Chapter 21: Lower Motor Neuron Disorders

For the Instructor Guide and Worksheet Key please contact user services at userservices@mheducation.com

OUTLINE

Objectives:

The student will:

1. Correctly apply patient positioning to discern manual muscle testing (MMT) grades between 0 and 3/5.

2. Select and prioritize appropriate functional strengthening activities, and provide logical progressions or digressions for each, per a specific client case.

3. Demonstrate critical thinking and application when presented with a case study discussing prognosis, methods of evaluation, treatment planning, and treatment implementation.

Activity 1. Review of Manual Muscle Testing

Students practice doing manual muscle testing for muscles with less than fair (3/5) strength.

Activity 2. Case Studies

Students are divided into groups of three to four students and assigned to one of three paper cases. Each group reads their case and answers questions on the student worksheet about that case. After completing the case, they read the other two cases and come up with strengthening exercises for both cases.

Activity 3. Wrap-Up Discussion of Cases

Students come together and discuss the answers to questions for each case. Each group must demonstrate one functional and one traditional trunk or LE strengthening activity and provide rationale for why the activities were chosen.

WORKSHEET

Activity 1. Review of Manual Muscle Testing

Demonstrate how to do a manual muscle test (MMT) for muscles with less than fair (3/5) strength. In your small group, set up a client for testing each of the muscles listed below following the directions given. An MMT grading scale is provided for your reference.

Manual Muscle Testing Grades

(Hislop & Montgomery, 2007)

• 5 Normal: Completes full range of motion (ROM) or maintains end-point range against maximal resistance.

• 4 Good: Completes full ROM against gravity and can tolerate strong resistance without breaking the test position. Maximal resistance clearly results in a break.

• 3+ Fair plus: Completes full ROM against gravity, and can hold the end position against mild resistance.

• 3 Fair: Completes full ROM against only the resistance of gravity (no manual resistance).

• 2 Poor: Completes full ROM in a position that minimizes the force of gravity.

• 2− Poor minus: Completes partial ROM in a gravity-minimized position.

• 1 Trace: Muscle contraction can be palpated, but there is no joint movement.

• 0 Zero: No palpable muscle contraction.

For the following muscles, first identify how the muscle with a 3 or 2 grade would present. Then, determine the testing position and performance that would indicate a 3/5, 2/5, 2−/5, or 1/5 muscle grade. Would you use the same position to strengthen the muscle? If not, what position would you use to strengthen?