​Grading Muscle Strength

Normal   (N)             5
Good       (G)             4
Fair Plus  (F+)         3+/5
Fair          (F)               3
Poor        (P)               2
Trace       (T)               1
Zero         (0)              0

        Muscle Grades                                                              How do we assess muscle strength?

Normal   =     full ROM    =        max. resist                                                     Observation/Screening
                                                                                                                                     -Occupation-based functional motion evaluation
Good     =       full ROM    =        mod. resist                                                                    -during ADL assessment
                                                                                                                                             -activity demand analysis  
Fair plus  =    full ROM    =        slight resist                                                    Manual Muscle Test (MMT)
​
Fair      =         full ROM     =       no resist

           ALL AGAINST GRAVITY
Manual Muscle Testing Technique
  1. Perform ROM first
    1. Active range of motion first- then passive PRN (as needed)
  2. Explain procedure to patient
    1. “I’d like to take a look at how strong your arms are.  I’m going to ask you to move your arm in different directions & then, I will ask you to hold it as tight as you can while I give you some resistance.”  
  3. Demonstrate each movement
  4. Position limb to be tested AGAINST GRAVITY
  5. Have patient move through full AROM
    1. Have patient repeat movement
    2. Stabilize proximally
    3. Palpate muscle group
Where should resistance be applied?
  1. To the distal end of the segment into which muscle inserts
  2. In the direction the movement came from
  3. Start with light resistance ---> increase to maximal resistance over 2-3 seconds
​
MMT Table

Assuming all AROM is
​within normal limits AG