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Motor variables correlated with the hand-to-mouth maneuver in stroke patients.

This study investigated the relationship between each of three independent variables and the completion of the hand-to-mouth maneuver in 23 hemiparetic stroke patients. The independent variables were elbow-extensor muscle tone (graded using the Modified Ashworth Scale); active elbow-flexion range-of-motion deficit measured without the influence of gravity; and elbow-flexion strength measured without the influence of gravity with a hand-held dynamometer. The hand-to-mouth maneuver was graded according to the degree of completion using a three-level ordinal scale. Spearman (rs) correlations demonstrated a significant relationship between the extent of completion of the hand-to-mouth maneuver and both the active elbow-flexion-range deficit (rs = -.853) and the elbow-flexor muscle force (rs = .829). The correlation of the maneuver with elbow-extensor muscle tone (rs = -.063) was not significant, but the relationship may have been influenced by the fact that only a minority of subjects had elevated tone, and that elevation was minimal. The result suggest that both active-movement deficits and muscle strength may be important to upper extremity function.

Arm↗

Resistance training improves strength and functional capacity in persons with multiple sclerosis.

The purpose of this study was to evaluate the effect of an eight-week progressive resistance training programme on lower extremity strength, ambulatory function, fatigue and self-reported disability in multiple sclerosis (MS) patients (mean disability score 3.7 +/- 0.8). Eight MS subjects volunteered for twice weekly training sessions. During the first two weeks, subjects completed one set of 8-10 reps at 50% of maximal voluntary contraction (MVC) of knee flexion, knee extension and plantarflexion exercises. In subsequent sessions, the subjects completed one set of 10-15 repetitions at 70% of MVC. The resistance was increased by 2-5% when subjects completed 15 repetitions in consecutive sessions. Isometric strength of the quadriceps, hamstring, plantarflexor and dorsiflexor muscle groups was assessed before and after the training programme using an isokinetic dynamometer. Magnetic resonance images of the thigh were acquired before and after the exercise programme as were walking speed (25-ft), number of steps in 3 min, and self-reported fatigue and disability. Knee extension (7.4%), plantarflexion (52%) and stepping performance (8.7%) increased significantly (P < 0.05). Self-reported fatigue decreased (P < 0.05) and disability tended to decrease (P = 0.07) following the training programme. MS patients are capable of making positive adaptations to resistance training that are associated with improved ambulation and decreased fatigue.

Adult↗

Resistive training increases fat-free mass and maintains RMR despite weight loss in postmenopausal women.

Percent body fat increases with age and is often accompanied by a loss in muscle mass, strength, and energy expenditure. The effects of 16 wk of resistive training (RT) alone or with weight loss (RTWL) on strength (isokinetic dynamometer), body composition (dual-energy X-ray absorptiometry), resting metabolic rate (RMR) (indirect calorimetry), and sympathetic nervous system activity (catecholamines) were examined in 15 postmenopausal women (50-69 yr). RT resulted in significant improvements in upper and lower body strength in both groups (P < 0.01). The nonobese women in the RT group (n = 8) did not change their body weight or fat mass with training. In the obese RTWL group (n = 7), body weight, fat mass, and percent body fat were significantly decreased (P < 0.001). Fat-free mass and RMR significantly increased with training in both groups combined (P < 0.05). There were no significant changes in resting arterialized plasma norepinephrine or epinephrine levels in either group with training. RT increases strength with and without weight loss. Furthermore, RT and RTWL increase fat-free mass and RMR and decrease percent fat in postmenopausal women. Thus, RT may be a valuable component of an integrated weight management program in postmenopausal women.

Aged↗

Isometric strength and thickness relationships in human quadriceps muscle.

The isometric Maximum Voluntary Contraction (MVC) of the right quadriceps femoris muscle was measured in 82 females and 58 males using a chair dynamometer and their mid-thigh quadriceps thickness was measured using real-time B-mode ultrasound. Statistically significant relationships (ranging from P < 0.001 to P < 0.0001) were found between quadriceps MVC, quadriceps thickness and body weight for both males and females. A significant inter-sex difference was present in the MVC-weight and MVC-thickness relationships, with males tending to have a higher MVC for a given body weight (P < 0.0001) and for a given muscle thickness (P < 0.0001). The inter-sex difference in the force-size relationship may relate to the previously demonstrated larger size of type 2b fibres and to the greater force generating capacity of these fibres compared with type 1 fibres.

Adult↗

Muscular recovery around the hip joint after total hip arthroplasty.

A prospective study was conducted to quantitatively measure the relative muscle torque strengths in 20 consecutive women with unilateral osteoarthritic hips and 20 consecutive men with unilateral osteonecrotic hips before and after primary cementless total hip arthroplasty. Maximal isometric torque strengths in the muscles of flexion, extension, and abduction around the hip joint were measured preoperatively and postoperatively at six months and one year, using a Cybex 340 dynamometer. The results showed improved muscle function after total hip arthroplasty in both diseased and healthy hips. In the diseased hips, all muscle groups improved significantly, from 150 to 250% of the preoperative levels, at six months and one year postoperatively, except in the osteoarthritic women, in whom the improvement at six months was minimal. Preoperatively, all muscle groups in the diseased hips were weaker than those in the uninvolved hips, especially in the osteonecrotic men (51-79% of healthy side). In both groups, however, the torques strengths of the diseased hips had not caught up to the healthy hips in the one-year follow-up period (84-89% in the osteonecrotic male group, and 79-81% in the osteoarthritic female group). The authors recommended that muscle strengthening exercises for the hip should be continued for at least one year, and perhaps longer, after total hip arthroplasty.

Adult↗

Isometric and isokinetic muscle strength in patients with fibrositis syndrome. New characteristics for a difficult definable category of patients.

A common complaint among patients with fibrositis syndrome is exhaustion and fatique. It was therefore felt desirable to evaluate the muscle strength of these patients compared with normal subjects. Maximum isometric and isokinetic strength of knee extension was measured in 15 patients and 15 healthy matched subjects, using an isokinetic dynamometer (Cybex II). Maximum isometric strength at various knee extension angles (90 degrees, 60 degrees and 30 degrees degrees) was significantly (p less than 0.001) lower in the fibrositis group than in controls, a reduction of approximately 58-66%. Maximum isokinetic strength at various knee extension velocities (30-240 degrees per second) was also significantly (p less than 0.01) lower in the fibrositis group than in controls, the reduction being approximately 41-51%. In conclusion, isometric and isokinetic muscle strength is found to be lower in patients with fibrositis syndrome than in healthy subjects.

Female↗

Quantifying shoulder rotation weakness in patients with shoulder impingement.

The purpose of this study was to determine whether strength deficits could be detected in individuals with and without shoulder impingement, all of whom had normal shoulder strength bilaterally according to grading of manual muscle testing. Strength of the internal rotators and external rotators was tested isokinetically at 60 degrees /s and 180 degrees /s, as well as manually with a handheld dynamometer (HHD) in 17 patients and 22 control subjects. Testing was performed with the shoulder positioned in the scapular plane and in 90 degrees of shoulder abduction with 90 degrees of elbow flexion (90-90). The peak torque was determined for each movement. The strength deficit between the involved and uninvolved arms (patients) and the dominant and nondominant arms (control subjects) was calculated for each subject. Comparisons were made for the scapular-plane and 90-90 positions between isokinetic and HHD testing. Despite a normal muscle grade, patients had marked weakness (28% deficit, P < .01) in external rotators at the 90-90 position tested with the HHD. In contrast, external rotator weakness was not evident with isokinetic testing at the 90-90 position (60 degrees /s and 180 degrees /s, 0% deficit, P = .99). In control subjects, greater internal rotator strength in the dominant compared with the nondominant arm was evident with the HHD at the 90-90 position (11%, P < .01) and in the scapular plane (7%, P < .05). Using an HHD while performing manual muscle testing can quantify shoulder strength deficits that may not be apparent with isokinetic testing. By using an HHD during shoulder testing, clinicians can identify weakness that may have been presumed normal.

Adolescent↗

Age-related differences in isometric and dynamic strength and endurance.

To measure age-related skeletal muscle changes, 30 healthy, moderately active women performed isometric and dynamic strength and endurance tests of their left quadriceps femoris muscle groups. Fifteen of the subjects were ages 20 to 29 years and 15 were ages 50 to 80 years. A cybex II isokinetic dynamometer was used to measure the torque output isometrically with the knee at 90 degrees of flexion on three trials. In addition, each subject performed three trials from 90 degrees of knee flexion to full knee extension and back to 90 degrees of knee flexion with the velocity of the isokinetic dynamometer set at 10 rpms. Endurance time was calculated to be the length of time a torque output of at least 50 percent of the maximal strength could be maintained. The t tests done revealed a significant difference between the two groups on isometric and dynamic strength, while no significant difference was found on isometric or dynamic endurance. Statistically correcting for the extraneous variables, height and weight, through a partial correlation revealed a significant negative correlation between age and strength. The younger subjects had higher torque outputs, both isometrically and dynamically, than the older subjects. The same partial correlation between isometric endurance and age and dynamic endurance and age demonstrated no significant correlation. The fact that endurance did not change in this older population while strength did may be the result of fast-twitch and slow-twitch muscle fibers changing with age.

Adult↗

Effect of oral creatine supplementation on isokinetic torque production.

PURPOSE: This study was conducted to examine the effect of oral creatine supplementation on the decline in peak isokinetic torque of the quadriceps muscle group during an endurance test. METHODS: Twenty-three active, but untrained, male subjects performed isokinetic strength tests on a Cybex II dynamometer at 180 degrees x s(-1). The protocol consisted of pre- and post-tests with five sets of 30 maximum volitional contractions with a 1-min rest period between sets. Subjects returned to perform the posttest after 5 d of placebo (4 x 6 g glucose x d(-1), N = 12) or creatine (4 x 5 g creatine + 1 g glucose x d(-1), N = 11) supplementation. Supplements and testing were administered in a double blind fashion. Peak torque was measured during each contraction and the 30 contractions were averaged for each set. RESULTS: A three-way mixed ANOVA with one between factor (placebo vs creatine) and two within factors (pre/post supplementation and sets 1-5) revealed no significant interactions, P > 0.05. The placebo vs creatine main effect was also nonsignificant, whereas the pre/post and set effects were significant (P < 0.05). Peak torque increased (approximately 3%) from pre- to post-testing, (P = 0.04), but the absolute magnitude of the differences is unlikely to be of any practical significance. Peak torque decreased from sets 1 to 4, whereas sets 4 and 5 were not different. A priori contrasts comparing the creatine group's performance pre vs post test for the fourth and fifth sets were nonsignificant (P > 0.05). CONCLUSIONS: Based on within and between group comparisons, we were unable to detect an ergogenic effect of oral creatine supplementation on the decline in peak torque during isokinetic exercise at 180 degrees x s(-1).

Adult↗

Test-retest reliability in isokinetic muscle strength measurements of the shoulder.

Test-retest reliability is important for long-term follow-up; however, data on the reliability of isokinetic dynamometry of the shoulder are scarce. Twenty subjects (50% male) were measured; 10 with asymmetrical use of the arms (mean age 27 years) and 10 used their arms symmetrically (mean age 32 years). A Biodex dynamometer (Multi joint system 2) was used. Abduction/adduction and external/internal rotation were measured following a standardized protocol. Performed scheme: two sessions with a 2-week interval, all measurements were done with 60 degrees/second (5 repetitions) and respectively 120 degrees/second and 180 degrees/second (10 repetitions). Differences in the mean peak torques, split for muscle group and gender were significant. Intraclass correlation coefficients ranged from 0.69 to 0.92. This implies good to excellent reliability in research on groups. To determine test-retest reliability of two consecutive individual measurements smallest detectable differences (SDD) were computed and ranged from 21% to 43%. It is questionable whether the SDDs are small enough to detect real changes in muscle strength.

Adolescent↗

Modifications to hydra-gym equipment provide for clinically useful strength measurements.

Modifications were made to the Series III-311 Omnikinetic Hydra-Gym apparatus (Hydra-Fitness Industries Inc., Belton, TX) in an effort to provide relatively inexpensive yet clinically useful isokinetic strength measurements. Signal transmission and processing functions were installed to calculate relevant strength characteristics for knee extension/flexion motions. Results from the modified Hydra-Gym were compared with matched procedures on the Kin-Com (model 500-10, Chattecx Corporation, Chattanooga, TN). Subjects (N = 10) performed three maximal concentric right knee extension/flexion cycles at different resistance settings (2, 4, and 6) on the Hydra-Gym and the corresponding angular velocities on the Kin-Com (190, 125, and 40 degrees/sec, respectively). Each subject completed eight testing sessions, four on each dynamometer. A five-way analysis of variance on the peak torque data revealed no significant difference between dynamometers; however, there was a significant interaction between dynamometer and extension/flexion measurements. The variance in angle of peak torque data was significantly different between dynamometers, with Hydra-Gym showing superior reproducibility (p < 0.005). Mechanical differences between dynamometers produced slightly different, though comparable and consistent, measurement values. Care must be taken when evaluating hamstring/quadriceps ratios from the Hydra-Gym because the interaction noticed between dynamometer and extension/flexion may exaggerate muscle imbalances. In summary, modifications to the Hydra-Gym appear to provide clinicians with a reliable and clinically useful strength testing alternative.

Adolescent↗

The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life.

The purposes of this study were to determine the reliability of strength and self-reporting measures, the relationship of different strength measures to function, and the impact of rotator cuff pathology on patients' quality of life. Patients with nonoperated rotator cuff pathology (n = 36) and unaffected control subjects (n = 48) were assessed by use of the LIDO dynamometer to determine isometric and isokinetic (concentric and eccentric) strength of the shoulder rotators. The Shoulder Pain and Disability Index and Short Form-36 were self-reported by patients. Intraclass correlation coefficients (ICCs) were used to assess reliability, and Pearson correlations and multiple linear regression were used to determine the relationship between strength and function. The findings of this study include the following: (1) measures of self-reported physical disability had high reliability (ICC = 0.89); (2) the LIDO dynamometer reliably measured internal and external shoulder rotation strength in both concentric and isometric modes of testing (ICC = 0.78-0.94), whereas eccentric muscle actions had lower reliability; (3) all shoulder rotation strength measures were predictive of disability, with isometric external rotation strength being the most predictive (r = 0.56); and (4) the presence of rotator cuff pathology was highly predictive of impaired physical health quality of life (R(2) = 0.71, P < .001).

Adult↗

Intertester reliability of the hand-held dynamometer for wrist flexion and extension.

This study was conducted to determine the intertester reliability of a hand-held dynamometer for the wrist flexor and extensor muscles. Using the break test on 20 healthy subjects, three testers obtained two measures of strength for each muscle group. The data were analyzed using the Pearson product-moment correlation coefficients, intraclass correlations, and an analysis of variance (ANOVA) for repeated measures. Our Pearson product-moment correlations ranged from 0.89 to 0.95 for the intertester reliability of the wrist extensors and 0.90 to 0.93 for the wrist flexors, whereas the intraclass coefficients were 0.91 and 0.85, respectively. Although these correlations were high, ANOVA tests revealed that significant differences existed between testers for both the wrist flexion and extension data (p less than .05). From these results we concluded that although the correlations between testers were good, ANOVA tests suggested that there was limited reliability between testers.

Adult↗

Isokinetic profile of elbow flexion and extension strength in elite junior tennis players.

STUDY DESIGN: Descriptive study. OBJECTIVES: To determine whether bilateral differences exist in concentric elbow flexion and extension strength in elite junior tennis players. BACKGROUND: The repetitive nature of tennis frequently produces upper extremity overuse injuries. Prior research has identified tennis-specific strength adaptation in the dominant shoulder and distal upper extremity musculature of elite players. No previous study has addressed elbow flexion and extension strength. METHODS AND MATERIALS: Thirty-eight elite junior tennis players were bilaterally tested for concentric elbow flexion and extension muscle performance on a Cybex 6000 isokinetic dynamometer at 90 degrees/s, 210 degrees/s, and 300 degrees/s. Repeated-measures ANOVAs were used to test for differences between extremities, muscle groups, and speed. RESULTS: Significantly greater (P<0.002) dominant-arm elbow extension peak torque values were measured at 90 degrees/s, 210 degrees/s, and 300 degrees/s for males. Significantly greater (P<0.002) dominant-arm single-repetition work values were also measured at 90 degrees/s and 210 degrees/s for males. No significant difference was measured between extremities in elbow flexion muscular performance in males and for elbow flexion or extension peak torque and single-repetition work values in females. No significant difference between extremities was measured in elbow flexion/extension strength ratios in females and significant differences between extremities in this ratio were only present at 210 degrees/s in males (P<0.002). CONCLUSION: These data indicate muscular adaptations around the dominant elbow in male elite junior tennis players but not females. These data have ramifications for clinicians rehabilitating upper extremity injuries in patients from this population.

Adaptation, Physiological↗

Hypertrophic response to unilateral concentric isokinetic resistance training.

The purposes of this study were to 1) determine the effect of concentric isokinetic training on strength and cross-sectional area (CSA) of selected extensor and flexor muscles of the forearm and leg, 2) examine the potential for preferential hypertrophy of individual muscles within a muscle group, 3) identify the location (proximal, middle, or distal level) of hypertrophy within an individual muscle, and 4) determine the effect of unilateral concentric isokinetic training on strength and hypertrophy of the contralateral limbs. Thirteen untrained male college students [mean age 25.1 +/- 6.1 (SD) yr] volunteered to perform six sets of 10 repetitions of extension and flexion of the nondominant limbs three times per week for 8 wk, using a Cybex II isokinetic dynamometer. Pretraining and posttraining peak torque and muscle CSA measurements for both the dominant and nondominant limbs were determined utilizing a Cybex II isokinetic dynamometer and magnetic resonance imaging scanner, respectively. The results indicated significant (P less than 0.0008) hypertrophy in all trained muscle groups as well as preferential hypertrophy of individual muscles and at specific levels. None of the muscles of the contralateral limbs increased significantly in CSA. In addition, significant (P less than 0.0008) increases in peak torque occurred for trained forearm extension and flexion as well as trained leg flexion. There were no significant increases in peak torque, however, for trained leg extension or for any movement in the contralateral limbs. These data suggest that concentric isokinetic training results in significant strength and hypertrophic responses in the trained limbs.

Adult↗

The effect of flexible magnets on hand muscle strength: a randomized, double-blind study.

The purpose of this study was to determine the effect of a flexible magnet on hand grip and thumb-forefinger pinch strength. Flexible magnet use has become popular in sports medicine and rehabilitation for a number of reasons, including augmenting muscle force output. Thirty-five university students (18 men and 17 women) volunteered for this study. Each subject was tested for grip strength (grip dynamometer) and thumb-forefinger pinch strength (pinch gauge) under 3 different treatment conditions: baseline (no magnet), sham magnet (placebo), and flexible magnet (700-G intensity). The order of treatments was randomly assigned, and all data collection followed a double-blind format. For grip strength measurements, magnet placement was over the bellies of the flexor digitorum profundus and flexor digitorum superficialis, and for pinch strength measurements, it was over the bellies of the flexor pollicis brevis and opponens pollicis. Three trials for each strength measurement for each of the 3 conditions were performed. Magnets (700 G or sham) were placed on the appropriate areas of the skin 3 minutes before the first test trial, with each subsequent test trial separated by 1 minute. Comparison among the 3 treatment conditions was analyzed using a 1-way analysis of variance (ANOVA) with repeated measures. ANOVA revealed no statistically significant (p > 0.05) mean differences for strength among any of the 3 treatments (baseline, 700-G magnet, or sham magnet) for either hand grip or thumb-forefinger pinch within each sex subgroup or for the combined group. The findings indicate that flexible magnets with a field strength of 700 G do not increase muscle strength.

Adult↗

Factor structure of trunk performance data for healthy subjects.

OBJECTIVE: To examine the factor structure of various measurements of trunk muscle performance for healthy subjects. DESIGN: A total of 22 performance scores were collected and their univariate and multi-variate relationships were examined. BACKGROUND: Extensive literature exists on the measurement of trunk performance data and the relationships between measurements but what needs to be collected to realize a true performance score remains unclear. METHODS: Trunk muscle performance scores of 150 subjects (71 males and 79 females) were obtained on an Isostation B-200 Dynamometer. Twenty-two parameters measuring range of motion, isometric strength, velocity, and endurance on all three planes of motion were collected. The factor structures were constructed using Principal Components Analysis. RESULTS: Clear-cut factor patterns (explained 96.3% of the total variance) suggests that the five-factor structure might be valid and appropriate for this population. The major loading on each factor indicated that: Factor 1 could be labeled as a static strength measure; Factor 2 as velocity; Factor 3 as flexibility; and Factors 4 and 5 as fatigue-resistance. CONCLUSIONS: No single mode of measurement can provide a good representation of a total trunk muscle performance. RelevanceFor the realization of trunk muscle performance, clinics have to measure all modes of isometric strength, velocity, range of motion, and endurance. Care must be taken in eliminating any parameter.

Adult↗