MMT for Duchenne Muscular Dystrophy; Brooke 1981 (MMT DMD Brooke 1981)
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General Information
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| Objectives |
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This is a manual muscle test as used for Duchenne Muscular Dystrophy.
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| Category of Outcome Measure |
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| Chronology of Development |
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This published in 1981 following, as the authors state; "literally hundreds of hours of consultation, discussion, and testing. The details were hammered out not only around conference tables but also in individual clinics".This has since been used in the first steroid trials in Duchenne Muscular Dystrophy.
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| Mode of Assessment |
Administered by trained evaluator
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| Age Group |
Children (2 to 11 Years)
Adolescents (12 to 15 Years)
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| Conditions of Use and Contact Information |
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Manual Muscle Testing
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| Total Number of Muscles Tested (Unilateral) |
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| Total Number of Muscles Tested (Bilateral) |
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| Actual Muscles Tested |
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Proximal |
Distal |
Not Defined |
| Neck Flexion |
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X |
| Neck Extension |
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X |
| Shoulder Abduction |
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X |
| Shoulder External Rotation |
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X |
| Elbow Flexion |
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X |
| Elbow Extension |
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X |
| Wrist Flexion |
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X |
| Wrist Extension |
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X |
| Hip Extension |
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X |
| Hip Flexion |
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X |
| Hip Abduction |
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X |
| Knee Flexion |
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X |
| Knee Extension |
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X |
| Ankle Eversion |
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X |
| Ankle Inversion |
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X |
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| Name of Scale and Number of Units |
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| Description of Scale |
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(5-) Barely detectable weakness.
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(4S) Same as 4 but stronger than reference muscle.
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(4) Muscle is weak but moves the joint against a combination of gravity.
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(4W) Same as 4 but weaker than reference muscle.
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(3+) The muscle is capable of transient resistance but collapses abruptly. This degree of weakness is difficult to put into words, but it is a muscle which is able to move the joint against gravity and an additional small amount of resistance. it is not to be used for muscles capable of sustained resistance throughout the whole range of movement.
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(3) Muscle cannot move against resistance but moves the joint fully against gravity With the exception of knee extensors,a the joint must be moved through the full mechanical range against gravity. If a patient has contractures that limit movement of the joint, the mechanical range will obviously be to the point at which the contractures cause a significant resistance to the movement. ’In the case of the knee extensors, the patient is graded 3 if the knee can be straightened to within 10” of full extension.
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(3-) Muscle moves the joint against gravity but not through the full extent of the mechanical range of the joint.
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(2) Muscle moves the joint when gravity is eliminated.
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(1) A flicker of movement is seen or felt in the muscle.
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Note 1; In the case of the knee extensors, the patient is graded 3 if the knee can be straightened to within 10 degrees of full extension.
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Note 2; Grades 4S, 4 and 4W are not synomous with 4+, 4, 4-; see key reference for explanation of how reference muscle is chosen for arms and legs.
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| Sum Score Calculations |
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The 0-10 scale is converted to numerical format as follows: 0 = 0, l = 1, 2 = 2, 3- = 3, 3 = 4, 3+ = 5, 4, 4S and 4W = 7.5, 5 - = 9, 5 = 10. This is used to calculate a numerical average of the 34 muscle tested known as the average muscle score.
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Reference 1
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| Reference Details |
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Brooke, M.H.; Griggs, R.C.; Mendell, J.R.; et al (1981) Clinical trial in Duchenne dystrophy. I. The design of the protocol, Muscle and Nerve, Vol 4, pp 186 - 197.
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| Other Information |
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This is the key reference for this version of MMT and gives the details of muscle testing positions and the order in which muscles should be tested.
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Reference 2
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| Reference Details |
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Brooke MH, Fenichel GM, Griggs RC, et al. Clinical investigation in Duchenne dystrophy: 2. Determination of the "power" of therapeutic trials based on the natural history. Muscle Nerve 1983 Feb;6:91-103.
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| Other Information |
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This reference gives natural history data for Duchenne MD allowing calculation of the power of this measure for clinical trials
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