MASTER OF CLINCIAL EXERCISE PHYSIOLOGY
(REHABILITATION)
Residential School Workbook
Musculoskeletal Testing and Assessment:
Non-clinical
Dr Stephen Bird, AEP / Dr Melissa Skein, AEP
Activities:
Page
1. Dynamic Postural Control
Star Excursion Balance Test......................................................................................................
2
2. Functional Movement Screen
FMS – Overhead Squat .............................................................................................................
7
3. Assessment of the Core
Lower Abdominal Neuromuscular Control Assessment ........................................................... 11
Sorensen Test ............................................................................................................................ 13
Bunkie' test ................................................................................................................................ 14
4. Lower-Extremity Muscular Function
Single-Leg Hop for Distance ..................................................................................................... 16
Single-Leg Timed Hop (6m) ..................................................................................................... 16
Single-Leg Cross-over for Distance .......................................................................................... 17
5. Upper-Extremity Muscular Function
Closed Kinetic Chain Upper Extremity Stability Test .............................................................
19
Workbook – Musculoskeletal Testing and Assessment: Non-clinical
STAR EXCURSION BALANCE TEST
BACKGROUND
The Star Excursion Balance Test (SEBT) is a multi-directional test of dynamic postural control that
involves unilateral stance while attempting maximal reach with the opposite leg in 8 different directions: 3
anterior, 2 lateral, and 3 posterior. These features make the SEBT an appropriate test of dynamic
postural control for healthy, athletic populations.
SEBT grid patterns for both right and left leg stances. From: Olmstead LC, Carcia CR, Hertel J,
Shultz SJ. 2002, Efficacy of the star excursion balance tests in detecting reach deficits in subjects
with chronic ankle instability. Journal of Athletic Training. 37(4):501-506.
•
Normalisation: (excursion distance/leg length) x 100 = %MAXD;
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METHOD
Students should perform the SEBT while working in pairs. One student will score the test while the other
student will execute the test. Each student should perform 6 practice trials in each direction to familiarise
themselves with the test manoeuvre.
1. To perform the test each subject will maintain a single-leg stance at the centre of the grid with
both hands on the hips. They then instructed with the opposite leg to reach as far as possible
along the appropriate vector.
2. The subject is asked to lightly touch the line to ensure that stability is achieved and then return to
the upright centre position.
3. The distance from the centre of the grid to this touch point is measured in centimetres and
recorded. A total of 3 reaches/trials along each vector are while standing on both the right and left
foot.
4. All trials are performed in sequential order working in either a clockwise or counterclockwise
direction at the outset. The average of the 3 trials is used in the scoring.
5. Trials are discarded if the subject (1) did not touch the vector line, lifts the stance leg from the
centre, (2) loses balance, or (3) did not maintain the start and return positions for 1 second
Trials are discarded if:
1. The subject lifted the stance foot from the centre of the grid
2. Subject lost his/her balance
3. Subject did not touch the line with the reach foot while continuing to fully weight bear on the
stance leg
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LEFT LIMB STANCE:
Vector: Anterior
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Anteromedial
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Medial
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Posteromedial
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Posterior
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Posterolateral
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Lateral
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Anteromedial
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
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RIGHT LIMB STANCE:
Vector: Anterior
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Anteromedial
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Medial
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Posteromedial
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Posterior
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Posterolateral
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Lateral
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
Vector: Anteromedial
Trial 1: _____ cm
Trial 2: _____ cm
Trial 3: _____ cm
Av Distance: ______________ cm
_____________________________________________________________________________________
_____________________________________________________________________________________
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DISCUSSION QUESTIONS
1.
The aim of the SEBT is to measure?
_____________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________________________________________
2.
What are reduced SEBT distances that were associated with?
_____________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________________________________________
3.
Performance of the SEBT, like any movement skill, requires?
_____________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________________________________________
READINGS
Brumitt, J. (2008). Assessing athletic balance with the Star Excursion Balance Test. NSCA Performance
Training Journal, 7(3), 6-7. [Free pdf]
Robinson, R.H., & Gribble, P. A. (2008). Support for a reduction in the number of trials needed for the
Star Excursion Balance Test. Arch Phys Med Rehabil, 89(2), 364-370. [ScienceDirect]
Olmstead, L.C., Carcia, C.R., Hertel, J., & Shultz, S.J. (2002). Efficacy of the Star Excursion Balance
Tests in detecting reach deficits in subjects with chronic ankle instability. Journal of Athletic Training.
37(4), 501–506. [PubMed]
Plisky, P.J. et al. (2006). Star Excursion Balance Test as a predictor of lower extremity injury in high
school basketball players. JOSPT, 36(12), 911-919. [Free Full Text]
Robinson, R., & Gribble, P. (2008). Kinematic predictors of performance on the Star Excursion Balance
Test. Journal of Sport Rehabilitation, 17(4), 347-357. [EBSCO]
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FUNCTIONAL MOVEMENT SCREEN – OVERHEAD SQUAT
BACKGROUND
While there is a significant amount of literature addressing how deficits in isolated risk factors can
increase the likelihood of an athlete getting injured; few, however, describe how multiple factors can
contribute to one isolated injury (Cook 2006). As such, physical and performance tests do not assess
functional performance; individuals are not assessed in a manner that resembles functional movement
patterns. The Functional Movement Screen (FMS) identifies individuals who are at risk of injury by
examining isolated variables. The FMS examines functional movement patterns by assessing muscle
imbalances, core strength, joint ROM, postural alignment, mobility and structural stability (Cook 2006a).
The FMS consists of seven movement screens to assess mobility and stability with an athlete’s total
movement score out of 21 assisting in prediction of non-contact soft tissue injuries (4). While injury risk
prediction based on muscle tightness/weaknesses, asymmetries, postural misalignments and
compensatory movement patterns can be identified by the FMS (Table 1), a limitation is that this data
does not provide specific exercise prescription information to assist in determining athlete loading
parameters. Furthermore, the FMS fails to assess more dynamic movements which require the interplay
between force production and reduction (2) deemed essential sport-specific characteristics. Finally, when
conducting the FMS on larger numbers of athletes (30+) we have found this to be a very time consuming
process.
Given the relevance of the Overhead Squat score on achievement of a passing score (14/21), the
purpose of this exercise is to provide students with the clinical skills to safely and effectively conduct
functional movement screens, specifically the overhead squat.
Table 1: Overview of FMS research
Outcome
Author
FMS score < 14 / 21 = ↑ injury risk
Kiesel et al., 2007
Asymmetry = 2.3× injury risk (professional American football)
Kiesel et al., 2008
FMS score less than 14 / 21 = 4× lower extremity injury risk
(female collegiate athletes)
Chorba et al., 2010
Overhead Squat score 1 = 5× more likely to achieve FMS score < 14
Kiesel et al. (2011).
Abbreviations: FMS = Functional Movement Screen; < = less than.
METHOD
The FMS is designed to identify persons who are at increased risk of injury, specifically from non-contact
injuries during athletic participation. The FMS was developed to improve the ability of the pre-participation
examination to detect functional movement patterns by assessing mobility and stability using a simple
grading system. The FMS attempts to quantify movement quality and fulfil the first requirement of
baseline testing, that of mobility and stability. The screen uses seven movements that represent the
mobility and stability milestones in human growth and development, these include squatting, stepping,
lunging, reaching, striding or kicking, and two movements that require trunk stability for anterior-posterior
stress (pushing) and rotary stress (segmental stabilisation).
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Scoring
0 scores will be considered first by the team physician and athletic trainer, who will conduct a sports
medicine evaluation of the painful site considering the movement pattern that produced the pain.
Score of 1 demonstrates that an athlete does not have a functional base of mobility and stability and is
therefore probably experiencing microtrauma, poor efficiency, and poor technique with common athletic
movements.
Score of 2 demonstrates areas of priority in conditioning and flexibility. It is advisable that the athletic
trainer, strength coach, and sport coach work together to develop complementary exercise, conditioning,
and sport-specific training programs around these areas of limitation.
Score of 3 demonstrates appropriate or optimal mobility and stability for a particular movement pattern;
screening is still periodically necessary to check for common imbalances acquired in training.
Overhead Squat
Assesses the following:
•
•
•
Structural alignment
Dynamic flexibility
Neuromuscular control
Positioning:
•
•
•
•
Feet shoulder-width apart and pointed straight ahead.
Arms overhead with elbows fully extended.
The upper arms should bisect the ears.
Have the client repeat the movement for 5 repetitions.
Checklist:




Upper torso is parallel with tibia or toward vertical
Upper arms should bisect the ears
Femur is below horizontal
Knees aligned over feet
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Clinical Implications:
The ability to perform the deep squat requires closed kinetic-chain dorsiflexion of the ankles, flexion of the
knees and hips, and extension of the thoracic spine, as well as flexion and abduction of the shoulders.
Poor performance on this test can be the results of several factors. Limited mobility in the upper torso can
be attributed to poor glenohumeral or thoracic-spine mobility. Limited mobility in the lower extremity
including poor closed kinetic-chain dorsiflexion of the ankle or poor flexion of the hip may also cause poor
test performance.
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RECORDING SHEET
Name: _________________________
Time: _____________
Date: ___ / ___/ ___
Testing Venue: ___________________________________________________________
Sport: ______________________________
Hand Dominance: L / R
Age: ____________
Position: ____________________________
Leg Dominance: L / R
Height: __________
Eye Dominance: L / R
Weight: __________
ο Male
ο Female
Injury Details: ______________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________________
View
Checkpoint
Compensation
Anterior
Foot
 Foot Turns Out
Overactive
Underactive
 Foot Flattens
Knee
 Moves inward
 Moves outward
Lateral
LPHC
 Excessive trunk lean
 Low back arches
 Low back rounds
Posterior
Upper body
 Arms fall forward
Foot
 Foot Turns Out
 Heals raise
LPHC
 Weight shift
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DISCUSSION QUESTIONS
1.
The aim of the FMS OHS is to measure?
_____________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________________________________________
2.
What are reduced FMS OHS that were associated with?
_____________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________________________________________
3.
Performance of the FMS OHS, like any movement skill, requires?
_____________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________________________________________
READINGS
Cook, G., & Burton, L. (2006). The functional movement screen. Perform Better(Spring), 9-11. [Free pdf]
Cook, G., Burton, L., & Hoogenboom, B. (2006a). Pre-participation screening: the use of fundamental
movements as an assessment of function – Part 1. North American Journal of Sports Physical
Therapy 1(2), 62-72. [Free pdf]
Cook, G., Burton, L., & Hoogenboom, B. (2006b). Pre-participation screening: the use of fundamental
movements as an assessment of function – Part 2. North American Journal of Sports Physical
Therapy 1(3), 132-139. [Free pdf]
Schneiders, A. G., Davidsson, A., Horman, E., & Sullivan, S. J. (2011). Functional movement screen
normative values in a young, active population. International Journal of Sports Physical Therapy,
6(2), 75-82. [Free pdf]
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ASSESSMENT OF THE CORE
BACKGROUND
It has long been argued that the anterolateral abdominal muscles and the muscles that form the roof
(diaphragm), floor (pelvic floor muscles) and posterolateral (quadratus lumborum and psoas) aspects of
the abdominal cavity contribute to the control of the lumbar spine and pelvis. There is ongoing debate
regarding the relative contribution of these muscles to stability and the mechanisms by which they may
mechanically control spinal and pelvic motion. Therefore, it may be argued that a multi-dimensional
assessment of the core may examine these key anatomical considerations, the mechanisms by which
these muscles provide mechanical stability to the region, the complex strategies used by the central
nervous system to control integrated activity of the multiple muscle layers and optimise spinal control, and
factors that complicate this control.
1. Lower Abdominal Neuromuscular Control Assessment
Purpose: The Lower Abdominal Neuromuscular Control Assessment indicates the ability of the lower
abdominal wall to preferentially stabilise the lumbo-pelvis-hip complex.
Method:
1. Place patient in a supine position with their knees and hips at 90°.
2. Position blood pressure cuff under the lumbar spine (L4-L5) and inflate to 40 mmHg.
3. Instruct patient to perform a drawing-in manoeuvre (pull belly-button to spine) to stabilise the
lumbar spine, and then to slowly lower the legs until pressure in cuff decreases.
4. Measure hip angle with a goniometer to determine the angle.
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Lower Abdominal Neuromuscular Control Assessment
Angle test terminated:
________ °
Muscle Grade:
________
Descriptor:
Observations:
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2. Sorensen Test
Demoulin, C., Vanderthommen, M., Duysens, C., & Crielaard, J.-M. (2006). Spinal muscle evaluation using the Sorensen test: a
critical appraisal of the literature. Joint Bone Spine, 73(1), 43-50.
Purpose: The Sorensen test allows for a rapid, simple, and reproducible evaluation of the isometric
endurance of the trunk extensor muscles. It discriminates between healthy individuals and patients with
low back pain and may predict the occurrence of low back pain in the near future.
Method:
1. Patient lies on the examining table in the prone position with the upper edge of the iliac crests
aligned with the edge of the table.
2. Lower body is fixed to the table by three straps, located around the pelvis, knees, and ankles,
respectively.
3. Arms folded across the chest, start with the upper body sloping downward toward the floor so that
a concentric contraction of the trunk extensor muscles was needed initially to reach the horizontal
position. Patient is asked to isometrically maintain the upper body in a horizontal position.
4. Time during which the patient keeps the upper body straight and horizontal is recorded. In
patients who experience no difficulty in holding the position, the test is stopped after 240 s.
a. Healthy: male 198 s / female 197 s CLBP: male 163 s / female 177 s
b. Position-holding time: <176 s predicted low back pain during the next year in males, >198
s predicted absence of low back pain
5. Hip flexion: the hips remain fully extended throughout the Sorensen test.
6. Method for documenting the horizontal position: Measure ability to sustain position (goniometer).
7. Criteria for stopping the test: trunk down-sloping by more than 5–10°
Position-holding time:
Duration: ________ s
Normative values Healthy persons
Males:
_________ s Females: _________ s
Persons with Chronic Low Back Pain:
Males:
_________ s Females: _________ s
Predicted Absence of Low Back Pain:
_________ s
Observations:
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3. Bunkie' Test
de Witt, B., & Venter, R. (2009). The `Bunkie' test: Assessing functional strength to restore function through fascia manipulation.
Journal of Bodywork and Movement Therapies, 13(1), 81-88.
Purpose: The ‘Bunkie’test, used as main assessment tool in the Lyno Method, as developed over a
period of 12 years of study in clinical practice, involving team athletes (e.g., rugby, netball, cricket),
cyclists, long-distance runners ,and sprinters. It is an accurate test to measure the function of all muscles,
involving all the different fascia lines. Assessments indicate that some muscles appear to be ‘locked-long’
and others ‘locked-short’.
Method:
1. Lie on mat in the required position, with feet or one foot on the Bunkie, supporting upper body on
elbows
2. Lift body up into a neutral position, and takes weight off one foot to test the specific fascia line
3. Held for 20–40s
5. Novice 20 s; Intermediate 30; Advanced/Endurance athlete 40s.
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BUNKIE' TEST
Position-Holding Time
L
R
Posterior Power Line:
________ s
________ s
Anterior Power Line:
________ s
________ s
Posterior Stabilizing:
________ s
________ s
Lateral Stabilizing:
________ s
________ s
Medial Stabilizing:
________ s
________ s
OBSERVATIONS:
Notes:
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LOWER-EXTREMITY MUSCULAR FUNCTION
BACKGROUND
Wilk, K. E., et al. (1994). The relationship between subjective knee scores, isokinetic testing, and functional testing in the ACLreconstructed knee. Journal of Orthopaedic and Sports Physical Therapy, 20(2), 60-73.
Functional testing provides the clinician with a picture of the athletes capabilities to perform specific tasks
related to sports performance. It will also give the clinician a starting point for progression through the
rehabilitation plan. Working with your lab partner, perform the following functional tasks. Lower-extremity
muscular function and performance deficits are commonly assessed using hop tests. The following three
hop tests are typically used.
1. Single-Leg Hop for Distance
Purpose: The Single Leg Hop for Distance test is used to assess
functional performance and considered useful as part of a battery of
tests to determine readiness to participate in activity.
Limb symmetry index: To calculate the limb symmetry index (LSI),
the mean score of the involved limb is divided by the mean time (or
distance) of the uninvolved limb and the result multiplied by 100.
Symmetry index of < 85% is usually considered abnormal.
Method:
1. Patient stands on one leg and hop as far forward as possible
landing on the same leg.
2. Measure the distance travelled.
3. The average of three trials is used in calculating the limb
symmetry index.
2. Single-Leg Timed Hop
Purpose: The Single-Leg Timed Hop test is used to assess
functional performance and considered useful as part of a battery of
tests to determine readiness to participate in activity.
Limb symmetry index: To calculate the limb symmetry index (LSI),
the mean score of the involved limb is divided by the mean time (or
distance) of the uninvolved limb and the result multiplied by 100.
Symmetry index of < 85% is usually considered abnormal.
Method:
1. Instruct patient to use explosive single-leg hops from start to
finish across a distance of 6 m.
2. Record the time required to perform the test using the
average of three trials.
3. Perform the test on both legs to calculate the limb symmetry
score.
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3. Single-Leg Cross-over for Distance
Purpose: The Single-Leg Cross-over for Distance test is used to
assess functional performance and considered functional tests useful
as part of a battery of tests to determine readiness to participate in
activity.
Limb symmetry index: To calculate the limb symmetry index (LSI),
the mean score of the involved limb is divided by the mean time (or
distance) of the uninvolved limb and the result multiplied by 100.
Symmetry index of < 85% is usually considered abnormal.
Method:
1. Place a 15 cm wide strip of tape extending down the centre
of the 6 m hop wide strip of tape extending down the centre
of the 6 m hop course. This will designate the “centre line”.
2. Have patient hop three (3) consecutive times on the same
foot crossing the centre line with each hop.
3. Measure the distance from the beginning to the third hop.
4. The average of three trials is used to calculate the limb
symmetry score. Perform the hops on both legs.
DISCUSSION QUESTIONS
1.
The aim of the hop tests is to measure?
_____________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________________________________________
2.
What are reduced hop tests that were associated with?
_____________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________________________________________
3.
Performance of the hop tests, like any movement skill, requires?
_____________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________________________________________________
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LOWER EXTREMITY HOP TESTS
1. Single-Leg Hop for Distance
Un-injuries
Injured
Trial 1: ______________
Trial 1: ______________
Trial 2: ______________
Trial 2: ______________
Trial 3: ______________
Trial 3: ______________
Limb Symmetry Score:
____________________
OBSERVATIONS:
2. Single-Leg Timed Hop
Un-injuries
Injured
Trial 1: ______________
Trial 1: ______________
Trial 2: ______________
Trial 2: ______________
Trial 3: ______________
Trial 3: ______________
Limb Symmetry Score:
____________________
OBSERVATIONS:
3. Single-Leg Cross-over for Distance
Un-injuries
Injured
Trial 1: ______________
Trial 1: ______________
Trial 2: ______________
Trial 2: ______________
Trial 3: ______________
Trial 3: ______________
Limb Symmetry Score:
____________________
OBSERVATIONS:
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UPPER-EXTREMITY MUSCULAR FUNCTION
BACKGROUND
Roush, J. R., Kitamura, J., & Chad Waitsc, M. (2007). Reference values for the Closed Kinetic Chain Upper Extremity Stability
Test (CKCUEST) for collegiate baseball players. North American Journal of Sports Physical Therapy 2(3), 159-163.
Functional testing provides the clinician with a picture of the athletes capabilities to perform specific tasks
related to sports performance. It will also give the clinician a starting point for progression through the
rehabilitation plan. Working with your lab partner, perform the following functional tasks. Lower-extremity
muscular function and performance deficits are commonly assessed using hop tests. The following three
hop tests are typically used.
Closed Kinetic Chain Upper Extremity Stability Test
Purpose: he Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) is a tool developed and used
in the clinic to evaluate progress during upper extremity rehabilitation.
Conversion factors:
•
•
•
1 foot = 30.48 centimetres
1 pound = 0.45359237
1 inches = 2.54 centimetres.
Method:
1. The test is performed in the push-up position (males) or modified push-up position on knees
(females) between two markings that are three (3) feet apart.
2. The subject moves their hands back and forth (criss – cross fashion) from each line marking as
many times as possible in 15 seconds.
3. The number of lines touched with each hand is then totalled.
4. Begin with one sub-maximal warm-up trial, followed by three (3) test trials.
5. The average of the three (3) trials is then used as the final score value.
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CKC UPPER EXTREMITY STABILITY TEST & SHOULDER MOBILITY
Bodyweight:
________ kg
convert to
________ lbs
Height:
________ cm
convert to
________ inches
Trial 1: ________________
Trial 2: _________________
Trial 3: _________________
Av Touches: ___________
a) Score: ______________
b) Power: _______________
a) Scores are then normalised for body height (inches).
Score
=
# of lines touched
Height (inches)
b) Power is then determined by applying the following formula:
Power
=
68% BW (lbs) × # of lines touched
15 sec
Compare your scores with the norms in the table provided below:
Variable
Patient
Norm Male (av)
Norm Female (av)
Av. Touches
14.5
20.5
Power
150
135
Score
.26
.31
OBSERVATIONS:
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