The document discusses principles of manual muscle testing (MMT). It describes how MMT is used to measure muscle strength by applying external loads and gravity. There are different grading scales for MMT, including the Medical Research Council scale and Daniels and Worthingham scale. Proper positioning, stabilization, and application of resistance are important for standardized MMT. Factors like joint position, type of muscle contraction, and distance of applied force can influence strength measurements.
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
Includes detailed description of BIOMECHANICS & PATHOMECHANICS OF KNEE JOINT AND PATELLOFEMORAL JOINT with recent evidences . Hope you find it useful!!
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
Introduction to muscle energy techniques (METs)Fared Alkordi
The use of Muscle Energy Techniques (METs) to reduce muscle pain and improve muscle length. Types, physiological mechanisms and practical techniques in clinical settings.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
Includes detailed description of BIOMECHANICS & PATHOMECHANICS OF KNEE JOINT AND PATELLOFEMORAL JOINT with recent evidences . Hope you find it useful!!
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
Introduction to muscle energy techniques (METs)Fared Alkordi
The use of Muscle Energy Techniques (METs) to reduce muscle pain and improve muscle length. Types, physiological mechanisms and practical techniques in clinical settings.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
Key points of control illustrations by examplesSara Sheikh
you can get a fair idea WHAT key points of control are and how can be they used to control a patient.... though it is demonstrated on children, it can be used with adults also, if beneficial.
Therapeutic Technique to improve neck holding in cerebral palsy jitendra jain
Head control is the first motor milestone to be achieved in early life. Good head control lays the foundation for the development and refinement of other milestones. It also enables the child to explore the environment effectively in play and to develop more advanced skills. Thus attaining head control is frequently used as the starting point in therapeutic intervention for the children with cerebral palsy or other developmental disabilities by the pediatric occupational therapist. It also very important to have good neck control before the age of two year because if child dont develop good neck vontrol before the age of two year then developemnent of ambulatory capability in child became remote pssiblity.
La moderna riabilitazione cardio-polmonareAngelo Longoni
Vengono descritti i cambiamenti che sono avvenuti negli anni nella modalità di lavoro e negli strumenti della riabilitazione cardiologica e respiratoria.
Bruce Hamilton - Classification and Grading of Muscle InjuriesMuscleTech Network
Bruce Hamilton
Sports medicine physician, High Performance Center, Oakland, New Zeeland,
-
Classification and Grading of Muscle Injuries: A Review of the Literature
(6th MuscleTech Network Workshop)
14th October, Barcelona
A chronicle on muscle strengthening:
MMT is a procedure for the evaluation of strength of individual
muscle or muscles group, based upon the effective performance of a movement in relation to the forces of gravity or manual resistance through the available ROM.
Manual Muscle Testing (MMT) is a clinical assessment technique used by healthcare professionals to evaluate the strength and function of individual muscles or muscle groups. It involves the systematic application of resistance while the patient contracts specific muscles, allowing the examiner to assess the muscle's ability to generate force and produce movement. Here's a detailed overview:
1. **Purpose**: MMT is used to:
- Identify muscle weakness or imbalance.
- Assess the extent and location of neuromuscular dysfunction.
- Monitor changes in muscle strength over time.
- Guide treatment planning and rehabilitation interventions.
2. **Procedure**:
- **Patient Positioning**: The patient is positioned appropriately to isolate and activate the muscle being tested.
- **Instruction**: Clear instructions are provided to the patient regarding the desired movement and level of effort.
- **Stabilization**: Adjacent joints or body segments may be stabilized to prevent compensatory movements.
- **Resistance Application**: The examiner applies resistance, typically manually, in the direction opposite to the muscle's action, gradually increasing it while the patient contracts the muscle.
- **Observation**: The examiner observes the quality of muscle contraction, noting factors such as initiation, strength, endurance, and any signs of fatigue or compensation.
- **Grading**: Muscle strength is graded on a scale ranging from 0 to 5:
- 0: No contraction detected.
- 1: Muscle flicker, but no movement.
- 2: Movement occurs, but not against gravity.
- 3: Movement against gravity, but not against resistance.
- 4: Movement against some resistance, but not full strength.
- 5: Full strength, normal movement against full resistance.
3. **Applications**:
- **Clinical Diagnosis**: MMT helps identify muscle weakness or dysfunction associated with various conditions, such as neuromuscular disorders, orthopedic injuries, and neurological impairments.
- **Treatment Planning**: Assessment findings from MMT guide the selection of appropriate therapeutic interventions, including strengthening exercises, manual therapy techniques, and functional training.
- **Rehabilitation Monitoring**: Serial MMT evaluations track changes in muscle strength and function during the rehabilitation process, informing progression and adjusting treatment goals as needed.
4. **Considerations**:
- **Reliability and Validity**: MMT results may vary based on factors such as examiner experience, patient cooperation, and testing conditions. Standardized protocols and repeated assessments can enhance reliability.
- **Limitations**: MMT may not be suitable for assessing deep muscles or muscles affected by pain, and results may be influenced by factors such as fatigue, motivation, and neurological impairment.
- **Clinical Judgment**: Interpretation of MMT findings requires clinical judgment,.
The manual muscle testing procedure was described in this power point, indications, contraindications, limitations of MMT was included. the MMT grading system (scale) was explained well in this PPT.
uscle strength is a common area evaluated when patient first come to rehabilitation. Most practitioners use manual muscle testing devices like hand held dynamometers to get results for muscle strength.
Master of Surgery - MS.
Doctor of Medicine - MD.
Bachelor of Ayurvedic Medicine and Surgery - BAMS.
Bachelor of Homeopathic Medicine and Surgery - BHMS.
Bachelor of Physiotherapy - BPT.
Bachelor of Unani Medicine and Surgery - BUMS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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4- Manual Muscle-Testing_in_pediatric_patient
1. aebrahim123@hotmail.com
LECTURE IV
MANUAL MUSCLE TESTING
DR. AMAL HM IBRAHIM
PROFESSOR OF PHYSICAL THERAPY
2. aebrahim123@hotmail.com
MANUAL MUSCLE TESTING
The ward “strength” has multiple meanings
within the profession of physical therapy.
These multiple meaning have caused difficulty
in communication, and led to opposing
conclusions among clinicians concerning a
patient’s functional ability.
3. aebrahim123@hotmail.com
MANUAL MUSCLE TESTING
Manual muscle test is one method by which
muscle strength is defined and measured.
History of manual muscle testing (Robert W.
Lovett 1912).
MMT uses the principles of gravity and applied
external load to determine the ability of a
patient to develop muscle tension voluntarily.
4. aebrahim123@hotmail.com
MANUAL MUSCLE TESTING
MMT must reflect the function of the
neuromuscular system.
MMT has been and still is considered
a useful diagnostic and prognostic
tool that can be used to judge the
effectiveness of therapeutic
programs.
5. aebrahim123@hotmail.com
PRINCIPLES OF MMT
The Guide to Physical Therapist Practice lists both manual
muscle testing (MMT) and dynamometry as appropriate
measures of muscle strength.
Manual muscle testing is a procedure for the evaluation
of the function and strength of individual muscles and
muscle groups based on the effective performance of a
movement in relation to the forces of gravity and manual
resistance.[2]
Dynamometry is a method of strength testing using
sophisticated strength measuring devices (e.g., hand-grip,
hand-held, fixed, and isokinetic dynamometry).
6. aebrahim123@hotmail.com
PRINCIPLES OF MMT
Muscle strength is the ability of
muscle to develop tension
through its long axis.
Muscle tension can be resolved
into two forces, one acting along
the long axis of the bone upon
which the muscle functionally
insert, and the other
perpendicular to that axis.
1- Stabilizing force.
2- Rotating force.
7. aebrahim123@hotmail.com
PRINCIPLES OF MMT
The muscle torque
must overcome the
torque created by the
weight of the
extremity and any
applied force in order
to move or maintain
the position of body
segment.
8. aebrahim123@hotmail.com
PRINCIPLES OF MMT
For grading strength there are three factors:
1- The extent of the arc of movement.
2- The gravity.
3- The amount of force applied by examiner
in a direction opposite to the torque exerted
by the muscle group being tested.
Some times the effect of gravity on the
segment cannot obtained.
9. aebrahim123@hotmail.com
PRINCIPLES OF MMT
Medical Daniels and Kendall and Explanation
Research Worthingham McCreary
Council
5 Normal(N) 100% Holds test position against maximal resistance
4+ Good + (G+) Holds test position against moderate to strong
pressure
4 Good(G) 80% Holds test position against moderate resistance
4- Good – (G-) Holds test position against slight to moderate
pressure
3+ Fair + (F+) Holds test position against slight resistance
3 Fair (F) 50% Holds test position against gravity
3- Fair- (F-) Gradual release from test position
2+ Poor + (P+) Moves through partial ROM against gravity OR
Moves through complete ROM gravity eliminated
and holds against pressure
2 Poor(P) 20% Able to move through full ROM gravity eliminated
2- Poor – (P-) Moves through partial ROM gravity eliminated
10. aebrahim123@hotmail.com
PRINCIPLES OF MMT
In the Medical Research Council scale, the
grades of 0, 1, and 2 are tested in the gravity-
minimized position (contraction is
perpendicular to the gravitational force). All
other grades are tested in the anti-gravity
position. The Daniels and Worthingham grading
system is considered the more functional of the
three grading systems outlined in Table 1
because it tests a motion that utilizes all of the
agonists and synergists involved in the motion
11. aebrahim123@hotmail.com
PRINCIPLES OF MMT
The Kendall and McCreary approach is designed to
test a specific muscle rather than the motion, and
requires both selective recruitment of a muscle by
the patient and a sound knowledge of anatomy and
kinesiology on the part of the clinician to determine
the correct alignment of the muscle fibers.[3]
Choosing a particular grading system is based on skill
level of the clinician while ensuring consistency for
each patient, so that coworkers who may be re-
examining the patient are using the same testing
methods.
12. aebrahim123@hotmail.com
PRINCIPLES OF MMT
It must be remembered that the grades obtained
with MMT are largely subjective and depend on a
number of factors including the effect of gravity,
the manual force used by the clinician, the
patient's age, the extent of the injury, and
cognitive and emotional factors of both patient
and clinician
13. aebrahim123@hotmail.com
PRINCIPLES OF MMT
Daniels and Worthingham describe P+ as the
grade indicating movement of the segment
through full range of motion in the gravity-
diminished or in the partial range against
gravity.
Kendall et al consider P+ (30%) as
movement of the extremity through a larger
arc of motion in the gravity-diminished
position than that designated by the criteria
for 20 percent grade.
14. aebrahim123@hotmail.com
PRINCIPLES OF MMT
In contrast, for the same muscle group, Kendall
et al, have the patient either sitting or supine,
moving the supinated forearm to a test position
of 90º flexion or less, or holding the test
position against the applied force. Stabilization
is minimal by the examiner who places one
hand under the patient’s elbow.
15. aebrahim123@hotmail.com
GRADING SCALE: (DANIEL & WORTHINGHAM
1995)
Rating muscle tests is a skill that takes a long time
to learn and perform with reliability. It is important
to learn how much resistance a “normal” muscle
can tolerate to know when a muscle is not
performing to its potential. All tests must be
performed bilaterally and the unaffected side
should be tested first. This is crucial because the
tester can then get an accurate idea of how much
resistance the unaffected side can tolerate and
what would be considered normal for the patient.
16. aebrahim123@hotmail.com
PRINCIPLES OF MMT
MMT requires attention to positioning,
stabilization and the methods of applying
external force to the body segment.
Standardization of these factors from one
patient to another is important because the
examiner must develop an experiential
model with which the results of each muscle
group tested will be compared.
17. aebrahim123@hotmail.com
PRINCIPLES OF MMT
There are differences between testing methods
in positioning , stabilization and the way in
which manual forces are applied.
Daniels and Worthingham 1980 recommended
elbow flexion test from sitting with arm
stabilized at the side, and if the biceps is the
main concern, the forearm supinated. The arm
should move through full arc of motion with the
examiner applying force at the end of motion
(break test).
18. aebrahim123@hotmail.com
PRINCIPLES OF MMT
In contrast for the same muscle group
Kendall et al 1971, have the patient either
sitting or supine, moving the supinated
forearm to a test position of 90ºof elbow
flexion or slightly less or holding the test
position against the applied force.
The examiner’s force is applied to the
forearm in the test position of 90º of elbow
flexion. Stabilization hand is under the
patient’s elbow.
19. aebrahim123@hotmail.com
PRINCIPLES OF MMT
Although the two methods are different
there is no evidence suggesting different
results.
Position (sitting and supine) can yield
different strength measures.
Muscle torque in example of Daniels and
Worthingham, the flexors are mechanically
and physiologically disadvantaged.
20. aebrahim123@hotmail.com
PRINCIPLES OF MMT
The effect of the external force in resisting
muscle group torque is a function of the
distance of its application from the joint axis.
If the examiner changes the distance at
different times with the same patient and
among patients, appropriate measurement can
not be obtained.
The skill of examiner to apply external force is
important (gradual, in correct direction and
differentiating).
21. aebrahim123@hotmail.com
PRINCIPLES OF MMT
The muscle ability to develop tension varies
according to the type of muscle contraction.
Eccentric contraction generates the greatest
amount of tension followed by isometric and
then concentric contraction.
22. aebrahim123@hotmail.com
PRINCIPLES OF MMT
The effect of the external force in resisting
muscle torque is a function of the distance of
its application from the joint axis.
If the examiner changes the distance at
different times with same patient or among
patients the muscle strength related to sex,
age, body type and life style cannot obtained.
23. aebrahim123@hotmail.com
RELIABILITY OF MMT
Intra-rater reliability examined by two
therapist performed MMT on poliomyelitis
patients at 6 week interval. Intra-examiner
agreement occurred on 65% and 54% of
the grades. Agreement occurred within a
plus or minus grade on 82% and 84% of
the muscle tested, Iddings and Smith
1961,
24. aebrahim123@hotmail.com
RELIABILITY OF MMT
Iddings and Smith 1961, had 10 physical
therapists complete a MMT on a poliomyelitis
patients within 2 week period. A training period
was not provided; each examiner performed the
test by his or her customary manner.
Nine of the examiner’s muscle grades were
compared with the tenth. The nine physical
therapist on the average agreed completely with
the tenth (45.3%) and 63.8% in plus or minus
grades.
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RELIABILITY OF MMT
An inter-rater reliability study, physical
therapist, nurses and physicians were
instructed in standardized methods of
muscle testing. They reported that the
average difference between examiners was
7.1%. When two physical therapist were
compared, the difference in grading was
3%, in agreement in 60% of instances and
95% within plus or minus one grade.
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VALIDITY OF MMT
MMT has face validity which is defined as the
extent to which the test appears to measure
what it was intended to measure.
Content validity reflects the adequacy of test
construction (known physiologic, anatomic, and
kinesiologic principles).
For example, test grade fair for tibialis anterior
the muscle should be able to move the foot
through full arc of motion against gravity.
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VALIDITY OF MMT
The tibialis anterior should be able to resist
some degree of applied external force.
MMT has some content validity because it
measure directly the torque of muscle testes
but not all types of contractions or the rate of
tension develop during test.
Agreement of knowledgeable persons that test
construction is sound is an indication of a high
degree of content validity of a test.
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VALIDITY OF MMT
Construct validity as related to MMT, represents
the degree to which one can generalize the
results of the test to relevant behaviors.
As in tibialis anterior example which indicates
the muscle inverts and dorsiflexes the foot
through full range of motion while subject is
sitting over edge of table (non-weight bearing)
while it is main muscle in gait (push off and
heel strike).
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VALIDITY OF MMT
Because MMT do not examine muscles
during meaningful functional activity, the
use may be limited for the neurological
patients.
MMT is hypothesized as valuable
measurement tool for the clinical
assessment of patients with
neuromuscular problems.
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MMT OF THE PEDIATRIC PATIENT
Muscle testing the pediatric patient is different
from the technique used in adult practice.
It is essential to have an understanding of
normal growth and development.
In very young child, the use of reflexes will
assist in the evaluation process.
In the older child, the use of developmental
tasks will help to assess muscle activity.
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MMT OF THE PAEDIATRIC PATIENT
It is better to divide the exam into three age
and developmental categories:
1- infants: birth through 12 months.
2- toddler: 12 months through 24 months.
3- preschooler: 24 months through 48 months.
Children over 4 years of age can be more
formally tested.
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MMT OF THE PEDIATRIC PATIENT
Early Reflexes
Reflex Emergence Disappearance
Moro birth 5 to 6 months
Palmar grasp birth 3 months
Plantar grasp birth 12 months
Placing birth 12 months
Protective: lateral 6 to 9 months Persists
Protective: parachute 9 months Persists
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MMT OF THE PEDIATRIC PATIENT
Developmental Milestones
Age Activity
birth Flexion of limbs
Ventral suspension, head in line with body
3 months Head control midline
Reaches for objects
Head upright in prone
6 months Sits with balance from hands
Can bear weight on leg
Transfers objects hand to hand
9 months Sits independently
Pulls to stand
Crawling and cruising
Pincer grasp
12 months Walking alone
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MMT OF THE PEDIATRIC PATIENT
Developmental Milestones
Age Activity
18 months Creep up stairs
Throws a ball
24 months Runs
Walks up and down steps
Kicks a ball
30 months Jumps
36 months Stands on one foot momentarily
48 months Hops on one foot
Throws a ball overhand
60 months skips
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THE MUSCULOSKELETAL EXAM
The infant exam:
1- by observation.
2- evaluation:
From supine.
From prone.
Vertical.
Horizontal.
Sitting.
Floor play
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THE MUSCULOSKELETAL EXAM
The toddler exam:
1- by observation.
2- by evaluation:
Sitting on the table or parent’s lap: evaluate
upper limb by using toy, transfer objects to the
opposite hand. Check lateral protective reflex.
Floor exam: watch child from supine to sit, stand
up and watch trunk and lower limbs, ask child to
walk, have child kick a ball.
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THE MUSCULOSKELETAL EXAM
The preschool exam
1- observation.
2- evaluation:
Sitting on the exam table.
Lying on the exam table.
Floor exam.
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6 MINUTE WALK TEST
This test measures your
response to exercise, at your
own pace. Some people have
no problems at all. Others may
have shortness of breath, chest
pains, leg pains, etc. You may
stop the test at any time if you
are not feeling up to it or if a
problem occurs during the
walk.
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TANDEM WALK TEST
Description
The TW quantifies characteristics of gait as the
patient walks heel to toe from one end of the
forceplate to the other. Measured parameters
are step width, speed, and endpoint sway
velocity.
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REACTION TIME
Reaction Time (RT) is the time in seconds
between the command to move and the
patient's first movement.
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STANDING BALANCE TEST
the person stands on one leg for as long as
possible. Give the subject a minute to practice
their balancing before starting the test. The
timing stops when the elevated foot touches
the ground or the person hops or otherwise
loses their balance position. The best of three
attempts is recorded. Repeat the test on the
other leg.