User's Manual
Contents
1.2. The Commander Algometer and DigiTrack is a digital force gauge housed in an ergonomically designed package suitable for generating force whether it is held in the palm or in the fingertips The processing unit can store up to 40 tests and calcu late CVs and bilateral differences Two algometry tips are included with both the Commander Algometer and the DigiTrack Commander The larger tip is 1cm and the smaller is 5cm The nor mative data is provided for a variety of tests see charts later in this section using the lcm tip The 5cm tip is used for testing around the cervical area Reliability Studies Fischer demonstrated excellent reliability and reproducibility with pressure thresh old measurement Reeves et al showed high inter and intrarater reliability for testing marked trigger points and for locating unmarked trigger points in the tem poro mandibular region Both examiners within the Reeves study were trained in myofascial therapy and similar results may not be feasible with untrained examin ers Merskey and Spear also showed good inter and intrarater reliability especial ly when the patient acts as his or her own control They also concluded that pain measurements were reliable enough to use as indicators of emotional state and the effectiveness of anesthesia and analgesia Test Methodology Pressure Threshold Measurement 1 Have the patient lie down exposing the areas to be tested Supporting pillow
3. REP2 REPS AVG CV TIME PL 0 10 REPI REP2 REPS AVG CY TIME 9 Index DIP Flex Deltoid 10 Middle DIP Flex a 11 Ring DIP lex T Adol Te 12 Litle DIP Fiex overage force of performed reps 4 ADEF is the percent deficit or difference existing between right and left side maximum values Th Index HP Een font of variation for performed tests two required 5 PL I 10 is evaluator supplied pain level rating between O none and 10 sever 4 gt average time above threshold for performed reps Al 14 Middle MP Ent 15 Lite MP Ex Sample worksheets 16 Index PIP Ex T7 Middle PIP En 18 Ring PIP Et 19 Litte PIP Ee To reorder worksheets call JTech Customer E ECH 2 a gt ka MEDICAL INDUSTRIES Service at 1 800 985 8524 a scaled Algometer Testing In 1949 Steinbroker provided the first documentation of utilizing a pressure gauge to measure palpation forces for the purposes of physical diagnosis The term algometer however wasn t coined until 1954 by Head and Keele Algometers sometimes referred to as dolorimeters palpameters algesiometers or pres sure threshold meters are designed to quantify and document levels of tenderness via pressure threshold measurement and pain sensitivity via pain tolerance measure ment An algometer is essentially a very sensitive force gauge mechanical or digi tal designed to measure forces applied to very specific locations on the patient Its tip gene
4. SELECT and CHANGE The buttons function as follows SETUP Press this button until Setup is displayed at the top of the LCD It is also used to exit Setup after setting parameters SELECT Use this button to advance and select the parameter to be changed CHANGE This button changes the parameter setting TEST ALT Press this button until console is in Setup mode After parameters are set use this button to exit back to Test mode While in Setup mode use this button to advance through parameters When a parameter is displayed use this button to change the Cz CHANGE default setting lt Adjustable Defaults The Commander console allows you to control the following default parameters THRESHOLD This setting determines the amount of force that must be exerted against the dynamometer before the console begins recording data This setting is used to avoid inadvertently beginning a test It can be set at 2 4 1 3 pounds TEST TIME Determines the length of a sustained test in seconds During the test the buzzer sounds The test ends when either the allotted time expires or the force drops below the threshold value Test Time can be set from 1 5 seconds 30 sec onds or to blank for untimed tests TEST Controls the number of tests available for an exam The console automati cally goes into Review mode when the number is reached It can be set from 5 40 in increments of fiv
5. each test 3R 11 0 10 8 10 9 10 8 1 4 9 3L 6 6 6 3 7 0 6 6 5 2 8 38 Consistency of Effort 6 of 6 CV s valid designed to interface with our Tracker Ave average force Time average for reps Tracker Computerized Testing The Commander Algometer is Software the leading Windows based CV coef of variation Def bilateral deficit musculoskeletal evaluation system The up grade package includes the Data provided with Downloader Software Tracker Software Engine and Interface Box and Tracker software module for computerized algometry The Commander Algometer plugs into the Algometer DigiTrack port of the Tracker Interface Box without modification Tracker software automatically records test results ana lyzes statistics makes comparisons to previous tests works seamlessly with other Tracker diagnostic devices and outputs data in a comprehensive report format For more information on upgrades contact your JTech sales representative or call JTech at 1 800 985 8324 Wrist and Desktop Use of the Console Your Commander system comes equipped with two cords for connecting the dynamometer to the console unit The short cord is used when the Commander console is strapped to the examiner s forearm The longer cord is used when the Commander console is placed on a desktop or left in the case during testing The cords connect to the console and dynamometer with telephone jack plugs To remove a cord press down
6. never be used alone to diagnose but should be used in conjunction with other diagnostic testing tools such hand range of motion and NCV Contraindications When active joint motion is not possible or disallowed by a physician MMT should not be performed Do not perform a manual muscle test if reinjury seems likely or in the presence of spasticity Remember the final responsibility for the risk of injury to the patient lies with the examiner Frequency If a rehabilitation program is initiated bilateral MMT should be completed at peri odic intervals along with other diagnostic testing According to an ASHT publica tion either monthly or bi monthly are acceptable intervals When applicable such as post surgery testing may be performed every visit to make sure the repair remains intact Reliability A number of factors can affect the reliability of MMT results such as examiner experience and knowledge patient cooperation patient stabilization direction of force and exertion of force and placement of the dynamometer To help improve the reliability of MMT 1 Position the patient and stabilize the body part being tested carefully 2 Make sure the joint being tested is always at the same degree of flexion or extension 3 Position the dynamometer at the same place in relation to the joint and anatomi cal landmarks 4 Provide the patient with consistent instructions about the procedure 5 Increase resistance gradually
7. on the cord jack s plastic release lever and slide the end out of the receptacle When installing a cord make sure the jack snaps securely into place NOTE fa cord is damaged or lost do not attempt to replace with a standard tele phone cord as the wiring is not the same Contact JTech Customer Service for the correct replacement cord Using the Commander Console NOTE The console for both the Algometer Commander and DigiTrack Commander operate in the same manner so the following instructions apply to both devices Conventions This manual adopts the following conventions throughout Test Refers to one pressure or strength assessment that may include multiple repetitions and comparisons between the right and left side For instance testing pressure threshold at one location with three repetitions for the right side and three repetitions for the left side is one test Exam Refers to multiple tests For example testing pressure threshold at multi ple locations comprises one exam On Off Button QA Press the button once to turn on press again to turn off Exams stored in memory are not erased when power is turned off Pressing this button and holding for two seconds deletes stored exams For information about deleting tests see Advanced Console Features on page 9 The console will shut off automatically after four minutes of inactivity Note Make sure no force is applied to the dynamometer when turning the con s
8. the left side skipped by pressing the NEXT button or the right side can be skipped by pressing NEXT and testing the left side Alternating Sides Repetition Order When Test Alt mode is displayed the rep etitions alternate between right and left side as follows TEST 1 REP 1 RIGHT TEST 1 REP 1 LEFT TEST 1 REP 2 RIGHT TEST 1 REP 2 LEFT TEST 2 REP 1 RIGHT TEST 2 REP 1 LEFT etc This method can be used if submaximal effort is indicated By mixing up the left and right side routine the subject may have a more difficult time repeating the results on each side as indicated by the coefficient of variation Testing Methods The Commander console can store up to 40 tests in memory complete with data for all repetitions and statistics In order to easily record multiple tests the Commander uses Automatic Indexing This method automatically indexes the display to the next test in the series without requiring you to press any buttons For example after completion of all right and left side repetitions of test 1 the display indexes to TEST 2 REP 1 RIGHT NOTE After completing a test Commander prevents inadvertent deletion of tests previously stored in memory by indexing to the next test not completed For example if test 2 was completed previously after test 1 is completed Commander will skip test 2 and index to test 3 TEST f tsr Sequential Testing Method REP RIGHT This method always begins with t
9. 5 Above values are only applicable when using the 1cm tip Algometry References 1 Fischer AA Pressure algometry over normal muscles Standard values validity and reproducibility of pressure threshold Pain 1987 30 115 126 2 Fischer AA Documentation of myofascial trigger points Arch Phys Med Rehab 1988 69 286 291 3 Fischer AA Pressure Threshold Meter Its use for quantification of tender spots Arch Phys Med Rehab 1986 67 836 838 4 Fischer AA Manual for Pressure Threshold and Tolerance Measurement 1986 Great Neck NY 5 Hollander JL Young DG Palpameter instrument for quantification of joint ten derness Arthritis Rheum 1963 6 277 6 Keele KD Pain sensitivity tests pressure algometer Lancet 1954 1 636 639 7 Lansbury J Methods for evaluating rheumatoid arthritis In Hollander JL ed Arthritis and Allied Conditions Textbook of Rheumatology ed 7 Philadelphia Lea amp Febiger 1966 269 291 8 McCarthy DJ Jr et al Dolorimeter for quantification of articular tenderness Arthritis Rheum 1965 8 551 559 9 Merskey H Spear FG Reliability of pressure algometer Br J Soc Clin Psychol 3 130 136 10 Merskey H et al Clinical investigation of reactions to pain J Ment Sci 1962 108 347 355 11 Moldofsky H Chester W J Pain and mood patterns in patients with rheumatoid arthritis prospective study Psychosom Med 1970 32 309 318 12 Moldofsky H et al Musculoskeletal symptoms and non
10. Algometer COMMANDER User s Manual Written by Tracy Livingston David Bernardi and Michael Carroll Published by JTech Medical Industries 4314 ZEVEX Park Lane Salt Lake City UT 84123 801 264 1001 www jtechmed com Copyright O 1998 JTech Medical Industries All rights reserved Contents Register Your Commander 0 00 e cece eee ee 1 Commander Warranty 0 644 a See eed beasts dete ee 1 To have your Commander or dynamometer repaired 1 Features and Benefits desirte riera 2 Check Your System isss cepai he Mees Sade SW Bald sees ees 3 Proper Cate suo 2h Gants tase eben lias toca ls heals sas tentials 3 Calibration cutis asa ates So Mates San o et cate dade 3 Battery Tite dudan cali ad 15 0 o ios 3 Available Uperad s s c 5 2 cara Bakes CaM keto ow Galle ea aa 4 Wrist and Desktop Use of the Console 0 0 0 0 cee eee nee 4 Using the Commander Console Conventions Ave i oe ee beh os ARA A LS 5 On Off Button oh dt A dd 5 Setup Modest e A eh ees A e dd ad 6 Test and Test Alt Modes 0 0 ccc eee nee T Testing Methods A ee e e n e A a ote E ale gs 8 Advanced Console Features 0 0 cece eee teenies 9 Reviewing and Exam 1 cece 10 Statistics Definitions syr poani r ie a eect tenes 11 Special Use of Statistics for Algometry 0 0 0 11 Deleting an E X m a 0 secon atk Ra eke wa Sh he Bee 12 Printing Reports aicet cast Geek whose A aida 12 Sample Wor
11. REM sleep disturbance in patients with fibrositis syndrome and healthy subjects Psychosom Med 1975 37 341 351 13 Reeves JL et al Reliability of the pressure algometer as a measure of myofas cial trigger point sensitivity Pain 1986 24 313 321 14 Steinbroker O Simple pressure gauge for measured palpation in physical diag nosis and therapy Arch Phys Med 30 389 390 15 Travell JG Simons DG Myofascial Pain and Dysfunction Trigger Point Manual Baltimore MD 1983 Williams amp Wilkins 16 Tunks E et al Tender points in fibromyalgia Pain 1988 34 11 19 17 Yamagata S et al Diagnostic re evaluation of electric skin resistance skin tem perature and deeper tenderness in patients with abdominal pain Tohuku J Exp Med 1976 118 Suppl 183 189 Manual Muscle Testing of Fingers Indications The general purpose of manual muscle testing MMT is to evaluate as closely as possible the strength or weakness of a specific muscle MMT of the hands should be performed when neurological problems at the nerve root or peripheral nerve are suspected or if disease or disuse affects the muscles MMT can help identify spe cific nerve motor function Bilateral testing indicating a weakness in several mus cles may further substantiate disease or injury involving nerve roots or peripheral nerves as long as disuse or disease of the fibers of the muscle and disorders of the higher levels of the central nervous system are ruled out MMT should
12. Statistics To scroll through and review all the statistics for the displayed test continue press ing REVIEW Press Next to view statistics for the next test In the following example the statistics for test 2 are displayed in the order they will appear by pressing REVIEW The number of repetitions was set at two TEST REVIEW REP RIGHT Vy l REVIEW RIGHT A Vamm LBS TEST REVIEW REP 2 RIGHT a TEST AVG o Pr Maximum force right side repetition 1 TEST 4 REVIEW RIGHT CV CV for right side or Maximum force right side repetition 2 ULI Average force for right side repetitions TEST 4 REVIEW RIGHT y SECONDS TEST TIME Average test time average for all reps of the time force was above threshold Continued top of next page 13 REVIEW TEST REP LEFT LBS ap MAX J e Maximum force left side repetition 1 e TEST 4 REVIEW TEST REVIEW TEST 4 REVIEW REP 2 LEFT LEFT LEFT Cl Cl Fe JU 1 L Maximum force Average force CV for left side left side repetition 2 for left side repetitions TEST REVIEW TEST REVIEW After all statistics have LEFT LEFT been selected the display A DEFICIT circles back to the begin ning L ceca L To VIEW the fix test l TEST TIME press NE
13. XT The dis Average test time Bilateral deficit play indexes only to test average for all reps of the time left side numbers with data force was above threshold Statistics Definitions LBS MAX In Test and Test Alt modes LBS displays force against the dynamometer in real time In Review mode LBS MAX shows the maximum force that was applied to the dynamometer for the displayed repetition LBS AVG The average force of all repetitions for the indicated side AVG TEST TIME The average time the force was above threshold for all the repetitions for the indicated side CV The coefficient of variation for all the repetitions for the indicated side using the n 1 method DEFICIT Bilateral deficit indicating weakness of one side compared to the other Special Use of Statistics for Algometry The LBS AVG and AVG Test Time statistic can be used to monitor the applied rate of force increase Some studies indicate that this rate should be approximately 2 2 lb per second up to the point of pressure tolerance then released To obtain rate of increase divide average force by average test time Deleting an Exam To erase an exam turn the Commander console on then press and hold the on off button for a minimum of two seconds or until the unit reactivates The unit will beep and turn off indicating data has been erased Note All test default values will be retained Printing Reports Reports can be printed by tw
14. d number of repetitions Check Your System Your dynamometer Commander system should include the following parts Commander Wrist Unit 3cm Algometer Pad Dynamometer 1cm Algometer Pad Short Cord Digit Testing Pad Long Cord Worksheets Make sure the serial number on the dynamometer matches the serial number on the Commander Console If these numbers do not match call JTech Customer Service Proper Care With proper care your new Commander device will provide many years of worry free use Do not immerse the dynamometer or the console in water place in an autoclave or sterilize with harsh disinfectant Clean the housings with a soft non abrasive cloth moistened with clean water Clean the console display using a non abrasive dry cloth Do not use cleaners Avoid dropping or banging console or dynamometer against hard objects Do not stand on apply more than 30 lb of force or use the dynamometer for anything other than algometry or finger strength testing Failure to follow these policies will void the warranty Calibration To ensure accuracy the dynamometer and Commander console have been factory calibrated with weights traceable to the National Institute of Standards and Technology When the Commander console is turned on it automatically zero cali brates itself Therefore make sure no force is being applied to the dynamometer when the Commander console is turned on Any force applied to the dynamometer when the console is t
15. e REP Sets the number of repetitions per side per test It can be set from 1 4 A minimum of two repetitions is required for CV calculations LBS N This parameter controls whether force readings are in pounds or new tons Test and Test Alt Modes Tests are conducted using either the Test or Test Alt modes How the modes are used is described below To conduct a test apply pressure on the dynamometer Test recording begins when the default threshold force is exceeded A test ends when test time expires or the force on the dynamometer drops back below the threshold The display then index es to the next repetition in the series After all repetitions for a test are completed the display indexes to the next sequential test number Continue testing with this method until all tests are recorded in memory Repetitions for a Test The Commander console can record and average up to four repetitions per side for each test The repetition order is selected by either of two methods Same Side Repetition Order When Test mode is displayed the unit prompts for all right side repetitions first then all left side repetitions For example if the default is two repetitions the test sequence in Test mode is TEST 1 REP 1 RIGHT TEST 1 REP 2 RIGHT TEST 1 REP 1 LEFT TEST 1 REP 2 LEFT TEST 2 REP 1 RIGHT TEST 2 REP 2 RIGHT etc Helpful Hint If unilateral testing is required the right side can be tested and
16. est 1 and uses Automatic Indexing to pro ceed from test 1 to test 2 etc Test results should be marked on the exam worksheet corresponding to the test numbers from the display Helpful Hint Since the display indexes past old tests stored in memory this method is recommended only if all pre vious tests have been erased In this example the test results would be written under 1 on the worksheet Assigned Testing Method This method is used for conducting a series of tests when a name has been perma nently assigned a test number in your clinic It can also be used when your testing sequence follows the worksheets such as for digit strength testing In this method index MP flexion is assigned test 1 index PIP flexion test 2 and index DIP flexion test 3 In this example test number 2 on TEST e TEST the display corresponds to a test q you have permanently assigned REP RIGHT the number or in the case of fin poy ee ger strength testing it would be index PIP flexion LBS MAX Helpful Hint You should be careful to select the proper test number for the type of test before beginning When performing an established series you can use Automatic Indexing to move from one test to the next in the series Use care to begin the series at test number and to use the assigned order Advanced Console Features Press REDO to test the last repetition again This feature is helpful if the current test was sta
17. g eliminat ing malfunctions resulting from random component failure is impossible Therefore JTech will at its option repair or replace the product with a new or reconditioned unit at no charge for a period of one year from the date of purchase In view of the varied conditions in which the unit will be used the Commander Console and the dynamometer are sold as is and JTech s responsibility does not go beyond the terms set forth above JTech will not be responsible for medical expenses or any direct indirect or consequential damages arising from the use of this product JTech shall in no way be liable loss of revenue or profits resulting or alleged to result from use of this product THIS WARRANTY IS MADE EXPRESSLY IN LIEU OF ANY OTHER WARRANTY EXPRESS OR IMPLIED INCLUDING AN IMPLIED WARRANTY OF MER CHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE UNDER NO CIR CUMSTANCES SHALL JTECH BE LIABLE FOR ANY DIRECT INDIRECT INCI DENTAL OR CONSEQUENTIAL DAMAGES THE REMEDIES SET FORTH IN THIS WARRANTY SHALL BE THE ONLY REMEDIES AVAILABLE EXCEPT AS SPECIFICALLY PROVIDED BY STATE LAW NO PERSON HAS ANY AUTHORITY TO BIND JTECH TO ANY REPRESENTATION OR WARRANTY EXCEPT AS SPECIF ICALLY SET FORTH HEREIN To have your Commander repaired 1 Contact JTech Customer Service and describe the problem After receiving a return authorization number return the product to JTech including all acces sories postage paid and insured to JTech JTec
18. h is not responsible for dam ages or losses incurred in shipping 2 Submit proof of purchase and date 3 Include a brief explanation describing the problem Features and Benefits Algometer and DigiTrack Dynamometers Can be used for both algometry and finger strength testing Uses ergonomic dynamometer design for comfort during testing Precision technology achieves fine resolution and 99 force accuracy Upgradable to Tracker computerized testing system Commander Console gt OOH 4 OF Easy to read 1 5 high LCD display Operates during exams either as a wrist unit or as a desktop system using the included longer cable Gathers stores and analyzes up to 40 bilateral tests with up to four repetitions per side Calculates CV maximum force test time and average force for each repetition Automatically documents bilateral deficit Tests can be timed from 1 5 seconds for 30 seconds or conducted untimed for maximum force measurements Measures up to 25 pounds in 1 lb increments for accurate pressure tolerance pressure threshold and finger strength testing Test now record later because the exam is stored in memory even when the Commander console is turned off Automatic audio prompts examiner for the next test in the series Battery powered for portable operation Test protocols can be customized according to number of tests starting force newtons pounds test time an
19. ksheets 0 0 0 cece eens 12 Algometry Testing General nformati n oss ooh oes peas eo Ss Bini a ea Bee ee Se bas 13 Reliability Studies am 2245 4 pees ghee de bn oe Sloe tacks thaws bate Sale 14 Test Methodology iseer gon body bass SOR Ee Behe cata eee ods 14 Clinical Significance of Results 0 0 0 0 0c eee ee eee 15 Normative Charts yla sth Sa bates ead a etek wh bere 16 References taras ba bout eal de bs ois ued tae ds bbe wah 17 Finger Manual Muscle Testing Indications e et ee es 18 Contraindications a bap eed ees 18 Frequency ate Sees ae ee eee on Sie te ee es A eee ee ons 18 Reliability 2000000 a Sk ee de a Ee ee ee Si 18 Grading 222 05 ba oe oh a eo Sa ee a we oe ee ee A 19 References A a cite Sd 19 Register Your Commander Please register your Commander products so we can provide you with easy access to our friendly customer service department Registering your device will also guarantee that you will be fully covered under your warranty Registration also provides you with these extra benefits New product upgrades New product announcements Seminar announcements Special offers For your convenience a registration card is included with your order Simply fill it out and return it to JTech Commander Warranty One year Limited Warranty The Commander console and Algometer or DigiTrack dynamometer are designed to perform reliably and to meet specifications In spite of diligence in manufacturin
20. o methods Method 1 Press PRINT to generate a complete report of all the test results includ ing statistics Method 2 Connect the Commander to the Reporter printer using the supplied cable Connect the Commander unit to a personal computer using the optional serial inter face cable Use the optional Commander Download software to transfer all tests and statistics to a word processor report or spreadsheet Sample Worksheets Your Commander includes Algometer and DigiTrack worksheets for manually recording test data The worksheets include standard protocols for algometry and digit strength testing The worksheet provides spaces for test values and all calculat ed statistics in the order they appear when viewed in Review mode ascription Right Side Left Side Threshold Rept pera REPS avs wo TIME PL 0 10 Repl rerz REPS AVG wy TIME Commander DigiTrack Report apezius Name Date Examiner 5 Major Tighe Side Test escri mep nera nera nepa oecv neos mera nees ners cv soe Scapulae L Index HP Fle jor 2 Mile MP Fle ntis 3 Ring MP Flex Medius 4 Uitte MP Fiex tatus 5 Index PIP Flex Deltoid 6 Middle PIP Flex ipinals 7 Ring PIP Flex pinals 8 Little PIP Flex Tolerance REPI
21. ole on When the console unit is turned on it will activate in either Test mode or Review mode depending on whether an exam is stored in memory If no exam is stored in memory the console will activate in Test mode ready for test 1 The active mode in this case TEST is displayed in this area Test and repetition numbers are shown here Side being tested is displayed on this line Real time force on dynamometer can be shown in fractions of a pound or in newtons Testing Mode If an exam is in memory when the console is turned on Commander activates in Review mode From this point you can review exam data change to Test mode to finish testing or delete the exam See the appropriate headings below Setup Mode Testing Defaults The Commander console enables you to use the Setup mode to control a variety of test parameters such as the testing threshold number of tests test time number of repetitions per test and force readings in pounds or newtons Once test parame ters are set they become the defaults for the console For example if you set the number of repetitions to three then the unit will test for three repetitions per side for every exam until you change the default Default settings do not change when the unit is turned off or when an exam is deleted Defaults can only be reset manu ally Setting Defaults Three buttons are used when setting console defaults SETUP
22. rally ranges between 5cm and 2cm Results are typically reported in terms of pressure Pressure threshold is defined as the minimum pressure force required to cause pain Pressure threshold measurements are usually performed over areas of muscle tenderness sometimes referred to as trigger points Normal data for male and females have been determined for many muscles in which trigger points are fre quently found Side to side comparison is also of significance when evaluating the results of testing Pressure tolerance is defined as the highest pressure force which can be tolerated under clinical conditions Pressure tolerance measurements are typically performed over normal muscle and bone Normal pressure tolerance data for males and females has been determined Many clinical applications of the algometer have been documented including eval uation of fibrositis and fibromyalgia identification of trigger points quantifica tion of joint tenderness in arthritis conditions evaluation of pain sensitivity abdominal pain and in psychological research Pressure measurement has also been shown effective for evaluating the results of pain relieving modalities such as anesthetic blocks heat manipulation anti inflammatories and for documenting the long term effectiveness of treatment Because of its reliability and reproducibility algometry can be used for objective medico legal documentation of pain intensity
23. rted inadvertently was done incorrectly or was for practice Redo or delete other tests Press REVIEW then press NEXT until the correct test number is displayed While holding the REVIEW button down press Redo The entire test including all right and left side repeti tions will be deleted Then redo all repetitions for the deleted test Important Note When using REDO for a test the entire test including repetitions for the right and left side is deleted Once a test is deleted it cannot be recovered later OOO 5 Review last repetition To review the measured force for the last repeti tion press REVIEW after the repetition is complete To review other Statistics associated with the test continue pressing REVIEW and the display will scroll through all available statistics To continue testing with the next repetition press TEST CONT To erase the repetition and start REDO over press REDO OD9 vs o viewing an Exam An exam can be reviewed at any time either during testing or after by pressing the REVIEW button The last completed repetition will be dis played To review other tests within the exam press NEXT to advance to the next test with recorded data When advancing through tests the Commander display shows the test number with the right side repetition To see left side repetitions and additional statistics press REVIEW 0900
24. s should be used to assist the patient in relaxing the muscles overlying the tender points 2 Explain the procedure to the patient Have the patient verbally indicate the onset of pain with a Yes 3 Have the patient point to the specific area of discomfort Palpate the area with your fingertip to identify the point of maximum sensitivity Mark that point with a pen and document its location with reference to an anatomical landmark for future testing 4 Locate mark and document the same point on the contralateral side 5 Remind the patient to say Yes upon the onset of pain and place the applicator tip over the mark Apply force perpendicular to the skin s surface at a gradually increasing rate of 2 pounds per second Remove the algometer when the patient says Yes and Commander will automatically record the result Multiple read ings may be taken to improve reliability 6 Test the contralateral side Pressure Tolerance Measurement 1 Have the patient lie down exposing the middle deltoid and the shin 2 Palpate the bulk of the deltoid muscle to rule out the presence of local tender ness and or pathology Mark the point of maximum muscle bulk with a pen 3 Explain the procedure to the patient Prepare the patient to verbally indicate when the pain becomes too great by saying Stop 4 Place the applicator tip over the mark Apply force perpendicular to the skin s surface at a gradually increasing rate of 2 pounds per
25. second Remove the algometer when the patient says Stop and Commander will automatically record the result 5 Multiple readings on the same site or contralateral side may be performed to improve measurement reliability 6 Repeat the procedure using the mid tibia Clinical Significance of Results Pressure Threshold Measurement Fischer has stated based on clinical experience that a difference exceeding 2 kg 4 4 lb using the 1cm tip between the painful and normal sides indicates clinically significant tenderness and is evidence of pathology As Merskey pointed out utilizing the patient as his or her own control is more reli able than using the normal values that have been established In the instance of bilateral pathology Fischer recommends using either an adjacent normal area as a reference or the 84 cutoff values associated with the normative database as summarized in Table 1 Pressure threshold values generally less than 3 kg cm 6 6 lb using the 1cm tip are indicative of pathology and are clinically significant Pressure Tolerance Measurement The normative data for pressure tolerance measurements are summarized in Table 2 and should only be used as a reference since tolerance measurements are thought to vary widely over diverse cultural groups Fischer has outlined various combina tions of pressure tolerance results and summarized the clinical significance of each Typically muscle pre
26. ssure tolerance values are higher than bone If test results show muscle pressure tolerance is lower than bone assuming local tenderness is ruled out myopathy may be the cause According to Fischer causative factors may include hypothyroidism or estrogen deficiency Normal muscle tolerance values with a reduction in bone tolerance may indicate bone pathology Local tenderness due to other causes must be removed as a consid eration before diagnosing a bone disease The instance where pressure tolerance is reduced for both muscle and bone may be indicative of a generalized low pain threshold and consequently an adverse reac tion to any medical intervention Fischer recommends anti depressant medication and biofeedback to help these patients master their pain coping abilities High pressure tolerances for both muscle and bone characteristic of athletic indi viduals indicates a high pain threshold and therefore may mask pathological ten derness in the diagnosis of triggerpoints Average Normative and Lowest Normal Pressure Threshold Values 1b cm2 Average PTM Ib cm2 Cutoff PTM Ib cm2 Teres Major Upper Trapezius Levator Scapulae Supraspinatus Infraspinatus Middle Deltoid Pectoralis Major Gluteus Medius L4 Paraspinals 2 cm out Above values are only applicable when using the 1cm tip Pressure Tolerance Measurement Normative Data Ib cm Middle Deltoid 26 0 5 7 22 5 7 0 Mid Tibia 22 9 4 9 19 6 7
27. to give the patient time to resist and hold Test repetitions typically take between 2 3 seconds Testing too quickly increases the chance of injury and too slowly can introduce fatigue 6 Two to three repetitions with a brief rest between are generally performed Commander requires two repetitions to calculate CV Grading Traditionally muscle testing uses a grading system for documentation and standard ization In the traditional system muscle test grades range from 4 5 Good Normal to 0 1 None Slight Contraction The following 0 5 scale is one that is commonly used 0 None or no muscle contraction 1 Slight muscle contraction with no movement 2 Poor contraction and movement only with gravity removed 3 Fair contraction with movement against gravity 4 Good contraction with some resistance against force 5 Normal contraction with full resistance against force In bilateral comparisons when a muscle can generate force but a strength deficit of 15 or more is present the muscle is generally assigned a grade of 4 References 1 Shultis Kiernan L Manual Muscle Testing In Clinical Assessment Recommendations ed 2 Chicago American Society of Hand Therapists 1992 47 53 2 Kendall FP McCreary EK Muscles testing and function 3rd edition Baltimore Williams amp Wilkins 1983 3 Daniels L Worthingham C Muscle testing techniques of manual examination Philadelphia W B Saunders Co 1986
28. urned on will become the zero value and will result in inaccu rate force readings NOTE To ensure accurate readings do not apply more than 24 9 lb of force during testing A maximum reading of 25 lb may indicate the unit has exceeded its 25 lb range Battery Life The Commander console uses a standard 9 volt alkaline battery The estimated bat tery life is 28 hours of operation The Commander console should always be turned off when not in use to maximize battery life The console will automatically shut itself off after four minutes of inactivity NiCad batteries can be used however the active battery life will be reduced to approximately eight hours or less When using a NiCad battery completely drain the battery before recharging to prevent memory in the battery that will further reduce battery life Available Upgrades Your Commander device can be used with the following upgrade products Downloader Software Kit Transfer Commander test data easily to virtually Algometry Tests any word processor exam form or Max Reps Ibs spreadsheet with Commander 1 2 3 4 Ave CV Time Def Downloader Software This 1R 8 7 9 0 8 8 88 2 3 9 Windows based package includes 1L 5 1 5 0 5 2 5 1 2 2 3 42 software and serial cable for transfer ring test data The software will auto 2R11 211 011 2 11 1 1 5 0 matically download all repetition and 2L 10 1 10 0 10 9 10 3 4 4 5 7 statistical information and the titles of
Download Pdf Manuals
Related Search