Table 6. Muscle groups with protocols for testing lower limb strength in children and young people with a neurological condition.
| Muscle groups (number of papers, n =) | Body and Limb position | Diagnosis | Equipment | Equipment placement | Body part stabilised | Test type | Trial used | |
|---|---|---|---|---|---|---|---|---|
| Ankle Plantarflexors (n = 7) [45,47,51–54,56] | ||||||||
| Sitting [45] | Knee extended 0o, hips flexed [45] | CP [45] | HHD, Citec [45] | plantar surface of foot, proximal to metatarsal heads [45] | lower leg, proximal to ankle joint [45] | Make [45] | Mean [45] | |
| Not reported [56] | Not reported [56] | DMD [56] | MMT (modified MRC scale 0–5 with +/- for grades 3–5) [56] | plantar surface of metatarsal headsa [56] | Nil [56] | Make [56] | Not reported [56] | |
| Supine [47,51–54] | Knee extended 0o, foot plantargrade [47] | CP [47] | HHD, Nicholas Manual muscle tester [47] | plantar surface of metatarsal heads [47] | nil [47] | Make [47] | Peak [47] | |
| hips 45o, knees extended [52,53] | CP [52] | HHD, MicroFET, Biometrics [52] | metatarsal heads [52] | pelvis with belt, manually on lower limb [52] | Make [52] | Peak [52] | ||
| CP [53] | HHD, Citec [53] | dorsum of foot at level of metatarsal headsb [53] | lower leg [53] | Make [53] Break [53] |
Peak [53] | |||
| Knee flexed 90o, hip 90o, ankle neutral [51,52,54] | CP [51] | HHD, Nicholas Manual muscle tester [51] | metatarsal heads [51] | lower leg [51] | Make [51] | Mean [51] | ||
| CP [52,54] | HHD, MicroFET, Biometrics [52,54] | plantar surface of metatarsal heads [52,54] | pelvis with belt, manually on lower limb [52,54] | Make [52,54] | Peak [52], All trials [54] | |||
| Standing [52] | Hip and knee extended [52] | CP [52] | SHR [52] | nil [52] | nil [52] | Dynamic [52] | Not reported [52] | |
| Ankle Dorsiflexors (n = 4) [45,47,55,56] | ||||||||
| Sitting [45,55] | Knee extended 0o [45] | CMT [45] | HHD, Citec [45] | dorsal surface of foot, proximal to metatarsal heads [45] | lower limb, proximal to ankle joint [45] | Make [45] | Mean [45] | |
| Not reported [55] | DMD [55] | RQMS strain gauge, Interface SM-50-12 [55] | Not reported [55] | back support [55] | Make [55] | Peak [55] | ||
| Not reported [56] | Not reported [56] | DMD [56] | MMT (modified MRC scale 0–5 with +/- for grades 3–5) [56] | Dorsal surface of foot over 1st metatarsala [56] | Nil [56] | Make [56] | Not reported [56] | |
| Supine [47] | Knee extended 0o [47] | CP [47] | HHD, Nicholas Manual muscle tester [47] | dorsal surface of metatarsal heads [47] | nil [47] | Make [47] | Peak [47] | |
| thigh, using stabilising belt [47] | Make [47] | Peak [47] | ||||||
| Ankle Evertors (n = 1) [56] | ||||||||
| Not reported [56] | Not reported [56] | DMD [56] | MMT (modified MRC scale 0–5 with +/- for grades 3–5) [56] | lateral aspect of foot over 5th metatarsala [56] | nil [56] | Make [56] | Not reported [56] | |
| Ankle Invertors (n = 1) [56] | ||||||||
| Not reported [56] | Not reported [56] | DMD [56] | MMT (modified MRC scale 0–5 with +/- for grades 3–5) [56] | medial aspect of foot over 1st metatarsala [56] | nil [56] | Make [56] | Not reported [56] | |
| Knee Flexors (n = 8) [46–48,53–56,56] | ||||||||
| Sitting [46–48,53–56] | Knee and hip flexed 90o [46–48,53–56] | CP [46] | HHD, Chatillion [46] | posterior calf, ~4cm proximal to malleoli [46] | thigh [46] | Make [46] | Peak [46] | |
| CP [47] | HHD, Nicholas Manual muscle tester [47] | proximal to bimalleolar linec [47] | nil [47] | Make [47] | Peak [47] | |||
| CP [54] | HHD, MicroFET, Biometrics [54] | posterior calf, 5 cm proximal to malleoli [54] | pelvis, thigh [54] | Make [54] | All trials [54] | |||
| CP [53] | HHD, Citec [53] | posterior calf, 5cm proximal to lateral malleolus [53] | thigh [53] | Make [53] Break [53] |
Peak [53] | |||
| SB [48] | HHD, Spark [48] | posterior calf, proximal to malleolid [48] | Thigh [48] | Make [48] | Peak [48] | |||
| Not reported [56] | Not reported [56] | DMD [56] | MMT (modified MRC scale 0–5 with +/- for grades 3–5) [56] | posterior leg, proximal to anklea [56] | nil [56] | Make [56] | Not reported [56] | |
| Knee Extensors (n = 13) [46–56] | ||||||||
| Sitting [46–55] | Knee and hip 90o [46–55] | CP [46] | HHD, Chatillion [46] | anterior calf, ~2 cm proximal to malleoli [46] | pelvis [46] | Make [46] | Peak [46] | |
| CP [47,51] | HHD, Nicholas Manual muscle tester [47,51] | anterior tibia, proximal to bimalleolar line [47] | nil [47] | Make [47] | Peak [47] | |||
| anteriorly, 5 cm proximal to lateral malleolus [47,51] | pelvis in chair using a belt [47] | Make [47] | Peak [47] | |||||
| nil [51] | Make [51] | Mean [51] | ||||||
| CP [53] | HHD, Citec 4 [53] | anteriorly, 5 cm proximal to lateral malleolus [53] | pelvis [53] | make [53] break [53] |
Peak [53] | |||
| SB, [48] DMD [50] | HHD, Spark [48,50] | anterior leg, proximal to ankle [48,50] | Thigh [48,50] | Make [48,50] | Peak [48] | |||
| CP [52,54] | HHD, MicroFET, Biometrics [52,54] | anterior tibia, 5 cm proximal from bimalleolar line [52,54] | pelvis in chair with belt, lumbar stabilisation adjusted with back of chair [52] | Make [52] | ||||
| pelvis, thigh [54] | Make [54] | All trials [54] | ||||||
| SB [49] | HHD, PowerTrack II Commander, Each [49] | anteriorly, mid-way between apex of patella and talocrural joint [49] | nil [49] | Make [49] | Mean [49] | |||
| SB [49] | MMT (0–5 scale with 1/2 points) [49] | Not reported [49] | Not reported [48] | Not reported [48] | Peak [48] | |||
| DMD [55] | RQMS strain gauge, Interface SM-50-12 [55] | Not reported [55] | back support [55] | Make [55] | ||||
| Knee flexed 20o [47] | CP [47] | HHD, Nicholas Manual muscle tester [47] | anterior tibia, proximal to bimalleolar line [47] | nil [47] | Make [47] | Peak [47] | ||
| Not reported [56] | Not reported [56] | DMD [56] | MMT (modified MRC scale 0–5 with +/- for grades 3–5) [56] | anterior tibia, proximal to bimalleolar linea [56] | nil [56] | Make [56] | Not reported [56] | |
| Hip Flexors (n = 6) [47–49,51,54,56] | ||||||||
| Sitting [47,51,54] | Hip flexed, off surface [54] | CP [54] | HHD, MicroFET, Biometrics [54] | anterior thigh, 3 cm proximal to patella [54] | Pelvis [54] | Make [54] | All trials [54] | |
| Hip flexed 90 [47] | CP [47] | HHD, Nicholas Manual muscle tester [47] | anterior thigh, proximal to knee above superior border of patella [47] | nil [47] | Make [47] | Peak [47] | ||
| Hip 30o [51] | CP [51] | HHD, Nicholas Manual muscle tester [51] | anterior thigh, distally [51] | nil [51] | Make [51] | Mean [51] | ||
| Supine [48,49] | Not reported [49] | SB [49] | HHD, PowerTrack II Commander, Each [49] | mid-way between ASIS and base of patella [49] | nil [49] | Make [49] | Mean [49] | |
| SB [49] | MMT (0–5 scale with 1/2 points) [49] | mid-way between ASIS and base of patella [49] | nil [49] | Not reported [49] | Peak [49] | |||
| Hip and knee flexed 90o [48] | SB [48] | HHD, Spark [48] | anterior thigh, proximal to kneed [48] | Trunk [48] | Make [48] | Peak [48] | ||
| Not reported [56] | Not reported [56] | DMD [56] | MMT (modified MRC scale 0–5 with +/- for grades 3–5) [56] | anterior thigh, proximal to knee above superior border of patellaa [56] | nil [56] | Make [56] | Not reported [56] | |
| Hip Extensors (n = 6) [47,48,50,51,53,56] | ||||||||
| Prone [47,51] | Knee extended 0o and thigh extended off surface [51] | CP [51] | HHD, Nicholas Manual muscle tester [51] | posterior distal thigh [51] | Pelvis [51] | Make [51] | Mean [51] | |
| Knee flexed 90o, hip extended off surface [47] | CP [47] | HHD, Nicholas Manual muscle tester [47] | posterior thigh, proximal to popliteal crease [47] | nil [47] | Make [47] | Peak [47] | ||
| Supine [47,48,50,53] | Hip and knee flexed 90o [47, 48, 50] | CP [47] | HHD, Nicholas Manual muscle tester [47] | posterior thigh, proximal to popliteal crease [47] | nil [47] | Make [47] | Peak [47] | |
| posterior thigh, proximal to popliteal crease [47] | pelvis to plinth using belt [47] | Make [47] | Peak [47] | |||||
| SB, [48] DMD [50] | HHD, Spark [48,50] | posterior thigh, proximal to knee [48,50] | Trunk [48,50] | Make [48,50] | Peak [48] Mean [50] |
|||
| hip 90 [53] | CP [53] | HHD, Citec [53] | anterior mid-thigh [53] | pelvis [53] | Make [53] Break [53] |
Peak [53] | ||
| Not reported [56] | Not reported [56] | DMD [56] | MMT (modified MRC scale 0–5 with +/- for grades 3–5) [56] | posterior leg, proximal to bimalleolar linea [56] | nil [56] | Make [56] | Not reported [56] | |
| Hip Abductors (n = 8) [46,48,49, 51–54,56] | ||||||||
| Supine [46,48,51–54] | Hip and knees extended 0o [46,47] | CP [46] | HHD, Chatillion [46] | lateral femur, ~5cm proximal from femoral epicondyle [46] | support of contralateral pelvis [46] | Make [46] | Peak [46] | |
| SB [48] | HHD, Spark [48] | lateral thigh, proximal to kneed [48] | Contralateral lower extremity [48] | Make [48] | Peak [48] | |||
| Hips neutral, 0o abduction/adduction [53] | CP [53] | HHD, Citec [53] | lateral mid-thigh [53] | pelvis [53] | Make [53] Break [53] | Peak [53] | ||
| Hip 45, knee extended [52], Hip slightly flexed off surface [54] | CP [52,54] | HHD, MicroFET, Biometrics [52,54] | 5 cm proximal from femoral epicondyle [52] | pelvis with belt, contralateral limb held in neutral manually [52] | Make [52] | Mean [52] | ||
| lateral thigh, 5 cm proximal to knee joint [54] | pelvis [54] | Make [54] | All trials [54] | |||||
| Hip and knee flexed 45o [51] | CP [51] | HHD, Nicholas Manual muscle tester [51] | lateral thigh, distally [51] | Pelvis [51] | Make [51] | Mean [51] | ||
| Side lying [49] | Knee extended 0o [49] | SB [48] | HHD, PowerTrack II Commander [49] | lateral leg, midway between ASIS and patella [49] | nil [49] | Make [49] | Mean [49] | |
| SB [49] | MMT (0–5 scale with 1/2 points) [49] | Not reported | Not reported | Not reported | Peak [49] | |||
| Not reported [56] | Not reported [56] | DMD [56] | MMT (modified MRC scale 0–5 with +/- for grades 3–5) [56] | posterior leg, proximal to bimalleolar linea [56] | nil [56] | Make [56] | Not reported [56] | |
| Hip Adductors (n = 1) [47] | ||||||||
| Supine [48] | Hip and knees extended 0o [48] | SB [48] | HHD, Spark [48] | medial thigh, proximal to kneed [48] | Contralateral lower extremity [48] | Make [48] | Peak [48] | |
aPositions as per Florence et al.’s [56] reference to Medical Research Council of the United Kingdom. Aids to examination of the peripheral nervous system: Memorandum No 45. Palo Alto, Calif: Pedragon House; 1978.
bThis placement is a direct quote from Verschuren et al’s [53] original article. The dorsum of foot is a likely error as the plantarflexor muscle group is in the posterior compartment.
cThis placement is a direct quote from Crompton et al.’s [47] original article. Resistance to the tibia is likely posterior as the knee flexor muscle group is in the posterior compartment.
d Protocol as per Effgen et al.’s [48] reference to Bohannon RW. Test-retest reliability of hand-held dynamometry during a single session of strength assessment. Phys Ther. 1986;66:206–209. CP, Cerebral Palsy; CMT, Charcot-Marie-Tooth; DMD, Duchenne’s muscular dystrophy; SB, Spina Bifida; NR, not reported; MRC, Medical Research Council; ASIS, Anterior superior iliac spine; MMT, Manual Muscle Test; HHD, Hand-held dynamometer; ICC, Intra-class Coefficient; SEM, Standard Error of Measurement/the mean