MMT Special Considerations 3 — Questions and Answers
Question 1: In a patient with Guillain-Barré syndrome in the ascending phase, MMT should be performed:
- Daily to track rapid progression
- With caution, as overexertion can worsen weakness (Correct answer)
- Using maximal resistance to maintain strength
- Only on proximal muscle groups
Correct answer: With caution, as overexertion can worsen weakness
During the acute ascending phase, aggressive testing or exercise can exacerbate weakness and is contraindicated; gentle, careful assessment is appropriate.
Question 2: When testing a patient with significant edema in the tested limb, which consideration is most relevant?
- Edema increases muscle strength and grades should be adjusted upward
- Edema may restrict ROM and affect the ability to achieve test position (Correct answer)
- Edema is irrelevant to MMT outcome
- Testing should always be avoided with any edema present
Correct answer: Edema may restrict ROM and affect the ability to achieve test position
Edema can mechanically limit joint ROM and alter the ability to assume and maintain the standard test position, affecting grade accuracy.
Question 3: A patient substitutes by laterally flexing the trunk when attempting hip abduction MMT. This substitution pattern most likely indicates:
- Tight hip flexors
- Weak gluteus medius (Correct answer)
- Strong tensor fasciae latae
- Lumbar disc pathology
Correct answer: Weak gluteus medius
Trunk lateral flexion toward the tested side is a classic substitution when the gluteus medius is too weak to abduct the hip independently.
Question 4: Which neurological condition requires the clinician to test muscles at the same time of day each session to ensure valid comparisons?
- Cerebral palsy
- Myasthenia gravis (Correct answer)
- Multiple sclerosis with stable lesions
- Post-polio syndrome
Correct answer: Myasthenia gravis
Myasthenia gravis causes fatigable weakness that fluctuates throughout the day, so consistent test timing is critical for valid serial comparisons.
Question 5: For a patient with a recent rotator cuff repair, the surgeon restricts active shoulder abduction for 6 weeks. The most appropriate MMT approach is to:
- Test against resistance to establish a baseline despite restrictions
- Perform MMT of all muscles except those crossing the surgical repair
- Document the restriction and defer prohibited muscle testing (Correct answer)
- Test only in gravity-eliminated positions to comply with restrictions
Correct answer: Document the restriction and defer prohibited muscle testing
Surgical precautions must be respected; deferred testing should be documented with the reason to maintain safety and medico-legal compliance.
Question 6: When performing MMT on a pediatric patient under age 5, which is the most significant challenge?
- Children have inherently lower strength grades
- Cooperation and ability to follow instructions reliably (Correct answer)
- Standard positions cannot be used for children
- Children cannot achieve grade 5 until adolescence
Correct answer: Cooperation and ability to follow instructions reliably
Young children may not reliably follow instructions or sustain effort, making standardized MMT results difficult to interpret.
Question 7: A patient with severe rheumatoid arthritis has joint instability at the wrist. During wrist extensor MMT, the examiner should:
- Apply full resistance distally at the metacarpals
- Avoid MMT of the wrist entirely
- Provide additional joint stabilization and use minimal resistance (Correct answer)
- Test wrist extensors with the elbow flexed to 90°
Correct answer: Provide additional joint stabilization and use minimal resistance
Unstable rheumatoid joints require careful proximal stabilization and reduced resistance to prevent joint injury during testing.
MMT Special Considerations 3
In a patient with Guillain-Barré syndrome in the ascending phase, MMT should be performed: