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PubMed1999

Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy.

OBJECT: In this investigation the authors quantified changes in ankle plantarflexor spasticity and strength following selective dorsal rhizotomy (SDR) and intensive physical therapy in patients with cerebral palsy (CP). METHODS: Twenty-five patients with cerebral palsy (CP group) and 12 able-bodied volunteers (AB controls) were tested with a dynamometer. For the spasticity measure, the dynamometer was used to measure the resistive torque of the plantarflexors during passive ankle dorsiflexion at five different speeds. Data were processed to yield a single value that simultaneously encompassed the three key elements associated with spasticity: velocity, resistance, and stretch. For the strength test, the dynamometer rotated the ankle from full dorsiflexion to full plantarflexion while a maximum concentric contraction of the plantarflexors was performed. Torque angle data were processed to include the work done by the patient or volunteer on the machine. Plantarflexor spasticity values for the CP group were significantly greater than similar values for the AB control group prior to surgery but not significantly different after surgery. Plantarflexor strength values of the CP group were significantly less than those of the AB control group pre- and postsurgery. Postsurgery strength values did not change relative to presurgery values. CONCLUSIONS: The spasticity results of the present investigation agreed with those of previous studies indicating a reduction in spasticity for the CP group. The strength results did not agree with the findings of most previous related literature, which indicated that a decrease in strength should have occurred. The strength results agreed with a previous investigation in which knee flexor strength was objectively examined, indicating that strength did not decrease as a consequence of an SDR. The methods of this investigation could be used to improve SDR patient selection.

Adolescent↗
PubMed1995

Age, gender, and muscular strength.

Muscular strength can be measured by cable tensiometry, non-motorized dynamometry (e.g., handgrip dynamometer), motorized dynamometry, or with free weights or exercise machines. Advantages and disadvantages of each are discussed. Cross-sectional studies indicate that isometric and concentric strength levels peak between the second and third decade, remain unchanged until the fourth or fifth decade, and start to decline from about the fifth decade at a rate of 12% to 15% per decade until the eighth decade in men. Greater strength losses in both men and women have been suggested from the few longitudinal studies available on this topic. However, concentric strength levels in women tend to peak sooner, start to decline earlier, and decrease at a slightly slower rate than men. Age- and inactivity-induced sarcopenia explains some but not all of the losses in strength with age. There is a need to determine the separate roles of disease, inactivity, and normal aging on these losses. New findings from the Baltimore Longitudinal Study of Aging suggest a preservation of eccentric strength levels with age in women.

Adult↗
PubMed2006

Age trajectories of grip strength: cross-sectional and longitudinal data among 8,342 Danes aged 46 to 102.

PURPOSE: The purpose is to study the age trajectory of hand-grip strength after the age of 45 years. METHODS: In this study, we use data from three large nationwide population-based surveys of Danes aged 45 to 102 years with a total of 8342 participants with grip-strength measurements and up to 4 years of follow-up. Grip strength was measured by using a portable hand dynamometer. RESULTS: Grip strength declines throughout life for both males and females, but among the oldest women, the longitudinal curve reaches a horizontal plateau. The course of the decline is estimated by using full information in the longitudinal data and is found to be almost linear in the age span of 50 to 85 years. In this age span, mean annual grip-strength loss is estimated to be 0.59 (0.02) (SE) kg for men and 0.31 (0.01) kg for women. CONCLUSION: This study confirms the previously reported grip-strength decline with increasing age. Estimates were obtained by using full-information methods from large population-representative studies. Equations of expected grip strength, as well as tables with sex-, age-, and height-stratified reference data, provide an opportunity to include grip-strength measurement in clinical care in similar populations.

Aged↗
PubMed1994

The relationship between subjective knee scores, isokinetic testing, and functional testing in the ACL-reconstructed knee.

It is important to examine the functional relationships between commonly performed clinical tests and to resolve inconsistencies in previous investigative results. The purpose of this study was to determine if a correlation exists between three commonly performed clinical tests: isokinetic isolated knee concentric muscular testing, the single-leg hop test, and the subjective knee score in anterior cruciate ligament reconstructed knees. To determine if a relationship exists would be beneficial to clinicians in determining patient progression, treatment modification, and return-to-sport objective parameters. Several investigators have analyzed two of these parameters, but no one has investigated three parameters to date. Additionally, this study explored the concept of limb acceleration and deceleration during high-speed isokinetics and its relationship to function. Fifty patients were randomly selected (29 males) with a mean age of 23.7 years (range 15-52). The subjects completed a subjective knee score questionnaire that rated symptoms (pain, swelling, giving way) and specific sport function and completed an overall knee score assessment. The patients were then evaluated performing three one-legged functional tests: 1) hop for distance, 2) timed hop, and 3) cross-over triple hop. Isokinetic testing was performed on a Biodex dynamometer at 180, 300, and 450 degrees/sec for knee extension/flexion. The patients' mean value of the self-assessed knee rating was 86 points. Sixty-four percent of the patients exhibited normal limb symmetry (within 85%) on all three single-leg hop tests. Sixteen percent exhibited quadriceps strength at least 90% of the contralateral limb isokinetically. A positive correlation was noted between isokinetic knee extension peak torque (180, 300 degrees/sec) and subjective knee scores, and the three hop tests (p < 0.001). A statistical trend was noted between knee extension acceleration and deceleration range at 180 and 300 degrees/sec for the timed hop test and triple cross-over hop (r = 0.48, r = 0.49, r = 0.51, r = 0.49). No positive correlations were found for isokinetic test results for the knee flexors.

Adolescent↗
PubMed1993

Low bone mineral density, grip strength and skinfold thickness are important risk factors for hip fracture in Hong Kong Chinese.

The purpose of the study was to compare the bone mineral density (BMD) at the hip and spine, the grip strength and the skinfold thickness in Chinese hip fracture patients and controls, and to document the relative risk of hip fracture associated with different levels of these risk factors. The study was conducted on 163 elderly patients with hip fracture (32 men and 131 women) and 317 controls (104 men and 213 women). BMD at the hip and spine was measured by dual-energy X-ray densitometry (Norland NR26). The mean grip strength was measured in both hands by a hand dynamometer; and bicep, tricep and iliac skinfold thicknesses were measured by a caliper (Holstain). Student's t-test was used to compare the mean bone densities, recalled body weight, grip strength and skinfold thickness; and multiple logistic regression was used to calculate the relative risk and 95% confidence intervals in quartiles of bone density, grip strength and skinfold thickness. In women, the mean BMD and anthropometric measurements were significantly lower in patients than controls. However, in men the mean recalled body weight and measured skinfold thickness were not significantly different between patients and controls. In both men and women the relative risk of hip fracture increased significantly with diminishing bone density at the spine, femoral neck and intertrochanteric area, but not at the Ward's triangle. In women the relative risk of hip fracture also increased significantly with a low recalled body weight, grip strength and skinfold thickness.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1997

Departures from linearity in the relationship between measures of muscular strength and physical performance of the lower extremities: the Women's Health and Aging Study.

BACKGROUND: Sarcopenia, an age-related reduction in muscular mass and strength, may cause a decline in physical functioning and subsequent loss of autonomy. It has been suggested that strength is associated with lower extremity function mainly in the lower portion of the range of strength. Identifying the threshold under which strength is most critical to function may help in targeting groups who may benefit most from exercise interventions. METHODS: The study uses data from the Women's Health and Aging Study. The study population, recruited by screening a population-based sample aged 65 years and older, comprised 1,002 women who represent the one-third most disabled women without severe cognitive impairment living in the community. Knee extensor and hip flexor strength were assessed using a hand-held dynamometer. Lower extremity performance was evaluated using tests of walking, standing balance, and rising from a chair. RESULTS: Among women tested for strength (n = 892), those who could walk (97%), do the side-by-side stand (87%), or complete 5 chair stands (74%) had significantly greater strength. Walking speed was linearly associated with knee extensor strength over the entire range of strength, but its association with hip strength was limited to values below 15 kg. Time for five chair stands was associated with knee extensor and hip flexor strength below 10 and 15 kg, respectively, and no significant association was detected above these values. Stronger women were more likely to hold balance for 10 sec in the side-by-side, semi-tandem, and tandem positions. The percentage of the variance in performance explained by strength alone was always lower than 20%. CONCLUSIONS: In this population, which does not include the strongest older women, there is a departure from linearity in the relationship between muscular strength and some measures of lower extremity performance.

Aged↗
PubMed1984

Norms for hand grip strength.

Norms for hand grip strength of healthy children are presented. Sex and age specific centiles for age 5 to 18 years have been determined using a portable strain gauge dynamometer with an accuracy of 0.5 N. The test group comprised 1417 healthy, urban school children from a middle class suburb of Brisbane. Mean maximum grip strength (of four tests, two with each hand) and mean peak grip strength (best of four tests) were recorded. Mean values of peak grip strength were 10 to 15% higher than the average maximum grip in all age groups. At all ages girls had a reduced grip strength compared with boys and although boys manifested a continual, approximately linear increase in grip strength through all age groups, girls manifested an approximately linear increase up to 13 years after which mean hand grip usually remained constant. By the age of 18 years boys had a mean grip strength some 60% higher than girls. Correlations with height and weight are also presented. "Handedness' influenced grip strength and was most noticeable in children aged over 10 years. The clinical use of hand grip strength centiles for the early indication of neurological and muscular disorders and for following the natural history of neuromuscular disease is discussed.

Adolescent↗
PubMedDate not supplied

Isokinetic concentric versus eccentric training of shoulder rotators with functional evaluation of performance enhancement in elite tennis players.

Thirty elite tennis players were randomly assigned to three groups to evaluate shoulder isokinetic internal and external rotation training: an isokinetic concentric group, an isokinetic eccentric group, and a control group with no training. Subjects were tested before and after training both concentrically and eccentrically using an isokinetic dynamometer. Functional output before and after training was assessed by the average and peak velocity of six maximal serves. The effect of training on serve velocity endurance was also assessed. Statistically significant concentric and eccentric strength gains (11%) were obtained in both training groups when compared with controls (decreased total average strain of 2%) (P < 0.0004). Serve velocity increased by greater than 11% in both training groups, which was a significant increase from the average of 1% in the control group (P < 0.0001). In the endurance study, training group subjects displayed a tendency to maintain their serve velocity (loss of approximately 2%) greater than controls (loss of 6.4%) (P < 0.05). Isokinetic training led to increases in objective and functional output in elite tennis players. This training regimen may have significance in the final stages of the rehabilitation of injured shoulders as well as in improved performance and reduced injury risk.

Adolescent↗
PubMed1993

Postsurgical shoulder strength in the older patient.

Following surgery, a goal of rehabilitation is to return the surgical extremity to its original strength. However, for the older rotator cuff repair patient, we are unsure if this is a realistic goal. The purpose of this study was to determine the quality of shoulder strength in older males who had undergone rotator cuff repair and acromioplasty surgery and to determine if test position and test velocity effects for rotation at the shoulder existed. Nine patients (mean age = 60.8 years) were tested bilaterally on the Cybex II isokinetic dynamometer for two movements (internal/external rotation), two velocities (60 degrees/sec, 120 degrees/sec), and two positions (neutral, 90 degrees abduction) to determine the peak torques for the shoulders. Following a three-way analysis of variance (ANOVA) with repeated measures, results indicated that the surgical shoulder had torque values approximating the nonsurgical shoulder and that test position had no significant effect on the internal or external rotation torques produced. As seen with nonshoulder-impaired younger subjects, peak torque decreased with increased test velocities. It was concluded that the older rotator cuff repair patient may be expected to attain a level of strength in the surgical shoulder similar to or exceeding the nonsurgical shoulder and that either test position recommended by Cybex for testing of the shoulder rotators was acceptable. Clinically, a full functional recovery similar to the nonsurgical shoulder should be expected in the older patient with postsurgical rotator cuff repair and acromioplasty.

Acromion↗
PubMedDate not supplied

Association between bone, body composition and strength in premenarcheal girls and postmenopausal women.

AIM: The study examined whether associations between bone, body composition and strength are age dependent. SUBJECTS AND METHODS: Two age levels (premenarcheal girls and postmenopausal women on HRT) were studied in a 10-month follow-up. Bone, lean and fat mass were measured by dual-energy X-ray absorptiometry (DXA), and strength was measured using an isokinetic dynamometer. RESULTS: In girls, significant correlations were found between mass (lean, fat and body mass), strength and most bone characteristics (r = 0.15-0.93). At the proximal femur changes in bone mineral density (BMD) were moderately related to changes in body composition. In the women, body mass and lean mass were significantly correlated with most bone characteristics (r = 0.34-0.82). Low to moderate correlations were observed between changes in bone and changes in body composition. After controlling for lean mass the relation between strength and bone was no longer significant. CONCLUSIONS: In premenarcheal girls, bone is partly determined by mass, with lean mass the most important predictor at the femoral sites. In postmenopausal women, lean mass is an important determinant of bone mineral content (BMC) and BMD, but changes in BMD are related to changes in fat. The relation between strength and BMD is mainly attributable to the relation between lean mass and BMD. The contributory effects of soft tissue to bone change over different life periods.

Body Composition↗
PubMed2001

Movement-related cortical potentials associated with progressive muscle fatigue in a grasping task.

OBJECTIVE: The present research was aimed to further address the general empirical question regarding the behavioral and neurophysiological indices and mechanisms that contribute to and/or compensate for muscle fatigue. In particular, we examined isometric force production, EMG, and EEG correlates of progressive muscle fatigue while subjects performed a grasping task. METHODS: Six neurologically healthy subjects were instructed to produce and maintain 70% of maximum voluntary contraction (MVC) for a total of 5 s in a sequence of 120 trials using a specially designed grip dynamometer. Three components of movement-related potentials (Bereitschaftspotential, BP, Motor potential, MP, and Movement-monitoring potential, MMP) were extracted from continuous EEG records and analyzed with reference to behavioral indicators of muscle fatigue. RESULTS: Experimental manipulations induced muscle fatigue that was demonstrated by decreases in both MVC values and mean force levels produced concomitant to increases in EMG root mean square (RMS) amplitude with respect to baseline levels, and EMG slope. EEG data revealed a significant increase in MP amplitude at precentral (Cz and FCz) and contralateral (C3) electrode sites, and increases in BP amplitude at precentral (Cz and FCz) electrode sites. CONCLUSIONS: The increases in EMG amplitude, EMG slope, and MP amplitudes suggest a possible link between the control signal originating in the motor cortex and activity level of the alpha-motoneuron pool as a function of progressive muscle fatigue. Overall, the data demonstrate that progressive muscle fatigue induced a systematic increase in the electrocortical activation over the supplementary motor and contralateral sensorimotor areas as reflected in the amplitude of movement-related EEG potentials.

Adolescent↗
PubMed1991

Grip strength: effects of testing posture and elbow position.

This study was designed to determine the effect of testing posture and elbow position on grip strength. A hand dynamometer was used to measure the grip strength of 61 subjects (26 female and 35 male) in four positions: (1) sitting with elbow in 90 degree flexion, (2) sitting with elbow in full extension, (3) standing with elbow in 90 degree flexion, and (4) standing with elbow in full extension. The four experimental conditions were randomized, and standardized instructions were followed. A two-factor (gender and treatment) repeated measures ANOVA was used to determine any significant difference in grip strength between the sexes and the experimental (treatment) conditions. The result of the ANOVA revealed a significant F-ratio for gender and treatment main effects. Scheffé post hoc analysis revealed that males had higher (p less than .01) grip strength than females at all the testing postures and elbow joint angles, and that there was a significant (p less than .05) difference between the grip strength measured in subjects sitting with the elbow in 90 degree flexion and standing with the elbow in full extension. The findings suggest the need for clinicians to maintain standard testing conditions while measuring grip strength.

Adolescent↗
PubMed1998

The development of the skeletal system in children and the influence of muscular strength.

In a study on 14 healthy children aged from 6 to 13 years, the volumetric spongiosa bone density (SBD), cortical bone density (CBD), bone cross-sectional area (BCSA), cortical area (CA), and bone strength index (BSI) at the distal radius were analyzed using peripheral quantitative computer tomography (pQCT Bone Scanner XCT-900, Stratec, Pforzheim, Germany). BSI values were calculated on the basis of the moment of resistance and cortical density using system integrated software. These parameters were correlated with grip strength measurements obtained using a grip dynamometer. There were age-dependent increases in BCSA (r = 0.68), CA (r = 0.78), BSI (r = 0.79). SBD and CBD, however, did not show an increase with age. Grip strength correlates strongly with the parameters of bone geometry BCSA (r = 0.8), CA (r = 0.86), and BSI (r = 0.9) at p < 0.01. SBD and CBD showed no significant correlation to grip strength. The results of this study suggest that an increase in cortical thickness and cross-sectional area represent the most important adaptation mechanisms of the growing bones in response to biomechanical usage. These parameters represent the most important factors of bone strength. Volumetric bone density (material characteristic) of spongiosa and cortical bone is an age-independent parameter which does not change significantly with increasing muscular strength in healthy subjects. These relationships must be considered when selecting parameters to be used as success criteria in studies on the influence of physical exercise on bone status.

Adolescent↗
PubMed2007

Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee.

AIM: This paper reports a study of the effects of aquatic exercise on physical fitness (flexibility, strength and aerobic fitness), self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee. BACKGROUND: Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement. Exercise is important for preventing and/or managing the functional limitations associated with joint disease. Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis; however, few studies have examined the effects on people with osteoarthritis, and these have yielded inconsistent results. METHODS: A two-group randomized controlled trial with a convenience sample was used. Participants were recruited from community sources and randomly assigned to a 12-week aquatic programme or a non-exercise control condition. Data for 38 participants were collected at baseline, week 6, and week 12 during 2003 and 2004. Instruments were a standard plastic goniometer, a handheld dynamometer, the 6-minute walk test, the multidimensional Health Assessment Questionnaire, and a visual analogue scale for pain. RESULTS: Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility, strength and aerobic fitness, but had no effect on self-reported physical functioning and pain. The exercise adherence rate was 81.7%, and no exercise-related adverse effect was observed or reported. CONCLUSIONS: Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee. Although the programme may not offer pain relief or self-reported improvements in physical functioning, results suggest that aquatic exercise does not worsen the joint condition or result in injury. Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients.

Activities of Daily Living↗
PubMed2003

Spasticity, strength, and gait changes after surgery for cervical spondylotic myelopathy: a case report.

STUDY DESIGN: A case report with repeated measures is presented. OBJECTIVE: To describe an objective method for evaluating changes in upper- and lower-extremity spasticity and strength, as well as temporal and kinematic gait variables, after surgical intervention for cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: Degenerative cervical spinal disease is a common disorder, with some form of spondylosis demonstrated radiographically in more than 80% of those older than 55 years. Normative pre- and postoperative objective data quantifying spasticity, strength, and gait do not exist. METHODS: A 65-year-old woman underwent C2-C3 anterior cervical discectomy and fusion for progressive myelopathy secondary to a spondylosis and disc herniation. The measure for spasticity and strength at the ankles and elbows and a gait analysis were collected before surgery and at 11 days, 3 and 6 months after surgery. Spasticity and strength were assessed using a dynamometer, and a six-camera video system was used to record the gait. RESULTS: Preoperative left elbow flexor spasticity was more than 10 times greater than the values for the able bodies. It was reduced to normal levels after surgery. Substantial presurgery weakness was present in the elbow flexors and extensors bilaterally. Elbow extensor strength was at able-body levels after surgery. Gait speed was 57% of the able-body level before surgery and 78% of the able-body level 6 months after surgery. CONCLUSIONS: This case study demonstrated the role of biomechanics in characterizing impairments associated with cervical spondylosis and its surgical intervention. Measures for spasticity, strength, and gait taken before and after surgery indicated a favorable outcome. This report provides a foundation for the continued use of biomechanical methods to measure changes in function and impairments associated with surgical intervention of cervical spine disorders.

Aged↗
PubMed2004

Reliability of isokinetic and isometric knee-extensor force in older women.

Because of the need for efficient, consistent strength measurements, the test-retest reliability of concentric, isometric, and eccentric strength; concentric work; and concentric power was determined in older women without a familiarization session. The reliability of measures derived from a single peak score were compared with those derived from an averaged score. On 2 occasions 25 older women with a mean age of 72 +/- 6 years performed 3 submaximal knee extensions and 5 maximal contractions on an isokinetic dynamometer at 90 degrees/s (CON), 0 degrees/s, and -90 degrees/s on both lower limbs. Statistical analyses for peak and averaged values (best 3 contractions of 5) exhibited good relative reliability (ICCs > .88), except for CON power. Typical error as a coefficient of variation and ratio limits of agreement for peak and averaged score values were larger than desired, with CON power scores demonstrating unacceptable error ranges. Although relative reliability of this 1-session assessment protocol was acceptable, further research is needed to determine whether additional practice trials could enhance absolute reliability.

Aged↗
PubMed1991

Effects of simultaneous training for strength and endurance on upper and lower body strength and running performance.

This study examined simultaneous training for strength and endurance during a 13-week, 3-day a week program of hydraulic resistive circuit training and running. Eighteen college males (U.S. Army ROTC) were placed into low resistance (LR; n = 10) or high resistance (HR; n = 8) groups, and 10 college males were controls and did not train. There were 20 exercise stations (7 upper and lower body, and 6 supplementary). LR and HR performed 2 circuits with a work/rest ratio of 20 to 40 s during the 40 min workout. LR trained at two low resistances (approximately 100 cm.s-1), while HR trained at a higher resistance (approximately 50 cm.s-1). Following the workout, subjects ran 2 miles. Pre and post tests included strength, physical fitness, and anthropometry. Strength was assessed with (1) hydraulic resistance dynamometry for 4 exercises at 2 speeds using a computerized dynamometer (Hydra-Fitness, Belton, TX); (2) isokinetic and isotonic upright squat and supine bench press using the Ariel Exerciser (Trabuco Canyon, CA); (3) concentric and eccentric arm flexion/extension at 60 and 120 degrees.s-1 on the Biodex dynamometer (Shirley, NY), and (4) 1-RM free weight concentric and eccentric arm flexion and extension. The fitness tests included 2-mile run, sit-ups, and push-ups. Anthropometry included 3 fatfolds, 6 girths, and arm and leg volume. There were no significant changes in body composition or interactions between the fitness test measures and the 2 training groups (p greater than 0.05). Improvements averaged 15% (run time), 30% (push-ups), and 19% (sit-ups; p less than 0.05). Significant improvements also occurred in 3 of 8 measures for hydraulic testing (overall change 8.8%), in 3 of 4 1-RM tests (9.4%), and in 2 of 8 Biodex tests (6%), but no significant changes for isokinetic and isotonic squat and bench press (1.9%). The change in overall strength averaged 6.5% compared to 16% in a prior study that used hydraulic resistive training without concomitant running. We conclude that gains in strength were somewhat compromised by the simultaneous run training, and that improvements in strength and run performance were independent of LR and HR training intensity.

Adult↗
PubMedDate not supplied

Simultaneous bilateral testing: validation of a new protocol to detect insincere effort during grip and pinch strength testing.

The detection of feigned weakness in hand grip strength assessment is difficult. The authors review several proposed methods and their weaknesses. A comparison of unilateral testing and simultaneous bilateral testing with the Jamar dynamometer and the Baseline pinch gauge is demonstrated as a solution. An experiment involved 100 asymptomatic subjects who were tested twice, once under instructions to give a full effort and once under instructions to feign weakness. Seven statistical criteria of noncompliance were chosen. Defining noncompliance as failing two or more of the seven criteria, 99% of the instructed noncompliant subjects were correctly classified as noncompliant. No subjects were incorrectly classified as noncompliant during instructed compliant testing. Twelve subjects failed on a single criterion. On retesting, all but one were correctly classified. One subject in the instructed noncompliant group passed all criteria. Accuracy was 99.5%, including retesting of the 12 "gray-zone" subjects.

Adolescent↗