Introduction to MMT Part 1 Lecture Notes PDF

Tests and measurements (1) course code:- (PTBA 2118) 1 Introduction to Manual Muscle Testing By Dr. Ahmed B. Abo Elatta (PT, PhD) Lecturer of Physical Therapy, Basic Sciences Department, Horus University in Egypt abayuomy@...

Tests and measurements (1) course code:- (PTBA 2118) 1 Introduction to Manual Muscle Testing By Dr. Ahmed B. Abo Elatta (PT, PhD) Lecturer of Physical Therapy, Basic Sciences Department, Horus University in Egypt [email protected] 3 Student Assessment :- 3 credit hours final exam time: 2 hours total marks: 100 mark Assessment Weight % Semester work 10% Mid term 10% (7th week) Practical exam 30% (14th week) Final written exam 50% (end of semester) Total 100% 4  Practical Theoretical Topics (Sec.) (Lec.) Weeks Introduction Introduction (1) 1st Week Scapula (1) Introduction (2) 2nd Week Scapula (2) Scapula 3rd Week Shoulder (1) Shoulder 4th Week Shoulder (2) Elbow, Forearm, Wrist 5th Week Elbow, Forearm, Hand (Fingers) 6th Week Wrist Hand (Fingers) Mid- teem exam 7th Week Hand (Thumbs) Hand (Thumbs) 8th Week Neck Extension Neck Extension 9th Week Neck Flexion & Neck Flexion & Rotation 10th Week Rotation Goniometry Goniometry 11th Week Ms. Length Ms. Length Assessment 12th Week Assessment 5  We start at time of lecture Recording is allowed NO side talking , all drinks are allowed Questions at the end All videos used are approved 6 Contact only via Lecture T203 7 1st step in assessment and hands-on 8 9 The main components of our course will be: 1. Manual Muscle Testing (MMT) 2. Goniometry (ROM & Muscle Length Testing) 3. Long & Round Measure (Tape Measure) 10 11 12 13 RELATING ASSESSMENT TO TREATMENT Same technique & procedure Different timing & repetition MMT (G 5 & 4) ↔ Resisted ex. MMT (G 3 & 2), AROM assessment ↔ AROM ex. Ms. length assessment ↔ Passive stretching 14 Lecture objectives: After completion of this lecture, you will be able to: Define manual muscle testing (MMT), Measurement Determine test position in relation to gravity Differentiate between Break Test & Make Test Apply appropriate resistance & stabilization in MMT Recognize the sequence of muscle testing procedures Define the criteria for assigning a muscle test grade Prepare the patient for muscle testing Enumerate the factors affecting muscle strength Recognize the limitations of MMT & ↑ its reliability Determine the alternatives to MMT 15 Prior to this course You should review the following Fundamental positions Planes of movement Active movement vs. passive movement concentric vs. eccentric vs. isometric contraction Active insufficiency vs. passive insufficiency Assistance vs. resistance proximal hand vs. distal hand Closed kinetic chain vs. Open kinetic chain Muscle strength vs. Muscle length 16 3 planes of the body: 1) Coronal (frontal) plane: separates the front (anterior) and back ( posterior) of the body. 2) Sagittal (longitudinal) plane: separates the left and right sides of the body 3) Transverse (axial) plane: separates the upper (superior) and lower (inferior) halves of the bod 17 Active and Passive Insufficiency Active Insufficiency: occurs in a two-joint muscle when it cannot shorten enough to cause full ROM of both of the joints it croses at the same time. Examples: The shortening of the Rectus femoris limits full hip flexion when the knee is fully extended. Maximal shoulder flexion cannot be achieved simultaneously with maximal elbow flexion due to the shortening of the Biceps Brachii. 18 Active and Passive Insufficiency Passive Insufficiency: occurs when the muscle cannot be stretched enough to permit full range of motion at both joints at the same time. Examples: Full finger flexion cannot be achieved if wrist flexion occurs simultaneously. Maximal hip flexion and maximal knee extension are limited by the lengthening of the Hamstrings. 19  Introduction to Manual Muscle Test and Measurement History of MMT:- polio., 1912, Wilhelmine Wright, assistant of Robert Lovett (orth. surg.) Measurement :- is the assignment of numbers to objects and variables. This help in reassessment & follow up ex. ROM, Height , Pain. There are many types of measurement scale (4) to cope with and deal with different data types whether it s quantitative or qualitative. 20  Principles of MMT MMT is an ordinal scale of 5-0 MMT consider the effect of gravity MMT is also important for follow-up 21 22 23 If positioning not possible: therapist offers either assistance/ resistance= weight of limb/ limb segment to resemble gravity-minimized position/ gravity resisted position, respectively. 24 26 Functional classification of muscles: 1. Agonist (prime mover):- Priciple ms to produce an action 2. Antagonist :- Ms that oppose the action. 3. Synergist: Ms contract at same time of agonist. 1. Stabilizing (fixating)(stabilize proximal parts). 2. Conjoint ms (contract at same time) to make movement neutral as wrist flexion. 3. Neutralizing (counteracting) finishing to movement, as in grasp a pen 27 Break Test Isometric resistance at test position after ensuring full active free ROM against gravity Make Test Concentric resistance throughout full ROM N.B. Make Test requires considerable skill & experience, less reliable. 28 MMT Example Video (Break Test) Elbow Flexion- Biceps Brachii (Gravity-resisted) 29 MMT Example Video (Break Test) Elbow Flexion- Biceps Brachii (Gravity-minimized) 30  Done by therapist Location of resistance (Test position) :- End or Mid of ROM Location of resistance :- On distal joint segment 31  Stabilization of proximal joint segment → prevent substitution (unwanted movement) [especially in case of weak stabilizers/ strong prime movers] Never apply too much pressure over muscle Belly. 32 Methods of stabilization: Manual fixation by therapist Patient’s position (BW) Patient’s muscle activation External fixation (e.g. belt) Firm testing surface 33 sequence of manual muscle strength testing procedures (Break Test) Ask the patient to make movement against gravity Full available ROM Partial ROM No movement Gravity-minimized position+ ↓ friction Hold test Yield against Can’t tolerate position against max. manual any manual max. manual Full available ROM Partial ROM No movement resistance (4-5 s) resistance* resistance confirm 2- (Poor -) 5 (Normal) 4 (Good) 3 (Fair) 2 (Poor) 2 (Poor) Visible/ palpable No Prepared by: Dr. Ahmed Elnahhas (PT, PhD) discernable contraction * Reference: Avers, D., & Brown, M. (2019). Daniels and contraction Worthingham's Muscle Testing: Techniques of Manual Examination and Performance Testing. Elsevier 1(Trace) 0 (Zero) Health Sciences 34 35 References: 36 QUESTIONS 37 THANK YOU 38