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The Manual Muscle Test :The Manual Muscle Test :

Moving Tow ardsMoving Tow ardsStandardizationStandardization

Michael HarrisMichael Harris--Love,Love, DScDSc, MPT, CSCS, MPT, CSCSThe George Washington UniversityThe George Washington University

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OverviewOverview

Adaptations to MMT procedureAdaptations to MMT procedure

Standardization of MMT for IMACSStandardization of MMT for IMACS

Examples of MMT procedureExamples of MMT procedure

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Why Modify the MMT?Why Modify the MMT?

Multiple versions of the MMT existMultiple versions of the MMT exist

Differences in scoring criteria and testDifferences in scoring criteria and testadministrationadministration

Continued use as a primary outcomeContinued use as a primary outcome

measuremeasure

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Standardization of the MMTStandardization of the MMT

for IMACSfor IMACS

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Standardization of the MMTStandardization of the MMT

for IMACSfor IMACS

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Standardization of the MMTStandardization of the MMT

for IMACSfor IMACS

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Standardization of the MMTStandardization of the MMT

for IMACSfor IMACS

Demonstrateand/or explainMMT position

Request thesubject toassume theMMT position

Adjust the subjectsposition manually if

necessary

Place your handson the subject toadminister theMMT

Execute withverbal cues(Hold!) andapply manualpressure

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The Manual Muscle TestThe Manual Muscle Test

Wrist extensors

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The Manual Muscle TestThe Manual Muscle Test

Shoulder Abduction

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Modifications: Elbow FlexorsModifications: Elbow Flexors

Elbow joint angle duringElbow joint angle during

resisted testingresisted testing

Near maximal flexion, orNear maximal flexion, or

near midrange?near midrange?

We have elected to performWe have elected to performthe MMT near the midrange ofthe MMT near the midrange of

the jointthe joint

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The Manual Muscle TestThe Manual Muscle Test

Knee extensors

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A MMTA MMTGolden RuleGolden Rule

Manual contact: hand placement is justManual contact: hand placement is just

proximal to the next distal joint of the targetproximal to the next distal joint of the targetmuscle group.muscle group.

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Modifications: Hip AdductorsModifications: Hip Adductors

Hand placement varies based on MMT method

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Modifications: Hip AdductorsModifications: Hip Adductors

Distribution of Muscle Weakness

PF

DF

WE

WF

KE

KF

HA

HE

HF

EE

EF

SAS

ENE

NF

MMTScore

10

9

8

7

6

5

4

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The Manual Muscle TestThe Manual Muscle Test

Hip extensors

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The Manual Muscle TestThe Manual Muscle Test

Ankle dorsiflexors

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Modifications: Cervical FlexorsModifications: Cervical Flexors

Testing method for musclesTesting method for muscles

too weak for AROMtoo weak for AROM

Sign of muscle contractionSign of muscle contractionoror

movement in horizontal plane?movement in horizontal plane?

We continue to use the MMTWe continue to use the MMT

scoring criteria (horizontalscoring criteria (horizontal

plane of motion)plane of motion)

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Coda: The Trouble with MeasuringCoda: The Trouble with Measuring

AnkleAnkle PlantarflexionPlantarflexion StrengthStrength

TriplanarTriplanar motion of themotion of theankle/foot complexankle/foot complex

22ndnd Class Lever: bias towardsClass Lever: bias towardspower (power (vsvs speed)speed)

Muscle architecture:Muscle architecture:

multipennatemultipennate fibersfibers

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Is the MMT Score Associated withIs the MMT Score Associated with

Peak AnklePeak Ankle PlantarflexionPlantarflexion Force?Force?

IBM subjects, N = 41, 29IBM subjects, N = 41, 29males, 12 females, agemales, 12 females, age

61.661.6 7.3 years, disease7.3 years, disease

duration 8.9duration 8.9 4.3 years4.3 years

IsometricIsometric plantarflexionplantarflexion

MMT scoring:MMT scoring:

Kendall method (break test)Kendall method (break test)

WorthinghamWorthingham method (heelmethod (heelraises)raises)

STRONGSTRONG KendallKendall WorthingWorthing..

PF Peak forcePF Peak force .01.01

r = .99r = .99

.29.29

r = .20r = .20

WEAKWEAK KendallKendall WorthingWorthing..

PF Peak forcePF Peak force .70.70

r < .01r < .01

.70.70

r < .01r < .01

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Repeated Heel Raises and Peak AnkleRepeated Heel Raises and Peak Ankle

PlantarflexionPlantarflexion ForceForce

plantarflexion force scaled to bodyweight

.7.6.5.4.3.2.1

PFreps

40

30

20

10

0 Rsq = 0.1156

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Is the MMT Score Associated withIs the MMT Score Associated with

Peak AnklePeak Ankle PlantarflexionPlantarflexion Force?Force?

Both MMT scoring criteriaBoth MMT scoring criteriaare suited for weak subjectsare suited for weak subjects

Ability to complete the task,Ability to complete the task,not task repetition, isnot task repetition, is

associated with strengthassociated with strength

WorthinghamWorthingham MMT scaleMMT scale

has a lower ceiling effecthas a lower ceiling effect

than the Kendall MMT scalethan the Kendall MMT scale

COMBINEDCOMBINED KendallKendall WorthingWorthing..

PF Peak forcePF Peak force .49.49

r < .01r < .01

.66.66

r < .01r < .01