Forever Testing

If you are thinking about starting the path to becoming an OT, first of all, congratulations.... you are embarking down a unique path where you get to do meaningful work every day of your career..... The second thing you should know is being an OT means testing will become a part of your daily routine. 

I'm not talking about the GRE or casual class exams or even the NBCOT exam you spend your whole maters program preparing for. The tests I'm referring to go way beyond your time at school...

Assessments are a large part of our career, and there are many kinds to make sure you never run out. The types I will be talking about today are related to biomechanics.

To assist your client in the best and safest ways possible, you need to assess the body area they have concerns about. This is where the assessments come in. Range of motion or ROM is one "test" you go through with your client to assess the range of motion of the affected area of the body. This is extremely useful because you can compare the results to what is considered a "full" range of motion possible for that joint. This benchmark also allows you to measure growth or decline as you proceed with treatment and modify any upcoming activities that might be difficult with their current ROM. 

To utilize all the information that a ROM assessment can provide you, you need an accurate measurement. To do that, you need to know your bones. Palpating a client to correctly identify bony landmarks is necessary to use a goniometer correctly. A goniometer is a device used to measure the ROM of a joint. For it to work correctly, you need to position it in line with the bony landmarks and position your client in a way where the full ROM is possible. Incorrect positioning of the body or the goniometer will lead to inaccurate results and affect your client's treatment.

Another test that will become a part of your OT routine is Manual Muscle Testing MMT. MMT sometimes called the "Break Test," allows you to test the strength of a muscle. This is important to consider when determining an intervention plan for a client. The results of this test, when done correctly, can ensure a client's safety or establish a need for possible modifications for future interventions. Test position is vital to this test because an incorrect positioning will lead to inaccurate results, but it could also injure your client. The client should be screened for ROM to accurately perform MMT to see if a gravity-free position is necessary. Gravity Free positioning is for clients showing low ROM and substantial muscle weakness during screening. Gravity is removed by positing the client, so the tested movement is parallel to the ground in the horizontal plane. This limits the resistance to the action to better assess the strength of the muscle. No resistance should be applied with the patient is in a Gravity Free position. The grading in an antigravity position can be 0,1 or 2 depending on their ability to complete the motion. 

If no modifications are needed, the client should be positioned where the joint in question is at about half of their ROM- this provides the optimal opportunity for the most vigorous muscle contraction. After ensuring the client's joint is adequately supported, you can apply resistance to the distal segment while palpating the concerned muscle. Inform the client that the goal is to "keep me from pushing you down." Depending on the strength and time they resist the push, you will give them a grade of 3,4, or 5 (5 being normal). 

Once again, incorrect test positing for an MMT can be detrimental to a client, especially if they should be in an antigravity position for the test. Injury or worsening of an injury can be caused if the patient is not adequately assessed or screened before this test. 

I know tests can be scary, but these ones will really make a difference in your client's intervention plan and serve as a means to see all of the progress you make during your time together. Overall, assessments are a powerful tool that I am excited to utilize as an OT.