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To investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on the vastus lateralis (VL) in the early stage after hip replacement surgery.
Twenty-two patients who underwent hip replacement after proximal femur fracture were included in this study. After hip surgery, the experimental group was applied with 15 sessions of 10 Hz rPMS over the VL 5 times per week for 3 weeks, while the control group took sham stimulation. All patients were also given conventional physical therapy. The VL strength was measured with the root mean square (RMS) value of the VL with surface electromyography technique. The ratio of RMS values between fractured and unfractured legs and tandem stand test were used to assess standing balance. Usual gait speed was measured to evaluate gait function. Pain in two groups was assessed with visual analog scale (VAS).
Both RMS value of the VL and the ratio of RMS values after rPMS were significantly improved (p<0.05). Also, tandem standing time and usual gait speed in rPMS group were dramatically increased (p<0.05). However, no significant difference in VAS was found between the two groups after 3 weeks.
rPMS on the VL improved muscle strength, standing balance and gait function in the early stage after hip surgery. Therefore, rPMS could be applied to patients who cannot take electrical stimulation due to pain and an unhealed wound.
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To analyze the effect of lumbar strengthening exercise in lower-limb amputees with chronic low back pain.
We included in this prospective study 19 lower-limb amputees who had experienced low back pain for longer than 6 months. Participants were treated with 30-minute lumbar strengthening exercises, twice weekly, for 8 weeks. We used the visual analog scale (VAS), and Oswestry low back pain disability questionnaire, and measured parameters such as iliopsoas length, abdominal muscle strength, back extensor strength, and back extensor endurance. In addition, we assessed the isometric peak torque and total work of the trunk flexors and extensors using isokinetic dynamometer. The pre- and post-exercise measurements were compared.
Compared with the baseline, abdominal muscle strength (from 4.4±0.7 to 4.8±0.6), back extensor strength (from 2.6±0.6 to 3.5±1.2), and back extensor endurance (from 22.3±10.7 to 46.8±35.1) improved significantly after 8 weeks. The VAS decreased significantly from 4.6±2.2 to 2.6±1.6 after treatment. Furthermore, the peak torque and total work of the trunk flexors and extensors increased significantly (p<0.05).
Lumbar strengthening exercise in lower-limb amputees with chronic low back pain resulted in decreased pain and increased lumbar extensor strength. The lumbar strengthening exercise program is very effective for lower-limb amputees with chronic low back pain.
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To determine if there is muscle mass reduction in patients with ankylosing spondylitis (AS) compared to the general population and to examine the relationship between skeletal muscle mass, quality of life (QOL), strength, and mobility in patients with AS.
A total of 30 AS patients were enrolled in this study. Skeletal muscle mass was measured by bioelectrical impedance analysis, and it was expressed as the skeletal muscle mass index (SMI). QOL was assessed using the EuroQOL (EQ-5D). To measure mobility, the modified Schöber test and chest expansion test were used. To measure grip strength as a measure of muscle strength, we used the hydraulic hand dynamometer. Additionally, we divided the patients into two groups according to the degree of X-ray finding and compared the differences between the two groups.
There was no significant reduction in skeletal muscle mass in patients with AS compared to the general population. Also, there was no significant correlation between SMI and QOL. On the other hand, there was a significant positive correlation between SMI and mobility, and grip strength. A significant positive correlation was found between mobility and QOL. Additionally, there was a statistically significant difference in mobility between the two groups according to the degree of X-ray finding.
Maintaining muscle mass in AS patients may not be helpful for improving QOL, but it may contribute to achieving adequate mobility and strength.
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To identify different contributions of motor and sensory variables for independent ambulation of patients with incomplete spinal cord injury (SCI), and reveal the most significant contributors among the variables.
The retrospective study included 30 patients with incomplete SCI and lesions were confirmed by magnetic resonance imaging. Motor and sensory scores were collected according to the International Standards for Neurological Classification of Spinal Cord Injury. The variables were analyzed by plotting ROC (receiver operating characteristic) curves to estimate their differential contributions for independent walking. The most significant functional determinant was identified through the subsequent logistic regression analysis.
Motor and sensory scores were significantly different between the ambulators and non-ambulators. The majority was associated to the function of lower extremities. Calculation of area under ROC curves (AUC) revealed that strength of hip flexor (L2) (AUC=0.905, p<0.001) and knee extensor (L3) (AUC=0.820, p=0.006) contributed the greatest to independent walking. Also, hip flexor strength (L2) was the single most powerful predictor of ambulation by the logistic regression analysis (odds ratio=6.3, p=0.049), and the model fit well to the data.
The most important potential contributor for independent walking in patients with incomplete SCI is the muscle strength of hip flexors, followed by knee extensors compared with other sensory and motor variables.
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To investigate the reliability and validity of a new method for isometric back extensor strength measurement using a portable dynamometer.
A chair equipped with a small portable dynamometer was designed (Power Track II Commander Muscle Tester). A total of 15 men (mean age, 34.8±7.5 years) and 15 women (mean age, 33.1±5.5 years) with no current back problems or previous history of back surgery were recruited. Subjects were asked to push the back of the chair while seated, and their isometric back extensor strength was measured by the portable dynamometer. Test-retest reliability was assessed with intraclass correlation coefficient (ICC). For the validity assessment, isometric back extensor strength of all subjects was measured by a widely used physical performance evaluation instrument, BTE PrimusRS system. The limit of agreement (LoA) from the Bland-Altman plot was evaluated between two methods.
The test-retest reliability was excellent (ICC=0.82; 95% confidence interval, 0.65–0.91). The Bland-Altman plots demonstrated acceptable agreement between the two methods: the lower 95% LoA was −63.1 N and the upper 95% LoA was 61.1 N.
This study shows that isometric back extensor strength measurement using a portable dynamometer has good reliability and validity.
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To evaluate sarcopenic indices in relation to respiratory muscle strength (RMS) in elderly people.
This study included 65 volunteers over the age of 60 (30 men and 35 women). The skeletal muscle mass index (SMI) was measured using bioimpedance analysis. Limb muscle function was assessed by handgrip strength (HGS), the Short Physical Performance Battery (SPPB), and gait speed. RMS was addressed by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) using a spirometer. The relationships between RMS and other sarcopenic indices were investigated using the Pearson correlation coefficients and multiple regression analysis adjusted for age, HGS, and SPPB.
Both MIP and MEP were positively correlated with SMI (r=0.451 and r=0.388, respectively, p<0.05 in both). HGS showed a significant correlation with both MIP and MEP (r=0.560, p<0.01 and r=0.393, p<0.05, respectively). There was no significant correlation between gait speed and either MIP or MEP. The SPPB was positively correlated with MEP (r=0.436, p<0.05). In the multiple regression analysis, MIP was significantly associated with HGS and SMI (p<0.001 and p<0.05, respectively), while MEP was related only with HGS (p<0.05).
This study suggests that respiratory muscles, especially inspiratory muscles, are significantly related to limb muscle strength and skeletal muscle mass. The clinical significance of MIP and MEP should be further investigated with prospective studies.
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To compare the respiratory muscle strength between patients with stable and acutely exacerbated (AE) chronic obstructive pulmonary disease (COPD) at various stages.
A retrospective medical record review was conducted on patients with COPD from March 2014 to May 2016. Patients were subdivided into COPD stages 1–4 according to the Global Initiative for Chronic Obstructive Lung Disease guidelines: mild, moderate, severe, and very severe. A rehabilitation physician reviewed their medical records and initial assessment, including spirometry, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), COPD Assessment Test, and modified Medical Research Council scale. We then compared the initial parameters in patients with a stable condition and those at AE status.
The AE group (n=94) had significantly lower MIP (AE, 55.93±20.57; stable, 67.88±24.96; p=0.006) and MIP% (AE, 82.82±27.92; stable, 96.64±30.46; p=0.015) than the stable patient group (n=36). MIP, but not MEP, was proportional to disease severity in patients with AE and stable COPD.
The strength of the inspiratory muscles may better reflect severity of disease when compared to that of expiratory muscles.
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To investigate the relationships between respiratory muscle strength and conventional sarcopenic indices such as skeletal muscle mass and limb muscle strength.
Eighty-nine young adult volunteers who had no history of medical or musculoskeletal disease were enrolled. Skeletal muscle mass was measured by bioelectrical impedance analysis and expressed as a skeletal muscle mass index (SMI). Upper and lower limb muscle strength were evaluated by hand grip strength (HGS) and isometric knee extensor muscle strength, respectively. Peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were evaluated using a spirometer to demonstrate respiratory muscle strength. The relationships between respiratory muscle strength and sarcopenic indices were investigated using Pearson correlation coefficients and multiple linear regression analysis adjusted by age, height, and body mass index.
MIP showed positive correlations with SMI (r=0.457 in men, r=0.646 in women; both p<0.01). MIP also correlated with knee extensor strength (p<0.01 in both sexes) and HGS (p<0.05 in men, p<0.01 in women). However, PEF and MEP had no significant correlations with these sarcopenic variables. In multivariate regression analysis, MIP was the only independent factor related to SMI (p<0.01).
Among the respiratory muscle strength variables, MIP was the only value associated with skeletal muscle mass.
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To investigate the relationship between grip and pinch strength and independence in activities of daily living (ADL) in stroke patients.
Medical records of 577 stroke patients from January 2010 to February 2013 were retrospectively reviewed. Patients' grip and pinch strength of both hemiplegic and non-hemiplegic hands and the Korean version of Modified Barthel Index (K-MBI) score were collected. These patients were divided into three groups: group A (onset duration: ≤3 months), group B (onset duration: >3 months and <2 years), and group C (onset duration: ≥2 years). The correlation between grip and pinch strength and the K-MBI score was analyzed.
In group A (95 patients), the K-MBI score was significantly (p<0.05) correlated with the grip and pinch strength of both hands in patients with right hemiplegia. Significant (p<0.05) correlation between the K-MBI score and the grip and pinch strength of the hemiplegic hand was shown in patients with left hemiplegia. In group B (69 patients) and group C (73 patients), the K-MBI score was significantly (p<0.05) correlated with the grip and pinch strength of the hemiplegic hand.
Stroke patients in subacute stage mainly performed activities of daily living using their dominant hand. However, independence in ADL was associated with the strength of the affected dominant hand. For stroke patients in chronic and late chronic stages, their hand power of the affected hand was associated with independence in ADL regardless whether the dominant hand was affected.
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To identify the potential predictors of ambulatory function in subacute stroke patients, and to determine the contributing factors according to gait severity.
Fifty-three subacute stroke patents were enrolled. Ambulatory function was assessed by gait speed and endurance. Balance function was evaluated by the Berg Balance Scale score (BBS) and the Timed Up and Go test (TUG). The isometric muscular strengths of bilateral knee extensors and flexors were measured using an isokinetic dynamometer. Cardiovascular fitness was evaluated using an expired gas analyzer. Participants were assigned into the household ambulator group (<0.4 m/s) or the community ambulator group (≥0.4 m/s) based on gait severity.
In the linear regression analyses of all patients, paretic knee isometric extensor strength (p=0.007) and BBS (p<0.001) were independent predictors of gait endurance (R2=0.668). TUG (p<0.001) and BBS (p=0.037) were independent predictors of gait speed (R2=0.671). Paretic isometric extensor strength was a predictor of gait endurance (R2=0.340, p=0.008). TUG was a predictor of gait speed (R2=0.404, p<0.001) in the household ambulator group, whereas BBS was a predictive factor of gait endurance (R2=0.598, p=0.008) and speed (R2=0.713, p=0.006). TUG was a predictor of gait speed (R2=0.713, p=0.004) in the community ambulator group.
Our results reveal that balance function and knee extensor isometric strength were strong predictors of ambulatory function in subacute stroke patients. However, they work differently according to gait severity. Therefore, a comprehensive functional assessment and a different therapeutic approach should be provided depending on gait severity in subacute stroke patients.
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To investigate whether motor evoked potential (MEP) amplitude ratio measurements are sufficiently objective to assess functional activities of the extremities. We also delineated the distribution between the presence or absence of MEPs and the Medical Research Council (MRC) scale for muscle strength of the extremities.
We enrolled 183 patients with first-ever unilateral hemiplegia after stroke. The MEP parameters were amplitude ratio (amplitude of affected side/amplitude of unaffected side) recorded at the first dorsal interosseous (FDI) and tibialis anterior (TA) muscles. We performed frequency analyses using the MRC scale for muscle strength and the presence or absence of evoked MEPs. Change on the MRC scale, hand function tests (HFTs), and the Modified Barthel Index (MBI) subscore were compared between the evoked MEP and absent MEP groups using the independent t-test. Receiver operating characteristic curves were used to determine the optimal cutoff scores for the MEP amplitude ratio using the HFT results and MBI subscores. Correlations between the MEP amplitude ratio and the MRC scale, HFTs, and MBI subscore were analyzed.
About 10% of patients with MRC scale grades 0-2 showed evoked MEPs at the FDI muscle, and 4% of patients with MRC scale grades 3-5 did not show MEPs. About 18% of patients with MRC scale grades 0-2 showed evoked MEPs at the TA muscle, and 4% of patients with MRC scale grades 3-5 did not show MEPs. MEP amplitude increased with increasing MRC scale grade. The evoked MEP group had more significant changes on the MRC scale, HFT, and the climbing stair score on the MBI than those in the group without MEPs. Larger MEP amplitude ratios were observed in patients who had more difficulty with the HFTs and ambulation. The MEP amplitude ratio was significantly correlated with the MRC scale, HFT, and MBI subscore.
We conclude that the MEP amplitude ratio may be useful to predict functional status of the extremities in patients who suffered stroke.
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To compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery.
We recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength (tip, palmar and lateral pinch), and forearm circumference of the subjects were assessed before and after the hand-squeezing exercise. The cephalic vein size, blood flow velocity and volume were also measured by ultrasonography in the operated limb.
All of the 3 types of pinch strengths, grip strength, and forearm circumference were significantly increased in the group using GD Grip. Cephalic vein size and blood flow volume were also significantly increased. However, blood flow velocity showed no difference after the exercise. The group using Soft Ball showed a significant increase in the tip and lateral pinch strength and forearm circumference. The cephalic vein size and blood flow volume were also significantly increased. On comparing the effect of the two different hand exercises, hand-squeezing exercise with GD Grip had a significantly better effect on the tip and palmar pinch strength than hand-squeezing exercise with Soft Ball. The effect on cephalic vein size was not significantly different between the two groups.
The results showed that hand squeezing exercise with GD Grip was more effective in increasing the tip and palmar pinch strength compared to hand squeezing exercise with soft ball.
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To determine overall handgrip strength (HGS), we assessed the short-term change of HGS after trigger point injection (TPI) in women with muscular pain in the upper extremities by comparison with established pain scales.
The study enrolled 50 female patients (FMS with MPS group: 29 patients with combined fibromyalgia [FMS] and myofascial pain syndrome [MPS]; MPS group: 21 patients with MPS) who presented with muscular pain in the upper extremities at Konyang University Hospital. In addition, a total of 9 healthy women (control group) were prospectively enrolled in the study. We surveyed the three groups using the following established pain scales: the Fibromyalgia Impact Questionnaire (FIQ), the 36-Item Short Form Health Survey (SF-36), and the Short Form McGill Pain Questionnaire (MPQ). HGS was measured in both hands of study participants using a handgrip dynamometer. We performed TPI (0.5% lidocaine, total 10 mL, injected at the pain site of upper extremities). After 20 minutes, we remeasured the patient's HGS and MPQ score.
ANOVA analysis was conducted among groups. Based on Tukey multiple comparison test, the majority of FIQ and SF-36 subscales, total FIQ and SF-36 scores, MPQ and HGS were significantly different between FMS with MPS and the other groups. There was no statistically significant difference between MPS and control groups. Higher HGS was positively associated with enhanced physical function, negatively associated with total FIQ and MPQ scores, and positively associated with the total SF-36 score calculated using Spearman correlation. Post-TPI MPQ decreased and HGS increased. In patient groups, a negative correlation was found between MPQ and HGS.
The HGS test might potentially be a complementary tool in assessing the short-term treatment effects of women with muscular pain in the upper extremities.
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To investigate the effects of asymptomatic back muscle weakness and spinal deformity on low back pain (LBP).
Sixty healthy subjects without LBP participated in this study. Radiography and an isokinetic/isometric dynamometer were used to respectively measure spinal scoliosis/lordosis and the strength of the trunk flexors/extensors. After 2 years, 48 subjects visited the hospital again and LBP episodes, its severity and the Korean version of the Oswestry Disability Index were assessed. Differences between the group with LBP and the group without LBP were evaluated and the association with LBP incidence and severity was determined.
Sex, age, and trunk strength were significantly different in both group. Sex and age were significantly positive associated with LBP incidence. The isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength were significantly and negatively associated with the LBP severity. The maximum isokinetic trunk extensor and maximum isometric trunk extensor strength was significantly negative associated with the LBP incidence.
LBP incidence is associated with isometric and isokinetic trunk extensor weakness, whereas LBP severity is associated with age, sex, isokinetic trunk extensor and flexor weakness, isometric trunk extensor and flexor weakness.
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To determine the reliability and validity of hand-held dynamometer (HHD) depending on its fixation in measuring isometric knee extensor strength by comparing the results with an isokinetic dynamometer.
Twenty-seven healthy female volunteers participated in this study. The subjects were tested in seated and supine position using three measurement methods: isometric knee extension by isokinetic dynamometer, non-fixed HHD, and fixed HHD. During the measurement, the knee joints of subjects were fixed at a 35° angle from the extended position. The fixed HHD measurement was conducted with the HHD fixed to distal tibia with a Velcro strap; non-fixed HHD was performed with a hand-held method without Velcro fixation. All the measurements were repeated three times and among them, the maximum values of peak torque were used for the analysis.
The data from the fixed HHD method showed higher validity than the non-fixed method compared with the results of the isokinetic dynamometer. Pearson correlation coefficients (r) between fixed HHD and isokinetic dynamometer method were statistically significant (supine-right: r=0.806, p<0.05; seating-right: r=0.473, p<0.05; supine-left: r=0.524, p<0.05), whereas Pearson correlation coefficients between non-fixed dynamometer and isokinetic dynamometer methods were not statistically significant, except for the result of the supine position of the left leg (r=0.384, p<0.05). Both fixed and non-fixed HHD methods showed excellent inter-rater reliability. However, the fixed HHD method showed a higher reliability than the non-fixed HHD method by considering the intraclass correlation coefficient (fixed HHD, 0.952-0.984; non-fixed HHD, 0.940-0.963).
Fixation of HHD during measurement in the supine position increases the reliability and validity in measuring the quadriceps strength.
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To evaluate the effect of anodal transcranial direct current stimulation (tDCS) over the lesioned leg motor cortex, which can enhance the strength and coordination of the contralateral lower extremity and furthermore, enhance the postural stability of the hemiplegic subject.
Anodal or sham stimulation on the lesioned cortex of a lower extremity was delivered to 11 ambulatory hemiplegic patients. The stimulation intensity was 2 mA. All subjects took part in two 10-minute tDCS sessions consisting of anodal stimulation and sham stimulation. The interval period between real and sham stimulation was 48 hours. The order was counter-balanced among the subjects. Before and after each stimulation session, static postural stability was evaluated with eyes opened and closed. Also, the isometric strength of the hemiplegic side of the treated knee was measured before and after each stimulation session. Repeated measure ANOVA was used to determine the statistical significance of improvements in postural stability and strength.
There was significant improvement for overall stability index with eyes opened and closed after anodal tDCS (p<0.05). Isometric strength of the lesioned quadriceps tended to increase after anodal tDCS (p<0.05). Postural stability and quadriceps strength were not changed after sham stimulation.
Anodal tDCS has potential value in hemiplegic stroke patients to improve balance and strengthen the affected lower extremity.
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To investigate the effect on pain reduction and strengthening of the whole body vibration (WBV) in chronic knee osteoarthritis (OA).
Patients were randomly divided into two groups: the study group (WBV with home based exercise) and control group (home based exercise only). They performed exercise and training for 8 weeks. Eleven patients in each group completed the study. Pain intensity was measured with the Numeric Rating Scale (NRS), functional scales were measured with Korean Western Ontario McMaster score (KWOMAC) and Lysholm Scoring Scale (LSS), quadriceps strength was measured with isokinetic torque and isometric torque and dynamic balance was measured with the Biodex Stability System. These measurements were performed before training, at 1 month after training and at 2 months after training.
NRS was significantly decreased in each group, and change of pain intensity was significantly larger in the study group than in the control group after treatment. Functional improvements in KWOMAC and LSS were found in both groups, but no significant differences between the groups after treatment. Dynamic balance, isokinetic strength of right quadriceps and isometric strengths of both quadriceps muscles improved in both groups, but no significant differences between the groups after treatment. Isokinetic strength of left quadriceps did not improve in both groups after treatment.
In chronic knee OA patients, WBV reduced pain intensity and increased strength of the right quadriceps and dynamic balance performance. In comparison with the home based exercise program, WBV was superior only in pain reduction and similarly effective in strengthening of the quadriceps muscle and balance improvement.
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To compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric strength of the lumbar extensors, pain severity and functional disability in patients with chronic low back pain (LBP).
Patients suffering nonspecific LBP for more than 3 months were included prospectively and randomized into lumbar stabilization exercise group (n=11) or lumbar dynamic strengthening exercise group (n=10). Exercises were performed for 1 hour, twice weekly, for 8 weeks. The strength of the lumbar extensors was measured at various angles ranging from 0° to 72° at intervals of 12°, using a MedX. The visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ) were used to measure the severity of LBP and functional disability before and after the exercise.
Compared with the baseline, lumbar extension strength at all angles improved significantly in both groups after 8 weeks. The improvements were significantly greater in the lumbar stabilization exercise group at 0° and 12° of lumbar flexion. VAS decreased significantly after treatment; however, the changes were not significantly different between the groups. ODQ scores improved significantly in the stabilization exercise group only.
Both lumbar stabilization and dynamic strengthening exercise strengthened the lumbar extensors and reduced LBP. However, the lumbar stabilization exercise was more effective in lumbar extensor strengthening and functional improvement in patients with nonspecific chronic LBP.
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To investigate the changes of ankle strength and range of motion with aging and which of the ankle strength and range of motion are contributed to balance.
Sixty healthy people (24 men and 36 women) have undergone tests for ankle strength and range of motion, using Biodex System 4 Pro; a one-leg balance, including postural sway and stability index using a Balance System; in which data were collected in a self-reported Desmond fall risk questionnaire.
Participants are classified into 3 groups by age (group 1, 20-40 years; group 2, 40-65 years; group 3, over 65 years). Stability index and postural sway is significantly increased with aging. Ankle plantarflexor strength and ankle eversion range of motion is significantly decreased with aging. Pearson's correlation revealed that ankle plantarflexor strength is significantly correlated with anterior/posterior sway, and ankle eversion range of motion is significantly correlated with medial/lateral sway in the aged group (over 65 years).
Stability, ankle plantarflexor strength, and eversion range of motion is declined with aging. In addition, strength of ankle plantarflexor and eversion range of motion is significantly correlated with balance stability. Further studies are needed for programs to improve the strength of plantarflexor, and range of motion of eversion of the ankle are beneficial in improving balance, stability, and prevention of falling in the elderly.
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To determine whether there is side to side difference of the trunk rotation muscle in Korean male professional golf players. Healthy controls who did not play golf were also evaluated and compared with professional golf players.
Fifty-one professional golf players and 50 healthy controls participated in this study. Bilateral isokinetic trunk rotation strength that represented the aiming side and non-aiming side trunk rotator function in a golf swing and other parameters were evaluated using the Biodex System III Isokinetic Dynamometer at angular velocities of 30, 60, and 120 degree per second.
The professional golf players' peak torque and total work on their aiming sides were significantly higher than on their non-aiming side at all angular velocities. Additionally, the golf players' peak torque on their aiming side was significantly higher than those of the healthy controls only at the 60 degree per second angular velocity, but there was a slight and consistent trend in the others. Finally, the difference between the aiming side and the non-aiming side of the professional golf players and the healthy controls was also significant.
The aiming side rotation strength of the male professional golf players was higher than that of non-aiming side. The controls showed no side-to-side differences. This finding is attributed to the repetitive training and practice of professional golf players. A further study is needed to investigate if the strengthening of the trunk rotation muscle, especially on the aiming side, could improve golf performance.
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To examine the intra-rater, inter-rater, and inter-instrumental reliability of the digitalized pinch muscle strength dynamometer.
Thirty normal subjects were examined for pinch strength, using both the Preston pinch gauge and the digitalized pinch dynamometer. The participants performed all pinch strength tests in the seated position as recommended by the American Society of Hand Therapists (ASHT). Three successive measurements were taken for each hand. The mean of the three trials was used for data analysis. The pinch strength tests performed used a repeated measure design and measurements were taken by each rater.
The relationship between the Preston pinch gauge and the digitalized pinch dynamometer in pinch strength was reliable (the ICC were 0.821 and 0.785 in rater 1 and rater 2 respectively). The relationship between the first session and second session in pinch strength using the digitalized pinch dynamometer was reliable (the ICC were 0.872 and 0.886 in rater A and rater B respectively). The relationship between rater A and rater B in pinch strength using the digitalized pinch dynamometer was reliable (the ICC was 0.754).
The pinch strength measurement using the digitalized pinch dynamometer is reliable within the rater and between raters. Thus, the Preston pinch gauge and the digitalized dynamometer measure grip strength equivalently, and can be used interchangeably.
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To assess the effect of lower limb strength on falls and balance in community-dwelling elderly persons by a health status questionnaire, evaluation of lower limb strength and balance.
A total of 86 subjects (age 69.8±5.3) were categorized into one of two groups, "Fallers" and "Non-fallers". Thirty one participants who had reported the experience of having fallen unexpectedly at least once in the past year were assigned into the group "Fallers", and the remaining 55 subjects having no fall history in the past year, "Non-fallers". A self-assessment questionnaire was taken. Lower limb strength was measured by a "Chair stand test". Balance was measured by the stability index of the fall risk test protocol of Balance System SD® (Biodex, New York, USA). The differences between the two groups were compared and the correlation between lower limb strength and balance were analyzed.
The questionnaire demonstrated no significant differences between two groups. The "Chair stand test" showed a significantly less for the "Fallers" (p<0.05). The stability index was significantly greater in the "Fallers" group (p<0.05). There was a moderate negative correlation between the "Chair stand test" and the "Stability index" (R=-0.576, p<0.01).
This study suggests that the "Chair stand test" is a useful screening process for lower limb strength which correlates to risk for falls and balance in the elderly.
Citations
Isometric Strength Measures are Superior to the Timed Up and Go Test for Fall Prediction in Older Adults: Results from a Prospective Cohort Study
To evaluate the relationship between the cross sectional area (CSA) and isokinetic strength of the back muscles in patients with chronic low back pain.
Data of twenty-eight middle-aged patients with chronic back pain were analyzed retrospectively. CSAs of both paraspinal muscles and the disc at the L4-L5 level were measured in MRI axial images and the relative CSAs (rCSA: CSA ratio of muscle and disc) were calculated. The degree of paraspinal muscle atrophy was rated qualitatively. Isokinetic strengths (peak torque, peak torque per body weight) of back flexor and extensor were measured with the isokinetic testing machine. Multiple regression analysis with backward elimination was used to evaluate relations between isokinetic strength and various factors, such as CSA or rCSA and clinical characteristics in all patients. The same analysis was repeated in the female patients.
In analysis with CSA and clinical characteristics, body mass index (BMI) and CSA were significant influencing factors in the peak torque of the back flexor muscles. CSA was a significant influencing factor in the peak torque of total back muscles. In analysis with rCSA and clinical characteristics, BMI was significant in influencing the peak torque of the back flexors. In female patients, rCSA was a significant influencing factor in the peak torque per body weight of the back flexors, and age and BMI were influencing factors in the peak torque of back flexors and total back muscles.
In middle-aged patients with chronic low back pain, CSA and rCSA were influencing factors in the strength of total back muscles and back flexors. Also, gender and BMI were influencing factors.
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To investigate the effect of Comprehensive Hand Repetitive Intensive Strength Training (CHRIST) on upper limb function in children with cerebral palsy using motion analysis.
The subjects in this study included 19 children (10 males, 9 females, mean age=8.8 years) with cerebral palsy. The experimental group (n=10) received CHRIST and general rehabilitation therapy. The control group (n=9) received a home program as well as general rehabilitation therapy. Both groups received 30 sessions of CHRIST or home program training for 60 minutes per session 3 times a week during the 10-week period. The reaching movements were captured by a motion analysis system. Kinematic variables including movement time (MT), mean velocity (MV), normalized jerk score (NJS), mean angular velocity (MAV) and normalized jerk score of the shoulder, elbow and wrist joint with comfortable and fast speed were analyzed between groups and the pre-post training group.
After pre- and post-training experimental group, MT, MV, NJS, MAV of shoulder, elbow, wrist and NJS of elbow and wrist improved significantlyin reaching movement of both comfortable and fast speed (p<0.05). However, After pre- and post-training control group, MV improved significantlyin reaching movement of only comfortable speed (p<0.05). Between two groups, MT and MAV of the elbow at comfortable speed and NJS of the elbow at fast speed were statisticallysignificant (p<0.05).
CHRIST proved to be an effective intervention for improving upper limb extremity function of reaching movement in children with cerebral palsy.
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Method Sixrteen physically active elderly men and women (age 64.40±3.66) were recruited. The subjects underwent a 12-week knee flexor/extensor isokinetic exercise program of concentric contractions at a velocity of 180 degrees/sec of the both knee twice a week for 12 weeks. Training was carried out on the isokinetic dynamometer. The subjects were evaluated with muscular strength at 90 degrees/sec, endurance at 180 degrees/sec, cardio-pulmonary function, balance, mood and life quality at baseline, 4-week, 8-week and 12-week.
Results Six of 16 people gave up in the middle of the course, 10 people completed a muscle strengthening exercise program. Muscular strength, balance, mood and life quality improved.
Conclusion Isokinetic exercise of the knee joint muscle was carried out and showed the result of multivalent effect in old age. Therefore strengthening exercise in aged persons was thought to be provided for welfare policy of an aging society as well as personal health improvement.
Objective: To evaluate the effects of back extensor strengthening exercise on improving the pain, activities of daily living (ADL) and bone mineral density in the chronic low back pain patients.
Method: 21 patients with chronic low back pain participated in back school program. Before program, measurement of lumbar extensor strength with MedXⰒ (Ocala, USA), visual analogue scale (VAS) for pain, level of ADL and bone mineral density (BMD) with DEXA (LunarⰒ, GE, USA) were done. For 12 weeks subjects had received the training for strengthening of back extensor and then, checked up with the above variables again.
Results: The results were as follows: 1) After 12 weeks of lumbar extensor strengthening program, isometric lumbar extensor strength was increased significantly (p＜0.01), 2) VAS and ADL were significantly improved from 5.1 to 3.3, and 8.1 to 9.9, respectively (p＜0.01), 3) BMD of lumbar spine were significantly improved from 1.1 to 0.8 (p＜0.05)
Conclusion: Twelve weeks lumbar extensor strengthening program with pelvic stabilization may be the effective therapeutic program for patients with chronic low back pain. (J Korean Acad Rehab Med 2002; 26: 576-580)
Method Fifty-nine subacute hemiparetic stroke in-patients participated in this study. All patients were randomly assigned to one of two groups: the control group and the experimental group. Both groups received the same conventional physical therapies for 4 weeks. The experimental group received an additional core strengthening program (CSP). Korean mini-mental state examination (K-MMSE) and Korean Modified Barthel Index (K-MBI) were performed on admission. CSP was performed for 30 minutes a day, 3 days per week for 4 weeks. We selected nine exercises available for stroke patients, and divided them as three steps according to the degree of difficulty. Because of the muscle weakness in stroke patients, a physical therapist often helped them during exercise. Outcome measurement included trunk control test (TCT), trunk impairment scale (TIS), and Berg balance scale (BBS) and we compared both groups before and after the period of training.
Results There were no significant differences in baseline general characteristics and initial values between the two groups. After rehabilitation therapy, both groups showed significant improvements in BBS, TIS, and TCT (p＜0.05). Following 4 weeks of therapy, changes of BBS, TIS score in the experimental group were significantly higher than those of the control group (p＜0.05). However, the change of TCT score was not significantly different.
Conclusion Analysis of different clinical parameters showed that better outcomes in BBS, TIS scores were achieved from CSP. This study suggests that CSP conducted for 4 weeks may be beneficial as a therapeutic technique for use in improvement of trunk balance in patients with subacute hemiparetic stroke.
Objective: To investigate the clinical feature and quantitative electromyographic (QEMG) findings in the patients with post-polio syndrome (PPS).
Method: Eleven patients who had clinical evidences of antecedent poliomyelitis were evaluated with standardized clinical history, physical examination and QEMG study. If a patient had fulfilled provisional criteria for PPS, he was regarded as PPS and six patients had fulfilled the criteria. Other patients were treated as control group with stable poliomyelitis. Manual muscle testing and needle EMG study including quantitative motor unit analysis was performed at the tibialis anterior and vastus medialis muscles. The existence of abnormal spontaneous activity and parameters of quantitative motor unit analysis, mean duration and amplitude of motor unit action potentials (MUAPs), were compared between PPS and control groups. The correlation between the muscle strength and parameters of QEMG was investigated.
Results: Abnormal spontaneous activities were noted in 4 out of 11 patients (36.4%) and three of these 4 patients were PPS. Mean duration and amplitude of MUAPs of tibialis anterior and vastus medialis muscles were not different significantly between the PPS and stable poliomyelitis group (p＞0.05). The parameters of MUAPs were poorly correlated with muscle strength.
Conclusion: Distribution of abnormal spontaneous activities and parameters of QEMG study were not different in PPS and stable poliomyelitis patients. QEMG study may not have additional benefit in differentiating PPS from stable poliomyelitis.
Objective: To determine the usefulness of Jebsen hand function test in rheumatoid arthritis patients
Method: The experimental subjects were divided into 3 groups (Group 1：17 persons; control, Group 2：21 persons; RA without hand deformity, Group 3：16 persons; RA with hand deformity). They were assessed by Jebsen hand function test. Further included assessments were grip and pinch strength, joint deformity counts, and visual analogue scales.
Results: Jebsen hand function test scores were significantly decreased in rheumatoid arthritis patients compared with control. Jebsen hand function test scores were well correlated with visual analogue scales in group 2 and correlated with joint deformity counts in group 3.
Conclusions: Jebsen hand function test would be useful tool for the evaluation of hand function in the rheumatoid arthritis patients with hand deformity.
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