manual muscle testing by K Adhi lakshmi vapms cop
- 1. MANUAL MUSCLE TEST (MMT) (MUSCLE GRADING) K ADHI LAKSHMI BPT-2nd year, VAPMS College of physiotherapy
- 2. SYNOPSE : INTRODUCTION DEFINITION GRADES OF MMT PRINCIPLES PROCEDURE INDICATIONS CONTRA INDICATIONS PRECAUTIONS
- 3. INTRODUCTION :- Manual muscle testing is used to determine the extent and degree of muscle weakness resulting from disease, injury or disuse. The records obtained from these tests provide a base or planning therapeutic procedures and periodic re-testing. Muscle testing is an important tool for all members of health team dealing with physical residuals of disability. MMT is useful in differential diagnosis, prognosis and treatment of NEUROMUSCULAR & MUSCULOSKELETAL disorders. Basic components of Motor Examination :- 1. Nutrition/Bulk of Muscle 2. Tone 3. Reflexes 4. ROM 5. MMT 6. Functional Assessment
- 4. GROUP OF MUSCLE ACTION :- AGONIST ANTAGONIST SYNERGIST 1. PRIMARY MOVERS/AGONISTS :- A Muscle/Muscle group that makes the major contribution to movement at the joint. 2. ANTAGONIST :- A Muscle/Group of Muscles has an opposite action to the prime movers. The Antagonists relaxes as the Agonist moves the part through a ROM.
- 5. 3. SYNERGISTS :- Muscle that contracts & works along with the Agonist to produce the desired movement.
- 6. DEFINITION :- MMT is the most vital part of Motor assessment performer in medical examination. MMT is a procedure for the evaluation of strength of the individual muscle or group muscle strength, based upon the effective performance of a movement in relation to the forces of gravity or MANUAL resistance through the available ROM.
- 7. GRADES OF MMT :- I. MRC Scale II. OXFORD Scale III. KENDALL Scale IV. AND Others
- 8. MRC Scale EXPLANATION 0 No Contraction 1 Flickering Contraction 2 Full Range of Motion with eliminated gravity 3 Full Range of Motion with against gravity 4 Full ROM with against gravity with minimal resistance 5 Full ROM with against gravity with maximum resistance MEDICAL RESEARCH COUNCIL (MRC)SCALE :
- 9. OXFORD SCALE EXPLANATION 0 No Contraction is present 1 There is a flickering contraction 2 Full Range of Motion with gravity counter balance *(Eliminated) 3 Full Range of Motion with against gravity 4 Full Range of Motion with against gravity +added resistance 5 Muscle Function normally. Oxford scale:-
- 10. KENDAL SCALE :-
- 11. + or – grades:-
- 14. CONTRA-INDICATION OF MMT :- Cerebral Palsy Pain Cardio vascular Disease / Brain Injury Dislocation Myositis Ossification Inflammation Parkinson’s Disease Severe Cardiac / Respiratory Disease Subluxation Joint Haemophilia Osteoporosis
- 15. Principles of MMT:- 1) Position 2) Stabilization 3) Demonstration 4) Application of grades 5) Application of resistance 6) Checking Normal strength 7) Objectivity 8) Documentation
- 16. Position: (patient position) 1) patient is positioned eliminated or against gravity. 2) not change patient position repeatedly . 3) patient should be in comfortable position . 4) the patient’s position must permit adequate stabilization of the part or parts being tested by virtue of body weight or with help provided by examiner .
- 17. Joint position 1) The joint position is also change depend upon their performance. 2) Distal part of the joint is moved, 3) Place the joint in antigravity position –grade 3 . 4) place the joint in horizontal position –grade 4 .
- 19. Stabilization : 1) Patient could stabilizes our self during performed antigravity position. 2) The hand placement of the patient is important . Hand placement : 1) Proximal hand – at origin of muscle and proximal joint giving stabilization. 2) Distal hand – distally offering resistance or assistance depend upon performance.
- 21. Demonstration : 1) Demonstrate the desired movement 2) PT demonstrate the application of movement or performance to the pt . APPLICATIONS OF THE GRADES : 1) Always start with GRADE 3 2) Isolation of muscle could be tested .
- 22. APPLICATION OF RESISTANCE : 1) Resistance is applied slowly and gradually 2) Increasing or decreasing manual resistance 3) Increase length of weight arm 4) Apply presence opposite to the lie of pull 5) it varies between the person 6) Use long lever to applied resistance whenever is possible..
- 23. CHECKING NORMAL STRENGTH : Therapist to check the strength of the muscle normal side first, OBJECTIVITY : Therapist ability to palpate and observe the tendon or muscle response in very weak muscle
- 24. DOCUMENTATION : 1) Examiners complete testing documentation or record first. 2) This will for next step of treatment application. 3) And help for checking improvement of treatment.
- 25. PROCEDURE :-
- 33. INDICATION OF MMT: Lower motor neuron disease Some other neurological disease such as: Multiple sclerosis Amyotropic lateral sclerosis Myasthenia grevis Guilian barre syndrome Some musculo-skeltal disorder
- 34. PRECAUTIONS : 1. Consider contraindications 2. Do not harm 3. Respect pain 4. Know the Available ROM 5. Follow the Principles of procedure 6. Comfortable Position 7. Record Accurately 8. Abdomen Surgery 9. Newly united Fractures 10.Ankylosis 11.Prolonged immobilization
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