I am currently on placement at RPH-SPC spinal unit. In the first week i was given 3 patients that i would eventually independently manage. My supervisor set me the task to re-assess and write a thorough SOAPIER on each patient. Obviously this includes muscle testing and sensation etc. As i was taking notes on a patient's previous MMT (which had been recorded in the integrated notes by the doctor), my supervisor advised me not to use these measures to compare with my assessment as they are rarely correct. i thought this a bit strange as surely a Doctor in this field would assess muscle function regularly. After completing my own MMT assessment i found that muscles barely scoring a grade 3 had been recorded by the doctor as grade 5.
I was astonished at how anyone who is familiar with the MMT system could get it so wrong. There is a big difference between a grade 3 (full range against gravity) and a grade 5 (full range with maximum resistance). In addition, this particular patient had been RIB for 5/52 with Halo traction so even fully innervated muscles are likely to be deconditioned. I would say this situation arises due to the time constraints and other priorities medically for a SCI patient. However i would be horrified if that patient had been informed that he had full muscle function when in fact he didn't.
i am sure that these doctors have a lot on their plate and MMT is not a priority as they know the physios are able to spend quality time doing a thorough assessment. This just demonstrates how important assessment and re-assessment is. I have learnt that for every new patient transferred to the ward, a full assessment is required prior to commencement of any treatment.
2 comments:
Well done on trusting your judgement Em, I find I doubt myself all the time when dealing with other medical professionals. Maybe because we still see ourselves as students and that we automatocally assume that we are wrong in our judgement? Unfortunaley this is something we have all seen far to often in the little time we have been on placement and we should give ourselves more credit. Speak soon!
If you get a chance to you might like to watch an approachable member of the medical team and see how they do their manual muscle testing, that is- do they do through range muscle testing or static muscle testing or a combination. I have observed them doing both. They use the Medical Research council Manual Muscle Testing scale. You might like to google it and see how it advises them to do their test. If you look at you MMT book you will see that it allows 3- when the muscle doesn't go through full range. Describing a muscle this way would make it harder for PT to know what is meant by this grade. We advocate grade 3 as full range antigravity and get students to avoid using the minus. But if you look further in the literature you will continue to see that muscle grading is not always used the way we teach you.So you need to be careful in interpreting other peoples scores as you indicated.
Post a Comment