The Importance of Test Positioning

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As occupational therapists, our goal is to facilitate independent engagement in occupations meaningful and important to our clients. In order to assess occupational functioning ability, we must assess the mobility of the joints as well as the strength and endurance of the muscles involved via assessing range of motion (ROM) and performing manual muscle tests (MMT). 

It is important to use specific bony landmarks and proper positioning when measuring ROM. For clinical purposes, any therapist who is measuring mobility at a certain joint should be able to easily find these landmarks and yield similar and accurate measurements, increasing inter-rater reliability. Consistent and proper positioning of the client and the joints being measured will not only increase accuracy of the measurements, but also should abide by the safety precautions relevant to that client. Clients that we see will most likely already be in pain, so positioning the client and the joint correctly will prevent any unnecessary pain when moving through full available ROM. 

 Based on the preliminary screening and ROM measurements, you can appropriately position the client to perform MMT. If the client has enough muscular strength to independently move through their full available ROM sitting upright, the client's strength is considered to be a grade 3 (fair), and the therapist should position client in the against gravity (AG) position, starting in the mid-range position, to further test the client's strength. The mid-range position allows for the most actin and myosin cross-bridge formations, and therefore enabling the strongest muscle contraction possible. To test for  grades of 3+ (fair +) and higher, we will measure how effectively the client can hold isometric contractions against varying levels of resistance added by the therapist. 

 If the client is very weak and cannot overcome the forces of gravity to reach full available ROM, let alone additional resistance, the client's strength is considered to be 3- (fair -) or lower, and the therapist should position them in the gravity eliminated (GE) test position. This positions the joint so that the motion is parallel to the ground and gravitational forces are not working against it. The therapist should record how effectively the client can move through their ROM in this position and any palpations or flickers of muscle activation felt. Proper positioning and good observation of these testing positions will increase accuracy and prevent compensatory movements. 

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