The effect of modified constraint-induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke

Purpose: The purpose of this study was to explore the effect of modified constraint-induced movement therapy (CIMT) in a real-world clinical setting on spasticity and functional use of the affected arm and hand in patients with spastic chronic hemiplegia.Method: A prospective consecutive quasi-experimental study design was used. Twenty patients with spastic hemiplegia (aged 22-67 years) were tested before and after 2-week modified CIMT in an outpatient rehabilitation clinic and at 6 months. The Modified Ashworth Scale (MAS), active range of motion (AROM), grip strength, Motor Activity Log (MAL), Sollerman hand function test, and Box and Block Test (BBT) were used as outcome measures.Results: Reductions (p<0.05-0.001) in spasticity (MAS) were seen both after the 2-week training period and at 6-month follow-up. Improvements were also seen in AROM (median change of elbow extension 5°, dorsiflexion of hand 10°), grip strength (20?Newton), and functional use after the 2-week training period (MAL: 1 point; Sollerman test: 8 points; BBT: 4 blocks). The improvements persisted at 6-month follow-up, except for scores on the Sollerman hand function test, which improved further.Conclusion: Our study suggests that modified CIMT in an outpatient clinic may reduce spasticity and increase functional use of the affected arm in spastic chronic hemiplegia, with improvements persisting at 6 months.     

Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke

OBJECTIVE: To evaluate the effectiveness of a distributed version of constraint-induced movement therapy (CIMT). DESIGN: Within-subjects control intervention study. SETTING: Outpatient rehabilitation center. PARTICIPANTS: Eleven persons with chronic stroke. All had active extension of at least 20 degrees at the wrist and at least 10 degrees for each finger of the more-affected hand. INTERVENTIONS: Intensive motor training of the more-affected arm for 3 hours a day for 20 days; restraint of the other arm for 9.3 hours daily to limit its use. This intervention provides the same amount of training as provided in the conventional CIMT therapy protocol (60 h) but distributes training time over twice the number of days. MAIN OUTCOME MEASURES: Real-world (Motor Activity Log) and laboratory motor activity (Wolf Motor Function Test, Frenchay Arm Test, Nine Hole Peg Test), strength (grip force) and spasticity (Ashworth Scale), and quality of life (QOL; Stroke Impact Scale) were assessed. RESULTS: Participants showed significant improvements in more-affected arm real-world motor activity, laboratory motor activity, strength and spasticity, as well as in some aspects of QOL, up to 6 months after treatment ( P .05). CONCLUSIONS: Distributed CIMT is a promising intervention for improving motor function and QOL in patients with chronic stroke.     

糖代谢异常患者脂联素水平与颈动脉内膜-中层厚度的关系

目的探讨糖代谢异常患者脂联素(adiponectin,APN)水平与颈动脉内膜-中层厚度(carotid intimal-medial thickness,CIMT)之间的关系。方法选取糖耐量正常30例、糖耐量减低36例、2型糖尿病36例,收集相关临床资料,应用酶联免疫法测定空腹血清APN,免疫散射比浊法测定血清超敏C-反应蛋白(high sensitivity C reactive protein,hs-CRP)。分析血清ANP和hs-CRP水平与CIMT的关系。结果从糖耐量正常、糖耐量低减至糖尿病,随着糖代谢异常的加重,APN逐渐降低,hs-CRP逐渐升高,CIMT逐渐增厚(P<0.05或0.01);以APN为因变量、各指标为自变量进行Pearson相关分析,甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、hs-CRP和CIMT与APN水平呈负相关,高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)与APN水平呈正相关。结论APN水平下降与糖代谢异常患者动脉粥样硬化关系密切。     

2型糖尿病患者糖化血红蛋白与颈动脉内-中膜层厚度的关系:Logistic及单核细胞中介效应检验

目的 研究2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)与颈动脉内-中膜层厚度(carotid inti-ma-media thickness,CIMT)的关系及单核细胞在HbA1c与CIMT间的中介作用.方法 选择2014年至2019年于华东疗养院体检的T2DM患者1 539例,根据CIMT的厚度分为正常组80...     

The initial effects of an elbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia

This preliminary study indicates the proportion of patients with lateral epicondylalgia that demonstrate a favourable initial response to a manual therapy technique - the mobilization with movement (MWM) for tennis elbow. Twenty-five subjects with lateral epicondylalgia participated. In a one-group pretest - post-test design, we measured (1) pain with active motion, (2) pain-free grip strength and, (3) maximum grip strength before and after a single intervention of MWM. Results of the study indicate that MWM was effective in allowing 92% of subjects to perform previously painful movements pain-free, and improving grip strength immediately afterwards. Significant differences were found between the grip strength of the affected and unaffected limbs prior to the intervention. Both pain-free grip strength and maximum grip strength of the affected limb increased significantly following the intervention. Pain-free grip strength increased by a greater magnitude than maximum grip strength. It can be concluded that MWM is a promising intervention modality for the treatment of patients with Lateral Epicondylalgia. Pain-free grip strength is a more responsive measure of outcome than maximum grip strength for patients with Lateral Epicondylalgia. Further research is warranted to investigate the long-term effectiveness of MWM in the treatment of impairment and disability resulting from Lateral Epicondylalgia.     

Assessing disability in morbidly obese individuals: the Italian Society of Obesity test for obesity-related disabilities

Purpose.?To validate a new obesity-specific disability assessment test: the Obesity-related Disability test (Test SIO Disabilità Obesità Correlata, TSD-OC).

Methods.?Adult obese individuals were assessed with the TSD-OC, 36-Item Short-Form Health Survey (SF-36), 6-min walking test (6MWT) and grip strength. The TSD-OC is composed of 36 items divided into seven sections (pain, stiffness, activities of daily living and indoor mobility, housework, outdoor activities, occupational activities and social life). Statistical correlations between the TSD-OC, functional assessment (6MWT and grip strength) and quality of life parameters (SF-36) were analysed. Internal consistency was assessed with Cronbach's α test. Test–retest reliability was evaluated in a subgroup of 30 individuals. A linking exercise between TSD-OC items and categories of the International Classification of Functioning, Disability and Health was performed.

Results.?Test–retest showed excellent stability (r == 0.90) and excellent internal consistency was reported (Cronbach's α > 0.90). Significant low to moderate correlations between TSD-OC, SF-36 scores, 6MWT and grip strength were observed. A total of 26 ICF categories were linked, mostly related to the area of mobility.

Conclusions.?The TSD-OC is a reliable and valid instrument for measuring self-reported disability in obese subjects. It may represent an important tool for establishing rehabilitation needs in individuals with obesity-related disability, for planning appropriate rehabilitation programmes and for evaluating their effectiveness.     

Increased Carotid Intima-Media Thickness as a Predictor of the Presence and Extent of Abnormal Myocardial Perfusion in Type 2 Diabetes

OBJECTIVE

Identification of asymptomatic patients with type 2 diabetes at increased risk for coronary artery disease (CAD) remains a challenge. We evaluated the potential of carotid intima-media thickness (CIMT) for prediction of abnormal myocardial perfusion in this population.

RESEARCH DESIGN AND METHODS

CIMT and SPECT myocardial perfusion imaging were assessed in 98 asymptomatic patients with type 2 diabetes. An increased CIMT was defined as ≥75th percentile of reference values.

RESULTS

Increased CIMT was an independent predictor of the extent of abnormal perfusion (P < 0.001). In patients with increased CIMT as compared with patients with normal CIMT, abnormal perfusion (75 vs. 9%) and severely abnormal perfusion (28 vs. 3%) were observed more frequently.

CONCLUSIONS

Increased CIMT was significantly related to the presence and extent of abnormal myocardial perfusion. Assessment of CIMT may be useful to identify asymptomatic patients with type 2 diabetes at higher risk for CAD.Identification of asymptomatic patients with type 2 diabetes at increased risk for coronary artery disease (CAD) remains a challenge. In the current study, we evaluated the potential of carotid intima-media thickness (CIMT) to identify asymptomatic patients with type 2 diabetes at higher risk for abnormal myocardial perfusion.     

Upper limb sensorimotor function and functional performance in patients with rheumatoid arthritis

PURPOSE: Although sensorimotor deficits have been identified in isolated upper limb joints of patients with rheumatoid arthritis (RA), relatively little is known about the presence or consequences of sensorimotor deficits in the upper limb as a whole. To address this, we compared sensorimotor and functional performance in multiple upper limb joints of patients with RA and healthy subjects. METHODS: Global upper limb strength, proprioception (joint position sense) and the time taken to perform 2 common functional daily activities (dressing and eating) were estimated in 31 RA patients and 18 healthy subjects. Disability, pain and clinical disease activity were also assessed in the RA patients. RESULTS: The RA patients were weaker (mean difference 280N, 95% Confidence Interval 172 to 389; P < 0.001), had poorer functional performance (6 sec, CI 8.1 - 23.9; P < 0.001), hand grip strength (117 mmHg, CI 61 - 173; P < 0.001) and proprioceptive acuity (2 degrees , CI 0.4 - 3.5; P < 0.05) than the healthy subjects. Upper limb functional performance and disability in the RA patients were inversely associated with global upper limb (r = -0.54 to -0.36) and hand grip strength (r = -0.51 to -0.32) but not proprioception (r = 0.55 - 0.11). CONCLUSIONS: Compared to healthy subjects, patients with RA had global upper limb sensorimotor deficits. Weakness contributes to poor upper limb function and disability in patients with RA, although the clinical importance of proprioception is unclear.     

Changes in Pain,Dysfunction, and Grip Strength of Patients with Acute Lateral Epicondylitis Caused by Frequency of Physical Therapy: A Randomized Controlled Trial

[Purpose] The purpose of this study was to investigate the changes in pain, dysfunction, and grip strength of patients with acute lateral epicondylitis and to suggest the appropriate treatment frequency and period. [Subjects] The subjects were divided into three: 2 days per week group (n=12), 3 days per week group (n=15), and 6 days per week group (n=13). [Methods] All groups received conventional physical therapy for 40 minutes and therapeutic exercises for 20 minutes per session during 6 weeks. The outcome measurements were the visual analogue scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and grip strength. [Results] The results of this study were as follows: at 3 weeks, there were no significant differences in VAS and PRTEE in the 3 groups, but at 6 weeks, 6 days per week group significantly decreased these two outcomes. Grip strength was significantly increased in 3 and 6 days per week groups at 6 weeks. [Conclusion] In conclusion, physical therapy is needed 3 days per week for 3 weeks in patients with acute lateral epicondylitis. After 3 weeks, 6 days per week is the most effective treatment frequency.     

Patients With Dupuytren Disease Use Excessive Grip Force When Lifting and Holding Small Objects,Independent of the Degree of Contracture

ObjectiveTo identify the extent and quality of fine motor skill alteration in patients with Dupuytren disease (DD) using an instrumented device measuring grip forces, beyond the commonly used measurement of contracture.DesignCase–control study.SettingUniversity outpatient clinic.ParticipantsPatients with DD (N=27) and a contracture >45° (Tubiana stage II, III, and IV) were included and compared with age-matched healthy control patients (N=27).InterventionsNot applicable.Main Outcome Measures(s)All individuals were subjected to a set of specific tests using a new instrumented device (“manipulandum”). These included lifting, grasping, and then holding the “manipulandum” with 4 different object characteristics (light and heavy weight, rough and smooth surface) along with a measurement of the precision grip strength. Standard measurements including the Nine-Hole Peg Test, a two-point discrimination, and the Disability of Arm, Shoulder and Hand score were evaluated in comparison.ResultsAlthough the measurements of precision grip, two-point discrimination, Nine-Hole Peg Test, and Disability of Arm, Shoulder and Hand score showed no statistically significant differences between both groups, patients with DD applied significantly greater forces when tested with the different subtests using the “manipulandum.” Analysis of the 2-phase movement (lifting and holding the “manipulandum”) revealed highly significant differences between the groups.ConclusionsPatients with DD use excessive grip forces when lifting and holding the “manipulandum” when compared with healthy control patients, independent of the degree of contracture. As no differences in precision grip strength were seen, the presented approach is useful to obtain additional important information about fine motor function in diseased hands.     

Grip Strength Measurement in Baseball Pitchers: A Clinical Examination to Indicate Stride Length Inefficiency

BackgroundUlnar collateral ligament injuries are rampant in the sport of baseball where kinetic chain impacts, stemming from misappropriation of stride length or changes that occur in competition due to fatigue, have not been evaluated for dynamic elbow stability effects.Hypothesis/PurposeTo examine the relationship between clinical measures of grip strength and altered stride length in baseball pitchers. It is believed that shorter stride lengths would reduce grip strength in baseball pitchers.Study DesignCrossover Study DesignMethodsA total of 19 uninjured pitchers (15 collegiate and 4 high school) (age 18.63 ± 1.67 years, height 1.84 ± 0.054 m, mass 82.14 ± 0.054 kg) threw two simulated 80-pitch games at ±25% of their desired stride length recorded by motion capture with two force plates and a radar gun to track each throw. A handheld grip dynamometer was used to record the mean change in grip strength after games from baseline measures. Pairwise comparisons at baseline and post-game denoted grip strength changes and dominant grip strength offsets for stride length conditions.ResultsSubjects with shorter stride lengths revealed a significant decline in grip strength in the dominant arm from baseline (pre-game; 45.1 kg vs. post-game; 43.2 kg, p=0.017, ES=0.28), however all other tests involving dominant grip strength changes and offset analyses were not statistically different for under-stride and over-stride length conditions.ConclusionsClinical evaluation of grip strength has the potential to identify altered lower body mechanics and may be considered as a safe and effective monitoring strategy to integrate with motion capture in determining optimal stride lengths for baseball pitchers.Level of EvidenceLevel 3     

ICU患者住院期间肢体握力及拉力的变化趋势

目的研究ICU患者住院期间肢体握力（上肢）及拉力（下肢）变化水平。 方法收集2019年4至7月我院ICU 77例患者,每日测量其上肢握力及下肢拉力,直至出ICU。比较患者入ICU 3、7、10 d及出ICU时同一侧握力及拉力间的差异。 结果患者入ICU 3 d（58例）、7 d（24例）、10 d（18例）内握力比较,差异无统计学意义（P＞0.05）;患者入ICU 3 d拉力比较,差异有统计学意义（P＜0.05）,患者入ICU 7、10 d内拉力比较,差异无统计学意义（P＞0.05）;患者入ICU（77例）与出ICU（77例）时握力及拉力比较,差异有统计学意义（P＜0.05）。较入ICU时,出ICU时握力平均增加17.2%;出ICU时拉力平均增加41.3%。 结论患者在入住ICU期间,其握力及拉力变化趋势并不明显,但仍需医护人员关注。     

Grip strength and the metabolic syndrome: findings from the Hertfordshire Cohort Study

INTRODUCTION: Sarcopenia, the loss of muscle mass and strength with age, is significantly associated with type 2 diabetes in older people. AIM: To determine whether there is a relationship between grip strength and features of the metabolic syndrome. DESIGN: Cross-sectional study. METHODS: Data were collected on grip strength, fasting glucose, triglycerides and HDL cholesterol, blood pressure, waist circumference and 2 h glucose after an oral glucose tolerance test, in a population-based sample of 2677 men and women aged 59-73 years. RESULTS: In men and women combined, a standard deviation (SD) decrease in grip strength was significantly associated with higher: fasting triglycerides (0.05 SD unit increase, 95%CI 0.02-0.09, p = 0.006); blood pressure (OR 1.13, 95%CI 1.04-1.24, p = 0.004); waist circumference (0.08 SD unit increase, 95%CI 0.06-0.10, p < 0.001); 2 h glucose (0.07 SD unit increase, 95%CI 0.03-0.11, p = 0.001) and HOMA resistance (0.05 SD unit increase, 95%CI 0.01-0.09, p = 0.008), after adjustment for gender, weight, age, walking speed, social class, smoking habit and alcohol intake. Lower grip strength was also significantly associated with increased odds of having the metabolic syndrome according to both the ATPIII (OR 1.18, 95%CI 1.07-1.30, p < 0.001) and IDF definitions (OR 1.11, 95%CI 1.01-1.22, p = 0.03). DISCUSSION: Our findings suggest that impaired grip strength is associated with the individual features, as well as with the overall summary definitions, of the metabolic syndrome. The potential for grip strength to be used in the clinical setting needs to be explored.     

The influence of obesity on the assessment of carotid intima-media thickness

BACKGROUND.: The assessment of carotid intima-media thickness (CIMT) may improve cardiovascular risk prediction. The optimal protocol for CIMT measurement is unclear. CIMT may be measured in the common carotid artery (CCA), carotid bifurcation (CB), and internal carotid artery (ICA), but measurements from CB and ICA are more difficult to obtain. We studied the influence of body mass index (BMI) and atheroma plaques on the capacity to obtain CIMT measurements at different carotid sites. METHODS.: Using an automatic system, CIMT was measured in 700 subjects aged 45-75, in the near and far walls of CCA, CB, and ICA bilaterally. The presence of atheroma plaques, BMI and vascular risk factors were recorded. RESULTS.: CIMT measurements in CCA were possible in all except one subject. It was not possible to obtain CIMT measurements at CB or ICA in 24.1% of normal weight and 58.8% of obese subjects. The likelihood of obtaining CIMT measurement at all carotid sites decreased as the BMI increased. Atheroma plaques in a carotid segment did not preclude CIMT measurement at this site. CONCLUSIONS.: CIMT measurements in distal carotid segments are more challenging in obese subjects. Measuring CIMT at CCA remains feasible in obese subjects and should be the primary endpoint in these subjects. Nevertheless, CB and ICA measurements, when feasible, would improve risk classification. ? 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:479-485, 2012.     

老年男性握力増龄性变化横断面研究及与国外参考值比较

目的评估不同年龄层老年人的握力表现,并与国外参考值比较。方法112名老年人依其年龄分成65～69岁、70～74岁、75～79岁、80～84岁、85～89岁和90～95岁6组。通过Jamar握力器对受试者进行握力测量。结果握力与年龄之间呈现中度负相关（左侧：r=-0.681,P＜0.001;右侧：r=-0.68,P＜0.001）。逐步回归分析结果显示年龄因素可以解释47%右利手握力变化（R²=0.468, F=47.951,P＜0.001）。在75～79和85～89岁两个年龄段的握力下降程度较其他年龄段更为显著。结论老年人的握力随着年龄增大而呈逐渐下降趋势,在75岁以上老年男性人群中尤为明显。国外老年男性握力参考值并不适用于中国人。     

Effect of wrist positioning on the repeatability and strength of power grip.

OBJECTIVE: This study tested the between-day repeatability and effect of wrist positioning on grip strength measurement. METHOD: Thirty healthy men 20 years to 69 years of age were tested twice, 1 week apart, in six wrist positions. RESULTS: The findings showed good repeatability for grip strength, with the intraclass correlation coefficient [ICC(1, 3)] ranging from .9043 to .9663. Significant differences were found in grip strength among the six positions (p < . 001), with grip strength measured at 15 degrees or 30 degrees of wrist extension (EXT) and 0 degrees ulnar deviation (UD) significantly greater than that of 0 degrees UD and 0 degrees EXT or 15 degrees UD with or without EXT This finding suggests the clinical importance of standardizing the testing position for grip strength measurement. CONCLUSION: The high repeatability of the tests supports the use of the grip strength measurement to evaluate treatment progress.     

谷氨酰胺在危重病患者中的应用

目的探讨危重病患者中早期经静脉应用谷氨酰胺（glutamine，Gl）的临床价值。方法42例患者随机分成两组（对照组和Gln组），Gln组进行Gln治疗（100mL／d，共7d）。治疗前后检测患者体质量、白蛋白、谷胱甘肽（GSH）、握力的变化和肠功能不全的发生率。结果体质量两组治疗前后比较差异无显著性（P〉0．05）。白蛋白、握力和GSH Gl治疗后非常显著高于治疗前（P〈0．01）；白蛋白对照组治疗后较治疗前显著增高（P〈0．05），但握力和GSH治疗前后均无显著变化（P〉0.05）；肠功能不全的发生率Gln组为4．8％，显著低于对照组（28．6％，P〈0．05）。结论在危重病患者疾病早期通过静脉途径外源性地补充Gln，有效改善了患者的营养状况；使患者血浆中的GSH水平增高，加强了机体的抗氧化能力；减少了患者肠功能不全的发生率。     

Relationship between grip strength and related regional bone mineral content

This study of postmenopausal women had two objectives: (1) to determine whether there is a correlation between the strength of grip muscles and bone mineral content in the midradius where these muscles attach, and (2) to determine whether this correlation is of sufficient magnitude to predict cortical bone content by measuring grip muscle strength. Nondominant power grip and bone mineral content of the midradius were measured in 63 healthy postmenopausal Caucasian women. Significant positive correlations (p less than 0.001) were noted between regional bone mineral content and nondominant power grip, and significant negative correlations (p less than 0.001) were found between nondominant power grip and age and between regional bone mineral content and age. When bone mineral data were normalized for skeletal size, there was no significant improvement of the correlation. In addition, the correlation between grip strength and bone mineral content at the midradius was not sufficiently strong to permit the use of grip strength measurements for prediction of midradius bone mineral content for clinical decision-making or epidemiologic studies. Furthermore, the correlation between grip strength and bone mineral content at the muscle insertion site was not better than the correlation between grip strength and bone mineral content at more distal sites on the same bone.