Measuring knee extensor muscle strength

OBJECTIVE: To compare manual muscle test with hand-held dynamometer measurements of knee extension strength. A secondary analysis of measurements (n = 256 knees) from 128 acute rehabilitation patients was performed. DESIGN: Knee extensor muscle testing was conducted according to the technique of Hislop and Montgomery; 0 to 5 grades were converted to an expanded 0 to 12 scale. Dynamometry was used to measure the isometric knee extension force with 'gravity eliminated.' RESULTS: Manual muscle test and dynamometer measures were highly correlated (r = 0.768; P < 0.001); the correlation was higher when the quadratic nature of the relationship was taken into account (R = 0.887; P < 0.001). Although the dynamometer forces that were associated with different manual muscle test grades differed overall (F = 67.736; P < 0.001), the forces associated with some of the higher grades did not differ statistically. CONCLUSIONS: These findings reinforce the convergent construct validity of the manual muscle test and dynamometry measurements but challenge the discriminant construct validity of manual muscle testing. An alternative manual muscle testing grading scheme is suggested that provides for discriminant validity and retains convergent validity.     

Intermittent subclavian artery occlusion following clavicular fracture

Although fractures of the clavicle are common, complications are rare. A 41 year old painter developed two uncommon complications of clavicular fracture, mechanical intermittent subclavian artery occlusion and subclavian vein thrombosis. Both conditions were clearly identified on the clinical symptoms and signs and confirmed with dynamic angiography and computerised tomography. Operative intervention led to complete resolution of symptoms.     

Relative decreases in knee extension torque with increased knee extension velocities in stroke patients with hemiparesis

I examined the isokinetic knee extension torque (KET) produced by the paretic and nonparetic lower limbs of 27 stroke patients, with hemiparesis, at knee extension velocities (KEVs) of 30 degrees, 60 degrees, 120 degrees, and 180 degrees/sec. The purpose of this study was to determine whether the relative decreases in KET at velocities greater than 30 degrees/sec were different on the two sides. To further investigate this relative decrease, the relationship between the torque at 30 degrees/sec and those at higher speeds also was examined on each side. Relative decreases in KET differed between speeds, but not between sides. Torques at speeds greater than 30 degrees/sec were correlated significantly with the torque at 30 degrees/sec. These findings suggest that patients with hemiparesis and minimal muscle spasticity may have difficulty moving forcefully at higher speeds because they are weak. Therapeutic interventions, therefore, might be most beneficial when they are directed toward helping patients with hemiparesis activate their weak muscles.     

胚胎嗅鞘细胞移植治疗脑性瘫痪：4例术后4周结果报告

目的:观察胚胎嗅鞘细胞移植治疗脑性瘫痪的有效性和安全性。方法:①病例资料:4例因出生时缺血缺氧确诊为脑性瘫痪的患者,男2例,女2例,年龄分别为14岁、岁、个月、岁。嗅92817鞘细胞由北京市虹天济神经科学研究院细胞中心提供,实验经医学伦理委员会批准,4例脑性瘫痪患者均签署知情同意书。②实验方法:根据术前MRI或CT片,患者均在局麻下行微创立体定向嗅鞘细胞移植术,选取双额放射冠为注射靶点,每侧注射1.0×106个细胞。术后给予止血、抗感染、康复等常规处理。③实验评估:分别于嗅鞘细胞移植前、移植后4周采用脑瘫综合功能评定量表、脑瘫日常生活能力量表评价患者神经功能及生活质量的改善。结果:①嗅鞘细胞移植术后4周,4例患者较术前均有不同程度的神经功能改善,未出现手术并发症。②脑瘫综合功能评定总分:病例1由92.5分增至94分,病例2由55分增至56分,病例3由10.5分增至11.5分,病例4由9.5分增至13分。③脑性瘫痪日常生活能力量表总分:病例1由82.0分增至83.5分,病例2无变化,为16.5分,病例3由5.0分增至7.5分,病例4由5.0分增至8分。结论:嗅鞘细胞移植治疗脑性瘫痪患者近期评价安全可行,可部分改善神经功能与生活质量,长期效果有待进一步随访。     

Assessment of strength deficits in eight paretic upper extremity muscle groups of stroke patients with hemiplegia

This retrospective investigation was undertaken to describe and compare the initial and discharge strength deficits of eight upper extremity muscle groups of 42 patients who were hemiparetic secondary to cerebrovascular accidents (CVAs). Static strengths of the eight muscle groups were measured using a hand-held dynamometer, and strength deficits were calculated against the side ipsilateral to the side affected by the CVA. A two-way analysis of variance for repeated measures revealed significant differences (p less than .001) in the strength deficits of the eight muscle groups and between initial and discharge strength deficits. The strength deficits of the shoulder medial rotator and abductor muscle groups were significantly less than those of any other muscle group. No difference was found in the proportion of muscle groups improving in strength in patients tested within six weeks after the onset of hemiplegia versus patients tested six weeks later. Our results do not confirm the common expectation of relatively lesser involvement of the elbow flexor muscles after a CVA. The results do suggest that patients improve in muscle strength concurrent with a rehabilitation program.     

Gait performance of hemiparetic stroke patients: selected variables

This study was designed to determine if specific variables measured routinely at a rehabilitation center were predictors of gait performance of hemiparetic stroke patients. Nine predictor and four gait measures were taken. Of the five predictor variables hypothesized to be significantly correlated with a gait measurement, four were correlated with at least two gait measures (balance, weight-bearing ratio, motor control, and normalized strength of paretic lower limbs). Four gait measures (speed, cadence, independence, and appearance) were all significantly correlated with one another. Stepwise multiple regressions indicated that motor control and balance were the best predictors of gait performance. The results provide guidance as to which predictor variables might be important in assessing stroke patients. The results also provide some guidance for identifying appropriate targets for treatment intervention with hemiparetic stroke patients.     

Rehabilitation therapy self-efficacy and functional recovery after hip fracture

Little is known about the role of psychological factors in the functional recovery process of hip fracture patients. This study employed a prospective cohort design to test the hypothesis that hospitalized hip fracture patients with greater reported self-efficacy for conducting rehabilitation therapy would have a greater likelihood of recovering to a pre-fracture level of locomotion function six months after the fracture. This hypothesis was tested controlling for pre-fracture level of function and depressive symptoms reported during hospitalization for surgical repair. An original measure of rehabilitation therapy self-efficacy was evaluated prior to hypothesis testing. Study patients were recruited from two hospitals, interviewed during hospitalization and followed up six months later. Patients included in hypothesis test analyses (n = 24) were mostly women (82%) with a mean age of 79 years. Results showed that patients with higher self-efficacy scores had a greater likelihood of locomotion recovery, controlling for pre-fracture locomotion function level (adjusted odds ratio (AOR) = 1.21; 95% confidence interval (CI) = 1.00-1.45; P= 0.05). This positive association between rehabilitation therapy self-efficacy and likelihood of locomotion recovery persisted after adding depressive symptoms (the Center for Epidemiological Studies-depression (CES-D) score) to this logistic regression model (AOR for self-efficacy = 1.18; 95% CI = 0.99-1.42; P= 0.07). It is concluded that rehabilitation therapy self-efficacy is a potentially important psychological factor in helping hip fracture patients recover locomotion functioning.     

Effect of resisted knee flexion on knee extension torque

We tested the principle of "reversal of antagonists" by measuring the effect of resisted knee flexion on subsequent peak knee extension torque at velocities of 60 degrees/sec and 120 degrees/sec using an isokinetic dynamometer. We determined peak knee extension torques from torque curves produced during knee extension that was performed reciprocally with either passive or maximum voluntary resisted knee flexion. We used a crossover design so that all 18 healthy adult subjects performed knee extension reciprocally with both passive and resisted knee flexion. Paired means t tests revealed no statistically significant difference between the peak knee extension torques produced under the two knee flexion conditions either at 60 degrees/sec or 120 degrees/sec. We, therefore, concluded that resisted knee flexion does not augment peak knee extension torque under our conditions of testing. The concept of reversal of antagonists was not supported. Antagonistic muscle functioning, therefore, may be irrelevant to agonist isokinetic testing and training in neurologically healthy persons.     

Orthotic aided training of the paretic upper limb in chronic stroke: results of a phase 1 trial

This was a phase 1 investigation of an upper limb training program using the SaeboFlex dynamic orthosis to improve upper limb motor status. Thirteen individuals with chronic hemiparesis from stroke (age 26-71 years) participated. After being fitted with a SaeboFlex orthosis, each participant was engaged in 5 days of training (6 hours per day) that consisted of repetitive, task oriented activities with the SaeboFlex, exercises, and functional electrical stimulation. Individuals demonstrated improvements in movement at the shoulder and elbow. Wrist extension also improved, but wrist flexion and finger movement did not. Two more global measures of upper limb status improved. Muscle tone decreased. All participants remained pain free. This investigation demonstrates that a program using the orthosis was accompanied by many desirable changes and no untoward consequences.     

Technical tips for carotid angioplasty and stenting

Angioplasty and stenting of the carotid artery has become an accepted procedure in properly selected patients with carotid artery stenosis. The potential for devastating neurologic complications and significant hemodynamic changes separates endovascular treatment of the carotid artery from other percutaneous peripheral vascular procedures. In this article, the technique for carotid artery angioplasty and stenting is described and the strategies for management of the hemodynamic changes occuring with carotid stenting are reviewed.