fold;2 CM to the right side of umbilicus
Triceps- Vertical fold ; posteriorly, halfway between the Acromion and Olecranon process, with
arm held freely at side.

21q. Define anthropmetry and explain muscle circumference aassessments

Ans. Anthropemetry is the measurement of human body
 Anthropometry is done to establish a target, od desirable/optimal weight of an individual
 Anthropemetry helps in determining body composition and to determine the stages of
obesity.
 Obesity can cause further complications such as –
1. Coronary artery disease
2. Hypertension
3. Hyperlipemia
4. Certain cancers
Circumference measurement –
 Circumference can be used to measure muscle girth , muscle size and therefore quantify
changes in muscles with specific training (Ex- Resistance training)
Procedure-
 Read the circumference (girth) to the nearest half of a centimeter (5mm)
 Apply the tape to the site so it taught but not tight
 Avoid skin compression or pinching of the skin
 Subject should stand straight or erect, but relaxed
 Be sure to use to standardized sites for measurement
Standardized sites of measurement include-
 1. Right forearm
2. Right arm
3. Abdomen
4. Buttocks
5. Right thigh
6. Right calf

Active movements question (Refer chapter 8 laxmi narayan pdf)