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FORM KEKUATAN OTOT

Nama

: Makbul

No. RM

: 00915857

Umur

: 42 Tahun

Fisioterapi

:

Diagnosis

:

Tanggal

:

KANAN

KIRI

T0 T1 T2 T3 T4

T0 T1 T2 T3 T4
Flexors
Extensors
Flexors
Extensors-thoracid
Extensors-lumbars

Neck

Trunk

HIP

Knee
Ankle
Foot

Toes (4
lateral)

Hallux

R ext obl
L int obl
3333333333333-

3333333333333-

3333333333333-

3333333333333-

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Rotators

Neck

Trunk

L ext obl
R ext obl

Evaluation pelvic
Flexors
Extensors
Abductors
Adductors
External rotation
Internal rotation
Sartorius
Tensor fasciae latae
Flexors-cuter hamstring
Flexsors-inner hamstring
Extensors
Plantar flexors gastroc & soleus
Plantar flexors soleus
Inventor anterior tibial
Inventor posterior tibial
Evertor peroneus brevis
Evertor peroneus longus
Flexors metatarsophalangeal
Extensors metatarsophalangeal
Plexors proximal inter phalangeal
Flexors distal inter phalangeal
Abductors
Adductors
Flexors metatarsophalangeal
Flexors interphalangeal
Extensor interphalangeal

0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0

HIP

Knee
Ankle
Foot

Toes (4
lateral)

Hallux

Scap ula Abdu ctorserrat us anteri or Adductor-middle trapezius Abductor-romboids Elevators Scap ula .

3 3.3 - 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 - 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 - Depressors Flexors 3.3- Extensors radial deviation 3.3.3.3 3.3.3.3.3 3.3.3.3.3.3 3.3 3.3- Abductors 3.3 3.3 3.3.3 3.3.3.3 3.3.3.3 3.3- Horizontal abductors 3.3 3.3- Extensors ulnar deviation 3.3.3.3.3 3.3.3.3.3- Horizontal adductors 3.3.3- Extensors 3.3.3.3.3.3 3.3.3.Shoulder Elbow Fore Form Wrist Finger 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 - 3.3- Extensors 3.3 3.3- Flexors 3.3.3- Flexors ulnar deviation 3.3.3.3- Supinator 3.3.3.3 3.3.3.3- Pronator 3.3- Internal rotators 3.3- Flexors radial deviation 3.3 3.3.3.3 3.3 3.3- External rotators 3.3 3.3.3.3.3.3- Flexors metacarpophalangeal 0 0 0 0 0 Extensor metacarpophalangeal 0 0 0 0 0 Flexor proximal interphalangeal 0 0 0 0 0 Flexor distal interphalangeal 0 0 0 0 0 Abductors 0 0 0 0 0 Adductors 0 0 0 0 0 Shoulder Elbow Fore Form Wrist Finger .3.3 3.3.3.3.3.

3 3.3 3.3 3.Thumbs Chest Abdomen t Lower extremity 3 3 3 3 3 3 3 3 - 3.3 3.3 3.3 3.3 3.3 - 3 3 3 3 3 3 3 3 - 3 3 3 3 3 3 3 3 - Opponens 5 th finger 0 0 0 0 0 Opponens 0 0 0 0 0 Flexors metacarpophalangeal 0 0 0 0 0 Extensor metacarpophalangeal 0 0 0 0 0 Flexors interphalangeal 0 0 0 0 0 Extensors interphalangeal 0 0 0 0 0 Abductors 0 0 0 0 0 Adductors 0 0 0 0 0 Measurement Inspirations Expirations Umbiliocus to Ant sup spine Circumferensi mid calf Circumferensi mid thingh Ant sup spne to in malleoeus Umbilicus to internal malleolus Thumbs Chest Abdoment Lower extremity .