The flexion-rotation test and active cervical mobility--a comparative measurement study in cervicogenic headache

A single blind, age and gender matched, comparative measurement study was designed to assess active range of cervical motion and passive range of rotation in cervical flexion in asymptomatic and cervicogenic headache subjects. Both procedures are commonly used in clinical practice to evaluate patients with cervicogenic headache. We studied 20 women and eight men with side dominant cervicogenic headache (mean age 43.3 years) matched with 28 asymptomatic subjects. Two experienced manipulative therapists, who were blind to each other's measurement, noted active ranges of cervical motion and passive cervical rotation performed in the flexion-rotation test using the Cervical Range of Motion Device. Headache severity was assessed by a questionnaire. Additionally, one therapist prior to neck motion assessment determined the dominant symptomatic cervical motion segment. Active cervical motion in each direction was identical between the cervicogenic and control groups. In contrast, average rotation in flexion was 44 degrees to each side in the asymptomatic group and 28 degrees towards the headache side in the symptomatic group. C1-2 was deemed to be the dominant segmental level of headache origin in 24 of 28 subjects. In those 24 subjects range of rotation during the flexion-rotation test was inversely correlated to headache severity.     

Strength and range of motion in the ankle in two age groups of men and women

Strength and range of motion of the ankle were measured in 20 normal men and 20 normal women divided equally into two age groups (25-35 and 50-60 years). Total range of dorsiflexion/plantar flexion averaged 75 degrees and the total range of inversion/eversion averaged 28 degrees. Few significant differences in range of motion were found between age groups, between men and women, or between dominant and nondominant limbs. Mean torque values for the men were greater than those for the women for all four muscle groups tested (plantar flexors, dorsiflexors, invertors and evertors). Strength of the women ranged from 62 to 70 percent of that of the men, depending upon muscle group. A multiple regression analysis showed that after the variability in muscle strength due to height and lean body weight had been taken into account, the additional variance accounted for by gender was very small. Differences in torque between age groups were not statistically significant. Differences in strength between dominant and nondominant limbs were significant only for the plantar flexors and dorsiflexors of the men.     

Pelvic mobility when bending forward in standing position: validity and reliability of 2 motion analysis devices

OBJECTIVE: To evaluate the validity and reliability of 2 measurement devices that assess pelvic mobility in persons bending forward while in a standing position. DESIGN: Validity and reliability studies. PATIENTS: The validity study included 10 patients (4 men, 6 women) aged 42 (range, 33--51yr). The reliability study included 50 subjects (25 men, 25 women) aged 30 (range, 18--49yr). INTERVENTIONS: A 3-dimensional ultrasound motion analyzer (CMS 50) and a spine motion analyzer using potentiometers (Rachimètre). METHODS: Two lateral radiographs of the patients' lumbosacral junction were taken, the first in neutral position, the second in full trunk flexion. Correlations between mobilities assessed by radiographs and both devices were evaluated by Spearman's rank correlation coefficient. Reliability was studied in healthy volunteers using the intraclass coefficient correlation (ICC) and the Bland and Altman plot. RESULTS: Spearman's coefficient between radiographic measures and the Rachimètre and the CMS 50 evaluations were.89 and.81, respectively. For the Rachimètre, ICC was.65 and increased with a better standardization of the measurement procedures. For the CMS 50, ICC was.85, and the Bland and Altman plot revealed no systematic trend. CONCLUSIONS: The Rachimètre and the CMS 50 have acceptable metric properties. Because few simple clinical measurements are available to evaluate pelvic mobility during trunk flexion in standing position, these 2 devices could be useful in the clinical evaluation of low back pain.     

Cervicocephalic kinesthetic sensibility in patients with chronic, nontraumatic cervical spine pain.

OBJECTIVE: To investigate cervicocephalic kinesthetic sensibility (head repositioning accuracy to subjective straight ahead) in patients with chronic, nontraumatic cervical spine pain. DESIGN: A prospective, 2-group, observational design. SETTING: An outpatient chiropractic clinic in the United Kingdom. PARTICIPANTS: Eleven patients (6 men, 5 women; mean age +/- standard deviation, 41.1 +/- 13.3 yr; range, 18-55 yr) with chronic, nontraumatic cervical spine pain (mean duration, 24 +/- 18 mo), with no evidence of cervical radiculopathy and/or myelopathy or any other neurologic disorder. Eleven asymptomatic, unimpaired volunteers (5 men, 6 women; mean age, 39.3 +/- 10.3 yr; range, 28-54 yr) with no history of whiplash or other cervical spine injury or pain served as controls. MAIN OUTCOME MEASURES: Cervicocephalic kinesthetic sensibility was investigated by testing the ability of blindfolded participants to relocate accurately the head on the trunk, to a subjective straight-ahead position, after a near-maximal active movement of the head in the horizontal or vertical plane. The active cervical range of motion and the duration and intensity of neck pain were also recorded. RESULTS: Mann-Whitney U testing indicated that the patient (P) group was no less accurate in head repositioning than the control (C) group for all movement directions except flexion (median global positioning error [95% confidence interval], P = 5.7 degrees [5.03-9.10], C = 4.2 degrees [3.17-5.32]; p <.05). CONCLUSIONS: Nontraumatic neck pain patients show little evidence of impaired cervicocephalic kinesthetic sensibility. These results contrast with studies of chronic cervical pain patients in which the origin was not controlled or involved a cervical whiplash injury.     

Radiographic mobility of the lumbar spine and its relation to clinical back motion

A sample of 194 examinees (117 women and 77 men), representative of the population, with a history of low back pain, were examined clinically and radiographed. The angles between vertebrae at the levels of L4-L5 and L5-S1 were measured from the lateral lumbar erect, maximal flexion, and maximal extension views. Average mobility at L4-L5 was 14.5 degrees in women and 13.4 in men, and at L5-S1 11.5 degrees in women and 12.1 in men. Mobility became more restricted with increasing age both in women and men; especially at L4-L5. In women decreased radiographic mobility at L4-L5 was significantly (p = 0.002) correlated with restricted side-bending and rotation found at the physical examination. These correlations were clearly less significant among men. At L5-S1, restricted extension in women but restricted flexion and Schober's test in men were significantly correlated with decreased radiographic mobility.     

Neck mobility measurement by means of the 'Flock of Birds' electromagnetic tracking system

OBJECTIVE: To establish the accuracy and reliability of a six-degrees-of-freedom electromagnetic tracking device, the "Flock of Birds", for measuring neck rotations and to identify the main sources of error. DESIGN: Ten human subjects made the same types of maximal neck rotation, both actively and passively: axial rotation in neutral position, from a flexed position and from an extended position, flexion/extension and lateral flexion. The same movements were mimicked in a 'dummy head' set-up. METHODS: One Flock of Birds receiver was mounted on the thorax, one on the head. By means of a third receiver, mounted on a stylus, bony landmarks on head and thorax were palpated. These served to define two anatomically based local coordinate systems, to which the rotations were referred. RESULTS: Measurements were accurate with a maximal measurement error of 2.5 degrees. No significant difference between active and passive rotation was seen. The intra-subject variation was low within the same session, SD between 2 degrees and 4 degrees. Between sessions the variability was considerable, SD between 5 degrees and 16 degrees. CONCLUSION: The Flock of Birds method is reliable and sufficiently precise. The variability in measured range of motion between sessions is a point of concern in interpreting follow-up studies in patients. RELEVANCE: A reduced range of neck motion is a major complaint in pathologies of the cervical spine or the shoulder. A method is described in which neck rotations are related to well-defined bony landmarks. In combined rotations, e.g. flexion combined with axial rotation, the measured range of motion can sometimes fluctuate strongly (up to 30 degrees ) between measurements, without apparent pathology.     

Normal functional range of motion of upper limb joints during performance of three feeding activities

This study was designed to quantify the range of upper limb joint motion required during the performance of a specific type of functional activity. Ten able-bodied men were studied as they performed three feeding tasks--eating with a spoon, eating with a fork, and drinking from a handled cup. Three shoulder joint rotations, one elbow joint rotation, one forearm joint rotation, and three wrist joint rotations were quantified simultaneously using a three-dimensional measurement system. It was found that the required ranges of motion for the feeding tasks were 5 degrees to 45 degrees shoulder flexion, 5 degrees to 35 degrees shoulder abduction, 5 degrees to 25 degrees shoulder internal rotation, 70 degrees to 130 degrees elbow flexion, from 40 degrees forearm pronation to 60 degrees forearm supination, from 10 degrees wrist flexion to 25 degrees wrist extension, and from 20 degrees wrist ulnar deviation to 5 degrees wrist radial deviation. Wrist rotation was also measured, but it was found to be negligible.     

Precision measurement of segmental motion from flexion-extension radiographs of the lumbar spine

OBJECTIVE: To measure sagittal plane motion of lumbar vertebrae from lateral radiographic views. Previously identified factors of imprecision such as distortion in central projection, off-centre position, axial rotation, and lateral tilt of the spine were compensated. STUDY DESIGN: This study presents a new protocol to measure sagittal plane rotational and translational motion from lateral flexion-extension radiographs of the lumbar spine. BACKGROUND: Conventional methods to determine sagittal plane rotation and translation are prone to error from the distortional effects of the divergence of the radiographic beam and the measurement error inherent in constructing tangents to the contours of the vertebral body. High precision is attained by roentgen-stereophotogrammetric methods, but because of their invasive nature they can be applied only in exceptional cases. Agreement has been reached only in that measurement of sagittal plane motion from lumbar spine flexion-extension radiographs is inaccurate. Normal patterns of sagittal plane motion and the definition of what is an abnormal flexion-extension radiograph have not been settled. METHOD: Starting from an analysis of vertebral contours in the lateral view, geometric measures are identified which are virtually independent of distortion, axial rotation or lateral tilt. Applying a new protocol based on those geometric measures, the pattern of translational and rotational motion was determined from flexion-extension radiographs of 61 symptom-free, adult subjects. Measurement errors were quantified in a specimen experiment; a reproducibility study quantified inter- and intraobserver errors. RESULTS: Magnitude and sign of 'translation per degree of rotation' determined from a cohort of 61 adult subjects were very uniform for all levels of the lumbar spine. An auxiliary study evaluating a cohort of 10 healthy subjects where flexion-extension radiographs had been taken standing and side-lying showed no dependence of the rotation/translation pattern on posture. The error study demonstrated errors in angle ranging between 0.7 and 1.6 degrees and errors in displacement ranging between 1.2% and 2.4% of vertebral depth (the largest errors occurring at the L(5)/S(1) segment). Intra- and interobserver tests showed no or only negligibly small bias and an SD virtually equal to the measurement error multiplied by radical2. The relation of displacement to angle observed in the normal cohort can be used in individual cases to predict translational motion depending on the rotation actually performed. A comparison of the predicted translation (determined from normal controls) and the value actually measured allows translational hypo-, normal, or hypermobility to be quantified. Examples illustrate application of the new method in cases of normal, hypo-, and hypermobility and in the case of an instrumented spine. CONCLUSIONS: The results of this study show that precision of the measurement of rotational and translational motion can be considerably enhanced by making allowance for radiographic distortional effects and by minimizing subjective influence in the measurement procedure.     

Reproducibility and validity of a new test protocol for measuring isokinetic trunk extension strength

OBJECTIVE: To investigate the reproducibility and validity of isokinetic trunk extension strength scores obtained using a range of motion of 20 degrees and velocities of 10 and 40 degrees /s. BACKGROUND: Common protocols for testing trunk extension strength incorporate a range of motion of 40 degrees or more and test velocities of between 30 and 180 degrees/s. These test parameters may be neither necessary for portraying the strength profile of the muscles involved nor suitable for patients impaired with low back dysfunction. DESIGN: Test-retest of maximal concentric and eccentric isokinetic trunk extension strength in healthy subjects. METHODS: 17 women and 18 men were tested twice within 1-2 weeks. Tests were performed with subjects positioned in sitting. RESULTS: The trunk extension strength scores revealed excellent agreement with the expected physiological moment-velocity curve. On average women's trunk extension strength was 62% that of men (range: 59.3-64.4%). The test-retest correlation coefficients were generally higher in women (0.70-0.87) than in men (0.52-0.78) and significant at P=0.01. The standard error of measurement ranged between 13 and 21 N m for women and between 35 and 50 N m for men, which were equivalent to 9% and 15% of the mean strength in women and men, respectively. CONCLUSION: This study indicates that the present protocol may be validly applied in assessing trunk extension strength in normal women. RELEVANCE: Reproducible and valid trunk extension strength findings are essential if measurable strength deficiency of the extensors is to be formally accepted as an impairment. The present protocol incorporates or meets most of the relevant problems associated with trunk concentric and eccentric strength testing, and hence has the potential of becoming a standard method for clinical applications.     

Three-dimensional analysis of active head and cervical spine range of motion: effect of age in healthy male subjects

OBJECTIVE: To assess the effect of age on active head-cervical range of motion in healthy men. DESIGN: Three-dimensional cervical motion ranges and patterns were measured in 70 men. BACKGROUND: The effect of age on cervical range of motion is still discussed. METHOD: Twenty adolescent (mean age 16 year), 30 young adult (mean age 23 year), and 20 mid-aged (mean age 37 year) men performed maximal head and cervical spine flexion-extension, lateral bending, and axial rotation. Movements were detected using a digital optoelectronic instrument. Maximum head-cervical spine and thoracic motions were separated. RESULTS: Flexion and extension were larger in the adolescents and young adults (130-132 degrees ) than in the mid-aged men (117 degrees ). Thoracic movement increased as a function of age. Lateral bending was symmetric, associated with head-cervical rotation and extension, and larger in adolescents (85 degrees ) than in young (77 degrees ) and mid-aged adults (79 degrees ). Axial rotation was symmetric, associated with flexion-extension and lateral bending, and similar in the three age groups (respectively, 160 degrees, 155 degrees, 153 degrees ). CONCLUSIONS: Active head-cervical range of motion reduced between 15 and 45 years of age in men.Relevance The present data can be used as a reference for cervical range in motion in men between 15 and 45 years.     

Glenohumeral subluxation, scapula resting position, and scapula rotation after stroke: a noninvasive evaluation.

OBJECTIVES: To determine whether scapular downward tilt (ScDT) and dynamic scapular lateral rotation (ScLR) in subjects with and without stroke is associated with subluxation, and to prove the reliability of a Scapula Locator System in an elderly population. DESIGN: Repeated measures of ScLR by 2 observers. SETTING: Outpatient rehabilitation department of a district general hospital. PARTICIPANTS: To test device reliability, 5 healthy men (mean age +/- standard deviation, 72 +/- 5 yr). To test scapula position, 30 stroke patients (19 men, 11 women; mean age, 73 +/- 6 yr) and 15 healthy controls (12 men, 3 women; mean age, 62 +/- 6 yr). INTERVENTIONS: The control subjects' ScDT was compared with stroke subjects' ScDT after stratification according to 3 patterns of ScLR symmetry and the presence of palpable glenohumeral subluxation. MAIN OUTCOME MEASURES: For device reliability, 3-way analysis of variance. For scapula position, triangulated location by Scapula Locator System of acromion, inferior angle, and root of the scapular spine; then measurement of scapula motion to determine symmetry, lag, or lead. RESULTS: The inter- and intraobserver reliability of the Scapula Locator System device was high (1% of variance each). Normal ScDT was positive (left side: 10.94 degrees +/- 2.62 degrees; right side: 9.69 degrees +/- 4.36 degrees ), indicating a downward-facing glenoid fossa. This finding was unchanged by stroke (10.46 degrees +/- 2.42 degrees ). All controls and 16 stroke subjects had symmetry between shoulders for ScLR rate and ScDT. Two other patterns (p <.01) of ScLR were found after stroke: 8 subjects had a slower rate of affected arm ScLR (lag) with a correspondingly greater ScDT on the affected side (2.61 degrees +/- 6.7 degrees ); 6 subjects had a faster rate of affected arm ScLR (lead) but with an upward-facing glenoid fossa on the affected side (ScDT: -11.84 degrees +/- 8.48 degrees ). No significant inter- or intrasubject difference in ScDT existed in the 6 cases of glenohumeral subluxation. CONCLUSIONS: The scapula normally tilts downward with or without stroke. The effect of stroke is similar on tonic (ScDT) and phasic (ScLR) control of scapula position. Subluxation is not linked with a particular scapular resting position after stroke.     

Reliability of isokinetic ankle dorsiflexor strength measurements in healthy young men and women

The purposes of this study were: (i) to determine the test-retest reliability of isokinetic ankle dorsiflexor strength measurements in young healthy adults using the Biodex dynamometer, and (ii) to examine several statistical measures for the interpretation of reliability. Thirty men and women (mean age 23 +/- 3 years) performed three maximal concentric contractions at 30 degrees/s, 60 degrees/s, 90 degrees/s, 120 degrees/s and 150 degrees/s. Reliability of peak torque, work and torque at a specific time were assessed by calculating the intraclass correlation coefficient (ICC 2,1), Pearson product moment correlation coefficient (r), standard error of the measurement (SEM), method error (ME) and coefficient of variation (CV), and by plotting the differences between observations against their means. Isokinetic tests of ankle dorsiflexor strength in healthy young adults using the Biodex dynamometer were highly reliable (ICC 0.61-0.93). It is recommended that test-retest reliability analyses include the ICC and assessments of measurement errors (SEM, ME or CV), as well as graphs to indicate any systematic variations in the data.     

Comparison of cyclic and sustained passive stretching using a mechanical device to increase resting length of hamstring muscles

The purpose of this study was to compare the effects of cyclic versus sustained passive stretching with a mechanical device on resting hamstring muscles' length. Group 1 subjects (5 men, 17 women) underwent cyclic stretching of their right hamstring musculature, and Group 2 subjects (5 men, 16 women) underwent sustained stretching of their right hamstring musculature. The stretching procedures were performed for 15 minutes on 5 consecutive days. A follow-up examination of the subjects' relative knee flexion range of motion was made one week posttreatment. The Group 1 subjects had a mean ROM increase of 15.4 +/- 5.0 degrees after the five stretching treatments and maintained a mean ROM increase of 10.4 +/- 5.5 degrees on the follow-up examination (p less than .001). In Group 2, the five stretching treatments resulted in a mean ROM increase of 13.4 +/- 4.4 degrees, and a mean increase of 7.9 +/- 4.0 degrees was maintained on the follow-up examination (p less than .001). Linear regression analysis revealed that initial ROM, sex, and treatment method significantly contributed to increases in ROM from Day 1 of treatment to the follow-up examination (F = 6.04; df = 4,36; p less than .0008). The cyclic stretching method resulted in a greater gain in ROM when the other variables were considered. Predicted values of ROM increases were also examined and discussed.     

Isometric and isokinetic knee extension and flexion torque in men and women aged 20-70

An investigation was made of the influence of age and sex on peak muscle torque in knee extension and flexion during maximal isokinetic and isometric contraction. The study was performed on both legs of 139 clinically healthy men and 141 clinically healthy women aged 20, 30, 40, 50, 60 or 70 years. Maximum knee extension and flexion muscle torque (Newtonmetre, Nm) was measured isokinetically at various angles of velocity (12, 90 and 150 degrees/s) and isometrically under standardized conditions (Cybex II). No significant differences were found between the right and the left leg in the whole material. Muscle torque was higher in men than in women in all age groups (p less than 0.001). Both isokinetic and isometric torque decreased with age in both sexes. Isokinetic torque decreased significantly (p less than 0.05) between 20 and 30 years of age in men and between 40 and 50 years of age in women (at all velocities studied; p less than 0.05). A significant decrease (p less than 0.05) was found between the ages of 60 and 70 years in both sexes. Maximum isometric torque showed a significant decrease (p less than 0.05) between 60 and 70 years in men and women. There were no significant differences in isokinetic or isometric torque between moderately active and inactive men or women. Significant correlations were found between muscle torque and body weight, height and body surface area.     

Gender effect on the scapular 3D posture and kinematic in healthy subjects

Populations considered for shoulder analysis are often composed of various ratios of men and women. It is consequently hypothesized that gender has no significant effect on the joint kinematic. However, the literature reports, for the shoulder, differences in the range of motion between genders. The specific influence of gender on the scapulo‐thoracic kinematics has not been studied yet. The dominant shoulder of two populations of men and women composed of 11 subjects each were evaluated in three dimensions for three distinct motions: flexion in the sagittal plane, abduction in the frontal plane and gleno‐humeral internal/external rotation with the arm abducted at 90°. Posture, kinematics and range of motion were studied separately. For flexion and abduction and with regard to the scapular kinematic, external rotation was significantly larger for women than men. The differences were of at least 5° at 120° of humeral elevation. Upward rotations were identical. Women also showed larger average active humero‐thoracic range of motion. The mean differences were of 13°, 7°, 12° and 5° for abduction, flexion, internal rotation and external rotation, respectively. No difference was observed between the scapular resting positions of both populations. The observed differences concerning both the scapular and humeral patterns would indicate that the shoulder behaviour of men and women should not be expected to be similar.     

Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions

OBJECTIVE: To examine the intra- and intertester reliability of the universal goniometer (UG) and parallelogram goniometer (PG), and to assess the criterion validity of the same instruments on subjects with knee restrictions. DESIGN: Reliability and validation study. SETTING: Radiology department at university hospital. PARTICIPANTS: Sixty subjects (34 men, 26 women; mean age, 52yr) with various knee restrictions. INTERVENTIONS: Sixteen goniometric measurements were collected per patient by 2 physical therapists. Subjects were evaluated in knee flexion and knee extension positions. To serve as a gold standard, radiographs were taken in both positions. MAIN OUTCOME MEASURES: Active knee flexion and knee extension on 2 goniometers, radiographs. Maximum active range of motion (AROM). RESULTS: The UG intratester reliability (intraclass correlation coefficients [ICCs]) was .997 in flexion and .972 to .985 in extension. The results were also high with the PG (ICC =.996,.953-.955) for flexion and extension, respectively. The intertester reliability was high for flexion (ICC =.977-.982) and for extension (ICC =.893-.926) when using the UG. For the PG, ICC results ranged from .959 to .970 for flexion and from .856 to .898 for extension. Criterion validity (r) varied from .975 to .987 for flexion and from .390 to .442 for extension with the UG, and from .976 to .985 for flexion and .423 to .514 for extension with the PG. CONCLUSION: Intra- and intertester reliability were high for both goniometers. The results for the criterion validity varied. Our study also revealed that it is preferable to use goniometry rather than visual estimations when measuring AROM. It is recommended that the same therapist take all the measurements when assessing AROM for UG and PG goniometric measurements on patients with knee restrictions.     

Videobasierte 2D-Gangbildanalyse

The purpose of this study was to evaluate the test-retest reproducibility and the rater reliability of 2D video processing using the video-based motion analysis software SIMI°MoStill (SIMI Reality Motion Systems GmbH). Sixteen healthy subjects (8 women, 8 men, 21–34 years of age) were videotaped during treadmill walking (walking speed: 1.25 m/s). Videos were recorded perpendicular to the treadmill using a digital camcorder (Canon MV 430i). In each video sequence the images of the maximal hip and knee flexion and extension movements were manually selected and relative joint rotation angles were measured. The reproducibility was determined in a test-retest design with a 7-day time interval between repeated analysis of the video images. Rater reliability was determined by four independent investigators. The reproducibility analysis showed high linear correlation between the repeated goniometry (r≥0.89; p<0.001). From the point of view of adequate standardization of the 2D-video processing, the calculated differences provided sufficient agreement between test and retest. Within the limits of ±4.7° the repeated measurement of a subject by multiple investigators seems to be reliable with the proposed method. Regarding standardized conditions, it can be concluded that this 2D video-based motion analysis software is applicable as a reproducible and reliable method for assessing relative hip and knee joint angles, although in clinical use possible perspective distorsions and projection errors of 2D-motion analysis must be taken into account.     

Slow passive stretch and release characteristics of the calf muscles of older women with limited dorsiflexion range of motion

OBJECTIVE: Examine the slow passive stretch and release characteristics of the calf muscles of older women with limited dorsiflexion range of motion. DESIGN: A cross-sectional comparative design. BACKGROUND: The passive stretch and release characteristics of the calf muscles of older women with limited dorsiflexion range of motion have not been studied. METHODS: Fifteen older women (mean 79 years) with active dorsiflexion < or =10 degrees and 15 younger women (mean 24 years) without limited dorsiflexion were tested. The right ankle was stretched from plantarflexion to maximal dorsiflexion and released into plantarflexion at 5 degrees /s with minimal surface EMG activity in the soleus, gastrocnemius, and tibialis anterior muscles. Length, passive-elastic stiffness and stored passive-elastic energy were examined. RESULTS: The older women had less maximal passive dorsiflexion, a greater initial stretch angle, and less angular change than the younger women (P < 0.05). The maximal passive resistive force (Newtons) of the stretch phase, and the stored passive-elastic energy ( degrees N) during both stretch and release phases were also less (P < 0.001). The older women had greater passive-elastic stiffness at 0 degrees and 5 degrees of dorsiflexion (P < 0.001). CONCLUSIONS: The older women had decreased calf muscle length, extensibility, maximal passive resistive force, stored passive-elastic energy, but greater angle-specific-stiffness at 0 and 5 degrees of passive dorsiflexion. RELEVANCE: Older women with limited dorsiflexion range of motion have decreased calf muscle length, passive resistive forces and stored passive-elastic energy that may impact static and dynamic standing balance activities. Greater passive-elastic stiffness within their ambulatory dorsiflexion range of motion may partially compensate for the deficits.     

What change in isokinetic knee muscle strength can be detected in men and women with hemiparesis after stroke?

OBJECTIVE: To assess the intra-rater (between occasions) test-retest reliability of isokinetic knee muscle strength measurements in subjects with chronic poststroke hemiparesis and to define limits for the smallest change that indicates real (clinical) improvements for stroke patients. SUBJECTS: Fifty men and women (mean age 58 +/- 6.4 years) 6-46 months post stroke, able to walk at least 300 m with or without a unilateral assistive device. METHODS: Maximal concentric knee extension and flexion contractions at 60 degrees/s and 120 degrees/s, and maximal eccentric knee extension contractions at 60 degrees/s, with the paretic and nonparetic limbs, were performed seven days apart using a Biodex dynamometer. MEASURES: Reliability of the maximum peak torque measurements was evaluated with the intraclass correlation coefficient (ICC(2,1)), the Bland and Altman analyses, the standard error of measurement (SEM and SEM%) and the smallest real difference (SRD and SRD%). RESULTS: Test-retest agreements were high (ICC(2,1) 0.89-0.96) with no discernible systematic differences between limbs, angular velocities and modes. The SEM%, representing the smallest change that indicates a real (clinical) improvement for a group of subjects, was relatively small (8-20%). The SRD%, representing the smallest change that indicates a real improvement for a single subject ranged from 26% to 33% for concentric knee extension, from 39% to 55% for concentric knee flexion, and from 22% to 25% for eccentric knee extension. CONCLUSION: Isokinetic knee muscle strength can be reliably measured and used to detect real improvements following an intervention for single subjects as well as for groups of subjects with chronic mild to moderate hemiparesis after stroke.