Techniques For Manual Muscle Testing Of Children

Manual muscle testing, MMT, is a form of muscle evaluation performed by a health care provider, typically a physician or physical therapist, to evaluate the strength of isolated muscles. This is done manually because imaging studies such as X-rays and MRIs do not provide detailed information related to soft tissues, such as muscles. MMT is often done when you are experiencing weakness in the muscles or tendons or symptoms that may be associated with nerve damage. MMT is performed in the same manner for both adults and children.

Technique

MMT is performed by a health care provider in order to assess the strength, or weakness, of a muscle or muscle group. The patient must be instructed on how to perform the test and what the test is looking for. The individual performing the test should provide consistent resistance and stabilize unrelated joints in order to increase the accuracy of the test. For example, if the elbow is being tested, the shoulder should be stabilized in order to prevent extraneous movement. The right side of the body should always be compared to the left side for accurate grading.

Testing Order

During the MMT, one muscle group is tested at a time, beginning with the right side followed by the left. For example, the right elbow flexors would be tested first, followed by the left elbow flexors before moving on to the wrist. The patient should begin in a seated position and all muscles are tested here before moving to their back, side-lying to the left, face down, side-lying to the right and finally standing. Relevant muscles are tested in sequence, starting at the head and moving toward the feet in each position.

Grading

The assessment of MMT results is referred to as grading. Grading is a measure of how well you can move the muscle in question against gravity and resistance. Grade 5 is normal and indicates that the patient has full strength and full range of motion. Grade 4 is good, with the patient displaying full range of motion against moderate resistance. Grade 3+ is fair-plus, with motion achieved against minimal resistance and grade three is fair, with motion is achieved against gravity only. Grade 2+ is poor-plus, when range of motion cannot be completed against gravity but can be done when gravity is eliminated and muscles give way to resistance. Grade 2 is poor and the motion cannot be completed against gravity, and grade 2- indicates only partial movement can be completed. Grade 1, or trace, is slight muscle contraction only. Grade 0, or no trace, indicates no muscle contraction.

Other Considerations

Administration of manual muscle tests of children, while done with the same technique as adults, requires some different explanations in order for them to carry out the intended action. Using phrases such as. "I am going to see how strong you are" and "Try really hard not to let me move you," help them to understand what movement they need them to make. Demonstrating the movement, such as holding your own arm straight out and having them imitate you, will help get them in the right position to test their shoulder muscles, for example.