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Lim JH, He K, Yi Z, Hou C, Zhang C, Sui Y, Li L. Adaptive Learning based Upper-Limb Rehabilitation Training System with Collaborative Robot. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083561 DOI: 10.1109/embc40787.2023.10340313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Rehabilitation training for patients with motor disabilities usually requires specialized devices in rehabilitation centers. Home-based multi-purpose training would significantly increase treatment accessibility and reduce medical costs. While it is unlikely to equip a set of rehabilitation robots at home, we investigate the feasibility to use the general-purpose collaborative robot for rehabilitation therapies. In this work, we developed a new system for multi-purpose upper-limb rehabilitation training using a generic robot arm with human motor feedback and preference. We integrated surface electromyography, force/torque sensors, RGB-D cameras, and robot controllers with the Robot Operating System to enable sensing, communication, and control of the system. Imitation learning methods were adopted to imitate expert-provided training trajectories which could adapt to subject capabilities to facilitate in-home training. Our rehabilitation system is able to perform gross motor function and fine motor skill training with a gripper-based end-effector. We simulated system control in Gazebo and training effects (muscle activation level) in Open-Sim and evaluated its real performance with human subjects. For all the subjects enrolled, our system achieved better training outcomes compared to specialist-assisted rehabilitation under the same conditions. Our work demonstrates the potential of utilizing collaborative robots for in-home motor rehabilitation training.Clinical relevance-The collaborative robot system is capable of providing safe and effective training comparable to specialized rehabilitation robots, enabling possibilities of convenient rehabilitation training at home.
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Lee JH, Kang N. Altered Bimanual Kinetic and Kinematic Motor Control Capabilities in Older Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2153. [PMID: 36767520 PMCID: PMC9915092 DOI: 10.3390/ijerph20032153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Older women may experience critical neuromuscular impairments interfering with controlling successful bimanual motor actions. Our study aimed to investigate altered bimanual motor performances in older women compared with younger women by focusing on kinetic and kinematic motor properties. Twenty-two older women and 22 younger women performed bimanual kinetic and kinematic motor tasks. To estimate bimanual kinetic functions, we calculated bimanual maximal voluntary contractions (i.e., MVC) and force control capabilities (i.e., mean force, accuracy, variability, and regularity of the total force produced by two hands) during bimanual hand-grip submaximal force control tasks. For bimanual kinematic performances, we assessed the scores of the Purdue Pegboard Test (i.e., PPT) in both hands and assembly tasks, respectively. For the bimanual MVC and PPT, we conducted an independent t-test between two groups. The bimanual force control capabilities were analyzed using two-way mixed ANOVAs (Group × Force Level; 2 × 2). Our findings revealed that the older women showed less bimanual MVC (p = 0.046) and submaximal force outputs (p = 0.036) and greater changes in bimanual force control capabilities as indicated by a greater force variability (p = 0.017) and regularity (p = 0.014). Further, the older women revealed lower scores of PPT in both the hands condition (p < 0.001) and assembly task condition (p < 0.001). The additional correlation analyses for the older women showed that lower levels of skeletal muscle mass were related to less bimanual MVC (r = 0.591; p = 0.004). Furthermore, a higher age was related to lower scores in the bimanual PPT assembly task (r = -0.427; p = 0.048). These findings suggested that older women experience greater changes in bimanual motor functions compared with younger women.
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Affiliation(s)
- Joon Ho Lee
- Department of Human Movement Science, Incheon National University, Incheon 22012, Republic of Korea
- Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon 22012, Republic of Korea
| | - Nyeonju Kang
- Department of Human Movement Science, Incheon National University, Incheon 22012, Republic of Korea
- Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon 22012, Republic of Korea
- Division of Sport Science, Sport Science Institute, Incheon National University, Incheon 22012, Republic of Korea
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Siddique T, Fareh R, Abdallah M, Ahmed Z, Rahman MH. Autonomous Exercise Generator for Upper Extremity Rehabilitation: A Fuzzy-Logic-Based Approach. MICROMACHINES 2022; 13:mi13060842. [PMID: 35744456 PMCID: PMC9229736 DOI: 10.3390/mi13060842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
In this paper, an autonomous exercise generation system based of fuzzy logic approach is presented. This work attempts to close a gap in the design of a completely autonomous robotic rehabilitation system that can recommend exercises to patients based on their data, such as shoulder range of motion (ROM) and muscle strength, from a pre-set library of exercises. The input parameters are fed into a system that uses Mamdani-style fuzzy logic rules to process them. In medical applications, the rationale behind decision making is a sophisticated process that involves a certain amount of uncertainty and ambiguity. In this instance, a fuzzy-logic-based system emerges as a viable option for dealing with the uncertainty. The system’s rules have been reviewed by a therapist to ensure that it adheres to the relevant healthcare standards. Moreover, the system has been tested with a series of test data and the results obtained ensures the proposed idea’s feasibility.
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Affiliation(s)
- Tanjulee Siddique
- Department of Electrical and Electronics Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates;
| | - Raouf Fareh
- Department of Electrical and Electronics Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Correspondence:
| | - Mahmoud Abdallah
- Department of Electrical Engineering, École de Technologie Supérieure, Montreal, QC H3C 1K3, Canada;
| | - Zaina Ahmed
- Department of Physiotherapy, University of Sharjah, Sharjah 27272, United Arab Emirates;
| | - Mohammad Habibur Rahman
- Biomedical/Mechanical Engineering Department, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA;
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Ghasemi M, Emerson CP, Hayward LJ. Outcome Measures in Facioscapulohumeral Muscular Dystrophy Clinical Trials. Cells 2022; 11:cells11040687. [PMID: 35203336 PMCID: PMC8870318 DOI: 10.3390/cells11040687] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is a debilitating muscular dystrophy with a variable age of onset, severity, and progression. While there is still no cure for this disease, progress towards FSHD therapies has accelerated since the underlying mechanism of epigenetic derepression of the double homeobox 4 (DUX4) gene leading to skeletal muscle toxicity was identified. This has facilitated the rapid development of novel therapies to target DUX4 expression and downstream dysregulation that cause muscle degeneration. These discoveries and pre-clinical translational studies have opened new avenues for therapies that await evaluation in clinical trials. As the field anticipates more FSHD trials, the need has grown for more reliable and quantifiable outcome measures of muscle function, both for early phase and phase II and III trials. Advanced tools that facilitate longitudinal clinical assessment will greatly improve the potential of trials to identify therapeutics that successfully ameliorate disease progression or permit muscle functional recovery. Here, we discuss current and emerging FSHD outcome measures and the challenges that investigators may experience in applying such measures to FSHD clinical trial design and implementation.
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Affiliation(s)
- Mehdi Ghasemi
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA; (C.P.E.J.); (L.J.H.)
- Wellstone Muscular Dystrophy Program, Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
- Correspondence: ; Fax: +1-508-856-4485
| | - Charles P. Emerson
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA; (C.P.E.J.); (L.J.H.)
- Wellstone Muscular Dystrophy Program, Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Lawrence J. Hayward
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA; (C.P.E.J.); (L.J.H.)
- Wellstone Muscular Dystrophy Program, Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
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Breen D, Farrell G, Delahunt E. The clinical assessment of hip muscle strength in professional rugby union players. Phys Ther Sport 2021; 52:115-120. [PMID: 34481341 DOI: 10.1016/j.ptsp.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
Groin/hip injuries are prevalent in rugby union (RU). Assessment of hip muscle strength is important when designing bespoke injury prevention and rehabilitation programmes. OBJECTIVE The primary aim of this study was to determine normative values of hip muscle strength in elite-level RU players. A secondary aim of this study was to compare the Copenhagen Hip and Groin Outcome Score (HAGOS) between players with and without a history of groin/hip injury. DESIGN Cross-sectional cohort study. SETTING Professional RU club. PARTICIPANTS 58 male professional RU players competing in the PRO14 league elite club level competition. MAIN OUTCOME MEASURES Handheld dynamometry eccentric strength values of hip abduction (ABD), adduction (ADD), internal rotation (IR) and external rotation (ER), HAGOS. RESULTS Players' dominant (DOM) and non-dominant (NDOM) hip strength values were, 2.38 and 2.34 N m/kg for ABD, 2.79 and 2.71 N m/kg for ADD, 2.69 and 2.55 N m/kg for IR, and 2.65 and 2.54 N m/kg for ER. ADD:ABD strength ratio was 1.17 ± 0.26 for the DOM limb and 1.16 ± 0.24 for the NDOM limb. There was no clinically significant difference in strength between players' DOM and NDOM limbs. Players with a history of groin/hip injury scored lower on four of the HAGOS subscales (pain; symptoms; sport; quality of life) compared to those without a history of groin/hip injury. CONCLUSIONS This study may help establish normative hip strength and HAGOS values for elite-level RU players. The results presented have important implications for the assessment of hip muscle strength and could provide clinical markers for return-to-play following injury.
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Affiliation(s)
- David Breen
- The Performance Team MCFC Academy, Manchester City FC, CFA Etihad Campus, 400 Ashton New Road, Manchester, England, United Kingdom.
| | - Garreth Farrell
- Medical Department, Leinster Rugby, Newstead Building A, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin 4, Ireland.
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Kinoshita K, Hoshino Y, Yokota N, Hashimoto M, Nishizawa Y, Kida N. Stepwise increase of upper limb muscle activity induced by progressive 4 positions of a handstand training. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-210169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Handstand is the most important fundamental skill in gymnastics. A gradual and well-balanced increase in muscle loading in a manner is preferred for young beginners and/or recovering gymnasts to safely achieve the muscle strength required to perform a stable handstand. OBJECTIVE: To examine upper limb muscle activity during different levels of handstand training positions. METHODS: This study utilized four different positions for progressive handstand training; namely, the 90, 135, elbow stand, and handstand positions. The activities of eight upper limb muscles (upper, middle, and lower trapezius; serratus anterior; anterior and middle deltoid; infraspinatus; and latissimus dorsi were measured by surface electromyography (EMG) for each position. The percentages of EMG in each muscle compared to the values during maximum voluntary contraction were calculated and compared between the positions. RESULTS: Muscle activity around the shoulder increased gradually throughout the progression of the four handstand training positions. Furthermore, the muscles required for scapular stabilization, such as the upper and middle trapezius and serratus anterior muscles, were activated at levels similar to those for a handstand without performing this movement. CONCLUSIONS: A progressive handstand training program of four different positions resulted in gradual and well-balanced increases in muscle activity.
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Affiliation(s)
- Kazuaki Kinoshita
- Department of Physical Therapy, Faculty of Rehabilitation, Shijonawate Gakuen University, Daito, Osaka, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Naoko Yokota
- Sports Medicine Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Yuichiro Nishizawa
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Hyogo, Japan
| | - Noriyuki Kida
- Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto, Japan
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Bakers JNE, van Eijk RPA, van den Berg LH, Visser-Meily JMA, Beelen A. Pattern of muscle strength improvement after intravenous immunoglobulin therapy in multifocal motor neuropathy. Muscle Nerve 2021; 63:678-682. [PMID: 33501670 PMCID: PMC8247955 DOI: 10.1002/mus.27185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/10/2022]
Abstract
Introduction In multifocal motor neuropathy (MMN), knowledge about the pattern of treatment response in a wide spectrum of muscle groups, distal as well as proximal, after intravenous immunoglobulin (IVIg) initiation is lacking. Methods Hand‐held dynamometry data of 11 upper and lower limb muscles, from 47 patients with MMN was reviewed. Linear mixed models were used to determine the treatment response after IVIg initiation and its relationship with initial muscle weakness. Results All muscle groups showed a positive treatment response after IVIg initiation. Changes in SD scores ranged from +0.1 to +0.95. A strong association between weakness at baseline and the magnitude of the treatment response was found. Discussion Improved muscle strength in response to IVIg appears not only in distal, but to a similar degree also in proximal muscle groups in MMN, with the largest response in muscle groups that show the greatest initial weakness.
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Affiliation(s)
- Jaap N E Bakers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anita Beelen
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Portable fixed dynamometry: towards remote muscle strength measurements in patients with motor neuron disease. J Neurol 2020; 268:1738-1746. [PMID: 33355879 PMCID: PMC8068646 DOI: 10.1007/s00415-020-10366-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022]
Abstract
Background We aimed to determine (1) the test–retest reliability of a newly developed portable fixed dynamometer (PFD) as compared to the hand-held dynamometer (HHD) in patients with motor neuron disease (MND) and (2) the PFD’s ability to reduce possible examiner-induced ceiling effects. Methods Test–retest reliability of isometric muscle strength of the quadriceps was measured in patients with MND and non-neurological controls using the HHD and PFD. Reliability was estimated by the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) using linear mixed effects models, and the Bland–Altman method of agreement. Results In total, 45 patients with MND and 43 healthy controls were enrolled in this study. The ICC of the PFD was excellent and similar in both patients and controls (ICC Patients 99.5% vs. ICC Controls 98.6%) with a SEM of 6.2%. A strong examiner-induced ceiling effect in HHD was found when the participant’s strength exceeded that of examiner. Employing the PFD increased the range of muscle strength measurements across individuals nearly twofold from 414 to 783 N. Conclusions Portable fixed dynamometry may significantly reduce examiner-induced ceiling effects, optimize the standardization of muscle strength testing, and maximize reliability. Ultimately, PFD may improve the delivery of care due to its potential for unsupervised, home-based assessments and reduce the burden to the patient of participating in clinical trials for MND or other neuromuscular diseases.
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Liu CY, Yao J, Kovacs WC, Shrader JA, Joe G, Ouwerkerk R, Mankodi AK, Gahl WA, Summers RM, Carrillo N. Skeletal Muscle Magnetic Resonance Biomarkers in GNE Myopathy. Neurology 2020; 96:e798-e808. [PMID: 33219145 DOI: 10.1212/wnl.0000000000011231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To characterize muscle involvement and evaluate disease severity in patients with GNE myopathy using skeletal muscle MRI and proton magnetic resonance spectroscopy (1H-MRS). METHODS Skeletal muscle imaging of the lower extremities was performed in 31 patients with genetically confirmed GNE myopathy, including T1-weighted and short tau inversion recovery (STIR) images, T1 and T2 mapping, and 1H-MRS. Measures evaluated included longitudinal relaxation time (T1), transverse relaxation time (T2), and 1H-MRS fat fraction (FF). Thigh muscle volume was correlated with relevant measures of strength, function, and patient-reported outcomes. RESULTS The cohort was representative of a wide range of disease progression. Contractile thigh muscle volume ranged from 5.51% to 62.95% and correlated with thigh strength (r = 0.91), the 6-minute walk test (r = 0.82), the adult myopathy assessment tool (r = 0.83), the activities-specific balance confidence scale (r = 0.65), and the inclusion body myositis functional rating scale (r = 0.62). Four stages of muscle involvement were distinguished by qualitative (T1W and STIR images) and quantitative methods: stage I: unaffected muscle (T1 = 1,033 ± 74.2 ms, T2 = 40.0 ± 1.9 ms, FF = 7.4 ± 3.5%); stage II: STIR hyperintense muscle with minimal or no fat infiltration (T1 = 1,305 ± 147 ms, T2 = 50.2 ± 3.5 ms, FF = 27.6 ± 12.7%); stage III: fat infiltration and STIR hyperintensity (T1 = 1,209 ± 348 ms, T2 = 73.3 ± 12.6 ms, FF = 57.5 ± 10.6%); and stage IV: complete fat replacement (T1 = 318 ± 39.9 ms, T2 = 114 ± 21.2 ms, FF = 85.6 ± 4.2%). 1H-MRS showed a significant decrease in intramyocellular lipid and trimethylamines between stage I and II, suggesting altered muscle metabolism at early stages. CONCLUSION MRI biomarkers can monitor muscle involvement and determine disease severity noninvasively in patients with GNE myopathy. CLINICALTRIALSGOV IDENTIFIER NCT01417533.
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Affiliation(s)
- Chia-Ying Liu
- From Radiology and Imaging Sciences (C.-Y.L., J.Y., W.C.K., R.M.S.) and Rehabilitation Medicine Department (J.A.S., G.J.), Clinical Center, National Institute of Diabetes and Digestive and Kidney Diseases (R.O.), Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (A.K.M.), and Medical Genetics Branch, National Human Genome Research Institute (W.A.G., N.C.), NIH, Bethesda, MD
| | - Jianhua Yao
- From Radiology and Imaging Sciences (C.-Y.L., J.Y., W.C.K., R.M.S.) and Rehabilitation Medicine Department (J.A.S., G.J.), Clinical Center, National Institute of Diabetes and Digestive and Kidney Diseases (R.O.), Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (A.K.M.), and Medical Genetics Branch, National Human Genome Research Institute (W.A.G., N.C.), NIH, Bethesda, MD
| | - William C Kovacs
- From Radiology and Imaging Sciences (C.-Y.L., J.Y., W.C.K., R.M.S.) and Rehabilitation Medicine Department (J.A.S., G.J.), Clinical Center, National Institute of Diabetes and Digestive and Kidney Diseases (R.O.), Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (A.K.M.), and Medical Genetics Branch, National Human Genome Research Institute (W.A.G., N.C.), NIH, Bethesda, MD
| | - Joseph A Shrader
- From Radiology and Imaging Sciences (C.-Y.L., J.Y., W.C.K., R.M.S.) and Rehabilitation Medicine Department (J.A.S., G.J.), Clinical Center, National Institute of Diabetes and Digestive and Kidney Diseases (R.O.), Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (A.K.M.), and Medical Genetics Branch, National Human Genome Research Institute (W.A.G., N.C.), NIH, Bethesda, MD
| | - Galen Joe
- From Radiology and Imaging Sciences (C.-Y.L., J.Y., W.C.K., R.M.S.) and Rehabilitation Medicine Department (J.A.S., G.J.), Clinical Center, National Institute of Diabetes and Digestive and Kidney Diseases (R.O.), Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (A.K.M.), and Medical Genetics Branch, National Human Genome Research Institute (W.A.G., N.C.), NIH, Bethesda, MD
| | - Ronald Ouwerkerk
- From Radiology and Imaging Sciences (C.-Y.L., J.Y., W.C.K., R.M.S.) and Rehabilitation Medicine Department (J.A.S., G.J.), Clinical Center, National Institute of Diabetes and Digestive and Kidney Diseases (R.O.), Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (A.K.M.), and Medical Genetics Branch, National Human Genome Research Institute (W.A.G., N.C.), NIH, Bethesda, MD
| | - Ami K Mankodi
- From Radiology and Imaging Sciences (C.-Y.L., J.Y., W.C.K., R.M.S.) and Rehabilitation Medicine Department (J.A.S., G.J.), Clinical Center, National Institute of Diabetes and Digestive and Kidney Diseases (R.O.), Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (A.K.M.), and Medical Genetics Branch, National Human Genome Research Institute (W.A.G., N.C.), NIH, Bethesda, MD
| | - William A Gahl
- From Radiology and Imaging Sciences (C.-Y.L., J.Y., W.C.K., R.M.S.) and Rehabilitation Medicine Department (J.A.S., G.J.), Clinical Center, National Institute of Diabetes and Digestive and Kidney Diseases (R.O.), Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (A.K.M.), and Medical Genetics Branch, National Human Genome Research Institute (W.A.G., N.C.), NIH, Bethesda, MD
| | - Ronald M Summers
- From Radiology and Imaging Sciences (C.-Y.L., J.Y., W.C.K., R.M.S.) and Rehabilitation Medicine Department (J.A.S., G.J.), Clinical Center, National Institute of Diabetes and Digestive and Kidney Diseases (R.O.), Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (A.K.M.), and Medical Genetics Branch, National Human Genome Research Institute (W.A.G., N.C.), NIH, Bethesda, MD
| | - Nuria Carrillo
- From Radiology and Imaging Sciences (C.-Y.L., J.Y., W.C.K., R.M.S.) and Rehabilitation Medicine Department (J.A.S., G.J.), Clinical Center, National Institute of Diabetes and Digestive and Kidney Diseases (R.O.), Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (A.K.M.), and Medical Genetics Branch, National Human Genome Research Institute (W.A.G., N.C.), NIH, Bethesda, MD.
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Reliability and Validity of a Novel Wearable Device for Measuring Elbow Strength. SENSORS 2020; 20:s20123412. [PMID: 32560409 PMCID: PMC7349842 DOI: 10.3390/s20123412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 11/27/2022]
Abstract
Muscle strength is an important clinical outcome in rehabilitation and sport medicine, but options are limited to expensive but accurate isokinetic dynamometry (IKD) or inexpensive but less accurate hand-held dynamometers (HHD). A wearable, self-stabilizing, limb strength measurement device (LSMD) was developed to fill the current gap in portable strength measurement devices. The purpose of this study was to evaluate the reliability and validity of the LSMD in healthy adults. Twenty healthy adults were recruited to attend two strength testing sessions where elbow flexor and extensor strength was measured with the LSMD, with HHD and with IKD in random order, by two raters. Outcomes were intra-rater repeatability, inter-rater reproducibility and inter-session reproducibility using intra-class correlation coefficients (ICC). Limits of agreement and weighted least products regression were used to test the validity of the LSMD relative to the criterion standard (IKD), and calibration formulas derived to improve measurement fidelity. ICC values for the LSMD were >0.90 for all measures of reliability and for both muscle groups, but over-predicted extensor strength and under-predicted flexor strength. Validity was established by transforming the data with the criterion standard-based calibration. These data indicate that the LSMD is reliable and conditionally valid for quantifying strength of elbow flexors and extensors in a healthy adult population.
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Sung KS, Yi YG, Shin HI. Reliability and validity of knee extensor strength measurements using a portable dynamometer anchoring system in a supine position. BMC Musculoskelet Disord 2019; 20:320. [PMID: 31286912 PMCID: PMC6615264 DOI: 10.1186/s12891-019-2703-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/03/2019] [Indexed: 12/23/2022] Open
Abstract
Background Muscle strength measurements using hand-held dynamometry (HHD) can be affected by the inadequate strength of the tester and lack of stabilization of the participants and the device. A portable HHD anchoring system was designed that enabled the measurement of isometric knee extensor muscle strength in a supine position. This can be used with individuals who are unable to assume the sitting position required for the measurement of knee extensor strength in conventional isokinetic dynamometry (IKD). The aim of this study was to evaluate the reliability and validity of knee extensor strength measurements using this device. Methods The maximal knee extensor isometric strength of the dominant leg in healthy adults aged 20 to 40 years was tested. Three trials of three contractions were assessed by two raters using the portable dynamometer anchoring system whilst the participant was in the supine position. After the three measurement trials, peak knee extensor torque was evaluated using IKD. The intraclass correlation coefficient (ICC) and 95% limits of agreement (LOA) for intra- and inter-rater reliability were obtained. Results Thirty-nine participants (19 male and 20 female, aged 30.08 ± 4.16 y), completed the three measurement trials. The ICC for intra-rater reliability was 0.98 for the maximum measurements of knee extensor strength (95% confidence interval [CI]: 0.96–0.98) and 0.98 (95% CI: 0.96–0.99) for inter-rater reliability. The mean difference (%) between the maximum knee extensor strength measurements of each trial was 1.02% (LOA range: − 11.13 to 13.16%) for intra-rater and − 1.44% (LOA range: − 13.98 to 11.08%) for inter-rater measurements. The Pearson correlation coefficient of the maximum voluntary peak torque measurements with the portable dynamometer anchoring system and IKD was 0.927. Conclusions The portable dynamometer anchoring system is a reliable and valid tool for measuring isometric knee extensor strength in a supine position. Future clinical feasibility studies are needed to determine if this equipment can be applied to people with severe illness or disabilities. Trial registration KCT0003041. Electronic supplementary material The online version of this article (10.1186/s12891-019-2703-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kwan-Sik Sung
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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12
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The Relevance of Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. Clin Chest Med 2019; 40:367-383. [DOI: 10.1016/j.ccm.2019.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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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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14
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Evaluation of Limb Muscle Strength and Function in People With Chronic Obstructive Pulmonary Disease. Cardiopulm Phys Ther J 2019. [DOI: 10.1097/cpt.0000000000000090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Quintana M, Shrader J, Slota C, Joe G, McKew JC, Fitzgerald M, Gahl WA, Berry S, Carrillo N. Bayesian model of disease progression in GNE myopathy. Stat Med 2018; 38:1459-1474. [PMID: 30511500 DOI: 10.1002/sim.8050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/25/2018] [Accepted: 11/08/2018] [Indexed: 12/31/2022]
Abstract
One Sentence Summary: A Bayesian repeated measures model based on quantitative muscle strength data from a prospective Natural History Study was developed to determine disease progression and design clinical trials for GNE myopathy, a rare and slowly progressive muscle disease. GNE myopathy is a rare muscle disease characterized by slowly progressive weakness and atrophy of skeletal muscles. To address the significant challenges of defining the natural history and designing clinical trials for GNE myopathy, we developed a Bayesian latent variable repeated measures model to determine disease progression. The model is based on longitudinal quantitative muscle strength data collected as part of a prospective Natural History Study. The GNE Myopathy Progression Model provides an understanding of disease progression that would have otherwise required a natural history of unfeasible duration. "Disease age," the model-generated measure of disease progression, highly correlates with a variety of clinical, functional and patient-reported outcomes. With the incorporation of a treatment effect parameter to the GNE Disease Progression Model, we describe a novel GNE Myopathy Disease Modification Analysis that significantly increases power and reduces the number of subjects required to test the effectiveness of novel therapies when compared to more traditional analysis methods. The GNE Myopathy Disease Progression Model and Disease Modification Analysis can be applied to muscle diseases with prospectively collected muscle strength data, and a variety of rare and slowly progressive diseases.
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Affiliation(s)
| | - J Shrader
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - C Slota
- Therapeutics for Rare and Neglected Diseases Program, National Institutes of Health, Bethesda, Maryland.,RTI Health Solutions, Durham, North Carolina
| | - G Joe
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - J C McKew
- Therapeutics for Rare and Neglected Diseases Program, National Institutes of Health, Bethesda, Maryland
| | | | - W A Gahl
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - S Berry
- Berry Consultants, Austin, Texas.,Kansas University Medical Center, Kansas City, Kansas
| | - N Carrillo
- Therapeutics for Rare and Neglected Diseases Program, National Institutes of Health, Bethesda, Maryland.,National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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16
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Intraspinal Transplantation of the Adipose Tissue-Derived Regenerative Cells in Amyotrophic Lateral Sclerosis in Accordance with the Current Experts' Recommendations: Choosing Optimal Monitoring Tools. Stem Cells Int 2018; 2018:4392017. [PMID: 30158984 PMCID: PMC6109475 DOI: 10.1155/2018/4392017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/26/2018] [Accepted: 06/14/2018] [Indexed: 12/11/2022] Open
Abstract
Stem cells (SCs) may constitute a perspective alternative to pharmacological treatment in neurodegenerative diseases. Although the safety of SC transplantation has been widely shown, their clinical efficiency in amyotrophic lateral sclerosis (ALS) is still to be proved. It is not only due to a limited number of studies, small treatment groups, and fast but nonlinear disease progression but also due to lack of objective methods able to show subtle clinical changes. Preliminary guidelines for cell therapy have recently been proposed by a group of ALS experts. They combine clinical, neurophysiological, and functional assessment together with monitoring of the cytokine level. Here, we describe a pilot study on transplantation of autologous adipose-derived regenerative cells (ADRC) into the spinal cord of the patients with ALS and monitoring of the results in accordance with the current recommendations. To show early and/or subtle changes within the muscles of interest, a wide range of clinical and functional tests were used and compared in order to choose the most sensitive and optimal set. Additionally, an analysis of transplanted ADRC was provided to develop standards ensuring the derivation and verification of adequate quality of transplanted cells and to correlate ADRC properties with clinical outcome.
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Barbosa AC, Vieira ER, Silva AF, Coelho AC, Martins FM, Fonseca DS, Barbosa MA, Bordachar D. Pilates experience vs. muscle activation during abdominal drawing-in maneuver. J Bodyw Mov Ther 2018; 22:467-470. [PMID: 29861251 DOI: 10.1016/j.jbmt.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/14/2017] [Accepted: 04/28/2017] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to compare the activation of deep abdominal and spine stabilizer muscles of subjects with and without Pilates experience. Twenty-three subjects were divided into a no-experience group (n = 13) and an experienced group (n = 10). The subjects performed three 12-s drawing-in maneuver trials at 50% TrA/IO maximal voluntary contraction (MVC). The experienced group presented greater activation of both muscles than the no-experience group (62% vs. 32% MVC for the TrA/IO, and 52% vs. 12% MVC for the LD, p < 0.001). The no-experience group had higher variability among trials and did not reach 50% MVC for the TrA/IO, while the experienced group was able to reach and keep the TrA/IO activation at or above 50% MVC. Pilates experience and muscle activation were strongly associated. Pilates trained subjects were able to sustain concomitant abdominal and low back muscle contraction during the drawing-in maneuver, while subjects with no Pilates experience were not able to reach the same levels of abdominal activation and did not present significant low back muscle co-activation.
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Affiliation(s)
- Alexandre Carvalho Barbosa
- Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadares, Brazil; Department of Physical Therapy, Florida International University, Miami, USA.
| | - Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, USA
| | - Angelica Fátima Silva
- Department of Physical Therapy, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Brazil
| | - Ana Carolina Coelho
- Department of Physical Therapy, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Brazil
| | - Fábio Mendonça Martins
- Department of Physical Therapy, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Brazil
| | - Diogo Simões Fonseca
- Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Michelle Almeida Barbosa
- Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Diego Bordachar
- Department of Physical Therapy, University Institute of Gran Rosario, Rosario, Argentina
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18
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Mañago MM, Hebert JR, Schenkman M. Psychometric Properties of a Clinical Strength Assessment Protocol in People with Multiple Sclerosis. Int J MS Care 2017; 19:253-262. [PMID: 29070966 DOI: 10.7224/1537-2073.2016-078] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Strength training in people with multiple sclerosis (MS) is an important component of rehabilitation, but it can be challenging for clinicians to quantify strength accurately and reliably. This study investigated the psychometric properties of a clinical strength assessment protocol using handheld dynamometry and other objective, quantifiable tests for the lower extremities and trunk in people with MS. METHODS This study determined discriminant validity between 25 participants with MS and 25 controls and between participants with MS who had higher versus lower disability; test-retest reliability across 7 to 10 days; and response stability. The protocol included handheld dynamometry measurements of ankle dorsiflexion, knee flexion and extension; hip flexion, extension, abduction, and adduction; and trunk lateral flexion. Muscular endurance tests were used to measure trunk extension, trunk flexion, and ankle plantarflexion. RESULTS The protocol discriminated between participants with MS and controls for all muscles tested (P < .001-.003). The protocol also discriminated between low- and moderate-disability groups (P = .001-.046) for 80% of the muscles tested. Test-retest reliability intraclass correlation coefficients were high (0.81-0.97). Minimal detectable change as a percentage of the mean was 13% to 36% for 85% of muscles tested. CONCLUSIONS This study provides evidence for the discriminant validity, test-retest reliability, and response stability of a strength assessment protocol in people with MS. This protocol may be useful for tracking outcomes in people with MS for clinical investigations and practice.
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19
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Mitchell M, Martin BJ, Adamo DE. Upper Limb Asymmetry in the Sense of Effort Is Dependent on Force Level. Front Psychol 2017; 8:643. [PMID: 28491047 PMCID: PMC5405061 DOI: 10.3389/fpsyg.2017.00643] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/11/2017] [Indexed: 11/13/2022] Open
Abstract
Previous studies have shown that asymmetries in upper limb sensorimotor function are dependent on the source of sensory and motor information, hand preference and differences in hand strength. Further, the utilization of sensory and motor information and the mode of control of force may differ between the right hand/left hemisphere and left hand/right hemisphere systems. To more clearly understand the unique contribution of hand strength and intrinsic differences to the control of grasp force, we investigated hand/hemisphere differences when the source of force information was encoded at two different force levels corresponding to a 20 and 70% maximum voluntary contraction or the right and left hand of each participant. Eleven, adult males who demonstrated a stronger right than left maximum grasp force were requested to match a right or left hand 20 or 70% maximal voluntary contraction reference force with the opposite hand. During the matching task, visual feedback corresponding to the production of the reference force was available and then removed when the contralateral hand performed the match. The matching relative force error was significantly different between hands for the 70% MVC reference force but not for the 20% MVC reference force. Directional asymmetries, quantified as the matching force constant error, showed right hand overshoots and left undershoots were force dependent and primarily due to greater undershoots when matching with the left hand the right hand reference force. Findings further suggest that the interaction between internal sources of information, such as efferent copy and proprioception, as well as hand strength differences appear to be hand/hemisphere system dependent. Investigations of force matching tasks under conditions whereby force level is varied and visual feedback of the reference force is available provides critical baseline information for building effective interventions for asymmetric (stroke-related, Parkinson's Disease) and symmetric (Amyotrophic Lateral Sclerosis) upper limb recovery of neurological conditions where the various sources of sensory - motor information have been significantly altered by the disease process.
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Affiliation(s)
- Mark Mitchell
- Rehabilitation Institute of Michigan, DetroitMI, USA
| | - Bernard J Martin
- Department of Industrial and Operations Engineering, University of Michigan, Ann ArborMI, USA
| | - Diane E Adamo
- Department of Health Care Sciences, Physical Therapy Program, Wayne State University, DetroitMI, USA.,Institute of Gerontology, Wayne State University, DetroitMI, USA
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20
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Motor Unit Number Index (MUNIX) detects motor neuron loss in pre-symptomatic muscles in Amyotrophic Lateral Sclerosis. Clin Neurophysiol 2017; 128:495-500. [DOI: 10.1016/j.clinph.2016.11.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/03/2016] [Accepted: 11/20/2016] [Indexed: 11/22/2022]
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21
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Slota C, Bevans M, Yang L, Shrader J, Joe G, Carrillo N. Patient reported outcomes in GNE myopathy: incorporating a valid assessment of physical function in a rare disease. Disabil Rehabil 2017. [PMID: 28637129 DOI: 10.1080/09638288.2017.1283712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aim of this analysis was to evaluate the psychometric properties of three patient reported outcome (PRO) measures characterizing physical function in GNE myopathy: the Human Activity Profile, the Inclusion Body Myositis Functional Rating Scale, and the Activities-specific Balance Confidence scale. METHODS This analysis used data from 35 GNE myopathy subjects participating in a natural history study. For construct validity, correlational and known-group analyses were between the PROs and physical assessments. Reliability of the PROs between baseline and 6 months was evaluated using the intra-class correlation coefficient model; internal consistency was tested with Cronbach's alpha. RESULTS The hypothesized moderate positive correlations for construct validity were supported; the strongest correlation was between the human activity profile adjusted activity score and the adult myopathy assessment endurance subscale score (r = 0.81; p < 0.0001). The PROs were able to discriminate between known high and low functioning groups for the adult myopathy assessment tool. Internal consistency of the PROs was high (α > 0.8) and there was strong reliability (ICC >0.62). CONCLUSION The PROs are valid and reliable measures of physical function in GNE myopathy and should be incorporated in investigations to better understand the impact of progressive muscle weakness on physical function in this rare disease population. Implications for Rehabilitation GNE myopathy is a rare muscle disease that results in slow progressive muscle atrophy and weakness, ultimately leading to wheelchair use and dependence on a caregiver. There is limited knowledge on the impact of this disease on the health-related quality of life, specifically physical function, of this rare disease population. Three patient reported outcomes have been shown to be valid and reliable in GNE myopathy subjects and should be incorporated in future investigations to better understand how progressive muscle weakness impacts physical functions in this rare disease population. The patient reported outcome scores of GNE myopathy patients indicate a high risk for falls and impaired physical functioning, so it is important clinicians assess and provide interventions for these subjects to maintain their functional capacity.
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Affiliation(s)
- Christina Slota
- a Therapeutics for Rare and Neglected Diseases , National Center for Advancing Translational Sciences, National Institutes of Health , Bethesda , MD , USA.,b RTI Health Solutions , NC , USA
| | - Margaret Bevans
- c National Institutes of Health Clinical Center , Bethesda , MD , USA
| | - Li Yang
- c National Institutes of Health Clinical Center , Bethesda , MD , USA
| | - Joseph Shrader
- d Rehabilitation Medicine Department , National Institutes of Health , Bethesda , MD , USA
| | - Galen Joe
- d Rehabilitation Medicine Department , National Institutes of Health , Bethesda , MD , USA
| | - Nuria Carrillo
- a Therapeutics for Rare and Neglected Diseases , National Center for Advancing Translational Sciences, National Institutes of Health , Bethesda , MD , USA.,e National Human Genome Research Institute, National Institutes of Health , Bethesda , MD , USA
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22
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Lee SY, Jo ME. Comparison of maximum voluntary isometric contraction of the biceps on various posture and respiration conditions for normalization of electromyography data. J Phys Ther Sci 2016; 28:3007-3010. [PMID: 27942110 PMCID: PMC5140790 DOI: 10.1589/jpts.28.3007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/19/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Maximum voluntary isometric contraction can increase the reliability of
electromyography data by controlling respiration; however, many studies that use
normalization of electromyography data fail to account for this. This study aims to check
changes in maximum voluntary isometric contraction based on changes in posture and
respiration conditions. [Subjects and Methods] Twenty-two healthy volunteers were included
in this study. Using 22 healthy subjects, MVIC of the biceps brachii muscle was measured
in three respiration conditions: (1) Maximum voluntary isometric contraction during
inspiration after maximal expiration, (2) Maximum voluntary isometric contraction during
expiration after maximal inspiration and (3) Maximum voluntary isometric contraction
during the Valsalva maneuver. The subjects were in tested in standing and supine postures
under all three respiration conditions. [Results] A significant difference was observed in
the standing and supine postures based on the respiration condition. A significant
difference was observed in the maximum voluntary isometric contraction during inspiration
after maximal expiration and maximum voluntary isometric contraction during the Valsalva
maneuver conditions when the subjects were in the supine posture. [Conclusion] It is
necessary to apply the same respiration condition and the same posture to each subject
when measuring Maximum voluntary isometric contraction for the normalization of
electromyography data.
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Affiliation(s)
- Sang-Yeol Lee
- Department of Physical Therapy, College of Science, Kyungsung University, Republic of Korea
| | - Marg-Eun Jo
- Department of Physical Therapy, Graduate School of Clinical Pharmacy and Health, Kyungsung University, Republic of Korea
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Solverson KJ, Grant C, Doig CJ. Assessment and predictors of physical functioning post-hospital discharge in survivors of critical illness. Ann Intensive Care 2016; 6:92. [PMID: 27646108 PMCID: PMC5028364 DOI: 10.1186/s13613-016-0187-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/25/2016] [Indexed: 12/19/2022] Open
Abstract
Background Prior studies of physical functioning after critical illness have been mostly limited to survivors of acute respiratory distress syndrome. The purpose of this study was to objectively assess muscle strength and physical functioning in survivors of critical illness from a general ICU and the associations of these measures to health-related quality of life (HRQL), mental health and critical illness variables. Methods This was a prospective cohort study of 56 patients admitted to a medical ICU (length of stay ≥4 days) from April 1, 2009, and March 31, 2010. Patients were assessed in clinic at 3 months post-hospital discharge. Muscle strength and physical functioning were measured using hand-held dynamometry and the 6-min walk test. HRQL was assessed using the short-form 36 (SF-36) and EuroQol-5D (EQ-5D) questionnaires. Results Three months post-hospital discharge, median age- and sex-matched muscle strength was reduced across all muscle groups. The median 6-min walk distance was 72 % of predicted. Physical functioning was associated with reductions in self-reported HRQL (SF-36, EQ-5D) and increased anxiety. Univariate regression modeling showed that reduced muscle strength and 6-min walk distance were associated with sepsis but not ICU length of stay. Multivariate regression modeling showed that sepsis and corticosteroid use were associated with a reduced 6-min walk distance, but again ICU length of stay was not. Conclusions Survivors of critical illness have reduced strength in multiple muscle groups and impaired exercise tolerance impacting both HRQL and mental health. These outcomes were worsened by sepsis and corticosteroid use in the ICU but not ICU length of stay. Interventions to minimizing the burden of sepsis in critically ill patients may improve long-term outcomes.
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Affiliation(s)
- Kevin J Solverson
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Christopher Grant
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada.,Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada.
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Grip and Muscle Strength Dynamometry Are Reliable and Valid in Patients With Unhealed Minor Burn Wounds. J Burn Care Res 2016; 37:388-396. [DOI: 10.1097/bcr.0000000000000414] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Witting N, Andersen LK, Vissing J. Axial myopathy: an overlooked feature of muscle diseases. Brain 2015; 139:13-22. [DOI: 10.1093/brain/awv332] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/16/2015] [Indexed: 12/21/2022] Open
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Lewelt A, Krosschell KJ, Stoddard GJ, Weng C, Xue M, Marcus RL, Gappmaier E, Viollet L, Johnson BA, White AT, Viazzo-Trussell D, Lopes P, Lane RH, Carey JC, Swoboda KJ. Resistance strength training exercise in children with spinal muscular atrophy. Muscle Nerve 2015; 52:559-67. [PMID: 25597614 DOI: 10.1002/mus.24568] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 12/05/2014] [Accepted: 01/06/2015] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Preliminary evidence in adults with spinal muscular atrophy (SMA) and in SMA animal models suggests exercise has potential benefits in improving or stabilizing muscle strength and motor function. METHODS We evaluated feasibility, safety, and effects on strength and motor function of a home-based, supervised progressive resistance strength training exercise program in children with SMA types II and III. Up to 14 bilateral proximal muscles were exercised 3 times weekly for 12 weeks. RESULTS Nine children with SMA, aged 10.4 ± 3.8 years, completed the resistance training exercise program. Ninety percent of visits occurred per protocol. Training sessions were pain-free (99.8%), and no study-related adverse events occurred. Trends in improved strength and motor function were observed. CONCLUSIONS A 12-week supervised, home-based, 3-day/week progressive resistance training exercise program is feasible, safe, and well tolerated in children with SMA. These findings can inform future studies of exercise in SMA.
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Affiliation(s)
- Aga Lewelt
- Division of Physical Medicine and Rehabilitation, Pediatric Motor Disorders Research Program, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, Utah, 84132, USA
| | - Kristin J Krosschell
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gregory J Stoddard
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah, USA
| | - Cindy Weng
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah, USA
| | - Mei Xue
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Robin L Marcus
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah, USA
| | - Eduard Gappmaier
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah, USA
| | - Louis Viollet
- Department of Neurology, Pediatric Motor Disorders Research Program, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Barbara A Johnson
- Department of Neurology, Pediatric Motor Disorders Research Program, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Andrea T White
- Department of Exercise and Sport Science, University of Utah, College of Health, Salt Lake City, Utah, USA
| | - Donata Viazzo-Trussell
- Department of Neurology, Pediatric Motor Disorders Research Program, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Philippe Lopes
- Neuromuscular Degeneration and Plasticity Laboratory, Institut National de la Santé et de la Recherche Médicale UMR-S 1124, University Paris Descartes, Paris, France
| | - Robert H Lane
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John C Carey
- Division of Pediatric Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kathryn J Swoboda
- Department of Neurology, Pediatric Motor Disorders Research Program, University of Utah School of Medicine, Salt Lake City, Utah, USA
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de Vasconcelos RA, Bevilaqua-Grossi D, Shimano AC, Paccola CJ, Salvini TF, Prado CL, Junior WAM. RELIABILITY AND VALIDITY OF A MODIFIED ISOMETRIC DYNAMOMETER IN THE ASSESSMENT OF MUSCULAR PERFORMANCE IN INDIVIDUALS WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION. Rev Bras Ortop 2015; 44:214-24. [PMID: 27004175 PMCID: PMC4783672 DOI: 10.1016/s2255-4971(15)30071-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the reliability and validity of a modified isometric dynamometer (MID) in performance deficits of the knee extensor and flexor muscles in normal individuals and in those with ACL reconstructions. Methods: Sixty male subjects were invited to participate of the study, being divided into three groups with 20 subjects each: control group (GC), group of individuals with ACL reconstruction with patellar tendon graft (GTP, and group of individuals with ACL reconstruction with hamstrings graft (GTF). All individuals performed isometric tests in the MID, muscular strength deficits collected were subsequently compared to the tests performed on the Biodex System 3 operating in the isometric and isokinetic mode at speeds of 60°/s and 180o/s. Intraclass ICC correlation calculations were done in order to assess MID reliability, specificity, sensitivity and Kappa's consistency coefficient calculations, respectively, for assessing the MID's validity in detecting muscular deficits and intra- and intergroup comparisons when performing the four strength tests using the ANOVA method. Results: The modified isometric dynamometer (MID) showed excellent reliability and good validity in the assessment of the performance of the knee extensor and flexor muscles groups. In the comparison between groups, the GTP showed significantly greater deficits as compared to the GTF and GC groups. Conclusion: Isometric dynamometers connected to mechanotherapy equipments could be an alternative option to collect data concerning performance deficits of the extensor and flexor muscles groups of the knee in subjects with ACL reconstruction.
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Affiliation(s)
- Rodrigo Antunes de Vasconcelos
- PhD student in Medical Sciences, Area of Concentration in Orthopedics, Traumatology and Rehabilitation, School of Medicine, Ribeirāo Preto, Universidade de Sāo Paulo (FMRP-USP), Sāo Paulo, Brazil
| | - Débora Bevilaqua-Grossi
- Lecturer, Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor Apparatus, School of Medicine, Ribeirāo Preto, Universidade de Sāo Paulo (FMRP-USP), Sāo Paulo, Brazil
| | - Antonio Carlos Shimano
- Professor, Department of Biomechanics, Medicine, and Rehabilitation of the Lomotor Apparatus, School of Medicine, Ribeirāo Preto, Universidade de Sāo Paulo (FMRP-USP), Sāo Paulo, Brazil
| | - Cleber Jansen Paccola
- Professor, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, School of Medicine, Ribeirāo Preto - Universidade de Sāo Paulo (FMRP-USP), Sāo Paulo, Brazil
| | - Tânia Fátima Salvini
- Professor, Department of Physical Therapy, Universidade Federal de Sāo Carlos (UFScar), Sāo Paulo, Brazil
| | - Christiane Lanatovits Prado
- Master's degree student in Physical Therapy, Department of Physical Therapy, Universidade Federal de Sāo Carlos (UFScar), Sāo Paulo, Brazil
| | - Wilson A Mello Junior
- Preceptor, Residency Program in Orthopedics, Knee Surgery, Hospital Municipal Celso Pierro, Pontifícia Universidade Católica de Campinas (HMCPPUCC)
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Barbosa AC, Carvalho RAN, Bonifácio DN, Martins FLM, Barbosa MCSA. Increased Activation Amplitude Levels of Gluteus Medius in Women During Isometric and Dynamic Conditions Following a 4-week Protocol of Low-load Eccentric Exercises. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 21:257-263. [DOI: 10.1002/pri.1643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/25/2015] [Accepted: 05/05/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Alexandre Carvalho Barbosa
- Department of Physiotherapy; Federal University of Juiz de Fora; Governador Valadares Minas Gerais Brazil
| | | | - Douglas Novaes Bonifácio
- Department of Physiotherapy; Federal University of Valleys of Jequitinhonha and Mucuri; Diamantina Minas Gerais Brazil
| | - Fábio Luiz Mendonça Martins
- Department of Physiotherapy; Federal University of Valleys of Jequitinhonha and Mucuri; Diamantina Minas Gerais Brazil
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Nicholson KA, Cudkowicz ME, Berry JD. Clinical Trial Designs in Amyotrophic Lateral Sclerosis: Does One Design Fit All? Neurotherapeutics 2015; 12:376-83. [PMID: 25700798 PMCID: PMC4404442 DOI: 10.1007/s13311-015-0341-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The last 2 decades have seen a surge in the number of amyotrophic lateral sclerosis (ALS) clinical trials with the hope of finding successful treatments. Clinical trialists aim to repurpose existing drugs and test novel compounds to target potential ALS disease pathophysiology. Recent technological advancements have led to the discovery of new causative genetic agents and modes of delivering potential therapy, calling for increasingly sophisticated trial design. The standard ALS clinical trial design may be modified depending on study needs: type of therapy; route of therapy delivery; phase of therapy development; applicable subpopulation; market availability of therapy; and utility of telemedicine. Novel biomarkers of diagnostic, predictive, prognostic, and pharmacodynamic value are undergoing development and validation for use in clinical trials. Design modifications build on the traditional clinical trial design and may be employed in either the learning or confirming trial phase. Novel designs aim to minimize patient risk, study duration, and sample size, while improving efficiency and promoting statistical power to herald an exciting era for clinical research in ALS.
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Affiliation(s)
- Katharine A Nicholson
- Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, 165 Cambridge Street, Suite 600, Boston, MA, 02114, USA,
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Stevens SL, Caputo JL, Fuller DK, Morgan DW. Effects of underwater treadmill training on leg strength, balance, and walking performance in adults with incomplete spinal cord injury. J Spinal Cord Med 2015; 38:91-101. [PMID: 24969269 PMCID: PMC4293539 DOI: 10.1179/2045772314y.0000000217] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To document the effects of underwater treadmill training (UTT) on leg strength, balance, and walking performance in adults with incomplete spinal cord injury (iSCI). DESIGN Pre-test and post-test design. SETTING Exercise physiology laboratory. PARTICIPANTS Adult volunteers with iSCI (n = 11). INTERVENTION Participants completed 8 weeks (3 × /week) of UTT. Each training session consisted of three walks performed at a personalized speed, with adequate rest between walks. Body weight support remained constant for each participant and ranged from 29 to 47% of land body weight. Increases in walking speed and duration were staggered and imposed in a gradual and systematic fashion. OUTCOME MEASURES Lower-extremity strength (LS), balance (BL), preferred and rapid walking speeds (PWS and RWS), 6-minute walk distance (6MWD), and daily step activity (DSA). RESULTS Significant (P < 0.05) increases were observed in LS (13.1 ± 3.1 to 20.6 ± 5.1 N·kg(-1)), BL (23 ± 11 to 32 ± 13), PWS (0.41 ± 0.27 to 0.55 ± 0.28 m·s(-1)), RWS (0.44 ± 0.31 to 0.71 ± 0.40 m·s(-1)), 6MWD (97 ± 80 to 177 ± 122 m), and DSA (593 ± 782 to 1310 ± 1258 steps) following UTT. CONCLUSION Physical function and walking ability were improved in adults with iSCI following a structured program of UTT featuring individualized levels of body weight support and carefully staged increases in speed and duration. From a clinical perspective, these findings highlight the potential of UTT in persons with physical disabilities and diseases that would benefit from weight-supported exercise.
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Affiliation(s)
- Sandra L. Stevens
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA,Correspondence to: Sandra L. Stevens, Department of Health and Human Performance, Middle Tennessee State University, PO Box 96, Murfreesboro, TN 37132, USA.
| | - Jennifer L. Caputo
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Dana K. Fuller
- Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Don W. Morgan
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA
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Gerhardsson L, Gillström L, Hagberg M. Test-retest reliability of neurophysiological tests of hand-arm vibration syndrome in vibration exposed workers and unexposed referents. J Occup Med Toxicol 2014; 9:38. [PMID: 25400687 PMCID: PMC4232643 DOI: 10.1186/s12995-014-0038-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/22/2014] [Indexed: 11/12/2022] Open
Abstract
Background Exposure to hand-held vibrating tools may cause the hand-arm vibration syndrome (HAVS). The aim was to study the test-retest reliability of hand and muscle strength tests, and tests for the determination of thermal and vibration perception thresholds, which are used when investigating signs of neuropathy in vibration exposed workers. Methods In this study, 47 vibration exposed workers who had been investigated at the department of Occupational and Environmental Medicine in Gothenburg were compared with a randomized sample of 18 unexposed subjects from the general population of the city of Gothenburg. All participants passed a structured interview, answered several questionnaires and had a physical examination including hand and finger muscle strength tests, determination of vibrotactile (VPT) and thermal perception thresholds (TPT). Two weeks later, 23 workers and referents, selected in a randomized manner, were called back for the same test-procedures for the evaluation of test-retest reliability. Results The test-retest reliability after a two week interval expressed as limits of agreement (LOA; Bland-Altman), intra-class correlation coefficients (ICC) and Pearson correlation coefficients was excellent for tests with the Baseline hand grip, Pinch-grip and 3-Chuck grip among the exposed workers and referents (N = 23: percentage of differences within LOA 91 – 100%; ICC-values ≥0.93; Pearson r ≥0.93). The test-retest reliability was also excellent (percentage of differences within LOA 96–100 %) for the determination of vibration perception thresholds in digits 2 and 5 bilaterally as well as for temperature perception thresholds in digits 2 and 5, bilaterally (percentage of differences within LOA 91 – 96%). For ICC and Pearson r the results for vibration perception thresholds were good for digit 2, left hand and for digit 5, bilaterally (ICC ≥ 0.84; r ≥0.85), and lower (ICC = 0.59; r = 0.59) for digit 2, right hand. For the latter two indices the test-retest reliability for the determination of temperature thresholds was lower and showed more varying results. Conclusion The strong test-retest reliability for hand and muscle strength tests as well as for the determination of VPTs makes these procedures useful for diagnostic purposes and follow-up studies in vibration exposed workers.
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Affiliation(s)
- Lars Gerhardsson
- Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital, University of Gothenburg, Medicinaregatan 16, Box 414, SE-405 30 Gothenburg, Sweden
| | - Lennart Gillström
- Company Health Service, Volvo Powertrain Corporation, SE-541 36 Skovde, Sweden
| | - Mats Hagberg
- Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital, University of Gothenburg, Medicinaregatan 16, Box 414, SE-405 30 Gothenburg, Sweden
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Schrama PPM, Stenneberg MS, Lucas C, van Trijffel E. Intraexaminer reliability of hand-held dynamometry in the upper extremity: a systematic review. Arch Phys Med Rehabil 2014; 95:2444-69. [PMID: 24909587 DOI: 10.1016/j.apmr.2014.05.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 05/13/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To summarize and appraise the literature on the intraexaminer reliability of hand-held dynamometry (HHD) in the upper extremity. DATA SOURCES MEDLINE, CINAHL, and EMBASE were searched for relevant studies published up to December 2011. In addition, experts were contacted, and journals and reference lists were hand searched. STUDY SELECTION To be included in the review, articles needed to (1) use a repeated-measures, within-examiner(s) design; (2) include symptomatic or asymptomatic individuals, or both; (3) use HHD to measure muscle strength in any of the joints of the shoulder, elbow, or wrist with the "make" or the "break" technique; (4) report measurements in kilogram, pound, or torque; (5) use a device that is placed between the examiner's hand and the subject's body; and (6) present estimates of intraexaminer reliability. DATA EXTRACTION Quality assessment and data extraction were performed by 2 reviewers independently. DATA SYNTHESIS Fifty-four studies were included, of which 26 (48%) demonstrated acceptable intraexaminer reliability. Seven high-quality studies showed acceptable reliability for flexion and extension of the elbow in healthy subjects. Conflicting results were found for shoulder external rotation and abduction. Reliability for all other movements was unacceptable. Higher estimates were reached for within-sessions reliability and if means of trials were used. CONCLUSIONS Intraexaminer reliability of HHD in upper extremity muscle strength was acceptable only for elbow measurements in healthy subjects. We provide specific recommendations for future research. Physical therapists should not rely on HHD measurements for evaluation of treatment effects in patients with upper extremity disorders.
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Affiliation(s)
- Patrick P M Schrama
- private practice Leidsevaart, Haarlem, The Netherlands; Stichting Opleidingen Musculoskeletale Therapie, Institute for Master Education in Musculoskeletal Therapy, Amersfoort, The Netherlands.
| | - Martijn S Stenneberg
- Stichting Opleidingen Musculoskeletale Therapie, Institute for Master Education in Musculoskeletal Therapy, Amersfoort, The Netherlands
| | - Cees Lucas
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Emiel van Trijffel
- Stichting Opleidingen Musculoskeletale Therapie, Institute for Master Education in Musculoskeletal Therapy, Amersfoort, The Netherlands; Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Clements S, Samuel D. Knee extensor strength measured using a Biodex dynamometer and an adapted hand held dynamometer. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.6.274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shaun Clements
- Pre-registration student at the Faculty of Health Sciences, University of Southampton
| | - Dinesh Samuel
- Lecturer at the Faculty of Health Sciences, University of Southampton, UK
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Paganoni S, Cudkowicz M, Berry JD. Outcome measures in amyotrophic lateral sclerosis clinical trials. CLINICAL INVESTIGATION 2014; 4:605-618. [PMID: 28203356 PMCID: PMC5305182 DOI: 10.4155/cli.14.52] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with an average survival of 3-5 years. While therapies for ALS remain limited, basic and translational ALS research has been host to numerous influential discoveries in recent years. These discoveries have led to a large pipeline of potential therapies that await testing in clinical trials. Until recently, ALS clinical trials have relied on a limited cadre of 'traditional' outcome measures, including survival and measures of function. These measures have proven useful, although imperfect, in Phase III ALS trials. However, their utility in early-phase ALS trials is limited. For these early trials, outcome measures focused on target engagement or biological pathway analysis might improve trial outcomes and better support the drug development process.
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Affiliation(s)
- Sabrina Paganoni
- Harvard Medical School, Department of Neurology, Neurological Clinical Research Institute (NCRI), Massachusetts Genera Hospital, MA, USA
- Harvard Medical School, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Merit Cudkowicz
- Harvard Medical School, Department of Neurology, Neurological Clinical Research Institute (NCRI), Massachusetts Genera Hospital, MA, USA
| | - James D Berry
- Harvard Medical School, Department of Neurology, Neurological Clinical Research Institute (NCRI), Massachusetts Genera Hospital, MA, USA
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Thorborg K, Bandholm T, Hölmich P. Men are stronger than women—Also in the hip. J Sci Med Sport 2013; 16:E1-3. [DOI: 10.1016/j.jsams.2013.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 03/29/2013] [Indexed: 11/24/2022]
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Thorborg K, Bandholm T, Hölmich P. Hip- and knee-strength assessments using a hand-held dynamometer with external belt-fixation are inter-tester reliable. Knee Surg Sports Traumatol Arthrosc 2013; 21:550-5. [PMID: 22773065 DOI: 10.1007/s00167-012-2115-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 06/18/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE In football, ice-hockey, and track and field, injuries have been predicted, and hip- and knee-strength deficits quantified using hand-held dynamometry (HHD). However, systematic bias exists when testers of different sex and strength perform the measurements. Belt-fixation of the dynamometer may resolve this. The aim of the present study was therefore to examine the inter-tester reliability concerning strength assessments of isometric hip abduction, adduction, flexion, extension and knee-flexion strength, using HHD with external belt-fixation. METHODS Twenty-one healthy athletes (6 women), 30 (8.6) (mean (SD)) years of age, were included. Two physiotherapy students (1 female and 1 male) performed all the measurements after careful instruction and procedure training. Isometric hip abduction, adduction, flexion, extension, and knee-flexion strength were tested. The tester-order and hip-action order were randomised. RESULTS No systematic between-tester differences (bias) were observed for any of the hip or knee actions. The intra-class correlation coefficients (ICC 2.1) ranged from 0.76 to 0.95. Furthermore, standard errors of measurement in per cent (SEM %) ranged from 5 to 11 %, and minimal detectable change in per cent (MDC %) from 14 to 29 % for the different hip and knee actions. CONCLUSION The present study shows that isometric hip- and knee-strength measurements have acceptable inter-tester reliability at the group level, when testing strong individuals, using HHD with belt-fixation. This procedure is therefore perfectly suited for the evaluation and monitoring of strong athletes with hip, groin and hamstring injuries, some of the most common and troublesome injuries in sports. LEVELS OF EVIDENCE Diagnostic, Level III.
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Affiliation(s)
- Kristian Thorborg
- Arthroscopic Centre Amager, Copenhagen University Hospital, Hvidovre, Italiensvej 1, 2300, Copenhagen S, Denmark.
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Bohannon RW, Kindig J, Sabo G, Duni AE, Cram P. Isometric knee extension force measured using a handheld dynamometer with and without belt-stabilization. Physiother Theory Pract 2011; 28:562-8. [DOI: 10.3109/09593985.2011.640385] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Thorborg K, Bandholm T, Schick M, Jensen J, Hölmich P. Hip strength assessment using handheld dynamometry is subject to intertester bias when testers are of different sex and strength. Scand J Med Sci Sports 2011; 23:487-93. [PMID: 22092308 DOI: 10.1111/j.1600-0838.2011.01405.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2011] [Indexed: 12/26/2022]
Abstract
Handheld dynamometry (HHD) is a promising tool for obtaining reliable hip strength measurements in the clinical setting, but intertester reliability has been questioned, especially in situations where testers exhibit differences in upper-extremity muscle strength (male vs female). The purpose of this study was to examine the intertester reliability concerning strength assessments of hip abduction, adduction, external and internal rotation, flexion and extension using HHD, and to test whether systematic differences in test values exist between testers of different upper-extremity strength. Fifty healthy individuals (29 women), aged 25 ± 5 years were included. Two physiotherapist students (one female, one male) of different upper-extremity strength performed the measurements. The tester order and strength test order were randomized. Intraclass correlation coefficients were used to quantify reliability, and ranged from 0.82 to 0.91 for the six strength test. The female tester systematically measured lower strength values for all isometric strength tests (P < 0.05). In hip strength assessments using HHD, systematic bias exists between testers of different sex, which is likely explained by differences in upper-extremity strength. Hence, to improve intertester reliability, the dynamometer likely needs external fixation, as this will eliminate the influence of differences in upper-extremity strength between testers.
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Affiliation(s)
- K Thorborg
- Arthroscopic Centre Amager, Copenhagen University Hospital, Amager, Copenhagen, Denmark.
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The interobserver agreement of handheld dynamometry for muscle strength assessment in critically ill patients. Crit Care Med 2011; 39:1929-34. [PMID: 21572324 DOI: 10.1097/ccm.0b013e31821f050b] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Muscle weakness often complicates critical illness and is associated with increased risk of morbidity, mortality, and limiting functional outcome even years later. To assess the presence of muscle weakness and to examine the effects of interventions, objective and reliable muscle strength measurements are required. The first objective of this study is to determine interobserver reliability of handheld dynamometry. Secondary objectives are to quantify muscle weakness, to evaluate distribution of muscle weakness, and to evaluate gender-related differences in muscle strength. DESIGN Cross-sectional observational study. SETTING The surgical and medical intensive care units of a large, tertiary referral, university hospital. PATIENTS A cross-sectional, randomly selected sample of awake and cooperative critically ill patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Handheld dynamometry was performed in critically ill patients who had at least a score of 3 (movement against gravity) on the Medical Research Council scale. Three upper limb and three lower limb muscle groups were tested at the right-hand side. Patients were tested twice daily by two independent raters. Fifty-one test-retests were performed in 39 critically ill patients. Handheld dynamometry demonstrated good interobserver agreement with intraclass correlation coefficients >0.90 in four of the muscle groups tested (range, 0.91-0.96) and somewhat less for hip flexion (intraclass correlation coefficient, 0.80) and ankle dorsiflexion (intraclass correlation coefficient, 0.76). Limb muscle strength was considerably reduced in all muscle groups as shown by the median z-score (range, -1.08 to -3.48 sd units). Elbow flexors, knee extensors, and ankle dorsiflexors were the most affected muscle groups. Loss of muscle strength was comparable between men and women. CONCLUSIONS Handheld dynamometry is a tool with a very good interobserver reliability to assess limb muscle strength in awake and cooperative critically ill patients. Future studies should focus on the sensitivity of handheld dynamometry in longitudinal studies to evaluate predictive values toward patients' functional outcome.
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Conable KM, Rosner AL. A narrative review of manual muscle testing and implications for muscle testing research. J Chiropr Med 2011; 10:157-65. [PMID: 22014904 PMCID: PMC3259988 DOI: 10.1016/j.jcm.2011.04.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 02/04/2011] [Accepted: 04/29/2011] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Manual muscle testing (MMT) is used for a variety of purposes in health care by medical, osteopathic, chiropractic, physical therapy, rehabilitation, and athletic training professionals. The purpose of this study is to provide a narrative review of variations in techniques, durations, and forces used in MMT putting applied kinesiology (AK) muscle testing in context and highlighting aspects of muscle testing important to report in MMT research. METHOD PubMed, the Collected Papers of the International College of Applied Kinesiology-USA, and related texts were searched on the subjects of MMT, maximum voluntary isometric contraction testing, and make/break testing. Force parameters (magnitude, duration, timing of application), testing variations of MMT, and normative data were collected and evaluated. RESULTS "Break" tests aim to evaluate the muscle's ability to resist a gradually increasing pressure and may test different aspects of neuromuscular control than tests against fixed resistances. Applied kinesiologists use submaximal manual break tests and a binary grading scale to test short-term changes in muscle function in response to challenges. Many of the studies reviewed were not consistent in reporting parameters for testing. CONCLUSIONS To increase the chances for replication, studies using MMT should specify parameters of the tests used, such as exact procedures and instrumentation, duration of test, peak force, and timing of application of force.
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Affiliation(s)
- Katharine M. Conable
- Associate Professor, Chiropractic Division, Logan College of Chiropractic, St Louis, MO
| | - Anthony L. Rosner
- Research Director, International College of Applied Kinesiology, Brookline, MA
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Predicting maximal grip strength using hand circumference. ACTA ACUST UNITED AC 2010; 15:579-85. [DOI: 10.1016/j.math.2010.06.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 06/23/2010] [Accepted: 06/28/2010] [Indexed: 11/21/2022]
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van Aswegen H, Eales CJ, Richards GA, Goosen J, Becker P, Mudzi W. Effect of penetrating trunk trauma on the recovery of adult survivors: a pilot study. Physiother Theory Pract 2008; 24:95-104. [PMID: 18432512 DOI: 10.1080/09593980701378231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gunshot and/or stab wounds to the trunk are injuries seen in South African hospitals. Patients are managed in the intensive care unit. Prolonged mechanical ventilation with immobilization results in some degree of muscle dysfunction. Our goal was to determine if patients recover adequately spontaneously following critical illness. No formal rehabilitation programmes exist in South Africa for these patients following discharge. A prospective, observational study was conducted. Patients were recruited from three ICUs in Johannesburg. Lung function tests, dynamometry, quality of life, 6-minute-walk, and oxygen uptake tests were performed over 6 months following discharge from the hospital. The control group consisted of existing data for healthy volunteers. Distance walked during 6-minute-walk test was significantly reduced for the study group compared to the control group (1 month [p = 0.00251]; 6 months [p = 0.0355]). At 1 month there was a significant reduction in quadriceps and triceps strength for the study group compared to the control group (p = 0.0089; p = 0.0246, respectively). Quadriceps strength remained significantly reduced for the study group (3 months [p = 0.0489]). No difference in muscle strength was detected between the groups at 6 months. Actual and predicted residual volumes differed significantly for the study group (1 month [p = 0.0034]; 6 months [p = 0.0157]). A trend of muscle weakness (to 3 months), poor exercise capacity, and abnormal lung volumes was identified. A formal rehabilitation programme may be needed to address these disabilities.
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Affiliation(s)
- H van Aswegen
- Physiotherapy Department, University of the Witwatersrand, Johannesburg, South Africa.
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Ali NA, O'Brien JM, Hoffmann SP, Phillips G, Garland A, Finley JCW, Almoosa K, Hejal R, Wolf KM, Lemeshow S, Connors AF, Marsh CB. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med 2008; 178:261-8. [PMID: 18511703 DOI: 10.1164/rccm.200712-1829oc] [Citation(s) in RCA: 472] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE ICU-acquired paresis (ICUAP) is common in survivors of critical illness. There is significant associated morbidity, including prolonged time on the ventilator and longer hospital stay. However, it is unclear whether ICUAP is independently associated with mortality, as sicker patients are more prone and existing studies have not adjusted for this. OBJECTIVES To test the hypothesis that ICUAP is independently associated with increased mortality. Secondarily, to determine if handgrip dynamometry is a concise measure of global strength and is independently associated with mortality. METHODS A prospective multicenter cohort study was conducted in intensive care units (ICU) of five academic medical centers. Adults requiring at least 5 days of mechanical ventilation without evidence of preexisting neuromuscular disease were followed until awakening and were then examined for strength. MEASUREMENTS AND MAIN RESULTS We measured global strength and handgrip dynamometry. The primary outcome was in-hospital mortality and secondary outcomes were hospital and ICU-free days, ICU readmission, and recurrent respiratory failure. Subjects with ICUAP (average MRC score of < 4) had longer hospital stays and required mechanical ventilation longer. Handgrip strength was lower in subjects with ICUAP and had good test performance for diagnosing ICUAP. After adjustment for severity of illness, ICUAP was independently associated with hospital mortality (odds ratio [OR], 7.8; 95% confidence interval [CI], 2.4-25.3; P = 0.001). Separately, handgrip strength was independently associated with hospital mortality (OR, 4.5; 95% CI, 1.5-13.6; P = 0.007). CONCLUSIONS ICUAP is independently associated with increased hospital mortality. Handgrip strength is also independently associated with poor hospital outcome and may serve as a simple test to identify ICUAP. Clinical trial registered with www.clinicaltrials.gov (NCT00106665).
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Affiliation(s)
- Naeem A Ali
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio State University, 473 W. 12th Avenue, Columbus, OH 43221, USA.
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Krause DA, Schlagel SJ, Stember BM, Zoetewey JE, Hollman JH. Influence of Lever Arm and Stabilization on Measures of Hip Abduction and Adduction Torque Obtained by Hand-Held Dynamometry. Arch Phys Med Rehabil 2007; 88:37-42. [PMID: 17207673 DOI: 10.1016/j.apmr.2006.09.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 09/14/2006] [Accepted: 09/19/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the reliability of clinical techniques for testing hip abductor and adductor muscle performance. DESIGN Repeated measures. SETTING Academic laboratory. PARTICIPANTS A sample of 21 healthy subjects (12 men, 9 women) between 22 and 31 years of age. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Reliability of repeated measures was estimated by calculating intraclass correlation coefficients. Torque production capability was calculated by multiplying force output obtained with a hand-held dynamometer by the length of the resistance lever arm. RESULTS The reliability of abduction testing was greatest in the long-lever condition. Adduction test reliability was greatest in the long-lever condition with bench stabilization. The maximal hip abduction torque tested in the long-lever position was significantly greater (t(20)=9.21, P<.001) than that in the short-lever position. The maximal hip adduction torque occurred using a long lever for resistance application and a bench to stabilize the nontest leg (F(1,20)=15.64, P=.001). CONCLUSIONS Muscle performance testing of hip abductors and adductors with a hand-held dynamometer can be performed with good to excellent intratester and intertester reliability. Hip abduction testing is best performed with a long lever. Hip adduction is best performed with a long lever and a bench to stabilize the nontest extremity.
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Affiliation(s)
- David A Krause
- Physical Therapy Program, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Dibble LE, Hale T, Marcus RL, Gerber JP, Lastayo PC. The safety and feasibility of high-force eccentric resistance exercise in persons with Parkinson's disease. Arch Phys Med Rehabil 2006; 87:1280-2. [PMID: 16935068 DOI: 10.1016/j.apmr.2006.05.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2005] [Accepted: 05/01/2006] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine the effect of high-force eccentric resistance exercise on measures of muscle damage and injury in persons with mild to moderate Parkinson's disease (PD). DESIGN Before-after trial. SETTING Tertiary care center clinical laboratory. PARTICIPANTS Ten persons with PD (Hoehn and Yahr Staging Scale, stage 1-3). INTERVENTION Participants trained 3 days a week for 12 weeks on an eccentric ergometer, performing high-force eccentric resistance exercise with bilateral lower extremities. MAIN OUTCOME MEASURES Serum creatine kinase (CK) concentrations, muscle pain scores, and isometric force production were measured before, during, and after training. RESULTS Mean CK levels did not differ and did not exceed the threshold of muscle damage at any time point (P=.17). Muscle visual analog scale scores were low and only differed at week 2 (P=.04). Participants were highly compliant, whereas total negative work and isometric force increased over time (P=.02, P=.006, respectively). CONCLUSIONS Persons with mild to moderate PD can safely and feasibly participate in high-force eccentric resistance training. The data we present provide a basis for future investigations of the efficacy of this type of training on muscle size, strength, and mobility in persons with PD.
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Affiliation(s)
- Leland E Dibble
- Division of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA.
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Palencia P, Quiroz-Rothe E, Rivero JLL. New insights into the skeletal muscle phenotype of equine motor neuron disease: a quantitative approach. Acta Neuropathol 2005; 109:272-84. [PMID: 15616793 DOI: 10.1007/s00401-004-0940-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Revised: 10/05/2004] [Accepted: 10/06/2004] [Indexed: 10/26/2022]
Abstract
Equine motor neuron disease (EMND) is a neurodegenerative disorder similar to the sporadic form of human amyotrophic lateral sclerosis. This study was conducted to quantify myofiber plasticity in response to EMND. Deep M. gluteus medius biopsy samples from eight horses with an ante mortem diagnosis of EMND, which in five cases was later confirmed by post mortem examination of spinal cord and peripheral nerves, were examined by combined methodologies of electrophoresis of myosin heavy chains (MyHC), muscle enzymes and substrate biochemistry, immunohistochemistry of MyHCs and sarcoendoplasmic Ca2+-ATPase (SERCA) isoforms, quantitative histochemistry of succinic dehydrogenase, glycerol-3-phosphate dehydrogenase, periodic acid-Schiff and capillaries, and photometric image analysis. The data were compared with muscle biopsies from healthy controls. Histopathological findings of EMND were observed in muscle biopsy specimens from all cases, but the severity and intra-biopsy extent varied from case to case. Compared with controls, muscle biopsy samples from EMND horses had a lower percentage of MyHC type I fibers, higher percentages of hybrid IIAX and pure IIX fibers, significant atrophy of all muscle fiber types, reduced oxidative capacity, increased glycolytic capacity, diminished intramuscular glycogen, lower capillary-to-fiber ratio, a higher ratio of myofibers expressing SERCA1a to SERCA2a isoforms, and a lower percentage of fibers expressing phospholamban. Objective discrimination of muscle biopsy specimens according to their healthy status (EMND vs controls) was possible on the basis of their muscular characteristics. A coordinated shift from slow to fast muscle characteristics in contractile and metabolic features of muscle fiber types, together with generalized myofiber atrophy, occurs in EMND and the extent of this change seems to be related to the duration of the disease.
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Affiliation(s)
- P Palencia
- Laboratory of Muscular Biopathology, Department of Comparative Anatomy and Pathological Anatomy, Faculty of Veterinary Science, University of Cordoba, Campus Universitario de Rabanales, Córdoba, Spain
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