OTHER DEVICES USED DURING ASSESSMENTS AND TREATMENTS

Various devices are utilized during assessment and treatment to enhance diagnostic accuracy and serve as objective measures for tracking treatment progression. These devices include:

Hand Held Dynamometer – Utilized to evaluate strength, primarily in arm and leg muscles.

Stabilizer Pressure Biofeedback Cuff – Measures the strength of core and deeper neck muscles.

PALM Palpation Meter – Aids in assessing any difference with leg length (leg length differences can be a common problem that can then lead onto musculoskeletal disorders.

HAND HELD DYNAMOMETERS

A dynamometer is a device used to measure the strength and force of muscles. It is commonly used in physiotherapy to assess a patient’s muscle strength and track their progress over time.

Benefits of using a dynamometer in physiotherapy:

It allows the patient’s progress to be tracked accurately.
It can help identify specific areas of weakness and tailor the treatment plan accordingly which can help patients recover faster and more efficiently. It gives us greater confidence when to progress strengthening exercises, and also return to sport following injury.
A dynamometer can also help diagnose certain conditions, such as muscular dystrophy or other neuromuscular disorders, by measuring the strength of specific muscles.

Overall, the use of a dynamometer in physiotherapy can help improve patient outcomes by providing an objective assessment of muscle strength, allowing for targeted treatment, and increasing patient motivation.

Here are some of the benefits of using a dynamometer in physiotherapy:

Objective assessment: A dynamometer provides an objective measurement of muscle strength, allowing the therapist to track the patient’s progress accurately.
Targeted treatment: With the help of a dynamometer, the therapist can identify specific areas of weakness and tailor the treatment plan accordingly. This targeted treatment approach can help patients recover faster and more efficiently.
Motivation: Measuring the patient’s strength with a dynamometer can provide them with a sense of accomplishment, motivating them to continue with their treatment.
Diagnosis: A dynamometer can also help diagnose certain conditions, such as muscular dystrophy or other neuromuscular disorders, by measuring the strength of specific muscles.
Research: Dynamometers are used in research to gather data on muscle strength and performance, helping to improve understanding of various conditions and develop more effective treatment methods.

The dynamometer used at Dynamic Movement Physiotherapy, Hereford is the integrated ActivForce system. This combines the physical device used to assess the strength with a digital dashboard using an app. This helps measure key strength data and quantifies real-time results.

The high-precision device provides accurate force data, and additional attachments can be used for extensive muscle movement and range of motion testing.

The ActivForce provides the following benefits:

It tracks data to allow close monitoring of individual markers, potential injury risks and chronic problems.
Using the data enables a highly personalized rehabilitation program.
It allows comprehensive Strength & ROM Analysis.
Assesses and tracks muscle symmetry (the strength on one side compared to the other, therefore assessing for any significant weakness)
Measures active and passive range of motion

Evidence for use of ActivForce2

In one study healthy adults aged 20-53 years of age, HHD demonstrated weak-to-moderate concurrent validity (r value 0.37-0.51, p≤0.05) with the "gold standard" measure of muscle strength assessment, isokinetic dynamometry (IKD) for peak torque values in hip extension
The American Academy of Physical Medicine and Rehabilitation published a systematic review which supports the use of HHD as a reliable and valid measure of muscle strength that is easy to use, portable, and more cost-affordable than IKD, but does question its efficacy for larger joint use such as the knee [4]
In The International Journal of Sports Physical Therapy The ActivForce Digital Dynamometer and microFET2 HHDs were found to have similar levels of intra- and inter-tester reliability and criterion validity for assessing shoulder muscle force production of internal rotation, external rotation, and forward elevation. Reported intraclass correlation (ICC) values for intra- and inter-rater reliability were high (0.85-0.99)
The Journal Physical Therapy has a study in which a proposed HHD measurement of 31.1% knee extension force (normalized to bodyweight) was established as necessary for independence in performing a sit to stand in hospitalized adult populations
The Journal of Athletic Training found that in healthy populations, external stabilization of the HHD using a belt (to avoid examiner strength as a confounding variable) has been shown to be reliable and valid for the assessment of hip and knee strength assessment
- Intrarater reliability was excellent (ICC = 0.8-0.96) for hip adductors, abductors, flexors, extensors, right internal rotators, external rotators and the knee extensors, and moderate for bilateral knee flexion (ICC = 0.62–0.66) and left hip internal rotation (ICC = 0.70). Correlation with IKD was moderate to high (r=0.6-0.90)[7]

STABILZER - PRESSURE BIOFEEDBACK CUFF

The Chattanooga Stabilizer is a pressure biofeedback device used for the assessment of the core and depper neck muscles and for assistance with strengthening exercises for these muscles.

It registers changing pressure in an air-filled pressure cell during spinal movements during exercise. The gauge can help the patient to focus on the exercise to increase the pressure as necessary.

It is specifically used for exercises that focus on the protection and stabilization of the lower back and neck muscles, which is important for the treatment and prevention of low back and neck pain.

Evidence:

Plos One found that the Stabilizer device 'facilitates a coordinated contraction of the abdominal trunk muscles at the anterior aspect and the roof of the core, and enables subjects to measure the strength of these muscles'.

The Journal of Physical Therapy Science that found that 'the pressure biofeedback unit could have great relevance when used in the clinic for biofeedback purposes in individuals with low back pain'.

PALPATION METER (PALM) FOR SKELETAL ALIGNMENT EVALUATION.

Leg length discrepancies (LLD) are categorized into two types: true (structural) LLD, which involves actual bony asymmetry, and apparent (functional) LLD, arising from responses to changes in the kinetic chain. For instance, muscles can alter leg positioning, creating the illusion of a short leg without true structural differences. LLD has been linked to various musculoskeletal disorders, making its measurement an essential aspect of physical examinations

The leg lengths can differ between the left and right leg with the right often being the shorter one. Many individuals may experienced this discrepancy since birth, while others develop it due to muscle imbalances. For example, tight adductor muscles may pull the leg inward creating an aquired change, or tight hip flexors can rotate the pelvic bone forwards causing an acquired short leg.

If there is a difference, even from birth, it can lead onto problems in other parts of the body. Each footis linked to the opposite shoulder through a dynamic chain. The foot can effect the knee, which can then affect the hip, then the opposite lower back muscle s and hip bone and then onto the muscles up towards the shoulder. (similar to the cogwheel effect in clocks etc). So theoretically, if you have one leg shorter, it can lead to problems in any part of the chain. That is why it is very important to assess the leg length difference.

Such differences, whether congenital (from birth) or acquired 9changes in muscle balance), can lead to problems elsewhere in the body, Therefore, leg length differences is crucial, and the PALM tool is effective in this regard. While X-rays provide most accurate measurements, the PALM offers more precise results than traditional tape measures.

The PALM (Palpation meter) provides a more reliable method for measuring LLD compared to tape measures, helping to distinguish between functional and structural short legs and identifying the specific areas where there is a difference.

Leg length discrepancies (LLD) are usually classified into two groups: true and functional.

True (Structural) LLD have an actual bony asymmetry between the top of the leg and the ankle - there is a structural difference between the legs.
Apparent (Functional) LLD occur because of a physiological response to changes in the kinetic chain anywhere from the foot to the lower spine. For example, some muscles may be tight and can then pull the leg into different positions. They may give the appearance of a short leg when a true LLD does not actually exist.

Leg length discrepancy has been associated with a variety of musculoskeletal disorders. This means that the measurement of LLD is an important part of the physical examination.

The PALM is an instrument that was recently developed to indirectly measure LLD. LLD has often been measured using eye ball estimates or using tape measures. However, there is a great deal of criticism and debate surroundings the accuracy of tape measure methods. It helps to differentiate between a functional and a structural short Leg. It can also help to determine what part of the leg length difference is structural and what part is functional.

The PALM can help determine the skeletal asymmetry and then used to determine where the asymmetry is by making measurements at various landmarks like in the pelvis, upper leg and lower leg.

Evidence:

In the journal of Clinical Orthopaedic and Related Research it was found that the PALM has been found to be a reliable and valid instrument for measuring pelvic height difference.

The Journal of Orthopaedic and Sports Physical Therapy found that in all subjects assessed, the validity for the estimates of pelvic crest heights were excellent with the PALM meter when compared with the standing X-ray of the pelvis.

OTHER DEVICES USED DURING ASSESSMENTS AND TREATMENTS

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HAND HELD DYNAMOMETERS

A dynamometer is a device used to measure the strength and force of muscles. It is commonly used in physiotherapy to assess a patient’s muscle strength and track their progress over time. ​ Benefits of using a dynamometer in physiotherapy:

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STABILZER - PRESSURE BIOFEEDBACK CUFF

PALPATION METER (PALM) FOR SKELETAL ALIGNMENT EVALUATION.

A dynamometer is a device used to measure the strength and force of muscles. It is commonly used in physiotherapy to assess a patient’s muscle strength and track their progress over time.

Benefits of using a dynamometer in physiotherapy: