Showing papers in "Physical Therapy in 1987"
TL;DR: The relationship between the raters' judgments was significant and the reliability was good, and it is believed these results to be positive enough to encourage further trials of the modified Ashworth scale for grading spasticity.
Abstract: We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified Ashworth scale. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. We agreed on 86.7% of our ratings. The Kendall's tau correlation between our grades was .847 (p less than .001). Thus, the relationship between the raters' judgments was significant and the reliability was good. Although the results were limited to the elbow flexor muscle group, we believe them to be positive enough to encourage further trials of the modified Ashworth scale for grading spasticity.
4,788 citations
TL;DR: Clinicians should adopt standardized methods of testing and should interpret and report goniometric results as ROM measurements only, not as measurements of factors that may affect ROM, to improve the reliability and validity of goniometry.
Abstract: Clinical measurement of range of motion is a fundamental evaluation procedure with ubiquitous application in physical therapy. Objective measurements of ROM and correct interpretation of the measurement results can have a substantial impact on the development of the scientific basis of therapeutic interventions. The purpose of this article is to review the related literature on the reliability and validity of goniometric measurements of the extremities. Special emphasis is placed on how the reliability of goniometry is influenced by instrumentation and procedures, differences among joint actions and body regions, passive versus active measurements, intratester versus intertester measurements, and different patient types. Our discussion of validity encourages objective interpretation of the meaning of ROM measurements in light of the purposes and the limitations of goniometry. We conclude that clinicians should adopt standardized methods of testing and should interpret and report goniometric results as ROM measurements only, not as measurements of factors that may affect ROM.
855 citations
TL;DR: Important neurophysiological and clinical considerations for developing measurement tools to assess postural control in adults are summarized.
Abstract: Postural control is the ability to maintain equilibrium and orientation in a gravitational environment. Effective approaches for clinical measurement of postural control remain to be developed. This article summarizes important neurophysiological and clinical considerations for developing measurement tools to assess postural control in adults. The postural control system is divided into three basic functional components for assessment: 1) biomechanical components, 2) motor coordination components, and 3) sensory organization components.
536 citations
TL;DR: Goniometric PROM measurements for the shoulder appear to be highly reliable when taken by the same physical therapist, regardless of the size of the goniometer used, and the degree of intertester reliability appears to be range-of-motion specific.
Abstract: The purpose of this study was to examine the intratester and intertester reliabilities for clinical goniometric measurements of shoulder passive range of motion (PROM) using two different sizes of universal goniometers. Patients were measured without controlling therapist goniometric placement technique or patient position during measurements. Repeated PROM measurements of shoulder flexion, extension, abduction, shoulder horizontal abduction, horizontal adduction, lateral (external) rotation, and medial (internal) rotation were taken of two groups of 50 subjects each. The intratester intraclass correlation coefficients (ICCs) for all motions ranged from .87 to .99. The ICCs for the intertester reliability of PROM measurements of horizontal abduction, horizontal adduction, extension, and medial rotation ranged from .26 to .55. The intertester ICCs for PROM measurements of flexion, abduction, and lateral rotation ranged from .84 to .90. Goniometric PROM measurements for the shoulder appear to be highly reliable when taken by the same physical therapist, regardless of the size of the goniometer used. The degree of intertester reliability for these measurements appears to be range-of-motion specific.
374 citations
TL;DR: Goniometric measurements of the knee joint are both reliable and valid, and the data analysis revealed that the intertester reliability and validity were high.
Abstract: The purposes of this study were to assess the intertester reliability of goniometric measurements at the knee and the validity of the clinical measurements by comparing them to measurements taken from roentgenograms. Thirty healthy subjects between the ages of 20 and 60 years were studied. The subjects were positioned on their right side on a roentgenographic table with their left lower extremity on a stabilizing board that was elevated 15 cm above the table's surface. For standardization of the position, an assistant placed the posterior aspect of the subject's left thigh in contact with two 15-cm pegs, which had been inserted perpendicularly into the stabilizing board. The assistant then moved the left leg to achieve an arbitrary angle of the knee joint and held the limb in that position. Two physical therapists then independently used a standard plastic goniometer to measure the knee joint angle in the sagittal plane using the greater trochanter, the lateral condyle of the femur, the head of the fibula, and the lateral malleolus as bony landmarks. A roentgenogram was taken of the extremity before the subject was moved. Pearson product-moment correlation coefficients (r's) and intraclass correlation coefficients (ICCs) were used to analyze the data. The data analysis revealed that the intertester reliability (r = .98; ICC = .99) and validity (r = .97-.98; ICC = .98-.99) were high. The results of this study indicate that goniometric measurements of the knee joint are both reliable and valid.
324 citations
TL;DR: Although the interrater reliability of the procedure was found to be good to high in the six muscle groups tested, the results of the t tests indicate that hand-held dynamometry should undergo further evaluation.
Abstract: Two raters performed hand-held dynamometer testing of six muscle groups of 30 patients to determine the interrater reliability of the procedure. The six muscle groups tested were the shoulder external rotators, elbow flexors, wrist extensors, hip flexors, knee extensors, and ankle dorsiflexors. The patients were of eight different diagnostic groups, with most having hemiparesis secondary to cerebrovascular accidents. We used Pearson product-moment correlations and t tests to compare the two raters' scores. The correlation coefficients ranged from .84 to .94 ( p < .001). Only two muscle groups (ie, shoulder external rotators and wrist extensors) had mean scores that differed ( p < .05) between raters. Although the interrater reliability of the procedure was found to be good to high in the six muscle groups tested, the results of the t tests indicate that hand-held dynamometry should undergo further evaluation.
317 citations
TL;DR: Both MMT and DMT are reliable testing methods, given the conditions described in this study, which have specific applications and limitations, which are discussed.
Abstract: Physical therapists require an accurate, reliable method for measuring muscle strength. They often use manual muscle testing or hand-held dynametric muscle testing (DMT), but few studies document the reliability of MMT or compare the reliability of the two types of testing. We designed this study to determine the intrarater reliability of MMT and DMT. A physical therapist performed manual and dynametric strength tests of the same five muscle groups on 11 patients and then repeated the tests two days later. The correlation coefficients were high and significantly different from zero for four muscle groups tested dynametrically and for two muscle groups tested manually. The test-retest reliability coefficients for two muscle groups tested manually could not be calculated because the values between subjects were identical. We concluded that both MMT and DMT are reliable testing methods, given the conditions described in this study. Both testing methods have specific applications and limitations, which we discuss.
310 citations
TL;DR: In this paper, the reliability of a computerized analysis system (CAS) for determining muscle burst onset was compared with the subjective assessments of three trained examiners, and the results showed that the system was free of variations in judgment, ensured perfect reproducibility of trial assessments, and was highly useful for analyzing multichannel EMG recordings.
Abstract: The reliability of a computerized analysis system (CAS) for determining muscle burst onset was compared with the subjective assessments of three trained examiners. A sample of 154 randomly selected, full-wave rectified and filtered electromyographic recordings was evaluated using a test-retest paradigm. Percentages of agreement, Pearson product-moment correlations, analyses of variance (ANOVAs), and intraclass correlation coefficients (ICCs) were used to measure the reliability. The between-rater agreement, which included the computerized EMG assessments, was only 23%. Within-rater agreement and Pearson correlation coefficients were perfect for CAS. The trained examiners' within-rater assessments averaged only 51% agreement, but test-retest correlations were high ( r = .78 - r = .82). All ICCs were statistically significant, ranged from .46 to .60, and tended to be higher when the CAS onset determinations were deleted from the analysis. The ANOVAs revealed that trained examiners were more consistent among each other than when their assessments were compared with CAS assessments of EMG recordings. This finding, however, may be facility-specific in that any generalization to other examiners was limited. In contrast to trained examiners, the CAS was free of variations in judgment, ensured perfect reproducibility of trial assessments, and was highly useful for analyzing multichannel EMG recordings. Although the CAS ensures perfect reliability, validity determinations require visual inspection of trial data.
297 citations
TL;DR: How the arch of the foot affects the normal biomechanics of the lower limb is discussed, and specific guidelines are presented for using both soft and permanent orthoses, which offer the foot increased shock absorption and proper structural alignment.
Abstract: The arch of the foot serves as an adaptable, supportive base for the entire body. This article discusses how the arch of the foot affects the normal biomechanics of the lower limb. An anatomical overview of the three components of the arch of the foot is presented, identifying the medial longitudinal arch as the arch mainly responsible for related structural problems throughout the lower limb. Deviations in the normal structure of the medial longitudinal arch produce unbalanced, functionally unstable conditions of the foot such as pes cavus or pes planus. Specific evaluation criteria for both pes cavus and pes planus are discussed, in addition to the adverse effects these two disorders have on weight bearing, force dissipation, and normal gait. Compensatory pronation associated with pes planus is one of the most common lower extremity disorders seen currently by physical therapists working in sports medicine, and its causes and related lower limb disorders are discussed. Most of these structural deformities can be corrected through the use of various orthotic devices. Specific guidelines are presented for using both soft and permanent orthoses, which offer the foot increased shock absorption and proper structural alignment.
183 citations
TL;DR: Using manual muscle testing to make accurate clinical assessments of patient status is of questionable value, and the results showed that interrater reliability for right and left middle trapezius and gluteus medius muscles was low.
Abstract: The purposes of this study were to develop a protocol to examine the reliability of manual muscle testing in a clinical setting and to use that protocol to assess the interrater reliability of manually testing the strength of the middle trapezius and gluteus medius muscles. One hundred ten patients with various diagnoses participated as subjects, and 11 physical therapists participated as examiners in this study. The results showed that interrater reliability for right and left middle trapezius and gluteus medius muscles was low. The percentage of therapists obtaining a rating of the same grade or within one third of a grade ranged from 50% to 60% for the four muscles. This study indicates that using manual muscle testing to make accurate clinical assessments of patient status is of questionable value.
165 citations
TL;DR: The results suggest that joint receptors play a dominant role in joint angle detection and that muscle receptors are more valuable in the perception of joint movement.
Abstract: The purpose of this study was to examine the effects of recurrent lateral ankle sprains on subjects' active and passive judgments of joint position. Fourteen subjects with recurrent unilateral ankle sprains contributed data to two groups: 1) In Group 1, the subjects' 14 sprained ankles were tested and 2) in Group 2, the same 14 subjects' contralateral nonsprained ankles were tested. An additional seven subjects with no history of injury to either ankle comprised Group 3 with 14 nonsprained control ankles. The experimenter tested all blindfolded subjects with active and passive attempts at replicating predetermined ankle joint positions in the inversion-eversion range of motion. An isokinetic dynamometer measured joint position. A two-way analysis of variance indicated no significant effect caused by ankle injury or noninjury. Passive judgments were significantly better than active judgments of joint position ( p < .01) in the nonsprained control group. The results suggest that joint receptors play a dominant role in joint angle detection and that muscle receptors are more valuable in the perception of joint movement.
TL;DR: Good reliability was obtained in the atrophy inspection of the small muscles of the hand, in the sensitivity tests for touch and pain, and in the neck compression and axial manual traction tests, but poor reliability was obtaining for many palpations.
Abstract: The purpose of this study was to collect data on interexaminer reliability of a set of tests representative of the clinical examination of a patient with neck and radicular pain. A conventional neurological examination, palpations, and tests for the provocation or relief of radicular symptoms were performed on 52 patients by two independent raters. Good reliability was obtained in the atrophy inspection of the small muscles of the hand, in the sensitivity tests for touch and pain, and in the neck compression and axial manual traction tests. Fair reliability was obtained in muscle strength testing and in the estimation of the range of motion, and poor reliability was obtained for many palpations. Poor standardization of examination procedures and changes in the patients' attention were considered the main factors affecting reliability. Better operational definitions and procedures, such as the standardization of palpation pressure and traction force, are suggested for future studies.
TL;DR: With increased emphasis from third-party payers and from the medical community for documentation of the effectiveness of physical therapy services, therapists must be aware how they can and cannot use isokinetic measurements in their clinical settings.
Abstract: Isokinetic measurements are widely used by physical therapists for evaluation and treatment planning. We believe that some use of isokinetic measurements is unwarranted in view of the paucity of credible scientific research on these measurements. With increased emphasis from third-party payers and from the medical community for documentation of the effectiveness of physical therapy services, we believe that therapists must be aware how they can and cannot use isokinetic measurements in their clinical settings. Concepts that relate to isokinetic testing are discussed and critically examined.
TL;DR: The results indicate that lumbar lordosis, pelvic tilt, and abdominal muscle function during normal standing are not related, and the need for a reexamination of clinical practices based on assumed relationships of abdominal muscle performance, pelvic tilted, and lordosis is demonstrated.
Abstract: The purpose of this study was to examine the relationships between measurements of lumbar lordosis, pelvic tilt, and abdominal muscle performance during normal standing. In addition, the reliability of the measurements used in this study was examined. Measurements of lumbar lordosis, pelvic tilt, and abdominal muscle performance were taken of 31 healthy adults aged 20 to 33 years. Each measurement was taken twice, and the measurements were shown to be reliable. The Spearman's rho correlation of the abdominal muscle performance measurements with pelvic tilt was .18 and with lordosis was .06. The Pearson product-moment correlation of lordosis with pelvic tilt was .32. The results indicate that lumbar lordosis, pelvic tilt, and abdominal muscle function during normal standing are not related. This study demonstrates the need for a reexamination of clinical practices based on assumed relationships of abdominal muscle performance, pelvic tilt, and lordosis.
TL;DR: Results indicate that TCC is an effective and rapid treatment for chronic plantar ulcers in patients with or without vascular compromise secondary to diabetes mellitus, and suggest that pressure reduction on the insensitive foot should be considered in treatment.
Abstract: The purpose of this clinical report is to describe the healing times of plantar ulcers treated by total contact casting (TCC) in nondiabetic and diabetic patients with and without evidence of severe peripheral vascular disease. Thirty patients with 33 chronic plantar ulcers were treated by applying total contact walking casts. Results demonstrate that 27 of 33 ulcers (81.8%) healed in an average time of 43.6 days. Healing times of patients with severe peripheral vascular disease secondary to diabetes mellitus are similar to those of patients without evidence of vascular disease. These results indicate that TCC is an effective and rapid treatment for chronic plantar ulcers in patients with or without vascular compromise secondary to diabetes mellitus. In addition, the results suggest that pressure reduction on the insensitive foot should be considered in treatment.
TL;DR: Increased tonic EMG levels produced by input from other neural pathways affecting alpha motoneurons in the AC and HR-AC procedures may have masked this inhibitory reflex.
Abstract: Volitional muscle contractions are used frequently in some combination with muscle stretching to promote muscle relaxation and to increase range of motion. In this study, muscle lengthening procedures were evaluated in the ankle plantar flexors. Four soleus muscle stretching procedures—static stretch (SS), hold relax (HR) (isometric plantar flexor contraction before stretch), agonist contract (AC) (dorsiflexor contraction assisting stretch), and hold relax-agonist contraction (HR-AC)—were performed in the sagittal plane by 12 physically active adults. The dorsiflexion angle, soleus muscle electromyogram, and soleus muscle motoneuron excitability as determined by the Hoffmann-reflex (H-reflex) amplitude were measured throughout the duration of each stretch. The range of dorsiflexion achieved at the end of the stretch did not differ significantly between stretching procedures, although in 8 of the 12 subjects and in the subject group as a whole, the AC and HR-AC procedures were associated with higher levels of soleus muscle EMG than the levels in the SS and HR procedures ( p < .01). The H-reflex amplitudes during the AC and HR-AC procedures were smaller than the amplitudes during the SS and HR procedures ( p < .001), suggesting the possibility of reciprocal inhibition during the agonist contraction. Increased tonic EMG levels produced by input from other neural pathways affecting alpha motoneurons in the AC and HR-AC procedures may have masked this inhibitory reflex. In healthy adults, a complicated procedure, involving muscle contractions for decreasing active resistance to stretch, may be unnecessary because 1) active resistance to stretch is minimal and 2) muscle relaxation during stretch appears to have little or no direct effect on the ROM achieved.
TL;DR: The widespread introduction of computers into clinical settings has increased the feasibility of conducting comprehensive functional disability assessment and disability assessment tools like the FSQ can be adapted easily for clinical use by physical therapists.
Abstract: The widespread introduction of computers into clinical settings has increased the feasibility of conducting comprehensive functional disability assessment. The Functional Status Questionnaire (FSQ) is a brief, self-administered questionnaire designed to facilitate clinical assessment of functional disability. The FSQ items can be scored by computer using a simple algorithm and summarized into disability index scores. These scales have alpha reliability coefficients of .64 to .82 and substantial convergent validity when used with primary care patients. Disability assessment tools like the FSQ can be adapted easily for clinical use by physical therapists.
TL;DR: For this group of young adults, no significant correlations existed between the vertical fingertip-floor distance and limb length and abdominal girth at maximum trunk flexion.
Abstract: The primary purpose of this study was to investigate the relationships between the vertical fingertip-floor distance (FFD) and the hip and vertebral components of trunk flexion during the toe-touch test. Measurements were taken from lateral photographs of each subject standing in the erect and maximally flexed positions. The subjects were healthy young men (n = 16) and women (n = 17). The mean FFD was 3 cm below floor level (-3 cm) with a standard deviation of 8 cm. Reliability of this measure was indicated by a test-retest correlation coefficient of .97. The FFD was a measure of both trunk (r = -.85) and hip flexion (r = -.79), but not of vertebral flexion (r = .10). At maximum trunk flexion, therefore, FFD is mainly a measure of the extensibility of the hamstring muscles that limit hip flexion when the knees remain extended. The toe-touch test was determined to be unsuitable for monitoring the effect of a treatment regimen to improve vertebral mobility because the partial correlation coefficient between vertebral flexion and FFD was -.64 (p less than .01), with the effect of hip flexion held constant. Although this correlation is significant, it means that less than half of the variation in FFD can be explained by changes in vertebral mobility. For this group of young adults, no significant correlations existed between the FFD and limb length and abdominal girth at maximum trunk flexion.
TL;DR: It is believed a clinician can use the knee ligament arthrometer to obtain objective and reliable measurements of A-P laxity of the knee and relatively high reliability coefficients are indicated.
Abstract: The purpose of this study was to determine examiner reliability with the use of a knee ligament arthrometer to measure the anterior-posterior (A-P) laxity of the right knee. Two clinicians performed an A-P laxity measurement on 43 healthy, male subjects. The first examiner positioned the arthrometer, recorded the subject's A-P laxity, removed the instrument, and repeated the measurement. A second examiner performed the same procedure. Subsequently, we computed interexaminer, intraexaminer, and intraclass reliability coefficients. Our results indicated relatively high reliability coefficients. We believe a clinician can use the knee ligament arthrometer to obtain objective and reliable measurements of A-P laxity of the knee.
TL;DR: It is demonstrated for the first time on human subjects that static stretch and ultrasound (SS and US) combined increases triceps surae muscle extensibility more than SS alone.
Abstract: The purpose of the study was to demonstrate for the first time on human subjects that static stretch and ultrasound (SS and US) combined increases triceps surae muscle extensibility more than SS alone. The SS and US combined consisted of seven minutes of continuous US at 1.5 W/cm2 to the muscle with SS during the seventh minute. The SS alone consisted of a 51-lb (23.1 kg) load applied for one minute. We randomly assigned 10 healthy, female subjects to each of three groups (N = 30). Each group received each of the three types of treatment (SS and US, SS, and no treatment) in a different order. Standardized goniometric measurements of active dorsiflexion were taken before and after each treatment session. The SS and US treatment increased dorsiflexion an average of 1.2 degrees, or 20%, more than the SS treatment. The SS treatment increased dorsiflexion an average of 1.3 degrees, or 27%, more than no treatment. Both increases were statistically significant.
TL;DR: The ability of wet ice, dry ice, and cryogenic packs to reduce and maintain the reduction of skin temperature directly under the cooling agent and to determine whether the cooling effect on skin extended beyond the surface area in contact with the coolingAgent are evaluated.
Abstract: The purposes of this study were to evaluate and compare the ability of wet ice (WI), dry ice (DI), and cryogen packs (CGPs) to reduce and maintain the reduction of skin temperature directly under the cooling agent and to determine whether the cooling effect on skin extended beyond the surface area in contact with the cooling agent. Ten female volunteers participated in the study, and each of the three cold modalities was applied randomly to the skin overlying the right triceps surae muscle. After 15 minutes of cold application, mean skin temperatures recorded under WI, DI, and CGP decreased 12°, 9.9°, and 7.3°C, respectively. The only significant differences in cooling were between WI and DI and between WI and CGP. Fifteen minutes after removal of the cold modalities, no significant differences were found in mean skin temperature between WI, DI, and CGP. The residual mean decrease in skin temperature between the pretreatment rest interval (time 0) and 15 minutes after removal of the cold modality (time 30) was significant for WI only. No cooling was demonstrated 1 cm proximal or distal to any of the cooling agents after 15 minutes of cold application. These findings provide valuable information for the use of cryotherapy in the clinical setting.
TL;DR: The results of this study show that orientation of the body in space affects upper extremity function and emphasizes the importance of positioning for maximizing upper extremities function.
Abstract: This study was conducted to determine the effect of body orientation on upper extremity function in children and adolescents with cerebral palsy. Thirteen children between ages 8 and 16 and diagnosed as having spastic or athetoid cerebral palsy were placed randomly in different seating orientations (30 degrees, 15 degrees, and 0 degrees of posterior inclination and 15 degrees of anterior inclination). In each seating position, the subject performed an upper extremity activity on cue. The tests were repeated in reverse sequence. Mean performance times were different at all seating orientations for both types of subjects. Performance time was lowest at the 0-degree orientation during the retest for the subjects with spasticity and highest at 15-degree anterior inclination during the retest for the subjects with athetosis. The results of this study show that orientation of the body in space affects upper extremity function and emphasizes the importance of positioning for maximizing upper extremity function.
TL;DR: The variables of age, lower extremity contractures, strength of the affected hip abductor muscles, type of surgical technique, number of visits to physical therapy, and number of days from surgery to discharge were associated with independence in ambulation.
Abstract: The ability to achieve independent ambulation after hip fracture, orthopedic stabilization, and subsequent rehabilitation was studied in 65 inpatients in a specialized geriatric rehabilitation center. The association of 10 factors with the ability to achieve independent ambulation was measured by Kendall's tau B analysis and a two-tailed t test. The 10 factors were sex, age, surgical technique, side of fracture, site of fracture, presence of previous fracture, presence of lower extremity contractures, strength of hip abductor muscles, number of visits to physical therapy, and number of days from surgery to discharge from physical therapy. Measurements were taken at discharge from physical therapy, at 60 days after surgery, and one year after surgery. Fifty-four (83%) of the 65 patients reached independent ambulation at some time between the date of surgery and one year later. At one year after surgery, only 4 of the 65 patients had died. The variables of age, lower extremity contractures, strength of the affected hip abductor muscles, type of surgical technique, number of visits to physical therapy, and number of days from surgery to discharge were associated with independence in ambulation.
TL;DR: It is concluded that more information is needed about the effects of low back schools so that they may be improved.
Abstract: The purpose of this article is to review and evaluate the empirical literature concerning low back schools. Although the low back school is a popular method of dealing with the growing number of patients with back pain, a general lack of studies exists of the effectiveness of this intervention technique. The studies that have been conducted, moreover, often lack control conditions and appropriate measurement techniques. The goal of most schools is to increase "self-care" behaviors and thereby decrease other related problems, such as pain intensity and absenteeism. The literature, however, provides limited support for the idea that a low back school can influence variables such as the number of health care contacts, sick leave, work status, pain intensity or duration, activity level, or medication consumption. Whether the patient's level of knowledge improves as a result of attending the low back school is unclear. Some evidence suggests that patients' attitudes toward back care do change. We conclude, therefore, that more information is needed about the effects of low back schools so that they may be improved. A central concept of low back school programs that should be examined is patient compliance. How well patients comprehend the material presented in the low back school or whether the school results in behavioral changes in the participants remains to be determined.
TL;DR: The author proposes that the incidence and degree of diastasis recti abdominis may be underestimated, that selected components of exercise prescriptions may be contraindicated, and that a reliable instrument for measuring the degree of separation is needed.
Abstract: Diastasis recti abdominis, or midline separation of the abdominal musculature, has not been investigated scientifically. The purposes of this study were to provide data on the incidence and degree of diastasis recti abdominis, to describe the measurement system used, and to determine the interrater reliability of the measurements performed. Forty subjects less than four days postpartum were tested by four raters. All subjects were measured in a supine, flexed-knee position at a standard point of palpation above the umbilicus. During palpation, each subject performed a partial sit-up, and the rater determined the number of finger widths filling the separation. An analysis of variance for repeated measures revealed a highly significant difference between the measurement scores of the four raters. This measurement system, therefore, was found to be unreliable. All subjects had some degree of diastasis recti abdominis; over 60% had separations significant enough to warrant protective exercises. The author proposes that the incidence and degree of diastasis recti abdominis may be underestimated, that selected components of exercise prescriptions may be contraindicated, and that a reliable instrument for measuring the degree of separation is needed.
TL;DR: The results do not confirm the common expectation of relatively lesser involvement of the elbow flexor muscles after a CVA, but suggest that patients improve in muscle strength concurrent with a rehabilitation program.
Abstract: This retrospective investigation was undertaken to describe and compare the initial and discharge strength deficits of eight upper extremity muscle groups of 42 patients who were hemiparetic secondary to cerebrovascular accidents (CVAs). Static strengths of the eight muscle groups were measured using a hand-held dynamometer, and strength deficits were calculated against the side ipsilateral to the side affected by the CVA. A two-way analysis of variance for repeated measures revealed significant differences ( p < .001) in the strength deficits of the eight muscle groups and between initial and discharge strength deficits. The strength deficits of the shoulder medial rotator and abductor muscle groups were significantly less than those of any other muscle group. No difference was found in the proportion of muscle groups improving in strength in patients tested within six weeks after the onset of hemiplegia versus patients tested six weeks later. Our results do not confirm the common expectation of relatively lesser involvement of the elbow flexor muscles after a CVA. The results do suggest that patients improve in muscle strength concurrent with a rehabilitation program.
TL;DR: The patellofemoral joint forces were increased with increased work load or decreased saddle height, and different pedaling rates or foot positions did not significantly change these forces.
Abstract: We estimated the patellofemoral joint forces generated during pedaling on a bicycle ergometer. Our calculations were based on measurements from a force transducer mounted on the pedal, 16-mm cine-film sequences, and biomechanical models of the cycling motion and of the patellofemoral joint. Six healthy male subjects cycled at different work loads, pedaling rates, saddle heights, and pedal foot positions. The maximum patellofemoral compressive force was 905 N (1.3 times body weight [BW]) when cycling with an anterior foot position at 120 W, 60 rpm, and middle saddle height. The mean peak compressive force between the quadriceps tendon and the intercondylar groove was 295 N (0.4 BW), and the patellar-tendon and quadriceps-tendon strain forces were 661 N (0.9 BW) and 938 N (1.3 BW), respectively. The patellofemoral joint forces were increased with increased work load or decreased saddle height. Different pedaling rates or foot positions did not significantly change these forces.
TL;DR: The study findings indicate that spinal ROM covers a wide spectrum of values and is affected by many individual factors, and any attempts to determine what is normal, excessive, or diminished must take into account variations caused by age, sex, and other physical attributes.
Abstract: We conducted an investigation to examine the spinal flexibility of a large, adult population and to study the effects of other individual physical characteristics on spinal range of motion. The study group consisted of 3,020 blue collar employees (2,350 men and 670 women) who underwent a physical examination that included assessments of standing and sitting height, weight, shoulder flexibility, and spinal flexibility in the sagittal and frontal planes. Flexibility measures were correlated positively to one another; however, lumbosacral flexion measurements assessed by the modified Schober method correlated to the other flexibility measurements to a much lesser degree. Age, sex, and height affected ROM, as did obesity and the ratio of standing height to sitting height. The study findings indicate that spinal ROM covers a wide spectrum of values and is affected by many individual factors. Any attempts to determine what is normal, excessive, or diminished must take into account variations caused by age, sex, and other physical attributes.
TL;DR: Consecutive concentric-eccentric testing and lack of mechanical stabilization might have contributed to test-retest variability and to the relatively small differences between concentric and eccentric torques.
Abstract: The purposes of this study were to describe torque-velocity relationships during concentric, eccentric, and isometric testing of elbow flexor muscles and to determine test-retest reliability of a specific isokinetic testing protocol. Thirty healthy women were tested using an isokinetic dynamometer at velocities of 0°, 30°, 120°, and 210°/sec. Reliability was assessed in 20 of the subjects by retesting concentric and eccentric torques at 30° and 120°/sec after a 30-minute rest interval. The highest torque from three maximal efforts was considered to be peak torque. Mean eccentric peak torque was greater than either isometric or concentric peak torque; as isokinetic test velocity increased, the differences between concentric and eccentric torques became larger. Intraclass correlation coefficients ranged from .72 to .83, indicating lack of consistency between test and retest torques. Consecutive concentric-eccentric testing and lack of mechanical stabilization might have contributed to test-retest variability and to the relatively small differences between concentric and eccentric torques. Continued study of reliability of isokinetic testing protocols and further investigation of concentric-eccentric torque-velocity relationships are advocated.
TL;DR: Muscle group spasticity and strength deficits appear to be covarying manifestations of cerebrovascular accidents, and clinicians may interpret an agonist muscle's capacity for force production in light of its own tone rather than that of its antagonist.
Abstract: The purpose of this retrospective investigation was to determine whether a relationship exists between static strength deficits in the shoulder medial (internal) rotator and elbow flexor muscles and spasticity in these muscles or their antagonists. We reviewed the records of the first 50 stroke patients with hemiparesis who met the entry criteria for the study and who were admitted over a four-month period of time. Static muscle strength was measured by hand-held dynamometry. Spasticity was graded on the Ashworth scale. Kendall's tau correlations were calculated between static muscle strength deficits and spasticity. Static strength deficits of the shoulder medial rotator and elbow flexor muscles were correlated (p less than .01) with the agonist muscles' spasticity, but not with the antagonist muscles' spasticity. Muscle group spasticity and strength deficits, therefore, appear to be covarying manifestations of cerebrovascular accidents. Clinicians, thus, may interpret an agonist muscle's capacity for force production in light of its own tone rather than that of its antagonist.