Supported by NIH grant # R01HL088045. Drs. Eddy Fan and Michelle Kho are each supported by a Fellowship Award from the Canadian Institutes of Health Research.

1. Introduction 
During manual muscle testing (MMT), each muscle group is tested bilaterally. For demonstration purposes, only one side is tested in this video for each of the 6 muscle groups. One hand of the examiner applies resistance or palpates the muscle or tendon for contraction while the other hand stabilizes the extremity being tested to keep it in the test position. The test is repeated if the patient does not understand the instructions or is not applying maximum effort.
<p class=...

<ol>
	<li>De Jonghe, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Paresis+acquired+in+the+intensive+care+unit:+a+prospective+multicenter+study.">Paresis acquired in the intensive care unit: a prospective multicenter study.</a> JAMA. 288, 2859-2867 (2002).</li><li>Ali, N. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acquired+weakness,+handgrip+strength,+and+mortality+in+critically+ill+patients.">Acquired weakness, handgrip strength, and mortality in critically ill patients.</a> Am J Respir Crit Care Med. 178, 261-268 (2008).</li><li>Angel, M. J., Bril, V., Shannon, P., Herridge, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuromuscular+function+in+survivors+of+the+acute+respiratory+distress+syndrome.">Neuromuscular function in survivors of the acute respiratory distress syndrome.</a> Can. J. Neurol. Sci. 34, 427-432 (2007).</li><li>Cheung, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Two-year+outcomes,+health+care+use,+and+costs+of+survivors+of+acute+respiratory+distress+syndrome.">Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome.</a> Am. J. Respir. Crit. Care Med. 174, 538-544 (2006).</li><li>Stevens, R. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuromuscular+dysfunction+acquired+in+critical+illness:+a+systematic+review.+Intensive+Care+Med.">Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med.</a> 33, 1876-1891 (2007).</li><li>Herridge, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=One-year+outcomes+in+survivors+of+the+acute+respiratory+distress+syndrome.">One-year outcomes in survivors of the acute respiratory distress syndrome.</a> N. Engl. J. Med. 348, 683-693 (2003).</li><li>Medical Research Council. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Aids to the Investigation of the Peripheral Nervous System. , (1976).</li><li>Fan, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Inter-rater+reliability+of+manual+muscle+strength+testing+in+ICU+survivors+and+simulated+patients.">Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients.</a> Intensive Care Med. 34, 1038-1043 (2010).</li><li>Hislop, H. J., Montgomery, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Daniels and Worthingham's Muscle Testing. , (2007).</li><li>Reese, N. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Muscle and Sensory Testing. , (2005).</li><li>Kendall, F. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Muscles; Testing and Function with Posture and Pain. , (2005).</li><li>Lieu, B. K., Hough, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+Weakness+in+Critically+Ill+Patients+Using+Physical+Examination.">Assessment of Weakness in Critically Ill Patients Using Physical Examination.</a> Am J Respir Crit Care Med. 175, A218-A218 (2007).</li><li>Gregson, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+measurements+of+muscle+tone+and+muscle+power+in+stroke+patients.">Reliability of measurements of muscle tone and muscle power in stroke patients.</a> Age Ageing. 29, 223-228 (2000).</li><li>Great Lakes ALS Study Group. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.+A+comparison+of+muscle+strength+testing+techniques+in+amyotrophic+lateral+sclerosis.">. A comparison of muscle strength testing techniques in amyotrophic lateral sclerosis.</a> Neurology. 61, 1503-1507 (2003).</li><li>Kleyweg, R. P., van der Meche, F. G., Schmitz, P. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interobserver+agreement+in+the+assessment+of+muscle+strength+and+functional+abilities+in+Guillain-Barre+syndrome.">Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barre syndrome.</a> Muscle Nerve. 14, 1103-1109 (1991).</li><li>Zink, W., Kollmar, R., Schwab, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Critical+illness+polyneuropathy+and+myopathy+in+the+intensive+care+unit.">Critical illness polyneuropathy and myopathy in the intensive care unit.</a> Nat. Rev. Neurol. 5, 372-379 (2009).</li><li>Sharshar, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Presence+and+severity+of+intensive+care+unit-acquired+paresis+at+time+of+awakening+are+associated+with+increased+intensive+care+unit+and+hospital+mortality.">Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality.</a> Crit. Care Med. 37, 3047-3053 (2009).</li><li>Griffiths, R. D., Hall, J. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intensive+care+unit-acquired+weakness.">Intensive care unit-acquired weakness.</a> Crit. Care Med. 38, 779-787 (2010).</li><li>Bohannon, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measuring+knee+extensor+muscle+strength.">Measuring knee extensor muscle strength.</a> Am J Phys Med Rehabil. 80, 13-18 (2001).</li><li>Needham, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mobilizing+patients+in+the+intensive+care+unit:+improving+neuromuscular+weakness+and+physical+function.">Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function.</a> JAMA. 300, 1685-1690 (2008).</li></ol>

Depending on the diagnostic criteria, 9 &#x2013; 87% of ICU patients develop neuromuscular complications, which are associated with prolonged mechanical ventilation, increased hospital stay and rehabilitation time, and potentially associated with increased mortality.1,2,16-18 Periodic reassessment of muscle strength, using a reliable method which minimizes inter-rater variability is helpful to detect changes over time. An important limitation of MMT using the MRC score system is the 6-point ordinal scale. M...

manual muscle testing:  a method of measuring extremity muscle strength applied to critically ill patients

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, and persistent nerve and muscle impairments after hospital discharge.1-6 Using an explicit protocol with a structured approach to training and quality assurance of research staff, manual muscle testing (MMT) is a highly reliable method for assessing strength, using a standardized clinical examination, for patients following ARDS, and can be completed with mechanically ventilated patients who can tolerate sitting upright in bed and are able to follow two-step commands. 7, 8 
This video demonstrates a protocol for MMT, which has been taught to &ge;43 research staff who have performed &gt;800 assessments on &gt;280 ARDS survivors. Modifications for the bedridden patient are included. Each muscle is tested with specific techniques for positioning, stabilization, resistance, and palpation for each score of the 6-point ordinal Medical Research Council scale.7,9-11 Three upper and three lower extremity muscles are graded in this protocol: shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion. These muscles were chosen based on the standard approach for evaluating patients for ICU-acquired weakness used in prior publications. 1,2.

Watch this Scientific Journal Video about Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients at JoVE.com

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Survivors of acute respiratory distress syndrome (ARDS) and critical illness frequently develop long-lasting muscle weakness. Manual muscle testing (MMT) is a standardized clinical examination commonly used to measure strength of peripheral skeletal muscle groups. This video demonstrates MMT using the 6-point Medical Research Council scale.

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, ...

Research

JoVE Journal

Medicine

Measuring the Strength of Mice

Kondziela7 devised the inverted screen test and published it in 1964. It is a test of muscle strength using all four limbs. Most normal mice easily score ...

Method to Measure Tone of Axial and Proximal Muscle

The control of tonic muscular activity remains poorly understood.  While abnormal tone is commonly assessed clinically by measuring the passive resistance ...

High-throughput Flow Cytometry Cell-based Assay to Detect Antibodies to N-Methyl-D-aspartate Receptor or Dopamine-2 Receptor in Human Serum

Over the recent years, antibodies against surface and conformational proteins involved in neurotransmission have been detected in autoimmune CNS diseases ...

Bladder Smooth Muscle Strip Contractility as a Method to Evaluate Lower Urinary Tract Pharmacology

We describe an in vitro method to measure bladder smooth muscle contractility, and its use for investigating physiological and pharmacological properties ...

Early Detection of Drug-Induced Renal Hemodynamic Dysfunction Using Sonographic Technology in Rats

The kidney normally functions to maintain hemodynamic homeostasis and is a major site of damage caused by drug toxicity. Drug-induced nephrotoxicity is ...

Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow ...

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload

Children with sickle cell anemia (SCA) may be at risk of cerebral vasculopathy and strokes, which can be prevented by chronic transfusion programs. ...

Improving Strength, Power, Muscle Aerobic Capacity, and Glucose Tolerance through Short-term Progressive Strength Training Among Elderly People

This protocol describes the simultaneous use of a broad span of methods to examine muscle aerobic capacity, glucose tolerance, strength, and power in ...

In Vivo Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue

In Vivo Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue

The tongue is a highly innervated and vascularized muscle hydrostat on the floor of the mouth of most vertebrates. Its primary functions include ...

Muscle Imbalances: Testing and Training Functional Eccentric Hamstring Strength in Athletic Populations

Many hamstring injuries that occur during physical activity occur while the muscles are lengthening, during eccentric hamstring muscle actions. Opposite ...