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Differential effects of unilateral striatal and nigrostriatal lesions on grip strength, skilled paw reaching and drug-induced rotation in the rat.

Lateralised motor deficits associated with basal ganglia dysfunction were compared in separate groups of rats receiving unilateral 6-hydroxydopamine-induced lesions of the dopaminergic nigrostriatal pathway, quinolinic acid-induced lesions of the striatum, or sham control injections. Amphetamine induced ipsilateral rotation in both lesion groups, whereas a low ('supersensitive') dose of apomorphine induced rotation only in the nigrostriatal lesion group. Both lesions induced impairments in skilled paw reaching with the contralateral paw in the 'staircase' test; by contrast the striatal lesions also induced a marked impairment with the ipsilateral paw, which was unaffected by the nigrostriatal lesion. A previously reported increase in grip strength with the contralateral paw after nigrostriatal lesion was replicated, whereas striatal lesions induced only minor bilateral deficits in this test. The results are discussed in the context of the utility, reliability and validity of alternative tests of motor deficit in animal models of Parkinson's and Huntington's diseases.

Amphetamine↗

Behavioural profiling of a murine Charcot-Marie-Tooth disease type 1A model.

Different features of motor behaviour were studied on a transgenic mouse model of Charcot-Marie-Tooth's disease (CMT). Mutants with 4 or 7 copies of the human PMP22 gene leading to a phenotype significantly close to CMT's disease type 1A were compared with control animals. The aim of the study was to validate this transgenic model and to characterise the impairments occurring in the various lines. Three main types of analysis were performed in 2-month-old mice without any peculiar visible deficit: (i) a study of standardised clinical tests (SHIRPA protocol) demonstrated that only a few motor deficits were expressed; (ii) a measurement of general spontaneous activity by means of a commercial video-tracking system was performed and revealed that the main spontaneous activities were identical in the three lines with, however, some slight localised modifications; and, (iii) by contrast, the three lines respond very differently to the footprints, grip strength, splay test and rotarod test. Even in lines with a significantly limited copy number of the transgene, we observed and quantified impairments. In conclusion, mutants of CMT1A seem to be a very pertinent model of this human pathology and will certainly be useful for therapeutic procedures and for theoretical studies on this disease.

Animals↗

Intraindividual variability in physical and emotional functioning: comparison of adults with traumatic brain injuries and healthy adults.

Recent research has shown that individuals with certain neurological conditions demonstrate greater intraindividual variability on cognitive tasks compared to healthy controls. The present study investigated intraindividual variability in the domains of physical functioning and affect/stress in three groups: adults with mild head injuries, adults with moderate/severe head injuries, and healthy adults. Participants were assessed on 10 occasions and results indicated that (a) individuals with head injuries demonstrated greater variability in dominant finger dexterity and right grip strength than the healthy controls; (b) increased variability tended to be associated with poorer performance/report both within and across tasks; and (c) increased variability on one task was associated with increased variability on other tasks. The findings suggest that increased variability in physical function, as well as cognitive function, represents an indicator of neurological compromise.

Adolescent↗

Assessment of the oral health status of the medically compromised homebound geriatric patient: a descriptive pilot study.

This pilot study was designed to assess the oral health status of homebound elderly and determine their dental care needs. Fifty-one subjects enrolled in a hospital-based home care program were recruited for this study. Subjects were visited in their homes by both a dentist and a physician. Care plans and medications were reviewed for each subject. Initial assessments to receive informed written consent were conducted by the physician. Oral health assessments by the dentist included comprehensive examinations for soft tissue pathology, periodontal health, caries, restoration, and tooth condition, as well as existing prosthesis assessment, plaque index, and grip strength. A Physical Self-Maintenance Scale was administered in order to determine the level of dependence of this population for their oral hygiene self-care. The oral health status of these homebound elderly was found to be poor, with 84% of the subjects requiring dental care.

Activities of Daily Living↗

31P-NMR study of skeletal muscle metabolism in patients with chronic respiratory impairment.

To evaluate the energy metabolism of peripheral skeletal muscle during exercise in patients with chronic respiratory impairment, the 31P-nuclear magnetic resonance (NMR) spectra of forearm muscle were investigated in nine patients and nine age-matched control subjects. We calculated the phosphocreatine (PCr) to PCr + inorganic phosphate (PI) ratio, the time constant of PCr recovery and the intracellular pH. The exercise consisted of repetitive hand grips against a 2-kg load every 3 s for 6 min (0.33 W). The patients showed a marked decrease in the PCr/(PCr + PI) ratio and pH in the muscle during exercise in contrast to the control subjects whose PCr/(PCr + PI) showed a minor decrease without any change in pH. The relationship between PCr utilization and pH demonstrated that anaerobic glycolysis switched on earlier in patients with chronic respiratory impairment. A split PI peak was observed in five of nine patients during exercise. The PCr/(PCr + PI) ratio during the last minute of exercise correlated significantly with the vital capacity (% predicted), with the FEV1/FVC, with the body weight, with the maximum strength of hand grip, and with the muscle mass. The results indicate impaired oxidative phosphorylation and the early activation of anaerobic glycolysis in the muscles of patients with chronic respiratory impairment. Several factors related to chronic respiratory impairment, such as disuse, malnutrition and dysoxia, would contribute to the metabolic changes observed in the muscles examined.

Aged↗

Diurnal variation in tennis service.

With informed consent, 6 competitive tennis players performed alternate 15 "first" (emphasis-speed) serves and 15 "second" (emphasis-accuracy) serves at 09:00, 14:00 and 18:00 hours. Serve velocity was measured by the digitisation of video footage of each serve. The Hewitt Tennis Achievement Test was employed to measure the accuracy of serve. The amount of spin imparted on the ball was not measured. First serves were at all times of day faster than second serves. First serves were faster but least accurate at 18:00 hours, the time of day that body temperature and grip strength were highest. At 09:00 hours, first serves were just as accurate as second serves, even though velocity of first serves was higher. No effects for time of day were found for the speed and accuracy of second serves. These results indicate that time of day does affect the performance of tennis serves in a way that suggest a nonlinear relationship between velocity and accuracy.

Adult↗

Effects of different resistance exercise programs on upper limb functional recovery in postoperative breast cancer patients.

PURPOSE: To investigate the effects of grip strength exercise combined with upper limb resistance exercise on upper limb functional rehabilitation in patients after breast cancer surgery. METHODS: A total of 111 patients who underwent either modified radical mastectomy with ALND or breast-conserving surgery with ALND were randomly assigned to a control group, an upper limb resistance exercise group, and a combined grip and upper limb resistance exercise group. Grip strength was measured at baseline, 16 weeks after intervention, and at 3- and 6-month follow-ups, while shoulder function was assessed using the Constant-Murley Scale (CMS). RESULTS: There were no statistically significant differences in grip strength or CMS scores among the groups before intervention (P&#x202f;>&#x202f;0.05). At the post-intervention, 3-month, and 6-month follow-ups, compared with the control group, both resistance training protocols significantly improved patients' joint range of motion, pain, muscle strength, total CMS score, and grip strength (P&#x202f;<&#x202f;0.05). Compared with the upper limb resistance exercise group, the combined grip and upper limb resistance exercise group demonstrated superior grip strength at the 6-month follow-up (P&#x202f;<&#x202f;0.05), as well as more significant improvements in joint range of motion, pain, muscle strength, and total CMS scores (P&#x202f;<&#x202f;0.05). CONCLUSION: A 16-week resistance exercise program effectively improves upper limb function in post-surgical breast cancer patients, with the combined grip and upper limb resistance exercise program yielding superior outcomes.

Humans↗

Ulnar lengthening and radial recession procedures for Kienböck's disease. Long-term clinical and radiographic follow-up.

Twenty patients with Kienböck's disease who had undergone a joint levelling procedure, were reviewed at a mean of 11 years following surgery. Clinical and radiological evaluation revealed good long-term results with all patients complaining of less pain than before surgery and with statistically significant increases in range of motion and grip strength. Radiologically a significant number of patients were found still to have lunate fractures and fragmentation. In addition, 13 patients have developed new bone formation in the lunate fossa, and 12 show osteoarthritic changes, particularly at the radioscaphoid interface. Radial shortening was felt to be superior to ulnar lengthening in that there were fewer problems with bone union.

Adult↗

The association between nutritional status and handgrip strength in older Rwandan refugees.

OBJECTIVES: To investigate the association between nutritional status and handgrip strength in older Rwandan refugees. DESIGN: Cross-sectional study. SETTING: Rwandan refugee camp located in Karagwe district in the north-west of Tanzania. The study was carried out in the post-emergency phase. The response rate was 85%. SUBJECTS: A total of 413 men and 415 women aged 50-92 y participated in the study. METHODS: Weight, height, mid-upper-arm circumference (MUAC) and triceps skinfold were obtained using standard techniques. For people with visible kyphosis, height was estimated from armspan using regression equations developed from non-kyphotic subjects within the sample. Handgrip was measured using a mechanical handgrip dynamometer. Information regarding physical activity and health status was obtained by interview and clinical screening. RESULTS: Handgrip strength (kg) was significantly higher in men than in women (30.3+/-6.7 vs 22.3+/-5.1), and significantly lower in each older age group in both sexes. Handgrip strength was positively correlated to BMI (body mass index) and AMA (arm muscle area). The relative risk of impaired handgrip strength in individuals with poor nutritional status (BMI<18.5 kg/m(2)) compared with those of adequate nutritional status was 1.75. After controlling for potential confounders (sex, age and height), BMI remained a significant contributor to the variation in handgrip strength. CONCLUSION: Poor nutritional status is associated with poor handgrip strength independent of sex, age and height, in this refugee population. This may indicate that underweight older people are likely to have more difficulties in functioning independently in the community. Research is needed to investigate if improving nutritional status can lead to better functional ability. SPONSORSHIP: Department for International Development (UK) and HelpAge International.

Aged↗

Early prediction of functional outcome after stroke.

OBJECTIVES: (I) To obtain biomechanical parameters and assessment scores applied at a very early stage after stroke that predict best the functional outcome after rehabilitation. (II) To evaluate the predictive value of changes (i.e. increase or decrease) of these parameters during the first week in relation to the predictive value of their absolute scores. DESIGN: Prospective outcome study. SUBJECTS: Forty-one stroke patients, admitted to the stroke unit within 24 hours. MAIN OUTCOME MEASURES: Barthel Index, Rivermead Motor Assessment, Motor Club Assessment and Functional movement activities, NIH-Stroke scale (NIH-SS), Grip strength. RESULTS: Parameters assessed within the first hours after stroke correlated only weakly with the outcome. The best model predicting functional outcome and independence in activities of daily living of stroke patients after 6 months was that including NIH-SS, grip strength, age and previous stroke explaining 79% of the variance. These parameters assessed on day 7 post-stroke are more predictive than the difference between stroke onset and day 7 post-stroke. CONCLUSION: Parameters for predicting outcome should not be assessed before day 7 post-stroke.

Adult↗

Incident fall risk and physical activity and physical performance among older men: the Osteoporotic Fractures in Men Study.

Physical activity and physical performance have been linked to fall risk in the elderly. The authors examined the relation between physical activity and physical performance with incident falls in the Osteoporotic Fractures in Men Study, a large prospective cohort study of 5,995 community-dwelling men in the United States at least 65 years of age. The authors also examined what types of activities are associated with falling. Incident falls between 2000 and 2005 were captured from up to 17 triannual follow-up questionnaires per participant and analyzed with generalized estimating equations. Follow-up averaged 4.5 years. The average risk of falling in the first 4 months of follow-up was 6.6%. The most active quartile had a significantly greater fall risk than did the least active quartile (relative risk = 1.18, 95% confidence interval (CI): 1.07, 1.29). Men with greater leg power and grip strength had significantly reduced fall risk (for highest leg power quartile vs. lowest: relative risk = 0.82, 95% CI: 0.73, 0.92; for highest grip strength quartile vs. lowest: relative risk = 0.76, 95% CI: 0.69, 0.85). Partitioning components of activity showed no association between fall risk and leisure activities but a positive association with household activities (for highest quartile vs.lowest: relative risk = 1.17, 95% CI: 1.07, 1.28).

Accidental Falls↗

Leisure time physical activity and strenuousness of work as predictors of physical functioning: a 28 year follow up of a cohort of industrial employees.

AIMS: To examine associations of leisure time physical activity and physical strenuousness of work with physical functioning 28 years later. METHODS: A cohort (n = 902) of metal industry employees was studied for exercise and housework activity in 1973 and 1978, and for BMI, current smoking, strenuousness of work, grip strength, and chronic diseases in 1973. Of the 670 survivors in 2000, 529 (79%) responded to all studied items in a follow up questionnaire including the SF-36 Physical Functioning (PF) scale. Belonging to the lower quartile of the PF scale denoted poor functioning. RESULTS: Vigorous exercise and housework activity were inversely associated with poor PF 28 years later in both white-collar and blue-collar workers. Engaging in activities of any intensity was similarly associated among the blue-collar workers. In a multiple logistic regression model including as independent variables age, sex, occupational class, the number of chronic diseases, vigorous leisure time physical activity, BMI, physical work strenuousness, and smoking (all measured at baseline), the risk of poor PF at follow up was decreased by vigorous leisure time physical activity and increased by high physical strenuousness of work, high BMI, and smoking. The effect of work strenuousness was mainly due to that among the blue-collar group. Allowing for baseline grip strength did not materially alter the results. CONCLUSION: Vigorous leisure time physical activity decreased the risk of poor physical functioning as perceived considerably later in life, while high work strenuousness, smoking, and overweight increased it. Among blue-collar workers a beneficial association was observed with all leisure time activity, including that of lower intensity.

Adolescent↗

Thumb metacarpal vascularized bone graft in long-standing scaphoid nonunion--a useful graft via dorsal or palmar approach: a cohort study of 24 patients.

PURPOSE: Long-standing scaphoid nonunion preferentially is treated by using a vascularized bone graft because of its superiority in achieving bone healing. In the present study nonunion was repaired using a bone graft raised from the thumb metacarpal and vascularized by the first dorsal metacarpal artery. METHODS: Twenty-four patients with scaphoid nonunion for longer than 5 years, without ligament injuries and panarthrosis, had surgery. According to the location of the nonunion and presence of dorsal intercalated segment instability deformity, surgery was performed by either a dorsal or palmar approach. The patients had a final clinical and radiographic evaluation 12 months after surgery. RESULTS: Complete healing was shown in 21 patients but incomplete healing was observed in the remaining 3 patients. After surgery patients had marked pain relief, with an improved range of motion and grasping strength. Anatomic restoration of carpal angles and scaphoid length was observed. None of the patients required additional surgery. Before surgery 15 patients presented radiographic signs of wrist arthrosis. During surgery, however, cartilage erosion on the proximal pole or on the radius articular surface was not confirmed. Despite the presence of radiographic arthrosis, wrist symptoms, motion, and grasping strength improved after surgery. CONCLUSIONS: Long-standing scaphoid nonunion, even in the presence of limited arthrosis, can be treated with surgery and healing promoted by a vascularized bone graft. Because of its versatility for use by dorsal or palmar approach and reliability, the first dorsal metacarpal artery vascularized bone graft represents our method of choice.

Adult↗

Laser therapy: a randomized, controlled trial of the effects of low intensity Nd:YAG laser irradiation on lateral epicondylitis.

OBJECTIVE: To assess the effectiveness of low intensity laser therapy in the treatment of lateral epicondylitis. DESIGN: A double-masked, placebo-controlled, randomized clinical trial. SETTING: A physical medicine and rehabilitation clinic. PARTICIPANTS: Fifty-two ambulatory men and women (age range, 18-70 yr) with symptomatic lateral epicondylitis of more than 30 days in duration and a normal neurologic examination. INTERVENTION: Subjects were bloc randomized into 2 groups with a computer-generated schedule. All underwent irradiation for 60 seconds at 7 points along the symptomatic forearm 3 times weekly for 4 weeks by a masked therapist. The sole difference between the groups was that the probe of a 1.06-microm continuous wave laser emitted 204 mW/cm2 (12.24 J/cm2) for the treated subjects and was inactive for the control subjects. Subjects were assessed at the beginning, midpoint (session 6), and end (session 12) of treatment, as well as at follow-up 28 to 35 days after their last treatment. MAIN OUTCOME MEASURES: Pain in last 24 hours, tenderness to palpation, and patient's perception of change (benefit). RESULTS: The treated and untreated groups were well matched demographically. Masking was maintained for subjects and therapists; however, the groups did not vary to a statistically significant extent in terms of the main outcome measures either during treatment or at follow-up. Secondary outcome variables, such as grasp and pinch strength, medication use, and pain with grasp and pinch, also failed to statistically differ significantly between the groups. No significant treatment side effects were noted. CONCLUSION: Treatment with low intensity 1.06-microm laser irradiation within the parameters of this study was a safe but ineffective treatment of lateral epicondylitis. Further research seems warranted in this controversial area.

Adolescent↗

Limited wrist fusions: comparison of results 22 and 89 months after surgery.

Limited wrist arthrodeses were performed to treat wrist diseases other than rheumatoid arthritis. The purpose of this study was to evaluate whether clinical and radiographic results noted 22 months after the procedure were maintained on re-examination an average of 89 months (range, 66-148 months) after the procedure. The study comprised 17 wrists. The average patient age was 42 years (range, 11-65 years). Two patients, both with Kienböck's disease, were lost to follow-up. Four radiocarpal and 11 intercarpal arthrodeses were performed. The range of motion between the first and second follow-up examination showed no significant difference. Grip strength likewise was nearly identical at both visits. At the last follow-up visit, progression of osteoarthrosis about the fusion area was noted in only 1 patient. These results suggest that the clinical and radiographic results at 22 months were maintained at the final follow-up visit and that the effect of limited wrist fusion does not deteriorate.

Adolescent↗

Physical and mental function and incident low back pain in seniors: a population-based two-year prospective study of 1387 Danish Twins aged 70 to 100 years.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To investigate whether physical performance, grip strength, cognitive function, and depression symptomatology are risk factors for incident low back pain (LBP) over a 2-year period in seniors. SUMMARY OF BACKGROUND DATA: LBP is common in the older age groups, but little is known about predictors of LBP in this age group. METHODS: Data from the 2001 and 2003 data collection from the population-based Longitudinal Study of Aging Danish Twins formed the basis of this analysis. Participants free from LBP at baseline (no LBP during the past month, N = 1387) were included and interview data on overall physical function, and assessment of grip strength, overall cognitive function, and depression at baseline were obtained. LBP status at follow-up was assessed using a modified version of the Standardized Nordic Questionnaire. Logistic regression was used to assess the associations between the baseline risk factors and LBP at follow-up. RESULTS: A total of 1387 persons 70 to 100 years of age at baseline were included in the analyses. Of the initially LBP-free individuals, 7% had experienced LBP more than 30 days out of the past year, 7% had altered or decreased their physical activities due to LBP, and 11% had received treatment for LBP at follow-up. Good overall physical function (being among the top 50%) at baseline was protective for LBP of more than 30 days duration and for diminishing physical activities due to LBP and for care seeking due to LBP. High depression scores (being among the top 25%) were strongly associated with altering or decreasing daily activities because of LBP. Grip strength and overall cognitive performance at baseline were associated with lower incidence of LBP and decreasing activities due to LBP at follow-up; however, these associations were not statistically significant. CONCLUSION: Poor overall physical function and depression symptomatology are associated with LBP and consequences of LBP in persons 70 years of age and older.

Activities of Daily Living↗

Respiratory muscle strength in chronic heart failure.

BACKGROUND: Several studies have suggested that the respiratory muscles are weak in patients with heart failure, but the aetiology and clinical relevance of this weakness are unclear. In order to see if respiratory muscle weakness in this context is part of a more generalised myopathic process, respiratory and limb muscle strength were compared in patients with heart failure. The relation between respiratory muscle strength, breathlessness on exercise, and exercise capacity was also examined. METHODS: Twenty patients (three women) with New York Heart Association (NYHA) class II-IV heart failure of mean age 63 years were studied. Respiratory muscle strength was assessed using maximum inspiratory and expiratory mouth pressures (MIP and MEP) and transdiaphragmatic pressure during sniffs (sniff PDI). These parameters were compared with cardiac output (indirect Fick) and with limb muscle strength as assessed by grip strength. The patients also performed two exercise tests during which they rated their breathlessness on a Borg scale. RESULTS: Mean (SD) cardiac index was 2.2 (0.4) l/min/m2. MIP and MEP were 66 (27) and 99 (29) cm H2O respectively. Sniff PDI was 103 (21) cm H2O and was positively correlated with grip strength and cardiac output (Spearman rank correlation coefficients 0.527 and 0.451, respectively). None of the indices of respiratory muscle strength were related to exercise time or breathlessness during exercise. CONCLUSIONS: The respiratory muscles are weak in patients with heart failure. This weakness reflects a more generalised myopathic process, possibly related to reduced cardiac output. However, respiratory muscle weakness does not appear to be an important factor in the aetiology of breathlessness on exercise.

Aged↗

Linear estimates of disease progression predict survival in patients with amyotrophic lateral sclerosis.

We have shown that linear estimates of rates of disease progression (LEP), derived from isometric myometry [grip or foot dorsiflexion (FD) strength] and forced vital capacity (FVC%), are clinically and statistically significant predictors of survival of patients with amyotrophic lateral sclerosis (ALS) from date of disease onset and, except those based on grip strength, of survival from the date of measurement. We tested these results in 2 additional groups of patients: 1) those who participated in a previously reported Protropin (GH) study; and 2) those enrolled in two other clinical trials (group 2). The LEP were derived and tested as predictors of survival. In a Cox proportional hazards model, LEP based on all measures predicted survival from disease onset in both groups of patients. Using cutoff points determined within the original group to stratify patients in the validation groups into faster and slower progressing subgroups resulted in statistically significant separation of survival curves from disease onset in group 2 for all LEP and in group 1 (the GH group) for LEP derived from FD strength; and, for survival from date of measurement in group 2, when stratified by LEP based on FD strength or FVC%. LEP based on data generated by myometry or pulmonary function studies have now been shown to predict survival in 3 unrelated groups of patients with ALS entering clinical trials. Their precise use in clinical trial design needs to be explored further.

Adult↗