Evaluation Of Muscle Function Research Articles

Use of handgrip strength in the assessment of the muscle function of chronic kidney disease patients on dialysis: a systematic review

Even though handgrip strength (HGS) is considered a simple and reliable method to evaluate muscle function and, indirectly, the nutritional status in clinical settings, there is still no consensus concerning its use in patients with chronic kidney disease (CKD) undergoing dialysis. This study presents a systematic review of the literature on the use of HGS as a parameter for nutritional assessment and a prognostic marker in patients on dialysis. The MEDLINE database (1966 to October 2009) was consulted for this systematic review by using the search terms hand strength or muscle strength dynamometer and dialysis. Eighteen articles were identified and included in the analysis. Similar to the general population, HGS values were associated with age and gender. The analysed studies showed correlation between muscle function estimated by HGS and variables used in the assessment of muscle mass and nutritional status, as well as the prediction of clinical complications. The analysis indicates that HGS is a useful tool for continuous and systematic assessment of muscle mass related to nutritional status in patients on dialysis. However, it is still necessary to standardize the techniques used for HGS, especially with respect to the position of measurement, the evaluation period, the choice of arm side and the diagnostic criterion.

抑制矯正で顎矯正手術を避けることが出来なかった下顎非対称を伴う骨格性下顎前突症例

Interceptive orthodontic treatment is important to prevent malocclusion. This treatment is performed to minimize maxillo-facial deformation and malocclusion by removing their causes from primary dentition in an early stage of the mixed dentition period.This case was mandibular protrusion in the growth period with left deviation of the mandibular bone. Although interceptive orthodontic treatment was performed, facial asymmetry became marked with adolescent growth. As a result, surgical orthodontic treatment was performed upon reaching adulthood.The orthognathic surgery consisted of intraoral vertical ramus osteotomy (IVRO) on the deviated side and sagittal splitting ramus osteotomy (SSRO) on the non-deviated side. Although good results were obtained, we evaluated the effects of interceptive orthodontic treatment during the growth period.This case suggests: 1) To prevent mandibular asymmetry, early treatment from the primary dentition period should be regarded as an option; 2) a chin cap should be used in consideration of the possibility of adverse effects; and 3) evaluation of muscle functions is important to facilitate the normal growth and development of the mandible.

Isokinetic Muscle Performance Test Can Predict the Status of Rotator Cuff Muscle

The isokinetic muscle performance test (IMPT) is a validated and objective method used to evaluate muscle function but it is unknown whether it correlates with severity of rotator cuff tears. We asked whether peak torque and total work deficit on the IMPT correlated with the preoperative manual muscle test (MMT), tear size, fatty degeneration (FD) of cuff, and postoperative cuff integrity in patients after rotator cuff surgery. We evaluated 221 patients who had undergone rotator cuff repair; of these 86 had the IMPT and a CT arthrogram (CTA) 1 year after surgery. We found a correlation (r = 0.125 approximately 0.464) between the preoperative IMPT and MMT. The IMPT deficit was greater in rotator cuff muscles with larger tears and greater degree of FD. Preoperative external and internal rotation deficits on the IMPT were related to the risk of cuff detachment on the postoperative CTA (r = 0.290, 0.319), and the postoperative abduction deficit was greater than 40% of the contralateral side indicating cuff detachment. The IMPT provides objective and quantitative data for estimating the preoperative status of rotator cuff tear and can provide baseline data for postoperative anatomic assessment in patients with rotator cuff disorders. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

M.P.5.02 Evaluating muscle function in mice lacking myostatin by functional nuclear magnetic resonance in vivo: Preliminary results

Deletion of the myostatin gene (mstn-/-) results in spectacular increase in muscle mass, and opened the path to therapeutic approaches. Yet improvement in strength does not necessarily match the observed increase in mass. If function is to be preserved in hypertrophic muscle, adequate oxygen supply and substrate utilization should also be maintained. Multi-parametric functional (mpf) NMR can explore these aspects in vivo and non-invasively. In this work, we simultaneously assessed muscle perfusion, capillary oxygenation level (BOLD), energetic phosphate metabolism and isometric force in response to electrical stimulation in mstn-/- mice. Mstn-/- (n=6) and wild-type (n=10) FVB mice were repeatedly subjected to a “exercise(2min)- recovery(10min)” protocol inside a 4 Tesla NMR imager-spectrometer, using custom-built coils and ergometer. Perfusion/BOLD and phosphocreatine (PCr) were monitored with a time resolution of 10s and 2.5s. Acquisitions were triggered to the electro-stimulation to allow perfusion measurement even during exercise. Phosphorus data were summed across exercises to compensate for the intrinsically low signal without degrading time resolution. A metabolic steady state was reached after the 2nd exercise for force, perfusion, and BOLD. Mstn-/- force was not different from WT when normalized for the 36% increase in muscle cross sectional area measured by NMR imaging. Maximal perfusion at exercise was the same in both groups, but hyperemic profile was prolonged in mstn-/-, and PCr recovery significantly delayed (P<.015). Adapting the mpf-NMR approach to mice makes it possible to non-invasively investigate the interplay of muscle oxygen supply and energetics in vivo. These preliminary findings show that although muscle strength matches its mass in mstn-/-, time to recovery from exercise is prolonged as compared to WT, in terms of oxygen supply and oxidative phosphorylation, compatible with an overall shift towards more glycolytic metabolism.

Performances of One-Dimensional Sonomyography and Surface Electromyography in Tracking Guided Patterns of Wrist Extension

Electromyography (EMG) and ultrasonography have been widely used for skeletal muscle assessment. Recently, it has been demonstrated that the muscle thickness change collected by ultrasound during contraction, namely sonomyography (SMG), can also be used for assessment of muscles and has the potential for prosthetic control. In this study, the performances of one-dimensional sonomyography (1D SMG) and surface EMG (SEMG) signal in tracking the guided patterns of wrist extension were evaluated and compared, and the potential of 1D SMG for skeletal muscle assessment and prosthetic control was investigated. Sixteen adult normal subjects including eight males and eight females participated in the experiment. The subject was instructed to perform the wrist extension under the guidance of displayed sinusoidal, square and triangular waveforms at movement rates of 20, 30, 50 cycles per min. SMG and SEMG root mean squares (RMS) were collected from the extensor carpi radialis, respectively, and their RMS errors in relation to the guiding signals were calculated and compared. It was found that the mean RMS tracking errors of SMG under different movement rates were 18.9% ± 2.6% (mean ± SD), 18.3% ± 4.5%, and 17.0% ± 3.4% for sinusoidal, square and triangular guiding waveforms, while the corresponding values for SEMG were 30.3% ± 0.4%, 29.0% ± 2.7% and 24.7% ± 0.7%, respectively. Paired t test showed that the RMS errors of SMG tracking were significantly smaller than those of SEMG. Significant differences in RMS tracking errors of SMG among the three movement rates ( p < 0.01) for all the guiding waveforms were also observed using one-way analysis of variance (ANOVA). The results suggest that SMG signal, based on further improvement, has great potential to be an alternative method to SEMG to evaluate muscle function and control prostheses. (E-mail: ypzheng@ieee.org)

Muscle contributions to support and progression over a range of walking speeds

Muscles actuate walking by providing vertical support and forward progression of the mass center. To quantify muscle contributions to vertical support and forward progression (i.e., vertical and fore-aft accelerations of the mass center) over a range of walking speeds, three-dimensional muscle-actuated simulations of gait were generated and analyzed for eight subjects walking overground at very slow, slow, free, and fast speeds. We found that gluteus maximus, gluteus medius, vasti, hamstrings, gastrocnemius, and soleus were the primary contributors to support and progression at all speeds. With the exception of gluteus medius, contributions from these muscles generally increased with walking speed. During very slow and slow walking speeds, vertical support in early stance was primarily provided by a straighter limb, such that skeletal alignment, rather than muscles, provided resistance to gravity. When walking speed increased from slow to free, contributions to support from vasti and soleus increased dramatically. Greater stance-phase knee flexion during free and fast walking speeds caused increased vasti force, which provided support but also slowed progression, while contralateral soleus simultaneously provided increased propulsion. This study provides reference data for muscle contributions to support and progression over a wide range of walking speeds and highlights the importance of walking speed when evaluating muscle function.

The Enteral vs Parenteral Nutrition Debate Revisited

Many trials and several meta-analyses have been devoted to comparing enteral with parenteral nutrition support. In this review, these studies are subjected to critical analysis with particular emphasis on their methodology and clinical relevance. Evidence is produced to suggest that the heterogeneous patient populations of the studies and the rigid approach taken to comparing different nutrition therapies inter alia render their conclusions highly questionable and of very doubtful clinical significance. An alternative approach to nutrition research is suggested in which strategies of nutrition support rather than fixed menus are compared. It is suggested that objective measures of intestinal function be evaluated more fully in patients requiring nonvolitional nutrition support, and these are briefly reviewed. In addition, a more scientific approach to evaluating the physiological effects of nutrition support, including chemical tagging and evaluation of muscle function, is recommended.

Characterization of Skeletal Muscle in Osteogenesis Imperfecta Model Mice

Osteogenesis imperfecta (OI), a heritable connective tissue disorder due to mutations in type I procollagen genes, results in bone deformity and fragility. OI model mice (oim) are homozygous for a null mutation in the COL1A2 gene and have significantly reduced bone biomechanical integrity and bone mineral density. Mice heterozygous for the mutation (oim/+) have a phenotype intermediate to that of homozygous (oim/oim) and wild type (+/+) mice. OI patients report reduced muscle capacity and strength, although no systematic evaluation of muscle function and pathology in humans or animal models of OI has been performed. We characterized muscle mass, fiber morphology and contractile generating capacity of oim and oim/+ mice to determine whether muscle weakness is inherent to the disease or due to inactivity. We demonstrated that the contractile generating capacity of hindlimb muscles is not impaired in oim/+ and oim/oim mice relative to +/+ mice; and that muscle cross sectional area and mass/body mass ratios are similar between genotypes, suggesting that oim/+ and oim/oim mice do not have inherent muscle pathology.NIH/T32 RR0007004‐29, MO Res Brd, Leda J Sears Trust Fdn.

Height of Chair Seat and Movement Characteristics in Sit-to-Stand by Young and Elderly Adults

The height of a chair seat affects the burden on the lower limbs during the sit-to-stand (STS). To develop an objective test to evaluate muscle function of the lower limbs using floor reaction force during a STS, the relationship between chair-seat height and the burden on the lower legs must be assessed. To examine the influence of the chair-seat height, floor reaction forces during a STS performed with 5 chair heights adjusted to each subject's lower leg length were compared. The force production and quickness of movement tended to decrease in the phases of trunk flexion and knee and hip joint extension when performing a STS from a lower chair, when the chair height differed by 20% (6.2 cm) from the lower leg length, and was marked when the difference between chair height and lower leg length became larger. In 52 elderly and 50 young adults, floor reaction forces during a STS performed from a chair of the same height as subjects' lower leg lengths were compared. Elderly persons were inferior in force production (strength) and quickness of movement, which decreased as elderly stood up from a chair of a lower height.

Modified trapezius transfer technique for restoration of shoulder abduction in brachial plexus injury

Aims and Objectives: Shoulder stability and restoration are very important in providing greater range of motion to the arm and forearm. When brachial plexus repair does not have the desired outcome and in patients with long standing denervation, the trapezius muscle is frequently used for transfer to restore the shoulder abduction and external rotation. We propose a modified simple technique for trapezius muscle transfer. Materials and Methods: From February 2004 to February 2006, eight patients with posttraumatic brachial plexus injury with insufficient shoulder abduction were treated by trapezius muscle transfer. All patients with brachial plexus palsy were posttraumatic, often resulted from motor cycle accidents. Before operation a full evaluation of muscle function in the affected arm was carried out. All patients were treated with trapezius muscle transfer performed by the modified technique. S-shaped incision from the anterior border of the trapezius just above the clavicle to the Deltoid up to its insertion was made. The accessory nerve and its branches to the trapezius were secured. The trapezius was dissected and detached from its insertion along with the periosteum and sutured to the insertion of the Deltoid muscle. Results: All patients had improved functions and were satisfied with the outcome. The average increase in active abduction of shoulder was from 13.7 degrees (0 to 35 degrees) preoperatively to 116 degrees (45 to 180 degrees) postoperatively and of shoulder flexion from 24.3 degrees (15 to 30 degrees) to 107 degrees (90 to 180 degrees). Conclusion: The modified technique proposed here for trapezius transfer is safe, convenient, simple and reliable for restoration of shoulder abduction and stability with clear subjective benefits.

Électromyographie de surface et fonction musculaire en pathologie

Surface electromyography (SEMG) had been and is still widely used in kinesiology and fatigue studies. Its use in routine clinical neurophysiology remains limited. Patients are requiring non-invasive EMG, which could also benefit to physicians and health care system looking for tools to evaluate muscle function in neuromuscular diseases as well as for therapeutic trials. This is the aim of our clinical studies. We apply SEMG envelope signal analysis acquired from maximal voluntary contractions, and the related compound muscle action potential (CMAP). These unspecific parameters cannot be used for neuromuscular diseases diagnosis, objective under study by many research teams. In nerve lesions follow-up studies, our SEMG procedure is related to motor clinical progression. We are currently evaluating it in chronic neuromuscular diseases. The respective contribution in neuromuscular disorders of the different neurophysiology techniques has still to be confirmed, and compared to force measurement by manual or quantitative testing, dynamometry, other suggested techniques (spectroscopy, imaging) as well as functional scales.

Altered behavioural response to acute stress in mice lacking cellular prion protein

Although many studies have investigated the function of cellular prion protein ( PrP c ), its physiologic role remains elusive. PrP c null mice have been reported to develop normally and to show normal performance in most behavioural tests. In the present study we investigated whether this also holds true after episodes of acute stress. PrP c gene ablated ( Prnp 0/ 0 ) and wild-type mice were subjected to restraint stress, electric foot shock, or swimming and compared with non-stressed animals. Immediately after the stressful situation, the anxiety levels and locomotion of the animals were measured using plus-maze and open-field tests. Among non-stressed animals, there was no significant difference in performance between Prnp 0/ 0 and wild type animals in either test. However, after acute stress provoked by a foot shock or a swimming trial, Prnp 0/ 0 animals showed a significant decrease in anxiety levels when compared with control animals. Moreover, after the swimming test, knockout mice presented decreased locomotion when compared to wild-type mice. Because of this observation, we also assessed both types of mice in a forced swimming test with the objective of better evaluating muscle function and found that Prnp 0/ 0 animals presented reduced forced swimming capacity when compared to controls. As far as we know, this is the first report suggesting that cellular prion protein is involved in modulation of anxiety or muscular activity after acute psychic or physical stress.

Isokinetic principle and its clinical application in orthopaedic rehabilitation

等速运动是一项新的肌肉功能评价和肌力训练方法,作为骨科康复的一项技术,其在肌肉功能评价方面具有较好的准确性和可重复性.等速肌力训练时,运动速度预先在等速仪器上设定,运动中阻力与肌肉实际力量相匹配,是一种顺应性阻力,这使肌肉在整个活动范围内始终承受最大阻力,产生最大肌力.因此,等速肌力训练在骨科康复治疗中即有效又安全。

Trapezius transfer in brachial plexus palsy

Between March 1994 and June 2003, 80 patients with brachial plexus palsy underwent a trapezius transfer. There were 11 women and 69 men with a mean age of 31 years (18 to 69). Before operation a full evaluation of muscle function in the affected arm was carried out. A completely flail arm was found in 37 patients (46%). Some peripheral function in the elbow and hand was seen in 43 (54%). No patient had full active movement of the elbow in combination with adequate function of the hand. Patients were followed up for a mean of 2.4 years (0.8 to 8). We performed the operations according to Saha's technique, with a modification in the last 22 cases. We demonstrated a difference in the results according to the pre-operative status of the muscles and the operative technique. The transfer resulted in an increase of function in all patients and in 74 (95%) a decrease in multidirectional instability of the shoulder. The mean increase in active abduction was from 6 degrees (0 to 45) to 34 degrees (5 to 90) at the last review. The mean forward flexion increased from 12 degrees (0 to 85) to 30 degrees (5 to 90). Abduction (41 degrees) and especially forward flexion (43 degrees) were greater when some residual function of the pectoralis major remained (n = 32). The best results were achieved in those patients with most pre-operative power of the biceps, coracobrachialis and triceps muscles (n = 7), with a mean of 42 degrees of abduction and 56 degrees of forward flexion. Active abduction (28 degrees) and forward flexion (19 degrees) were much less in completely flail shoulders (n = 34). Comparison of the 19 patients with the Saha technique and the 15 with the modified procedure, all with complete paralysis, showed the latter operation to be superior in improving shoulder stability. In all cases a decrease in instability was achieved and inferior subluxation was abolished. The results after trapezius transfer depend on the pre-operative pattern of paralysis and the operative technique. Better results can be achieved in patients who have some function of the biceps, coracobrachialis, pectoralis major and triceps muscles compared with those who have a complete palsy. A simple modification of the operation ensures a decrease in joint instability and an increase in function.

An in vivo model for assessing muscle function during skeletal ischemia-reperfusion injury

Objectives: Acute limb ischemia is associated with a high mortality and amputation rate despite surgical revascularisation, as the ischemia-reperfusion injury that occurs further compromises muscle function. This study's aim was to establish an in vivo assessment of ischemia-reperfusion injury by evaluating muscle function in a rabbit hind-limb model.

Anatomy and histochemistry of spread‐wing posture in birds. 3. Immunohistochemistry of flight muscles and the “shoulder lock” in albatrosses

As a postural behavior, gliding and soaring flight in birds requires less energy than flapping flight. Slow tonic and slow twitch muscle fibers are specialized for sustained contraction with high fatigue resistance and are typically found in muscles associated with posture. Albatrosses are the elite of avian gliders; as such, we wanted to learn how their musculoskeletal system enables them to maintain spread-wing posture for prolonged gliding bouts. We used dissection and immunohistochemistry to evaluate muscle function for gliding flight in Laysan and Black-footed albatrosses. Albatrosses possess a locking mechanism at the shoulder composed of a tendinous sheet that extends from origin to insertion throughout the length of the deep layer of the pectoralis muscle. This fascial "strut" passively maintains horizontal wing orientation during gliding and soaring flight. A number of muscles, which likely facilitate gliding posture, are composed exclusively of slow fibers. These include Mm. coracobrachialis cranialis, extensor metacarpi radialis dorsalis, and deep pectoralis. In addition, a number of other muscles, including triceps scapularis, triceps humeralis, supracoracoideus, and extensor metacarpi radialis ventralis, were found to have populations of slow fibers. We believe that this extensive suite of uniformly slow muscles is associated with sustained gliding and is unique to birds that glide and soar for extended periods. These findings suggest that albatrosses utilize a combination of slow muscle fibers and a rigid limiting tendon for maintaining a prolonged, gliding posture.

Evaluation of muscle function to diagnose catabolism

Evaluation of muscle function to diagnose catabolism

Electromyographic and kinematic analysis of therapeutic knee exercises under water

Objective. This study aimed to evaluate muscle function and kinematics during commonly used knee rehabilitation exercises performed in water. Design. Maximal effort single extension and flexion trials in still water and repeated extension–flexion trials in flowing water in barefoot condition were analysed from 18 healthy participants (8 men, 10 women). Background. Despite the fact that water exercises are widely used, there are only few studies involving biomechanical and hydrodynamical analysis of aquatic exercises in rehabilitation. Methods. Electromyography of the quadriceps (vastus medialis, vastus lateralis) and hamstring muscles (biceps femoris, semitendinosus) and angular velocities of the movements were recorded under water. Results. In the repeated extension–flexion exercises the early reduction of agonist activity occurred concurrently with a high level of activity of the antagonists. In the single trial exercises the level of antagonistic activity was low throughout the range of motion, whereas the level of agonist activity was higher during the final phase of the range of motion as compared with the repeated exercises. Angular velocity patterns and values were similar between the two types of exercises. Conclusions. The present data demonstrated that the flowing properties of water modified the neuromuscular function of the quadriceps and hamstring muscles acting as agonists and antagonists in the knee flexion–extension exercises. Relevance The biomechanical data of the present study indicated that hydrodynamical properties of water, different flowing conditions and the goal of exercises should be carefully taken into account to plan effective therapeutic water exercises.

Development of validated disease activity and damage indices for the juvenile idiopathic inflammatory myopathies. II. The Childhood Myositis Assessment Scale (CMAS): a quantitative tool for the evaluation of muscle function. The Juvenile Dermatomyositis Disease Activity Collaborative Study Group.

To develop, validate, and determine the measurement characteristics of a quantitative tool for assessing the severity of muscle involvement in children with idiopathic inflammatory myopathies. The Childhood Myositis Assessment Scale (CMAS) was developed from 2 existing observational functional assessment tools to assess muscle function in the areas of strength and endurance across a wide range of ability and ages. The 14 ordinal items included were chosen to assess primarily axial and proximal muscle groups and are ranked with standard performance and scoring methods. Following the development of the CMAS, a training video and written instructions were developed and reviewed by the physicians participating in this study. Subsequently, utilizing a randomized block design, 12 physicians independently scored 10 children (9 with dermatomyositis, 1 with polymyositis; ages 4-15 years) twice in one day (morning and afternoon) on the CMAS. A pediatric physical therapist performed quantitative manual muscle strength testing (MMT) twice on each child (morning and afternoon), including the neck, trunk, and proximal and distal extremity muscle groups. The CMAS has a potential range of 0-51, with higher scores indicating greater muscle strength and endurance. The observed mean for the 10 patients was 36.4 (median 44, SD 14.1, observed range 5-51). The total score for the CMAS correlated with the physician's global assessment (by visual analog scale) of disease activity, the MMT score, serum creatine kinase level, and the Juvenile Arthritis Functional Assessment Report score. The score on the CMAS was not correlated with patient age. Interrater reliability (Kendall's coefficient of concordance) ranged from 0.77 to 1.0 for individual items (all P < 0.001), and overall, it was 0.95 (P < 0.001). Intrarater reliability for the individual physicians was measured by correlation of the CMAS scores for each patient on 2 separate evaluations and ranged from 0.97 to 0.99, with an overall correlation for all physicians of 0.98 (all P < 0.001). The CMAS demonstrated an acceptable range of observed scores, excellent convergent validity, and excellent inter- and intrarater reliability. The CMAS is validated to quantitatively assess muscle function in the areas of strength and endurance in children with idiopathic inflammatory myopathies. It can be used in routine clinical care as well as therapeutic trials.

STRENGTH DIFFERENCES IN TRAUMATIC LIMBS WITH LENGTH INEQUALITY

606 A variety of physical characteristics of children, including leg length inequality, may be related to the risk of sustaining a sports injury. Isokinetic muscle strength testing is a popular clinical tool for evaluating muscle function after injury and is used as an indicator for return to activity, such as competitive sport or recreation. To determine muscle strength deficiencies, our purpose was to quantify isokinetic muscle strength of the lower extremities of children who had a leg length discrepency (LLD) due to a femur fracture. Muscle strength data was collected on the hip, knee and ankle joints of eleven recreationally active children who had an LLD due to a traumatic femur fracture. Tests were supine hip flexion/extension at 30 degrees/s, seated knee flexion/extension at 60 degrees/s and prone ankle plantar/dorsiflexion at 30 degrees/s. The testing session included 5 maximal repetitions for each movement. T-tests were used to determine differences between the injured and uninjured and the short and long limbs. 15% deficit was clinically significant. Only hip flexion was significantly stronger in the injured limb. However, only 4 of 11 had clinically significant deficits. We found no strength differences between short and long limbs. No consistent pattern of weakness was seen following femur fracture. An absence of deficiencies would indicate a return to more vigorous activity, such as competitive sport or recreation. This test should be used with other clinical assessments to help determine the extent of lower limb functions.