It is important to note that this scale does not have equal range between each number such as 1=2=3=4=5. Hence, Grade 1 muscles are less than 5% of normal, Grade 2 muscles are approximately 5 to 10% of normal, Grade 3 muscles are approximately 15 to 20% of normal, and Grade 4 muscles are approximately 40% of normal. (Beasley WC, Quantitative Muscle Testing: Principles and Application to Research and Clinical Studies. Arch Phys Med Rehab 42: 398-425, 1961)

In general, at least a Grade 3 muscle is needed to perform usual function because it is able to move a limb against gravity. However, it is important to know that a Grade 3 muscle does not have much endurance and will tire easily.

Muscle grades can also be defined more specifically by adding a plus or minus sign that designates “something in between”:

Examples: 1, 1+, 2-, 2, 2+, 3- 3, 3+, 4-, 4, 4+, 5.

Muscle Grade 3+ can resist the force of 2 fingers plus gravity.

Do you understand the meaning of muscles grades?

Test yourself…Yes or No

· 4 out of 5 means 80% …………..No

· 3 out of 5 is like getting a “C” in class …………………………..………No

· 5 out of 5 means 100% …………No

· 3 out of 5 for the hip extensor means 20% ………………………….…Yes

Torque Muscle Testing

Another way of measuring muscle strength is Torque testing. This method is best used for testing stronger muscles.

Torque testing uses a machine (like an exercise machine at the gym) to provide the opposing force. This testing is performed under the supervision of a trained examiner. The results in Torque tests are then calculated and the muscle group strength is graded as a percentage of normal rather than the 0-5 scale of MMT.

Why is Muscle Testing Important?

There are 3 reasons why muscle testing is important:

1) To help diagnose PPS

2) To evaluate a person’s muscle/nerve reserve, i.e. determine his ability to exercise and help answer the following questions:

· Which muscles are at high risk for getting weaker with overuse?

· How much can or should a person exercise?

· Which muscles can tolerate exercise and which muscles cannot tolerate exercise?

3) To help the physician prescribe for and advise the patient

· What type of brace and which joint mechanism can substitute specifically for a given muscle that is found to be too weak to perform its function during walking?

· What lifestyle modifications need to be suggested?

· Could it possibly be time for the “chair”?

Muscle Testing Helps Diagnose PPS

A finding of “random patchy weakness” can be determined by thorough manual muscle strength testing and can also help establish that the person has a history of having had acute poliomyelitis. “Random patchy weakness” refers to muscle weakness that does not follow any specific pattern, e.g. one may have right arm and left leg weakness, as opposed to left or right sided weakness as seen in stroke.

The criteria for a diagnosis of post-polio syndrome from the March of Dimes International Conference on Post-Polio Syndrome Identifying Best Practices in Diagnosis & Care, 2001 are:

“1. Prior paralytic poliomyelitis with evidence of motor neuron loss, as confirmed by history of the acute paralytic illness, signs of residual weakness and atrophy of muscles on neurologic examination, and signs of denervation on electromyography (EMG). [Dr. Chun stated that EMG might not be necessary.]

“2. A period of partial or complete functional recovery after acute paralytic poliomyelitis, followed by an interval (usually 15 years or more) of stable neurologic function.

“3. Gradual or sudden onset of progressive and persistent new muscle weakness or abnormal muscle fatigability (decreased endurance), with or without generalized fatigue, muscle atrophy, or muscle and joint pain. (Sudden onset may follow a period of inactivity or trauma or surgery.) Less commonly, symptoms attributed to PPS include new problems with breathing or swallowing.

“4. Symptoms persist for at least a year.

“5. Exclusion of other neurologic, medical and orthopedic problems as causes of symptoms.”

Exercise/Activity Recommendations

Results from manual muscle testing can help a physician advise how much or how little an individual can exercise. Exercise can help maintain and possibly strengthen muscles that are Grades 3+, 4, or 5 as long as a person doesn’t over do it, but exercise can be detrimental/harmful to muscles that are Grade 3 or less. A Grade 3 muscle can move the limb full range against gravity but it has only 15 to 20% of normal strength so it has very little endurance.

Grade 3 to 3+ muscles are considered at high risk because they can get weaker by both too little activity and by too much activity. A person with PPS and Grade 3 to 3+ muscles has a daunting task of trying to find the correct balance to prevent losing muscle strength either from disuse or from overuse. In addition, if a Grade 3 muscle weakens and becomes a Grade 2 muscle it can lead to a decline in function if this is a key muscle.

Grade 2 muscles may need some bracing support, especially in the lower extremities, because they do not have the strength to overcome gravity.

Determining Bracing Needs

There are three key muscle groups that are tested in the lower extremities to help the physician determine the most appropriate type of bracing needed to substitute for the weak muscle groups. These muscles groups are called “key” muscle groups because their strength determines whether a person can walk safely or not:

Hip Extensor muscles (Glutes)

Knee Extensor muscles (Quadriceps/

Quads)

Ankle Plantar Flexor muscles (Gastrocs or calf muscles)

Experience at the Rancho Post-Polio Clinic has shown that the calf muscle often is the first muscle to show signs of overuse weakness in survivors who are walking in the community. A person with weak calf muscles often substitutes for this weakness by locking his knees. This substitution can be functional except that over time, the “locking” of the knees causes an overuse of the knee extensor muscles (quadriceps) and can also lead to low back pain. A person with weak calf muscles can sometimes feel unstable and is not able to stand for very long.

A person with symptoms caused by weak calf muscles as described above is at risk of further overusing the quadriceps muscles, so a physician will prescribe an AFO (ankle-foot-orthosis) specifically designed to substitute for the weak calf muscle. The physician prescribing the brace should understand the patient’s gait and know what type of joint mechanism is needed to substitute for the muscle weakness found in the manual muscle testing. A “wrong” brace can actually cause further overuse resulting in more muscle weakness.

There are very specific joint mechanisms but in general, one should know that a KAFO (knee, ankle, foot orthosis) is used to substitute for weak quadriceps (knee extensors), and that an AFO (ankle, foot orthosis) is used to substitute for weak ankle muscles including the calf muscle. A cane is often the best support for weak hip muscles.

Range of Motion Testing

Range of motion testing for each joint is often done in conjunction with manual muscle testing. This testing helps determine the flexibility of the joints and determines if there are any contractures.

A contracture is the tightening of soft tissue that results in a limited range of motion. Not all contractures or limited range of joints is bad. A good or a “useful” contracture can act like an “internal brace”, while a bad contracture puts a person at a mechanically unstable position.

· An example of a “useful” contracture is Achilles tendon tightness because it can act as an internal ankle brace (AFO).

· An example of a bad contracture is knee flexion contracture, i.e. a permanent bend at the knee. This is a bad contracture because if a person does not have adequate muscles to extend the knee, the knee contracture can cause the knee to buckle.

Some abnormality in range of motion is not always bad. For example, a person who back-knees may benefit by locking the knee for added stability. However, an excessive back-knee or (knee hyperextension) can cause pain in the front of the knee over time.

QUIZ

Based on the information in this report, in the following examples try to determine:

Who can walk safely?

What joints need to be braced?

Who needs to “ride”?

Assume that none of the persons below have any useful contractures.

Person 1: Hip Extensor Grade 5, Knee Extensor Grade 4, and Ankle Plantar Flexor Grade 4

Answer: All key muscles in this person are greater than 4, therefore he can walk safely without a brace.

Person 2: Hip Extensor Grade 5, Knee Extensor Grade 0, and Ankle Plantar Flexor Grade 4

Answer: This person has zero Knee Extensor (Quadriceps); therefore he needs a knee brace (KAFO) to substitute for the inability to lock his knees.

Person 3: Hip Extensor Grade 4, Knee Extensor Grade 5, and Ankle Plantar Flexor Grade 0

Answer: This person has zero Ankle Plantar Flexor (calf muscle); therefore he needs an ankle brace (AFO) to substitute for his weak calf muscle.

Person 4: Hip Extensor Grade 1, Knee Extensor Grade 0, and Ankle Plantar Flexor Grade 2

Answer: All key muscles are less than 3, which are not strong enough to provide support for walking, especially if they do not have any useful contractures. This person needs to ‘ride’.

Person 5: Hip Extensor Grade 0, Knee Extensor Grade 4, and Ankle Plantar Flexor Grade 1

Answer: The only muscle that can help this person walk is the Knee Extensor Muscle (Quadriceps). This person can probably walk, but would need the assistance of a cane and an ankle brace (AFO).

Conclusion

The information in this report should help a person with PPS have a better understanding of muscle testing and what the numbers mean to him. By knowing one’s own muscle grades a person will have a better understanding of how to protect the strength he has.

Muscle testing provides good baseline information. It is not necessary to repeat MMT until a person’s symptoms change. “If you are having new PPS symptoms it means you need to slow down”, said Dr. Chun.

Mary Clarke Atwood

Reprint permission must be obtained directly from Rancho Los Amigos Post-Polio Support Group

RanchoPPSG@hotmail.com

Dr. Sophia Chun is Chief of Post-Polio Service at Rancho Los Amigos National Rehabilitation Center. For more than five years she has worked closely with Dr. Jacquelin Perry who established this polio clinic many decades ago. Dr. Chun has dual board certification in Physical Medicine & Rehabilitation and Internal Medicine. In 1993 she received her M.D. from Loma Linda University and then completed their dual residency program. Her other responsibilities at Rancho Los Amigos include Medical Director of Outpatient Clinic & Rehabilitation Services; Chief, Neuro-medicine Stroke Service; and Director, Women with Disabilities GYN/Wellness Clinic. In 2000 Dr. Chun was named “Physician of The Year” at Rancho Los Amigos National Rehabilitation Center.

****************************************

This article is reprinted from USA Weekend, January 16-18, 2004. EAT SMART by Jean Carper. Seemed like some good ideas.

10 BEST NUTRITION MOVES

Every meal can easily include several points on this

no-nonsense list.

Details about specific nutrients are fascinating. But in tracking down the fine points, don’t lose sight of the big picture. Here are 10 solid, sweeping actions that will get you the best nutrition bang in 2004.

w Eat seven to nine servings of fruits and vegetables a day. Antioxidant-packed, they can cut your risk of heart disease up to 70%, diabetes 40%, lung cancer 30% and breast cancer 20%, studies show. Tops in antioxidants: prunes, raisins, blueberries, black-berries, garlic, kale, cranberries, raspberries, strawberries, spinach.

w Eat fatty fish two or three times a week. That provides enough omega-3 fat to help prevent heart disease, arthritis and brain dysfunction. Fish oil protects brain cells, and suppresses inflammation and irregular heartbeats. In a new study, eating fish just once a week cut the risk of Alzheimer’s disease 60%. Best: salmon, sardines (fresh and canned), mackerel, herring.

w Restrict red meat to once or twice a week. Recent evidence ties red meat (beef, pork, veal, lamb) to increased cancer of the colon, pancreas, breast, prostate and kidney. Reason: Carcinogens form in meat during cooking. Worst methods: frying, barbecuing. Best: baking, stewing, boiling, microwaving.

w Eat 25 grams of fiber a day. Most adults eat less than half that. Fiber lowers cholesterol and blood pressure; cuts the risk of heart disease, diabetes and cancer; and helps control weight. Super sources: All-Bran, Fiber One, oat-bran cereals (check labels), dried beans, barley.

w Use olive oil primarily; avoid trans fats. Olive oil is the main choice of people who live the longest and have the least heart disease, cancer and other chronic diseases. Deadliest: trans fats in some margarines and baked goods, such as doughnuts – they clog arteries more than saturated animal fats do.

w Eat “good” carbs. Slash “whites” – bread, sugar, potatoes – that causes rapid spikes in blood sugar. Such foods can double your odds of heart attack, diabetes and certain cancers, and make you fat. Eat carbs that produce a slow rise in blood sugar. Best: legumes (including peanuts); whole-grain, high-fiber breads and cereals; fruits and vegetables.

w Drink three or more cups of tea a day. “Real” tea (not herbal) helps save you from heart disease, cancer, osteoporosis, infection, age-related mental decline, dental cavities and weight gain. In one study, three cups a day cut the risk of heart attack 11%. Brewed caffeinated green tea has the most antioxidants; bottled and instant teas have the least.

w Eat nuts every day. A mere ¾ ounce of nuts (almonds, walnuts, pecans, peanuts) daily slashed the risk of heart disease and diabetes 30% and Parkinson’s disease 43% in Harvard studies. Daily consumption of nuts and peanuts, including peanut butter, helped control weight in other research.

w Shave portions by one-third to half. Gigantic portions are a major cause of weight gain and obesity. In studies, adults given a large serving ate 30% more calories than when given a small one. Kids, too, devoured 25% more calories when served oversized portions. If it isn’t on the plate, you aren’t tempted.

w Take a daily multivitamin/mineral pill. It can erase subtle deficiencies that make you more prone to infections and chronic diseases, including cardio-vascular disease. Cancer and bone fractures. Many leading authorities now urge all adults to take a daily supplement.

****************************************

The following article was written by one of our members – Marion Schoeller.

Thanks, Marion.

I Forgot (almost)

That You Are Disabled.

Recently a new friend in my neighborhood made the above state-ment to me. We were discussing entertainment venues and I asked if this venue was accessible. My neighbor said, "I forgot that you are disabled."

Many of us can relate to the fact that we even forget (at least sometimes) that we have a physical disability especially if it is a "hidden disability." It is still tough for me to admit I have a disability even to myself.

As a formerly active person, my limitations seem to be huge compared to my abilities of just what seems like a few years ago. I regularly danced, roller skated, rode bicycles and horses, played tennis and more. I even played wheelchair tennis when I became less ambulatory but had to give that up too. Most post-polios have similar stories.

I've become a spectator rather than a participant in physical sports (but a darned good one at that!). My senses however, seemed to have survived up to this point unscathed. So, I concentrate more in those area. I enjoy live concerts and plays, movies, art, crafts and music festivals, reading, dining out, relaxing by the pool and ocean, watching new and old movies I've missed on DVD instead of VCR, and making a fool of myself with Karoake in public.

I've learned to adapt my life to my changing physical condition. That doesn't mean I like it. Still, it is uplifting when someone says, "I forgot you are disabled."

Marion Schoeller

FECPPSG Editor’s Note:- I know just what Marion is talking about – before PPS made my walking into just going about 100 yards or so, I was able to do the malls, walk the boardwalk (I grew up in Brighton Beach, Brooklyn, NY, and walked from the beginning of the boardwalk all the way past Coney Island, a total of about 5 miles each way), go up and down the subway steps, etc. However, I never was able to walk fast, sooooo every now and then when I would be out with one of my friends (namely, Brenda), she would, inevitably, wind up several feet in front of me. I would then call to her and ask what the rush was and her answer to me each time was that she “Forgot (almost) That You Are Disabled”. In talking with her this morning, after putting Marion’s article into the newsletter and telling her that I was commenting on what used to happen with us, she again told me that she never thinks of me as being disabled. I’m sure that all of us have family and friends that think of us the same way Brenda thinks of me, even thought now, as with Marion, I’ve become a spectator rather than a participant in many ways.

****************************************

Found this among some e-mails that I “saved” to use as fillers in the newsletter – thought this was a good one.

~~~~~~~~~~~~~~~~~~

"FRIENDS"

Friends are very special people who accept each other with unconditional caring. They

Recognize each other's talents and faults, and acknowledge them without judgment.

They are Incapable of turning away when times are tough and life's problems seem hard to bear.

Instead, they Encourage each other so they can enjoy the good times and find strength to endure the

bad times. They're Never afraid to say what they feel and can be honest without causing

hurt or pain. They can Depend on each other because they have the kind of trust

that allows them to Share the best and worst of their lives with laughter and without fear.

You are one of those special people,
and I'm glad you are my friend.

-Andrea Hines

****************************************

Reprinted from Polio Epic, Inc. Newsletter, April/May 2004

EXERCISE YOUR BRAIN

Put your brain to work or it loses power

The brain is the center of the identity that makes you uniquely human. Decline in brain function is one of most people’s greatest fears in regards to aging.

The severity of age-associated mental impairment can range from forgetfulness to senility to dementia. Both the aging process and a variety of disease processes, most that are treatable, can cause mental decline. But recent research maintains that age-associated cognitive impairment doesn’t have to be an inevitable consequence of growing older. Participating in increased physical and mental activity and following a healthy diet can improve mental function directly and indirectly by enhancing overall health.

Here are the 10 most important things you can do to maintain your mental health, recommended by Cynthia Green, Ph.D., founding director of the Memory Enhancement Program at the Mount Sinai School of Medicine, and Paul Takahashi, M.D., of the Mayo Clinic, a geriatric specialist and expert on cognitive decline, authors of Total Memory Workout.

Give your mind a daily workout. Just as physical activity keeps your body strong, mental activity keeps your mind sharp and agile. “It is important to experience new frontiers,” says Dr. Takahashi. If you continue to learn and challenge yourself, your brain continues to grow. He recommends that you:

· Learn to play a musical instrument.

· Play Scrabble, Catch-Phrase, Tri-bond, Balderdash, chess, bridge, and trivia games.

· Do crossword puzzles, word puzzles, jigsaw puzzles, and logic puzzles.

· Play Bingo, which requires visual skills and memory.

· Interact with people.

· Switch careers or start a new one.

· Start a new hobby, like crafts, painting, biking or bird watching.

· Learn a foreign language.

· Take college classes or community ed classes.

· Volunteer.

· Stay informed about what’s going on in the world.

· And above all – READ.

Engage in physical exercise. Believe it or not, exercise is a big determinant of mental health. Researcher in the University of Illinois at Urbana Champaign found that three areas of the brain – the frontal, temporal and parietal cortexes – can be adversely affected by aging, but they retain a higher level of function if a person stays physically fit. Using magnetic resonance imaging (MRI), psychologist Arthur F. Kramer, Ph. D., and colleagues detected significant anatomical differences in the gray and white matter between physically fit and less fit seniors. Beginning at the age of 30, these tissues are known to shrink through the years in a pattern that correlates with declines in cognitive performance. But Kramer’s findings show that staying physically fit slows the rate of brain shrinkage, and possibly the rate of cognitive decline. The authors conclude that their findings “provide the first empirical confirmation of the relationship between cardiovascular fitness and neural degeneration.”

Dutch researchers led by Dr. Albertine Schuit studied 347 men in their 70’s to assess the impact of physical exercise on cognitive function. Results showed that the men who exercised for an hour or more each day were by far the least likely to have impaired mental function. Those who exercised for less than an hour were two times more likely to have impaired mental function. Decline among totally inactive men was about four times greater. Physical exercise increases blood flow to the brain, which delivers more oxygen to the brain. It also appears that regular exercise stimulates nerve cell regeneration and reduces levels of the stress hormone cortisol.

Eat, drink and be healthy. Consume a diet rich in fruits and vegetables. They contain antioxidants, substances that protect and nourish brain cells. These foods also reduce your risk of cancer, high blood pressure, coronary artery disease, diabetes and osteoporosis. And drink plenty of water. You also want to include long-chained omega-3 fatty acids, (EPA and DHA) found in deep-water fish and algae or in supplements.

Develop a system of reminders. Information bombards you. So utilize memory triggers to keep in mind what’s important.

· Write lists, diaries and calendars.

· Establish a routine.

· Complete tasks in the same order.

Take time to remember. Normal aging makes your mind slightly less efficient in processing new information, but wisdom can compensate for physical changes. Forgetfulness may indicate nothing more than having too much on your mind. Slow down and pay full attention to the task at hand.

Practice relaxation techniques. Stress and anxiety can interfere with concentration, so it’s important to take time to relax. One technique involves taking a mental break from the world. Lie down or sit in a comfortable position with your eyes closed. Then take a relaxation tour of your body. Breathe slowly, regularly and deeply. Once relaxed, imagine you’re in a favorite place or in a spot of beauty and stillness. After five or 10 minutes, rouse yourself from the state gradually.

Maintain a positive attitude. “Happiness plays an enormous role in your outlook on life,” says Dr. Takahashi. It makes you more alert, and then your senses open up to new information and experience.

Talk to your doctor. Factor unrelated to aging or genetics can contribute to memory problems. These include the use of certain medications, poor vision and hearing, vitamin deficiencies, fatigue, depression, stress and illnesses unrelated to Alzheimer’s disease. Depression, in particular, can cause problems with memory and concentration and often is mistaken for Alzheimer’s disease in older adults. Depression can be treated, improving memory and concentration.

Check your levels. Know your blood pressure, cholesterol and blood sugar levels. Make sure your thyroid gland is functioning normally. Tests of levels are relatively easy and are good indicators of what’s going on inside your body.

Establish fresh goals. Nothing keeps you going better than having goals – physical, social, creative, intellectual and spiritual. Maintain a forward-looking attitude in each of those areas.

By the way, you don’t have to worry about occasionally misplacing your car keys. It happens to everyone.

****************************************

QUERY

A reader asked if any of our members with PPS happen to have taken dopamine or related drugs, either for PPS or another related disorder. If so, what was their experience with the medication. If you have a response to this, please either write us, call us, or e-mail us.

****************************************

In going over some “old” newsletters, came across this which is apropos even now, so here it is:- reprinted from Polio Deja View, Central VA PPSG, Jan/Feb, 1998.

NEW COPING SKILLS

By Linda VanAken

For the majority of us, polio struck at an early age. Consequently, we developed unique and individualized coping skills which helped us to live our lives to the fullest.

As one fellow polio survivor reminded me, we are taught to push harder…push further. Sometimes I think our physicians and therapists all had Marine drill sergeant mentalities. I’ve heard their motto is “pain is good, extreme pain is excellent.” So, for most of us, we are conditioned to ignore discomfort and to fight through fatigue when we are tired. We become very independent and self sufficient, no matter what level of disability we endured. Many of us have Type A personalities, and I would suspect we could be considered over achievers.

Now with the onset of post polio, we find ourselves in a position where those coping skills are no longer effective. Suddenly, it is detrimental for us to push harder and farther. In our 40’s and 50’s, we are having to completely reverse our thought processes and must now “conserve to preserve.”

For the first time in our lives, we must “give in” to our disability and “listen” to our bodies. Often, it is extremely difficult to make that transition from being Superman or Superwoman, to a person who is less active and somewhat dependant o others.

We must teach ourselves new skills. We have to learn ways to pace our activities and conserve energy. Again, we must accept the need for braces, crutches and other adaptive equipment. We need to examine methods that will help us to change our daily lives by simplifying everyday chores and activities.

The emotional impact of coming to terms with post polio can be as traumatic as the physical limitations brought on by it. Those highly honed coping skills must be discarded and replaced by new methods and new emotions.

I am convinced I have made this transition more easily and quickly with the help of my contacts in our support group. My fellow members have taught me to be kind to myself. Instead of daily aerobic exercise, my daily discipline is an afternoon nap. I now try to avoid activities that cause pain rather than just “enduring.” I’ve discovered it is not only okay to ask for help or assistance, but wiser when at all possible. So we change, we grow, we redefine ourselves and our coping skills.

Once again, the spirit and determination which helped us to overcome the original affects of polio can help us to develop new skills and methods for living our lives. We need to recognize that it is just as good for us to pace, rest and take care of ourselves as it use to be to push harder, faster and farther. So, as the New Year approaches, make a pact with yourself to change. Let go of those old worn out ideas and methods and accept the new and improved and as always…..the uniquely wonderful you.

FECPPSG Editor’s Note:- What Linda has said is true. I know how hard it was for me to adjust to the fact that I wasn’t able to do things I used to do. Why, I was even co-running a support group on Long Island and telling others what they should be doing but ignoring the fact that I needed to be doing what I was telling them to do. Maybe, if I had, I wouldn’t have needed the knee and ankle surgery I went through in 1995 to put me back into a brace.

By the way, I’ve found a lot of articles in some of the “older” newsletters that are just as appropriate now as they were several years ago, soooo – look for some more in the next few newsletters.

****************************************

DUES FOR 2004:- Please take a look at your mailing label - on it you’ll see the month and year we received your 2004dues, i.e., 01/2004 means it was received in January 2004, so your 2003 dues was due in January 2004. If your mailing label has the year first and then the month, i.e., 2003/01 it means that you indicated to us in January 2003 that you wanted to receive the newsletter but paid no dues. That’s OK as we still believe that anyone who wants information should receive it – but we do need you to return the tear sheet with either the “Dues” box checked or the “Keep me on the Mailing List” box checked.

Your dues covers the supplies we need to send out the information packets to all inquiring about Post-Polio Syndrome, any other correspondence we do, and postage for publicity and for the out-of-country (33) newsletters that we send out. We’re fortunate in that the “Free Matter for the Blind and Physically Handicapped” status takes care of the postage for the over 450 newsletters sent out within the United States. We network with many other support groups throughout the United States, as well as Australia, Brazil, Canada, England, France, Germany, Israel, Panama, Portugal, Lebanon, New Zealand, Sweden, Taiwan and Wales – some 40 of these reciprocate by sending us their newsletters. We receive as many dues checks from our out-of-state members as we do from our Florida members. So, please check your mailing label and return the tear sheet if your date is due. We really need your support now more than ever.

************

WHEN YOU MOVE PLEASE be sure to send us your new address. Sometimes the post-office will return the newsletter to us with a “forwarding period expired” notice on the front with your new address but most of the time they are just returned to us with “address unknown” on it. SO, if you want to continue receiving the newsletter it is UP TO YOU to make sure we have your new address.

************************************

		The muscle being tested…
0	Zero	has no muscle twitch.
1	Trace	has some muscle twitch that can be felt.
2	Poor	is only able to move the limb when gravity is eliminated.
3	Fair	is able to move the limb against gravity.
4	Good	is able to provide good resistance against the examiner.
5	Normal	is as strong as the maximum resistance provided by the examiner.

FLORIDA EAST COAST POST-POLIO SUPPORT GROUP - Vol. 11 #6

12 Eclipse Trail / Ormond Beach, FL 32174 / 386 676-2435

E-Mail:- bgold@iag.net - Web Site:- home.iag.net/~bgold

MAY / JUNE 2004

WE WISH ALL OUR FRIENDS

A FLOWER FILLED and LOVING MOTHER’S DAY

A SUNNY MEMORIAL WEEKEND

-and-

A FANTASTICALLY LOVING FATHER’S DAY

Rancho Los Amigos National

Rehabilitation Center

What is Manual Muscle Testing?

The muscle being tested…

Torque Muscle Testing

Why is Muscle Testing Important?

Muscle Testing Helps Diagnose PPS

Exercise/Activity Recommendations

Determining Bracing Needs

Range of Motion Testing

QUIZ

Based on the information in this report, in the following examples try to determine:

Who can walk safely?

What joints need to be braced?

Who needs to “ride”?

Conclusion

Support Group I belong to:- ____________________________________________