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Manual Muscle Testing in the acute/rehab setting
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Manual Muscle Testing in the acute/rehab setting - February 4, 2006 5:29:00 PM
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valmarie
Posts: 13
Joined: July 1, 2003
From: Texas
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Hey all, I've been out of practice for a years now and am just coming back to rehab. Our eval forms include specifics for every major muscle group so it has really forced me to get back on the wagon with MMT.
However, I wonder, when you have a patient who is clearly weak, not following commands and cannot properly assess, what is the appropriate grading? If they are moving their legs voluntarily in bed against gravity BUT if it is not FULL ROM (which is normally is not for normal movement) then you cannot grade a 3, correct, bc that would have to be FULL ROM. But you know they are probably more than a 2 bc they ARE moving against gravity. What in the world do you do?
Advice? Opinions? Debates?
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Re: Manual Muscle Testing in the acute/rehab setting - February 4, 2006 6:23:00 PM
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Jeffre
Posts: 130
Joined: August 18, 2005
From: Lafayette, LA
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At that point it is really just a guess. What is more important at that stage (acute) is function. Bed mobility, transfers and what their level of assistance is. You will be using FIM scores on a rehab unit anyway, although not sure in Mexico.In the situation you described you wouldn't be able to assess progress anyway especially if the pt is not following commands. More than likely you will not pick up that pt due to poor therapy potential. I guess you can ask the therapists who have been there for a while what they have done or what the policy is as it will be different at different facilities.
_____________________________
"You are as well as your insurance company is willing to allow."
- Dr. Hibbert
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Re: Manual Muscle Testing in the acute/rehab setting - February 4, 2006 8:26:00 PM
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Randy Dixon
Posts: 744
Joined: August 6, 2004
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Does it really matter? It's not an exact science or even reliable between two different PT's. Pick a system and stick with it.
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Re: Manual Muscle Testing in the acute/rehab setting - February 5, 2006 2:27:00 AM
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Geert Jeuring
Posts: 92
Joined: June 26, 2002
From: Möhnesee, Germany
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Hello Valmarie, I think I agree with Jeffre on the subject of function. I think any ambulation scale would give a better assessment then Musclefunctiontests. It is very difficult to get relevant information out of muscletests. When a patient tests 3 in all tests, are you sure he can walk?
Greetings
Geert
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Re: Manual Muscle Testing in the acute/rehab setting - February 5, 2006 2:28:00 AM
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Geert Jeuring
Posts: 92
Joined: June 26, 2002
From: Möhnesee, Germany
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But if you stick with the test you could say 3-.
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Re: Manual Muscle Testing in the acute/rehab setting - February 5, 2006 3:20:00 AM
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jma
Posts: 2405
Joined: August 24, 2000
From: NY
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I agree with using the FIM scores, that is, if your facility uses it. You can usually find a copy of the form in the chart. There should be a hard copy of one on the floor where they keep nursing manuals. Find it and then make a copy for yourself for reference.
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Re: Manual Muscle Testing in the acute/rehab setting - February 5, 2006 8:26:00 AM
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PTupdate.com
Posts: 1474
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Hi Valmarie,
I challenged my teachers with this in PT school, and they never did have an answer. There are people, who do not have full ROM (adhesive capsulitis, bony block, etc), but can still be "5/5" if using the Kendall type MMT grading system
I always use a mixture of what I can feel isometrically with them, based on all the muscles I have tested over the years, and also take into account their age. Some people may not be 5/5 compared to Jerome Bettis, but for an 88 year old women, are 5/5 for their age.
And one extra bit of advice....do the "make" type test instead of the "break" type, which could easily injure the person. You will get the same result, with much much less risk
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Manual Muscle Testing in the acute/rehab setting - February 5, 2006 8:29:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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I also agree, do not get lost looking at the trees when you need to see the whole forest kind of scenario. MMT is so disproven anyway, and what does it really tell you unless it is below a 3. Very subjective, poor inter-rater reliability, and very poor validity. Mor eimportantly, what is the quality of the movement, how is the motor control, motor programming, volitional control, etc. You would not grade someone with Parkinson's MMT, they're tone makes them strong, yet they cannot volitionally provide power to the muscle groups. I'd stick with things you may treat, so you can have a list of impairments and functional limitations, and what disabilities those create. Then treat the things that create the most functional limitations and decrease the disability. Look more at the patient as a whole. What is the limiting factor, and what can you do about it. If they are non responsive or non communicating, and they have trouble getting out of bed, maybe it will be more appropriate to do caregive training or adaptive equipment or safety assessment for bed rails etc, rather than worrying about MMT. Don't forget MMT was developed during the Polio days and was merely a scale to screen patients, it was never fully adapted for a normal population, just guestimated and extrapolated to refer to normal values. So, moral of the story, who cares about MMT (ever really) but especially with this patient. You can write patient has no volitional control of movement of LE when asked to move against or with gravity in any range but has enough power to move leg uncontrollably through gravitational range. I think that tells a way bigger story and way bigger idea of treatment or lack of treatment parameters than MMT 3/5. I love looking at objective impairments, but they really should match what your treatment will be, and make sure you are measuring what you are seeking out to measure, neurological weakness is different than muscle fiber atrophy weakness, which is different from central nervous system weakness, different from spinal cord weakness, different from peripheral nerve weakness, different from neuromuscular junction weakness, different from motor planning and recruitment weakness, different from motor control/skill weakness, different from being SOB fatigue weakness, and so on and so on...so does giving these scenarios the same grading scale make sense?? I guess I have beaten this horse so dead it is time to call Elmer's glue, but maybe it'll help you see the forest again and get out of looking at individual trees. Take care-
Ben
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