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Grade 4 in muscle strength assessment refers specifically to "full range of motion (ROM) against gravity with decreased strength." This implies that the muscle can move through the full range of motion while opposing the effects of gravity, but it does so with less force than what would be considered normal strength, which would be graded at a 5.

Muscle strength is typically evaluated on a scale from 0 to 5, with each number representing different functional capabilities. Here's a brief overview of the relevant grading:

- Grade 5 indicates a full range of motion against gravity with normal strength.

- Grade 4 indicates full range of motion against gravity but with some weakness, meaning the muscle can perform the activity but not with as much force as would be expected.

Understanding the implications of muscle grading can be crucial in rehabilitation and clinical assessments to gauge the level of muscle function patients possess and to develop appropriate treatment plans. In contrast, the other options represent different levels or conditions of strength that do not fit the definition of grade 4.