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Lee MY, Sung KS, Ham H, Yi YG, Shin HI. Knee Extensor Strength Measurement in Patients With Limited Physical Activity Using a Supine Dynamometer Anchoring Frame. Ann Rehabil Med 2021; 44:502-509. [PMID: 33440098 PMCID: PMC7808794 DOI: 10.5535/arm.20056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/27/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the reliability of knee extensor strength measurements using a supine hand-held dynamometer (HHD) anchoring frame in patients with limited physical activity. Although an HHD is suitable for bedside use, its inter-rater reliability is low because measurements can be influenced by tester strength. METHODS Maximal knee extensor isometric strength was measured using an HHD anchored to the supine frame. Three trials of three maximal contractions were assessed by two raters. RESULTS A total of 33 inpatients who were non-ambulatory due to acute illness participated in the study. The intraclass correlation coefficients were 0.974 (inter-rater) and 0.959 (intra-rater). The minimal detectable changes in intra- and inter-observer measurements were 29.46 N (24.10%) and 36.73 N (29.26%), respectively. The limits of agreement ranged from -19.79% to 24.81% for intra-rater agreement and from -21.45% to 37.07% for inter-rater agreement. CONCLUSION The portable dynamometer anchoring system can measure the isometric strength of the knee extensor reliably in the supine position, and could be used for measurements in patients who have difficulty visiting the laboratory and maintaining a seated posture.
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Affiliation(s)
- Min-Yong Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kwan-Sik Sung
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyungsuk Ham
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Bohannon RW. Isokinetic testing of muscle strength of older individuals post-stroke: An integrative review. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-201146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Barzideh A, Marzolini S, Danells C, Jagroop D, Huntley AH, Inness EL, Mathur S, Mochizuki G, Oh P, Mansfield A. Effect of reactive balance training on physical fitness poststroke: study protocol for a randomised non-inferiority trial. BMJ Open 2020; 10:e035740. [PMID: 32606059 PMCID: PMC7328813 DOI: 10.1136/bmjopen-2019-035740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Regular exercise is essential in the chronic phase of stroke recovery for improving or maintaining function, and reducing the risk of a second stroke. To achieve these goals, multiple components of fitness should be targeted with poststroke exercise, including aerobic capacity, strength and balance. However, following the recommended frequency and duration of each component separately can take a long time and lead to fatigue in people with stroke. Therefore, finding types of exercise that target multiple components of fitness all together is valuable.Reactive balance training (RBT) is a novel type of exercise where individuals repeatedly lose their balance in order to practise balance reactions. When people do RBT, they increase their heart rate and exert forces with their leg muscles which could improve aerobic fitness and muscle strength, respectively. This means that RBT could have the potential to improve multiple components of fitness, simultaneously. METHODS AND ANALYSIS This is a randomised controlled non-inferiority trial with internal pilot study. Participants with chronic stroke will be randomly assigned to one of two groups: (1) RBT or (2) aerobic and strength training (AST). Participants in both groups will complete 1 hour of exercise, three times/week for 12 weeks. The primary objective is to determine the effect of RBT on aerobic capacity and knee muscles' strength. The secondary objective is to determine the effects of RBT and AST on balance control and balance confidence. We expect to find that RBT is superior to AST in terms of improving balance control and balance confidence, yet not inferior to AST in terms of its effects on aerobic capacity and strength. ETHICS AND DISSEMINATION Research ethics approval has been received. Results will be disseminated directly to study participants at the end of the trial, and to other stakeholders via publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04042961.
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Affiliation(s)
- Azadeh Barzideh
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Susan Marzolini
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Cynthia Danells
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - David Jagroop
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew H Huntley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sunita Mathur
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Evaulative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
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Nuzzo JL, Taylor JL, Gandevia SC. CORP: Measurement of upper and lower limb muscle strength and voluntary activation. J Appl Physiol (1985) 2019; 126:513-543. [DOI: 10.1152/japplphysiol.00569.2018] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Muscle strength, the maximal force-generating capacity of a muscle or group of muscles, is regularly assessed in physiological experiments and clinical trials. An understanding of the expected variation in strength and the factors that contribute to this variation is important when designing experiments, describing methodologies, interpreting results, and attempting to replicate methods of others and reproduce their findings. In this review (Cores of Reproducibility in Physiology), we report on the intra- and inter-rater reliability of tests of upper and lower limb muscle strength and voluntary activation in humans. Isometric, isokinetic, and isoinertial strength exhibit good intra-rater reliability in most samples (correlation coefficients ≥0.90). However, some tests of isoinertial strength exhibit systematic bias that is not resolved by familiarization. With the exception of grip strength, few attempts have been made to examine inter-rater reliability of tests of muscle strength. The acute factors most likely to affect muscle strength and serve as a source of its variation from trial-to-trial or day-to-day include attentional focus, breathing technique, remote muscle contractions, rest periods, temperature (core, muscle), time of day, visual feedback, body and limb posture, body stabilization, acute caffeine consumption, dehydration, pain, fatigue from preceding exercise, and static stretching >60 s. Voluntary activation, the nervous system’s ability to drive a muscle to create its maximal force, exhibits good intra-rater reliability when examined with twitch interpolation (correlation coefficients >0.80). However, inter-rater reliability has not been formally examined. The methodological factors most likely to influence voluntary activation are myograph compliance and sensitivity; stimulation location, intensity, and inadvertent stimulation of antagonists; joint angle (muscle length); and the resting twitch.
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Affiliation(s)
- James L. Nuzzo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Janet L. Taylor
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, Australia
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Kristensen OH, Stenager E, Dalgas U. Muscle Strength and Poststroke Hemiplegia: A Systematic Review of Muscle Strength Assessment and Muscle Strength Impairment. Arch Phys Med Rehabil 2017; 98:368-380. [DOI: 10.1016/j.apmr.2016.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/26/2016] [Indexed: 12/17/2022]
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Rabelo M, Nunes GS, da Costa Amante NM, de Noronha M, Fachin-Martins E. Reliability of muscle strength assessment in chronic post-stroke hemiparesis: a systematic review and meta-analysis. Top Stroke Rehabil 2015; 23:26-36. [PMID: 26243549 DOI: 10.1179/1945511915y.0000000008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque. OBJECTIVE To systematically investigate and organize the evidence of the reliability of muscle strength evaluation measures in post-stroke survivors with chronic hemiparesis. DATA SOURCES Two assessors independently searched four electronic databases in January 2014 (Medline, Scielo, CINAHL, Embase). STUDY SELECTION Inclusion criteria comprised studies on reliability on muscle strength assessment in adult post-stroke patients with chronic hemiparesis. DATA EXTRACTION We extracted outcomes from included studies about reliability data, measured by intraclass correlation coefficient (ICC) and/or similar. The meta-analyses were conducted only with isokinetic data. RESULTS Of 450 articles, eight articles were included for this review. After quality analysis, two studies were considered of high quality. Five different joints were analyzed within the included studies (knee, hip, ankle, shoulder, and elbow). Their reliability results varying from low to very high reliability (ICCs from 0.48 to 0.99). Results of meta-analysis for knee extension varying from high to very high reliability (pooled ICCs from 0.89 to 0.97), for knee flexion varying from high to very high reliability (pooled ICCs from 0.84 to 0.91) and for ankle plantar flexion showed high reliability (pooled ICC = 0.85). CONCLUSION Objective muscle strength assessment can be reliably used in lower and upper extremities in post-stroke patients with chronic hemiparesis.
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Affiliation(s)
- Michelle Rabelo
- College of Ceilândia, University of Brasília , Brasília, Brazil
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Fernandes B, Ferreira MJ, Batista F, Evangelista I, Prates L, Silveira-Sérgio J. Task-oriented training and lower limb strengthening to improve balance and function after stroke: A pilot study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2015. [DOI: 10.3109/21679169.2015.1028102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jegu AG, Pereira B, Andant N, Coudeyre E. Effect of eccentric isokinetic strengthening in the rehabilitation of patients with knee osteoarthritis: Isogo, a randomized trial. Trials 2014; 15:106. [PMID: 24693988 PMCID: PMC3976356 DOI: 10.1186/1745-6215-15-106] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 03/20/2014] [Indexed: 11/23/2022] Open
Abstract
Background Femorotibial knee osteoarthritis is associated with muscle weakness in the lower limbs, particularly in the quadriceps, which results in disease progression. The interest of having muscular strengthening as part of the therapeutic arsenal for the medical treatment of knee osteoarthritis is now well established. The functional disability induced by knee osteoarthritis manifests itself principally when walking, notably downhill, during which the muscles are called upon to contract eccentrically. We can therefore think that eccentric muscular strengthening could bring a functional benefit that is superior to concentric muscular strengthening. Methods/Design This is a prospective, randomized, bicenter, parallel-group, international study. Eighty patients aged from 40 to 75 years old, suffering from medical-stage knee osteoarthritis, will undertake 6 weeks of isokinetic muscular strengthening. Randomization determines the mode of muscular strengthening: either exclusively eccentric or exclusively concentric. The principal objective is to demonstrate the superiority of the improvement in the quadriceps isokinetic torque after isokinetic muscular strengthening by the eccentric mode compared to the concentric mode. The following parameters are also evaluated: the variations in the level of pain, the parameters of walking (maximum speed over 10 and 200 meters, analysis on a computerized Gaitrite™ treadmill), static equilibrium (on a FUSYO™ force platform), and the functional status of the patient using the Western Ontario and MacMaster Universities osteoarthritis index (WOMAC) questionnaire after the strengthening period and at 6 months. Discussion A better knowledge of the most effective mode of muscular strengthening is needed to optimize the functional benefits to the patients. In case of superiority in terms of efficacy of the eccentric mode, the latter could be given priority in the rehabilitation treatment of knee osteoarthritis patients. Trial registration Clinical trials.gov number: NCT01586130.
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Affiliation(s)
| | | | - Nicolas Andant
- CHU Clermont-Ferrand, Biostatistics Unit, Délégation Recherche Clinique & Innovation (DRCI), Villa annexe IFSI, Clermont-Ferrand F-63003, France.
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Hammami N, Coroian FO, Julia M, Amri M, Mottet D, Hérisson C, Laffont I. Isokinetic muscle strengthening after acquired cerebral damage: a literature review. Ann Phys Rehabil Med 2012; 55:279-91. [PMID: 22503293 DOI: 10.1016/j.rehab.2012.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 01/24/2012] [Accepted: 03/02/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Isokinetic strengthening is a rehabilitation technique rarely used in stroke patients. However, the potential benefits of force and endurance training in this population are strongly suspected. METHOD This literature review synthesizes the results of clinical trials on this topic. The research was conducted on PubMed, using "Stroke", "rehabilitation", "isokinetic", "upper limb" and "training" as keywords. RESULTS Seventeen studies focusing on the use of isokinetics in assessment or rehabilitation (six studies) following stroke were reviewed. For the lower limb, muscle strength and walking ability improved after isokinetic rehabilitation programs. For the upper limb, the only two studies found in the literature suggest improvement in the strength of the trained muscles, of grip force, of the Fugl-Meyer motor score and of global functional capacities. This review does not reveal any consensus on the protocols to be implemented: type of muscle contraction, velocities…. CONCLUSION While isokinetic strengthening has not proven its efficiency in rehabilitation of the upper limb following stroke, its interest with regard to rehabilitation of the lower limbs has been recognized. Randomized controlled trials in this field are necessary to confirm its efficiency, especially concerning upper arm rehabilitation.
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Affiliation(s)
- N Hammami
- Movement to Health, Montpellier-1 University EuroMov, France
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Eitzen I, Hakestad KA, Risberg MA. Inter- and Intrarater Reliability of Isokinetic Thigh Muscle Strength Tests in Postmenopausal Women With Osteopenia. Arch Phys Med Rehabil 2012; 93:420-7. [DOI: 10.1016/j.apmr.2011.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 09/13/2011] [Accepted: 10/03/2011] [Indexed: 11/25/2022]
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Andersen LL, Zeeman P, Jørgensen JR, Bech-Pedersen DT, Sørensen J, Kjær M, Andersen JL. Effects of intensive physical rehabilitation on neuromuscular adaptations in adults with poststroke hemiparesis. J Strength Cond Res 2012; 25:2808-17. [PMID: 21904232 DOI: 10.1519/jsc.0b013e31822a62ef] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hemiparesis-disability and muscle weakness of 1 side of the body-is a common consequence of stroke. High-intensity strength training may be beneficial to regain function, but strength coaches in the field of rehabilitation need evidence-based guidelines. The purpose of this study was to evaluate the effect of intensive physical rehabilitation on neuromuscular and functional adaptations in outpatients suffering from hemiparesis after stroke. A within-subject repeated-measures design with the paretic leg as the experimental leg and the nonparetic leg as the control leg was used. Eleven outpatients with hemiparesis after stroke participated in 12 weeks of intensive physical rehabilitation comprising unilateral high-intensity strength training with near-maximal loads (4-12 repetition maximum) and body weight supported treadmill training. At baseline and 12-week follow-up, the patients went through testing consisting of isokinetic muscle strength, neuromuscular activation measured with electromyography (EMG), electrically evoked muscle twitch contractile properties, and gait performance (10-m Walk Test and 6-min Walk Test). After the 12-week conditioning program, knee extensor and flexor strength increased during all contraction modes and velocities in the paretic leg. Significant increases were observed for agonist EMG amplitude at slow concentric and slow eccentric contraction. Twitch torque increased, whereas twitch time-to-peak tension remained unchanged. By contrast, no significant changes were observed in the nonparetic control leg. Gait performance increased 52-68%. In conclusion, intensive physical rehabilitation after stroke leads to clinically relevant neuromuscular improvements, leading to increased voluntary strength during a wide range of contraction modes and velocities, and improved gait velocity. Strength training coaches working in the field of rehabilitation can use this knowledge to safely and efficiently add high-intensity strength training to existing rehabilitation paradigms.
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Affiliation(s)
- Lars L Andersen
- National Research Center for the Working Environment, Copenhagen, Denmark.
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Chen CY, Chen CL, Hsu SCC, Chou SW, Wang KC. Effect of Magnetic Knee Wrap on Quadriceps Strength in Patients With Symptomatic Knee Osteoarthritis. Arch Phys Med Rehabil 2008; 89:2258-64. [DOI: 10.1016/j.apmr.2008.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 05/08/2008] [Accepted: 05/17/2008] [Indexed: 10/21/2022]
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