Manual Muscle Testing

Question 1

Measurable force exerted by a muscle or group of muscles to overcome resistance in one maximal effort

Answer 1

Strength

Question 2

Ability to contract a muscle repeatedly over a period of time

Answer 2

Endurance

Question 3

Work produced per unit of time (product of speed and strength)

Answer 3

Power

Question 4

Three primary approaches used to determine muscle strength

Answer 4

Isotonic
Isokinetic
Isometric

Question 5

Testing of strength using constant external resistance

Answer 5

Isotonic

Question 6

Since constant (isotonic) muscle tension rarely occurs, contraction is usually referred to as

Answer 6

Concentric or eccentric

Question 7

Assess the con and ecc strength of muscle using ____________

Answer 7

Free weights, resistance machines

Question 8

T/F gross strength of muscle groups is assessed rather than the strength of the individual muscles

Answer 8

T

Question 9

An isolines if dyanamometer allows measurement of strength by having subject provide resistance through the ROM at a _________

Answer 9

Constant velocity

Question 10

The isokinetic dynamometer provided _______ values at specific points in the ROM or throughout full ROM

Answer 10

Peak torque

Question 11

Disadvantages to isokinetic

Answer 11

Cost of equipment is high

Considered non-functional since a muscle strength is assessed in non-weight bearing

Question 12

During an isometric contraction, the muscle length remains _______ throughout the contraction

Answer 12

Almost the same

Question 13

How is isometric muscle strength tested

Answer 13

Having the muscle generate force against an immovable resistance

Question 14

What issues are eliminated in isometric contraction

Answer 14

Since muscle length is unchanged, issues with variability in muscle length and velocity of joint motion are eliminated

Question 15

Most common methods of isometric testing

Answer 15

MMT and HHD

Manual muscle testing and Handheld dynamometry

Question 16

What type of contraction is MMT

Answer 16

Isometric

Question 17

Disadvantage of isometric contraction

Answer 17

Provides muscle strength data at only one point in ROM

Question 18

Patients with significant muscle weakness are best assessed using

Answer 18

Manual muscle testing

Question 19

T/F HHD and other instrumented forms of muscle testing are sensitive enough to detect low levels of strength

Answer 19

F

Question 20

Patient’s with strength in the range of Good (4) to Normal (5) should be tested

Answer 20

• Using HHD
• strength testing (10 rep max)
• isokinetic dynamometry
• not MMT

Question 21

Method of choice for the assessment of muscle strength of patient whose muscle test grades fall below Fair+ (3+)

Answer 21

MMT

Question 22

What is manual muscle testing designed to measure?

Answer 22

Muscle strength which is defined as ability of muscle to develop isometric tension against resistance.

Question 23

Some neuromusculoskeletal diseases that MMT is used to assess muscle strength

Answer 23

• spinal cord injuries
• Gillian-barre syndrome
• muscular dystrophy
• multiple sclerosis
• RA & OA

Question 24

Manual muscle testing assists the PT in (4)

Answer 24

1- diagnosis and prognosis by determining level of lesion
2- planning treatment program
3- evaluating progress or regression of patient
4-basic starting point for developing an exercise program for the patient

Question 25

T/F we can eliminate gravity when performing a MMT

Answer 25

F we can lessen gravity, but cannot eliminate

Question 26

Why is palpating of muscle being tested important?

Answer 26

There can be an active contraction even if limb movement is not observed

Question 27

Where does the examiner apply resistance force

Answer 27

Perpendicular to the distal end of the distal segment of the bone being tested

Question 28

Difference between make vs. break test

Answer 28

MAKE - patient exerts a max force against the resistance applied on the limb by the examiner throughout the ROM - patient is instructed to pull or push as hard as they can BREAK - patient holds the position of the limb and the examiner applies max resistance until the patient's maximal muscular effort is overcome and the limb begins to move. - patient is instructed, do not let me move your arm

Question 29

Required to ensure desired action occurs at the specific muscle we are testing

Answer 29

Stabilization (Fixation)

Question 30

Occurs when muscle or muscle groups attempt to compensate for the lack of function of a weak or paralyzed muscle

Answer 30

Substitution

Question 31

Classic example of substitution

Answer 31

Hip hike using QL to substitute for a weak gluteus medius | *Substitution can never be allowed

Question 32

Development of tension by the muscle varies based on both,

Answer 32

Muscle physiology issues | Patient issues

Question 33

Muscle physiology issues (4)

Answer 33

1 - number and firing rate of motor units activated 2 - length of muscle at time of contraction 3 - cross-sectional area of muscle 4 - fiber type composition of muscle

Question 34

Patient issues (5)

Answer 34

``` 1- variation in true effort 2- willingness to suffer pain or discomfort 3- cognition and language 4- fatigue and age 5- psychological issues ```

Question 35

What can a PT control during MMT (4)

Answer 35

1- correct patient positioning 2- proper point of application of resistance 3- use of proper stabilization techniques 4- motivation of patient

Question 36

PT can demonstrate by passively moving distal segment through ROM, if

Answer 36

Patient does not understand | Patient is extremely weak

Question 37

From starting position, ask patient to perform required movement, then

Answer 37

Palpate muscle and maintain stabilization | Observe for substitutions

Question 38

If patient can complete full ROM against gravity,

Answer 38

PT applies resistance with palpation hand at END of the ROM in the exact opposite direction of the movement

Question 39

If patient can complete full ROM against gravity, apply resistance for ______ seconds instructing the patient to ________. Continue to apply resistance until _____ or until resistance was held for _______.

Answer 39

4-5 Continually hold Patient breaks 4-5 sec

Question 40

If patient cannot complete full ROM against gravity,

Answer 40

Reposition the patient in gravity lessened position and repeat the procedure we previously used WITHOUT applying resistance

Question 41

Higher levels of inter-rated reliability are attained when

Answer 41

The uniform method of MMT is used by all testers

Question 42

MMT is more valid for grades of

Answer 42

3 or lower

Question 43

Importance of the order of muscle testing when performing a MMT

Answer 43

- to prevent fatigue of proximal muscles, order of the muscles we are testing from proximal to distal - MMT progression should be planned to prevent frequent change of patient position

Question 44

The PT should be very cautious when using MMT:

Answer 44

- to assess muscle strength in the presence of spasticity or increased muscle tone as a result of a neurological impairment - when significant pain or muscle guarding is present

Question 45

Against gravity grades

Answer 45

3,3+,4,5

Question 46

Movement though the full ROM against gravity

Answer 46

3, F, Fair

Question 47

Movement through the full ROM against gravity and able to hold against minimum resistance

Answer 47

3+,F+, Fair plus

Question 48

Movement through the full ROM against gravity and able to hold against moderate resistance

Answer 48

4,G, Good

Question 49

Movement through the full ROM against gravity and able to hold against maximum resistance

Answer 49

5,N,Normal

Question 50

Gravity lessened grades

Answer 50

0,1,2-,2,2+,3-

Question 51

No evidence of contraction by vision or palpation

Answer 51

0,0,zero

Question 52

Slight contraction, but NO MOVEMENT

Answer 52

1,Tr, Trace

Question 53

Movement through partial ROM in gravity-lessened position

Answer 53

2-,P-, poor minus

Question 54

Movement through full ROM in gravity-lessened position

Answer 54

2,P,Poor

Question 55

Movement through full ROM in gravity-lessened position and up to 1/2 ROM against gravity

Answer 55

2+,P+, poor plus

Question 56

Movement through full ROM in gravity-lessened position and more than 1/2 ROM against gravity

Answer 56

3-,F-, Fair minus

Question 57

Muscle performance includes what 3 things

Answer 57

Strength Endurance Power