Relationship of manual muscle testing to objective strength measurements

Aitkens, Susan G.; Lord, Janet P.; Bernauer, E. M.; Fowler, William M.; Lieberman, James S.; Berck, Peter

doi:10.1002/mus.880120302

Cited by 160 publications

(74 citation statements)

References 10 publications

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“…In fact, we observed much variability and overlapping of the myometry values for all muscle groups rated four or more. These ®ndings correspond to previous observations in able-bodied subjects 28 and in individuals with SCI. 13,21 For most grades 3.5, less variability of myometry values were present and the overlapping with grades 4.0 was smaller, except for the shoulder¯exors and abductors.…”

Section: Discussionsupporting

confidence: 92%

Comparison of three methods to assess muscular strength in individuals with spinal cord injury

Noreau

Vachon²

1998

Spinal Cord

134

101

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The aim of the project was to compare three methods for measuring muscle strength in individuals with SCI: the manual muscle test (MMT), the hand-held myometry and the isokinetic dynamometry (Cybex). Thirty-eight (38) subjects, 31 men and seven women (age range=14 ± 63; lesion from C5 to L3) were included in this project. Muscle strength assessment of upper limbs was performed at admittance and discharge using MMT and myometry for the left and right side, and using Cybex dynamometer for the stronger side. The testing sessions were at least a day apart and performed by a single evaluator (trained physiotherapist). Signi®cant and non-signi®cant dierences of myometry mean strength values were observed between consecutive levels of MMT. However, the range of myometry scores within each MMT grade led to signi®cant overlaps between two adjacent MMT grades of each muscle group. Variables correlations were observed between the strength values measured by MMT and myometry with paraplegia (0.264r40.67) and tetraplegia (0.504r40.95). Similar results were observed when compared MMT and Cybex with the stronger side.Moderate to strong correlations were observed between the strength values measured by myometry and Cybex with paraplegia (0.704r40.90) and tetraplegia (0.574r40.96). These results suggest that the MMT method does not seem to be suciently sensitive to assess muscle strength, at least for grade 4 and higher and to detect small or moderate increases of strength over the course of rehabilitation. Since outcome measures is an important issue in rehabilitation, objective measurements of strength should be used in clinical settings. Considering cost and assessment time, the myometry technique seems to be highly valuable.

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Section: Discussionsupporting

confidence: 92%

Comparison of three methods to assess muscular strength in individuals with spinal cord injury

Noreau

Vachon²

1998

Spinal Cord

134

101

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“…Two kinds of non-invasive technique are generally used to characterize muscle functional properties in DMD patients. (i) Semi-quantitative measurements (manual testing, timed scores during motor acts) are performed in routine clinical practice and afford a functional evaluation (Edwards & Hide, 1977;Brooke et al 1981;Aitkens et al 1989). For instance, manual testing (scored from 0 to 5) is based on an international graduated scale of muscle ability: MRC scale (Medical Research Council, 1943) reorganized from 0 to 10 (Brooke et al 1981).…”

mentioning

confidence: 99%

Muscle and joint elastic properties during elbow flexion in Duchenne muscular dystrophy

Cornu

Goubel

Fardeau

2001

The Journal of Physiology

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Duchenne muscular dystrophy (DMD) is characterized by a direct effect on muscle fibres leading to muscle atrophy and weakness due to a lack of muscle dystrophin. Dystrophin is a sarcolemma cytoskeletal protein whose deficit leads to segmental necrosis of the muscle fibre. DMD is thus characterized by a decrease in the number of muscle fibres, which are progressively replaced by fibroadipose tissue. The first observed clinical signs relate to difficulties in running or climbing stairs and calf hypertrophy. Gait then becomes lordotic and waddling. Between 6 and 11 years of age, limb and torso muscles progressively and steadily decrease in strength. Loss of ambulation occurs (average 10.5 years of age) and all torso and limb muscles decrease in size.The assessment of muscle mechanical properties in DMD patients is mostly limited to a more or less sensitive evaluation of strength production, generally in static conditions and occasionally during a locomotor act. Two kinds of non-invasive technique are generally used to characterize muscle functional properties in DMD patients. (i) Semi-quantitative measurements (manual testing, timed scores during motor acts) are performed in routine clinical practice and afford a functional evaluation (Edwards & Hide, 1977;Brooke et al. 1981;Aitkens et al. 1989). For instance, manual testing (scored from 0 to 5) is based on an international graduated scale of muscle ability: MRC scale (Medical Research Council, 1943) reorganized from 0 to 10 (Brooke et al. 1981).(ii) Quantitative measurements (manual dynamometry) can be performed in some muscle groups and give a maximal voluntary contraction (MVC) measurement (Munsat, 1989).Understanding of the mechanisms responsible for muscle adaptation to altered functional demand (pathology or training) requires quantification of muscle mechanical properties. For instance, muscle contractility and muscle elasticity were experimentally found to be sensitive to periods of hyperactivity as well as hypoactivity (Goubel & Marini, 1987; Almeida Silveira et al. 1994;Canon & Goubel, 1995 1. Maximal voluntary contraction (MVC), series elastic stiffness and total joint stiffness during elbow flexion were investigated in healthy boys and in boys with Duchenne muscular dystrophy (DMD) in order to assess changes in mechanical properties induced by the disease.2. Two methods were used to perform stiffness measurements: (i) the application of sinusoidal perturbations to the joint during flexion efforts, allowing the calculation of total joint stiffness; (ii) the use of quick-release movements of the elbow, which had previously been maintained in isometric contraction, allowing the calculation of series elastic stiffness. In each case, stiffness was linearly related to torque, leading to the calculation of a normalized stiffness index as the slope of this stiffness-torque relationship.3. As expected, mean MVC was found to be much higher for healthy boys (20.02 ± 5.20 N m) than for DMD patients (3.09 ± 2.44 N m). Furthermore, the results showed that it was poss...

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“…Inadequate trunk muscle strength and endurance increase the risks of lower back pain, falls and dependence in daily living activities. Muscle strength tests provide very important information to help guide therapeutic interventions for patients with neurological and orthopedic disorders in the clinical setting [1][2][3][4][5][6][7][8] . Two tests are commonly used to clinically assess and monitor trunk flexor strength.…”

Section: Introductionmentioning

confidence: 99%

The Relationship between Muscle Activity and Muscle Grade of the Trunk Flexors Using Manual Muscle Testing with Electromyography

2010

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Abstract. [Purpose] To quantitatively investigate whether the muscle grades of the Curl-up (CU) and Double-leg-lowering (DLL) test show any electromyographic changes in the upper and lower rectus abdominis (RA) as trunk flexors.[Methods] The muscle activities of both the upper and lower RA in thirty healthy young males were recorded during each muscle grade task of two tests. The percentages of maximum voluntary contractions (%MVC) of the upper and lower RA were compared between each muscle grade and test. The %MVC ratios of the upper and lower RA were calculated to investigate the contribution of each muscle site in two tests.[Results] Although there were significant electromyographic differences among muscle grades in the CU test, there was no significant difference in the DLL test. The %MVC from both sites in the CU test were significantly larger in all muscle grades than in the DLL test. However, the %MVC ratio was consistently ~1.0 in both tests and the contribution of each muscle site did not differ. [Conclusion] These findings suggest that the three grading tasks used in this manual muscle testing procedure may be insufficient to objectively detect muscle weakness in the trunk flexors. The grading criterion for trunk flexors may need remediation.

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Relationship of manual muscle testing to objective strength measurements

Cited by 160 publications

References 10 publications

Comparison of three methods to assess muscular strength in individuals with spinal cord injury

Comparison of three methods to assess muscular strength in individuals with spinal cord injury

Muscle and joint elastic properties during elbow flexion in Duchenne muscular dystrophy

The Relationship between Muscle Activity and Muscle Grade of the Trunk Flexors Using Manual Muscle Testing with Electromyography

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