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Community Health Services↗
Biomedical subjects
G Grimby
Publications and source records attributed to G Grimby.
Development of fatigue during repeated eccentric-concentric muscle contractions of plantar flexors in patients with stroke.
OBJECTIVE: To better understand the mechanisms behind fatigue in muscles affected by a neuromuscular disease. DESIGN: Patients recruited by convenience compared to age-matched healthy subjects from a population study. SETTING: University hospital laboratory. METHODS: Repetitive eccentric-concentric plantar flexions at 60 degrees/sec were performed on a dynamometer until exhaustion. The mean power frequency and root mean square of the electromyogram were recorded, and work was calculated. SUBJECTS: Both legs of seven patients with upper motor neuron lesion from stroke and one leg of healthy men were tested. RESULTS: There were no significant (p > .05) differences in number of cycles performed or decrease of work between any of the tested legs. There was a significant (p > .05) difference in work performed by the affected leg and the reference group. Mean power frequency decreased significantly (p > .05) for the gastrocnemius muscle in the nonaffected leg and for the reference group, while no such decreases were found in the affected leg. The statistical methods used were the nonparametric tests: the Wilcoxon one-sample for differences between paired observations, and the Mann-Whitney U for differences between groups. CONCLUSION: A reduction in work in high-intensity dynamic muscle activity may not be associated with a reduction in mean power frequency, especially in patients with altered supraspinal control. There may be peripheral fatigue factors not reflected in the electromyographic activity.
Brain Infarction↗
Upper motor neuron lesions: their effect on muscle performance and appearance in stroke patients with minor motor impairment.
OBJECTIVE: To evaluate muscular performance and appearance in patients with prior stroke who were ambulatory. DESIGN: Nonrandomized study. SETTING: University hospital laboratory. SUBJECTS: Sixteen persons (11 men, 5 women) with minor motor impairments, 6 to 24 months after stroke, were included. As reference, data were used from a population-based sample of 144 men and women. MAIN OUTCOME MEASUREMENTS: Muscle performance was evaluated using a Kin-Com dynamometer in both the affected and the nonaffected leg. Peak isometric strength was measured at a 60 degree angle in both extension and flexion. Maximal isokinetic strength was measured at 60 degrees/sec and at 180 degrees/sec. Endurance was evaluated during isometric and dynamic knee extensions. Muscle biopsies were taken on nine patients and muscle tissue areas were determined with computed tomography. RESULTS: The affected leg was weaker but not different in relative endurance compared with the nonaffected side. The performance of the nonaffected side was somewhat lower than that of a matched reference population. No major difference in fiber composition between the affected and nonaffected legs was noted, except for a lower degree of capillarization in the affected leg. CONCLUSION: In well-functioning stroke patients with good motor performance, further muscle training that includes resistance exercise might be indicated.
Adult↗
An 8-year longitudinal study of muscle strength, muscle fiber size, and dynamic electromyogram in individuals with late polio.
Twenty-one subjects with polio 24 to 51 years prior to the first examination were studied on three occasions, each 4 years apart with measurements of muscle strength and endurance for knee extension, macro EMG, and muscle biopsy from vastus lateralis. On average the muscle strength decreased during the 8-year follow-up by 9-15%. Endurance decreased during the observation period. The muscle fiber area was markedly increased in most subjects. There was a decrease in the capillarization during the follow-up. Macro EMG was increased in all subjects (range 3-42 times control) and increased in 20 legs during the 8-year follow-up, but showed a decrease in 8 of 9 legs with an approximative breakpoint when macro MUPs were around 20 times the normal size. Thus, evidence of on-going denervation/reinnervation as well as of failing capacity to maintain large motor units was demonstrated. SFEMG showed a moderate degree of disturbed neuromuscular transmission.
Adult↗
Questionnaire to evaluate the effects of assistive devices and altered working methods in women with rheumatoid arthritis.
The objectives of the study were to identify perceived difficulty and reduction of difficulty when using assistive devices and altered working methods in performing daily activities and to detect which activities were unaffected by interventions. Twenty-one women aged 29-65 years with rheumatoid arthritis answered the Evaluation of Daily Activity Questionnaire (EDAQ), which contains 102 items divided into 11 dimensions of daily activities. The women rated their perceived difficulty twice: first when not using devices or altered methods and then when using them. The use of devices or altered methods led to a reduction in perceived difficulty in 42% of the ratings. The number of items that the women found difficult when not using devices/altered methods ranged between 13 and 99. With the interventions, the number of items still found difficult decreased to between 6 and 57, 91% of the devices provided were still in use. The dimensions Eating, Cooking and Toileting contained the most items affected by the use of devices such as lever taps, springy scissors, breadknife and wrist orthosis. Few effective devices were identified for the dimensions Dressing, Washing, Cleaning and Mobility Outdoors. It was concluded that the EDAQ represents a new approach to demonstrating difficulties in performing various daily activities, to describing the effects of assistive devices/altered methods, and to identifying areas not affected by interventions.
Activities of Daily Living↗
Pain, physical activity, and disability in individuals with late effects of polio.
OBJECTIVE: The aim of this study was to provide a description of pain and its relationship to the effects of polio, physical activity, and disability. DESIGN: Assessment instruments used were: a pain questionnaire, a pain drawing, a visual analogue scale (VAS), a 30-m walk indoors, isokinetic muscle strength, serum creatine kinase concentration, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP). SETTING: A university hospital department. SUBJECTS: Thirty-two consecutive individuals with late effects of polio. RESULTS: More than 50% of the individuals had pain every day, mostly during physical activity. The mean VAS score for daily pain intensity was 55mm, range 0 to 93mm. In the lower limbs cramping pain was the most common pain characteristic in both polio-affected and non-polio-affected limbs. In the upper limbs and in the trunk, aching pain was the most common pain characteristic, especially in the polio-affected areas. The degree of muscle weakness had no correlation to pain experience. The walking test demonstrated a relatively small difference between spontaneous and maximal walking speed. The NHP questionnaire demonstrated that all six dimensions (energy, pain, physical mobility, sleep, emotional reactions, and social isolation) were affected. The dimensions pain and physical mobility both strongly correlated with energy. CONCLUSIONS: There is a relationship between physical activity in daily life and experience of pain. In many postpolio individuals who experience a high level of pain, spontaneous and maximal walking speed are approximately the same. It is strongly recommended that individuals with late effects of polio, experiencing aching and especially cramping pain, modify their level of physical activity.
Activities of Daily Living↗
Muscular performance in heart failure.
BACKGROUND: Some of the major symptoms in patients with chronic heart failure are muscle weakness and fatigue. However, not much is known about muscle performance in these patients compared to healthy controls. METHODS AND RESULTS: Activity level, gait speed, hand grip strength, muscle performance of the knee extensors and flexors along with the plantar and dorsal flexors of the foot were evaluated. Muscle biopsies from the lateral vastus lateralis were taken. Sixteen patients in New York Heart Association class II or III were tested and compared to 112 reference subjects. Compared to the reference subjects, there was a reduction in activity level, gait speed, isometric and isokinetic peak torque for knee extension at different velocities, hand grip strength, peak torque for plantar and dorsal flexion of the ankle and isometric and isokinetic endurance for the knee extension. Recovery was faster. There were small differences in fiber composition. 3-Hydroxy-acylCoA-dehydrogenase and citrate synthase were lower, and lactate dehydrogenase was increased. CONCLUSIONS: Muscle performance is affected in terms of both strength and endurance, which might affect performance in everyday activities. The more pronounced reduction in hand grip compared to the other muscles tested could be an indication of intrinsic abnormalities in the skeletal muscle.
Adult↗
Comparison of muscle and tendon stiffness, jumping ability, muscle strength and fatigue in the plantar flexors.
An isokinetic dynamometer was used to measure plantar flexion muscle strength at 60 degrees/s and 200 degrees/s in 10 healthy young men (mean age 25 years). Muscle and tendon stiffnesses were determined on the dynamometer by the use of electrical stimulation and passive stretch (200 degrees/s). Differences in jumping heights between squat and counter-movement jumps were calculated from flight times. The number of heel-rises performed until exhaustion, standing on one leg, were counted. Stepwise regression analysis showed that differences in jumping height increased with lower muscle strength and with higher muscle and tendon stiffnesses, indicating that elastic components may be of more importance in persons with lower muscle strength. The number of heel-rises was negatively dependant on tendon stiffness, indicating that increased stiffness may enhance the development of fatigue.
Adult↗
Dependence and perceived difficulty in daily activities in community-living stroke survivors 2 years after stroke: a study of instrumental structures.
BACKGROUND AND PURPOSE: There is a need for better understanding of the structure of instruments for functional outcome assessment after discharge from rehabilitation. One purpose of the study was to contribute to the analysis of instrumental dimensionality. Another purpose was to compare disability in stroke patients within the younger age range 2 years after onset of stroke with that at discharge with respect to both dependence and patients' perceived difficulty and to extend the assessments with instrumental activities. METHODS: We studied 68 stroke survivors aged 18 to 71 years at onset (59% aged <55 years) by means of interviews in their home, using activities from the Functional Independence Measure (FIM) and Instrumental Activity Measure (IAM) for ratings of dependence and perceived difficulty. Rasch analysis was used to construct calibrated linear measures and to evaluate the level of fit. RESULTS: Acceptable models for comparison of dependence between discharge and follow-up were found for the physical and the social-cognitive items in FIM. However, personal care and social-cognitive items showed an increased level of dependence at follow-up compared with at discharge. A combination of physical activities from FIM and IAM also gave acceptable models for both dependence and perceived difficulty, and the hierarchical orders of activities are presented. In general, there was agreement between the ratings of dependence and perceived difficulty, but with some discrepancies. Men found it harder to be independent in such instrumental activities as cooking and cleaning than women; the opposite was true for small-scale shopping and locomotion outdoors. Subjects aged > or =55 years had slightly higher level of dependence and perceived difficulty in IAM activities than those below that age. CONCLUSIONS: Changes in the hierarchical order of activities should be taken into account in follow-up studies. Differences in the environment between hospital and home, as well as differences in support and motivation, might explain the relatively larger degree of dependence at follow-up compared with at discharge and indicate the need for further rehabilitation efforts. Instrumental activities could be combined with FIM activities in a model. For individual items, ratings of both dependence and perceived difficulty may provide further insight into the disablement process.
Activities of Daily Living↗
Muscle fatigue in a standing heel-rise test.
The fatigue process of the triceps surae was evaluated during a standing heel-rise test, comprising of eccentric and concentric muscle actions. Ten healthy women with a mean age of 24 years participated. The heel-rise test was performed until exhaustion. Work and electromyographic activity expressed as root mean square and mean power frequency of the gastrocnemius and soleus muscles were calculated. The average number of heel-rises performed was 25 +/- 1. Work decreased significantly during the test. Mean power frequency decreased significantly in both phases. During the eccentric phase the decrease was significantly larger in the gastrocnemius than in the soleus muscle. There were no significant changes in root mean square except for a decrease in the soleus muscle during the eccentric phase. The present results, showing different fatigue patterns in the two muscles, could be used as reference when testing the fatigue process in different clinical conditions. Recommendations for standardization of a heel-rise test are given.
Adult↗
The standing heel-rise test in patients with upper motor neuron lesion due to stroke.
The objective was to investigate the fatigue process in the triceps surae during the heel-rise test (eccentric and concentric phases) in comparison with a walking test and muscle strength. Eight men with prior stroke and 8 age-matched healthy men participated. The electromyographic activity in form of root mean square and mean power frequency of the gastrocnemius and soleus muscles were measured and work estimated. Walking speed and maximal peak torque were measured and differed significantly between the patient and reference groups. There were no significant differences between the groups nor legs concerning the number of heel-rises or work performed. In the eccentric phase, mean power frequency decreased significantly more in the gastrocnemius than in the soleus muscle in the reference group, while mean power frequency in the soleus muscle tended to decrease more, though non-significantly, in the affected leg. The conclusion is that the capacity to perform the heel-rise test in patients with prior stroke is better than plantarflexor peak torque and walking speed.
Case-Control Studies↗
Skeletal muscle alterations in patients with chronic heart failure.
AIMS: To investigate skeletal muscle in patients with chronic heart failure and controls, and relate skeletal muscle variables to functional class, exercise capacity, central haemodynamics, muscle strength and medical treatment. METHODS: Biopsy from the lateral vastus muscle was obtained in 43 patients and 20 controls. Right sided heart catheterization was performed in 19 patients and maximal exercise testing in 26 patients. In nine patients muscle strength was measured. Patients had higher lactate levels, higher lactate dehydrogenase activity, and lower oxidative enzymes activity than controls. In patients, the percentage of type I fibres and capillarization were decreased while the percentage of type II B fibres were increased. Lactate dehydrogenase activity correlated with exercise capacity, muscle strength and right atrial pressure. Digoxin-treated patients had significantly lower oxidative enzyme activity than patients without digoxin treatment. CONCLUSION: Patients with chronic heart failure have several skeletal muscle abnormalities. Central haemodynamics and medical treatment may, in addition to inactivity, be important in skeletal muscle changes.
Adenosine Triphosphate↗
Two years of growth hormone (GH) treatment increase isometric and isokinetic muscle strength in GH-deficient adults.
GH deficiency in adults is associated with reduced muscle mass and muscle strength. The objective of this trial was to follow the effect of 2 yr of GH treatment in GH-deficient adults on muscle performance in relation to a reference population. Knee extensor and flexor strengths for isometric and isokinetic concentric muscle strength were measured using a Kin-Com dynamometer. Hand-grip strength was measured in both hands. The fatigue index was calculated as the percent reduction in peak torque at 50 repeated isokinetic knee extensions. Superimposed, single twitch electrical stimulation was performed. The GH-deficient subjects had lower isometric knee extensor, knee flexor, and hand-grip strength than the reference population. Two years of GH treatment increased and normalized the mean isometric knee extensor and flexor strengths. The concentric knee flexor and extensor strength at an angular velocity of pi rad/s increased, as did the concentric knee flexor strength at an angular velocity of pi/3 rad/s. The increase in muscle strength was more marked in younger patients and in patients with lower initial muscle strength than predicted. Quadriceps endurance decreased, whereas the effect of superimposing single twitches on isometric contraction and hand-grip strength was unaffected by the GH treatment. Two years of GH therapy in GH-deficient adults increased and normalized isokinetic and isometric muscle strength studied in proximal muscle groups. Hand-grip strength and the degree of lack of maximal motor unit activation on voluntary isometric knee extensor force did not change. The dynamic local muscle fatigue index decreased.
Adult↗
Assessments of disability in women with rheumatoid arthritis in relation to grip force and pain.
The aim of this study was to assess disability with the Health Assessment Questionnaire (HAQ) and to evaluate the relationships between grip force, pain and difficulty in daily activities. Twenty women with rheumatoid arthritis were assessed with measurements of grip force and pain before and after grip test. Both the original HAQ version and an alternative rating model, not taking the use of assistive devices into account, were used. All patients reported pain which significantly increased after grip test and with a significant inverse correlation to grip force. All patients had assistive devices, on average 15 devices (range 1-27). Ninety-one per cent of the patient's devices were in continued use, most frequently in the categories; Eating, Grip and Hygiene. Disability was significantly correlated to pain, grip force and use of assistive devices. When using the alternative ratings of 20 questions in HAQ, 8 of the 20 questions showed significantly (p = 0.0003-0.0339) lower scoring, and the number of questions with significant correlations between grip force and disability increasing from 9 (r = 0.48-0.74, p = 0.039-0.001) to 14 questions (r = 0.47-0.74, p = 0.047-0.001). Difference between intrinsic disability (without assistive devices) and actual disability (with such assistance) is not reflected in original HAQ. The present study indicates that assessment of actual disability by the alternative rating model is more often correlated to impairment (grip force) than disability assessed by original HAQ and can be considered to give a better assessment of actual disability than the original HAQ model.
Activities of Daily Living↗
The structure of an instrument for assessing the effects of assistive devices and altered working methods in women with rheumatoid arthritis.
OBJECTIVE: To use Rasch analysis to transform the ordinal score from a newly developed instrument, the Evaluation of Daily Activities Questionnaire (EDAQ), in order to obtain unidimensional linear measures; to analyze whether items change in difficulty with interventions; and to follow changes in subjects' degree of ability. METHODS: Twenty-one women with rheumatoid arthritis rated their perceived difficulty without and with assistive devices or altered working methods using the EDAQ; the EDAQ consists of 102 items of daily activities, divided into 11 dimensions. RESULTS: All items in the EDAQ could be structured into an acceptable model from "hard" to "easy" with the subjects overall measures ranging from "more able" to "less able." Forty-one items showed a significant reduction of difficulty with interventions. For some items results indicated that easier initial difficulty led to greater effect of interventions. In general, difficulty without assistive devices could not predict difficulty with interventions. Twenty women demonstrated a significant increase in activities of daily living (ADL) ability after interventions. CONCLUSION: The EDAQ analyzed with the Rasch model, demonstrated a hierarchical order of difficulty in 102 items showing that it was possible to evaluate the effect of using assistive devices or altered working methods.
Activities of Daily Living↗
Lateralization of cutaneous inflammatory responses in patients with unilateral paresis after poliomyelitis.
Unilateral paresis remaining after poliomyelitis may affect the expression of inflammatory diseases by lateralization of the disease manifestations. The purpose of this study was to assess the impact of the unilateral paresis after poliomyelitis on lateralization of neurogenic inflammation and immune responsiveness. The delayed-type hypersensitivity (DTH) reaction to tuberculin was used as an in vivo measure of antigen-specific T lymphocyte reactivity. Assessment of axon reflex vasodilatation was simultaneously employed to test for neurogenic inflammation. Fourteen of the 16 polio patients displayed a positive DTH reaction to tuberculin. All but two showed weaker DTH reaction on the paretic- compared to the contralateral-side (P = 0.001). Magnitude of electrically evoked axon reflexes significantly correlated to asymmetries of DTH responses. We conclude that damage of lower motor neuron leads to ipsilateral down-regulation of T cell-mediated cutaneous inflammation. This lateralization of DTH responses is related to deficiencies in motor and sympathetic innervation of the paretic extremity.
Adult↗
Life after cardiac arrest; a retrospective study.
AIM: We decided to evaluate the life situation of the survivors after out-of-hospital cardiopulmonary resuscitation (CPR). METHOD: CPR survivors who were 75 years or younger at the time and who were discharged alive from the hospital were identified consecutively. Average follow-up time was 25.5 months, and at follow-up 24% were deceased and 9% were lost. A questionnaire was completed by 93% and 71% were positive to an interview. RESULTS: Cognitive functions were reduced as well as capacity to perform activities in daily living. This resulted in dependence on other persons for living (nursing homes) and a low return to work. Social isolation was a common complaint. The survivors also reported lower pain awareness than the reference population. As far as other aspects of health-related quality of life, this small group show many similarities with previously evaluated post-infarction patients. CONCLUSION: Lower pain awareness should be taken into consideration when the CPR patients have ischemic heart disease. If possible, try to prevent social isolation.
Activities of Daily Living↗
Reduction in thigh muscle cross-sectional area and strength in a 4-year follow-up in late polio.
OBJECTIVE: To study changes in cross-sectional thigh muscle area and muscle strength in late polio subjects over a 4-year period. DESIGN: Longitudinal study of a cohort of polio survivors, comparing subjects who acknowledge (unstable) with those who do not acknowledge (stable) new muscle weakness. SETTING: University hospital. SUBJECTS: Eighteen subjects (6 men, 12 women) with polio-myelitis sequelae (39 to 46 years of age) were studied on two occasions 4 years apart; the first examination was 37 to 44 years after onset of polio. Subjects were recruited through hospital registers, newspaper advertisement, and a patient organization. OUTCOME MEASUREMENTS: Thigh muscle and intermuscular and intramuscular adipose tissue (AT) cross-sectional areas were measured by computed tomography. Isometric muscle strength for knee extension and flexion was measured using a Kin-Com dynamometer. RESULTS: Cross-sectional muscle area decreased on average 1.3 +/- 3.6 cm2 (1.4%, p < .05); the intermuscular and intramuscular AT area increased 1.8 +/- 3.4 cm2 (12.1%, p < .05). When divided by legs in which subjects reported (unstable) or did not report (unstable) or did not report (stable) increased muscle weakness, unstable legs showed significant reduction (p < .05) in muscle area, whereas stable legs did not. Estimated total thigh muscle strength decreased 7.8% +/- 2.9% (p < .01), with a significant (p < .001) reduction in unstable legs (13.4% +/- 4.3%) but not in stable legs. The reduction in strength appears to be greater than the reduction in cross-sectional muscle area, but there is still a significant correlation (r = .44, p < .05). CONCLUSION: The present results demonstrate not only progress of muscle weakness, but also of muscle atrophy in postpolio subjects.
Adipose Tissue↗