Manual Muscle Testing MMT Flashcards
Factors affecting a person’s strength
- Gender (males surpass girls at 21 y/o)
- Age
- Lifestyle
- Muscle size/type of contraction
- Joint position
- Vascular and/or respiratory status
- Diet/nutrition through lifespan
- Exercise
- Activity level
- Time of day/Temperature
- Fatigue
Causes of loss of strength
- Neurological injuries/disorders (CVA, GSW)
- Orthopedic injuries/disorders (arthritis, fractures)
- Congenital deformities (juvenile RA)
- Trauma (burns, amputations)
Why test muscles?
1) Gives idea of where injury may be, and functional ability at that point
2) Establishes baseline for tx planning
3) Provides tasks that challenge the deficit (grading)
4) For insurance/legal purposes (proof of improvement)
What does MMT test?
1) CONTRACTABILITY (can you palpate contraction? is it firing?)
2) GRAVITY (can muscle move against gravity?)
3) RESISTANCE (can muscle overcome external forces?)
How are muscles tested in MMT (what state)?
- ISOMETRICALLY (static muscle)
* GROSS (group as in flex elbow) vs. specific muscles (isolated muscle); WE MOSTLY DO GROSS
Contraindications for MMT
PHYSICAL:
• Inflammation
• Pain (with touch, movement, resistance)
• Recent surgery (in musculoskeletal system or abdomen—may clench abs during test!)
• Myositis Ossificans (boney overgrowth at joint/bone)
• Osteoporosis
PATHOLOGICAL:
• Dementia (inability to follow commands)
• COPD (shortness of breath/inability to move limb)
• Cardiovascular conditions (heart surgery, etc.)
• Multiple Sclerosis (increased fatigue)
• Arthritis (compromised joint function/structure)
What MMT CANNOT measure
- Muscle endurance
- Muscle coordination
- Motor performance in ADLs
- Upper motor neuron disorders (ie: CVA or CP)
- Poor reliablity/validity
- Functional capacity
How to improve reliability/validity of MMT?
- Improve tone of voice of tester (encourage, firmness)
- Comfortable ambient temperature/limb temperature
- Eliminate distractions of patient/tester
- Improve posture; reduce fatigue (or do when not fatigued)
General Steps for MMT:
1) Pre-screen patient
2) Pre-screen muscle/movement
3) Position the patient/tester
4) Stabilize the proximal part
5) Palpate with fingers
6) Observe patient doing motion
7) Add resistance
8) Grade
Pre-screening the Patient Prior to MMT:
Observe:
• Functional tasks (dressing, grooming, etc.)
• Mobility
• Bilateral arm motion
• How they walk into the room
• How they shake your hand
• Check if patient shows considerations (fatigue, pain, swelling, psych factors?)
Pre-screening the Muscle/Movement Prior to MMT:
- Look for symmetry (atrophy/hypertrophy; tone)
- Observe quality of muscle motion (smooth?)
- Can client move against gravity?
- Speed of motion (how fast is bend, is there delay?)
- Look for tremors, spasms, etc.
- Does clothing allow free movement?
Compensation vs. Substitution
Look for these during patient movement to prevent inaccuracies.
COMPENSATION = holding onto something to increase force of movement, such as the chair. SUBSTITUTION = moving past baseline or with another part to extend movement, such as shoulder during elbow flexion
Steps of Administering Resistance:
• Start where muscle is strongest, usually mid-range
• Place resistance at distal end of segment to which muscle attaches (except in case of hip abduction and scapulas)
• Apply resistance slowly/gradually and build to max tolerable
• Use “Break Test” where patient tries not to allow examiner to move position
**Discontinue if signs of pain!
**Do not grasp muscle belly or apply sudden/jerky resistance!
Steps to Grade MMT:
• Passively move limb through ROM (PROM)
• Ask patient to repeat movement (AROM)
• If patient moves through ROM against gravity with no resistance OR maintains testing position against gravity, then score FAIR (3)
• After achieving a (3), proceed to add resistance in direction to bring limb back to neutral:
- If position held w/min. force, score FAIR+ (3+)
- If position held w/max. force, score NORMAL (5)
***Extremely rare to score between (4-) and (4)!
How to grade for clients who CANNOT perform full ROM with gravity?
• Score FAIR (3-) if joint moves more than half but not full ROM against gravity
• Score POOR (2+) if joint moves less than half available ROM against gravity
**For clients who cannot perform more than half available ROM against gravity, we reduce gravity by re-positioning for anti-gravity. Then, score (2) or lower. THIS IS RARE.
Amount of strength it takes to support limb against gravity?
It takes about 35% of a patient’s maximal strength to support limb against gravity.
Considerations when setting strength goals:
- Diagnosis
- Expected course of disease (is it terminal/degenerative?)
- Overall health of the person
- Age
- Cognition
- Previous functional abilities
Purpose of MMT
1) Determine strength and identify impairments
2) Establish a baseline
3) Document improvements in strength
4) Aid in selecting effectiveness of interventions
In gravity-eliminated MMT, practitioner does not:
Apply resistance. (All other steps remain the same.)
MMT grade given to Pt. who can move joint through full ROM against gravity.
3
MMT when client successfully resists without change in ROM is a _____ muscle contraction.
Concentric
MMT grade given to Pt. whose contraction can be felt, but there is no motion.
1
MMT grade given to Pt. who can move limb through complete ROM with gravity eliminated.
2
Screening Test Scores (Base MMT Grades)
AROM Scores, before applying resistance:
Fair (3) – Beginning score; full ROM against gravity, or maintains testing position.
Fair (3-) – Moves through greater than half but less than full ROM against gravity.
Poor (2+) – Moves through less than half ROM against gravity.
Gravity Eliminated Scores (Lower MMT Grades)
WHEN PT. CANNOT MOVE LIMB MORE THAN HALF AVAILABLE ROM AGAINST GRAVITY. We eliminate gravity from equation by positioning. Then grade:
Poor (2) – Moves full ROM with gravity eliminated.
Poor (2-) – Moves greater than half but not full ROM.
Trace (1+) – Moves joint less than half ROM.
Trace (1) – No joint movement, but slight observable/palbable contraction.
Zero (0) – No joint movement or contraction.
Isometric Scores (Higher MMT Grades)
If Pt. resists minimal force AND GRAVITY, you may increase resistance, and grade:
Fair + (3+) – Maintains testing position w/minimal resistance.
Good- (4-) – Maintains position with less-than-moderate resistance.
Good (4) – Maintains position with moderate resistance.
Normal (5) – Maintains position with maximal resistance.
