Hi irishneurohead

Thanks for your post. I was beginning to think no one is interested

Yes I totally agree we need to concentrate on functional outcomes and measuring things at the activity limitation and participation levels are where a lot of it is at. I would never not take a relevant functional measure in assessing a patient's status.

Having said that strength is such a huge issue at an impairment level in stroke. It is also a very important pillar for clinical reasoning when identifying and activity limitation. High quality data on strength could greatly improve our ability to answer WHY a person is unable to perform a given activity. There is good evidence for the importance of weakness in affecting function and as a lot of our interventions in stroke do involve strengthening - including many of our task-based interventions. I don't think we should trivialising it's importance. Just one example is in the markedly weak patient; here impairment measures may be the only measure that may be able to detect change following treatment whereas functional measures may be too blunt. Detectable improvements in strength may precede a a functional gain. MMT won't be able to do this.

As for the MMT being an "common language" between disciplines I think that is a good point to make. Then again I wouldn't think that would be the main reason for using it. If I wanted to communicate to other members of the team a patient's strength status I could quote a patients strength against norms so if you could say "this patient has 25% strength of triceps expected for his/her gender and age and 10% that of the other side" - I know that sonds a bit verbose but it could be contracted in note writing. I think this would be much more meaningful. As we are the experts on weakness in the team wouldn't the team usually want more detailed information than what they can provide?

Another problem I find with MMT (and this may be better handled in Ireland than here) every physio seems to do a different sort of MMT for a given muscle. Some do screening isometric manoeuvres and ignore the affect of gravity, some test in the inner range some test in the outer range some test through full range etc. Some do concentric resistance through full range, some through part of the range. Physios have abandoned the protocols in the book(s). Doctors are even worse at this than physios. So there is no standardisation anymore. Physios trained in the days when MMT was one of their main measurements would have a fit seeing what happens in practice today. All this failure to standardise means whatever adequate reliability there might be in the research (and on the whole there isn't much) is sacrificed in practice. If you don't have a reliable tool then you really don't have a measurement tool.