Manual Muscle Strength Testing Research Articles

Selected morphological, cardiovascular and neuromuscular risk profiles among asymptomatic sedentary men performing Islamic prayer

BackgroundThis study investigated morphological, cardiovascular and neuromuscular profiles among asymptomatic sedentary men performing the Islamic prayer (Salaah). This study emphasised the need for an inquiry into unique sedentary populations who...

Review of outcomes measures used to evaluate upper extremity surgical treatment of cervical spinal cord injury with recommendations for the future

Cervical spinal cord injury is a life-altering event that profoundly affects an individual’s upper extremity function. Nerve transfer surgeries have been shown to restore more natural movement and fine motor control in this population. At present, there is no consensus on how to evaluate the efficacy of these restorative surgeries. The purpose of this work was to perform a comprehensive review of the existing literature and describe the outcome measures used. We hypothesized that the assessments will be heterogeneous across studies and will incompletely capture the effect of nerve transfers on upper extremity motion in cervical spinal cord injury. A search strategy was designed and a review of multiple databases (Embase.com, Ovid-Medline All, and Scopus) yielded 481 articles; 26 unique studies met inclusion criteria and underwent analysis. Both manual muscle strength testing and video content were presented in the majority of studies. Outcome assessments including myometry, functional outcomes measures (such as the grasp and release test), patient-reported outcomes (including generic, extremity, and disease-specific types), and custom de novo questionnaires were used variably across studies. Future work should focus on standardizing outcomes measures in the field and developing and incorporating kinematic analysis to quantify the intricate, coordinated, and precise movement attained after nerve transfer surgery in the setting of cervical spinal cord injury.

Hypokalemic periodic paralysis: a 3-year follow-up study

Background and objectivesPrimary hypokalemic periodic paralysis (HypoPP) is an inherited channelopathy most commonly caused by mutations in CACNA1S. HypoPP can present with different phenotypes: periodic paralysis (PP), permanent muscle weakness (PW), and mixed weakness (MW) with both periodic and permanent weakness. Little is known about the natural history of HypoPP.MethodsIn this 3-year follow-up study, we used the MRC scale for manual muscle strength testing and whole-body muscle MRI (Mercuri score) to assess disease progression in individuals with HypoPP-causing mutations in CACNA1S.ResultsWe included 25 men (mean age 43 years, range 18–76 years) and 12 women (mean age 42 years, range 18–76 years). Two participants were asymptomatic, 21 had PP, 12 MW, and two PW. The median number of months between baseline and follow-up was 42 (range 26–52). Muscle strength declined in 11 patients during follow-up. Four of the patients with a decline in muscle strength had no attacks of paralysis during follow-up, and two of these patients had never had attacks of paralysis. Fat replacement of muscles increased in 27 patients during follow-up. Eight of the patients with increased fat replacement had no attacks of paralysis during follow-up, and two of these patients had never had attacks of paralysis.DiscussionThe study demonstrates that HypoPP can be a progressive myopathy in both patients with and without attacks of paralysis.

Case Report of Cellgram® Autologous Mesenchymal Stem Cell Treatment for Relapsing-Remitting Multiple Sclerosis

Multiple sclerosis is an autoimmune disease of the central nervous system that is increasing worldwide but difficult to diagnose and treat. Previous studies have revealed that the autologous Mesenchymal Stem Cells (MSC) for MS may serve as a possible effective tool for cell-based therapy of inflammatory, immune-mediated, and degenerative diseases due to their immunomodulatory, immunosuppressive, and regenerative potentials. This case report presents a patient diagnosed with Relapsing-Remitting Multiple Sclerosis (RRMS) who was treated with an autologous mesenchymal stem cell drug (Cellgram®). We administered two doses of Cellgram® to a 54-year-old Southwest Asian male with a 28-year history of RRMS. Changes were also observed in manual muscle strength test, range of motion, and lower extremity stiffness, but the biggest change was in functional performance. Before treatment, the patient was unable to stand without assistance even with an orthosis, but was able to stand up from a wheelchair using a walker on the 24th day after the first injection, and was able to stand up from the wheelchair without assistance on the 26th day. Thirty days after the first injection, and 3 days after the second injection, he was able to walk a few steps back and forth using a walker. Five months after the first injection, he was able to climb six steps. In conclusion, this case report illustrates that MSC therapy might serve as a potential therapeutic option for RRMS as it may be a safe and effective treatment for MS patients.

Motor Strength Measurements Obtained Using an Inexpensive Spring Tensiometer and a Clinical Dynamometer Correlated Well: A Prospective Cohort Study

Manual muscle strength testing is the primary method for testing muscle strength in clinical settings but is highly subjective. An objective measure of muscle strength can be obtained using a handheld dynamometer, but its cost inhibits its widespread usage. We hypothesized that a spring tensiometer (ST) could be an objective tool that can be used as a viable alternative to a dynamometer. Twenty-six outpatients were included, and the strengths of several muscle groups were measured using tensiometers and dynamometers. A paired t-test and Pearson's correlation coefficient and Bland-Altman plot analyses were used to estimate the reliability and measurement accuracy of both tools. Multiple regression analysis was performed to identify the factors contributing to the measurement gap between the two instruments. A total of 260 muscle force values were evaluated. Pearson's correlation coefficient and Bland-Altman analyses indicated that the measurements of the two instruments were strongly correlated and highly accurate. In the multiple regression analysis, the gap between the two instruments was significantly related to the original muscle strength and muscle part but was not significantly related to sex, age, body mass index, or laterality. For biceps and triceps muscle groups, the correlations were particularly strong and accurate, indicating that a tensiometer could be well substituted for a dynamometer. Our data show that a ST is similar to a dynamometer in terms of precision. A ST is an inexpensive alternative to a dynamometer and more accessible for clinical use than a dynamometer.

Neuromuscular Ultrasound in Intensive Care Unit-Acquired Weakness: Current State and Future Directions.

Intensive care unit-acquired weakness (ICUAW) is one of the most common causes of muscle atrophy and functional disability in critically ill intensive care patients. Clinical examination, manual muscle strength testing and monitoring are frequently hampered by sedation, delirium and cognitive impairment. Many different attempts have been made to evaluate alternative compliance-independent methods, such as muscle biopsies, nerve conduction studies, electromyography and serum biomarkers. However, they are invasive, time-consuming and often require special expertise to perform, making them vastly impractical for daily intensive care medicine. Ultrasound is a broadly accepted, non-invasive, bedside-accessible diagnostic tool and well established in various clinical applications. Hereby, neuromuscular ultrasound (NMUS), in particular, has been proven to be of significant diagnostic value in many different neuromuscular diseases. In ICUAW, NMUS has been shown to detect and monitor alterations of muscles and nerves, and might help to predict patient outcome. This narrative review is focused on the recent scientific literature investigating NMUS in ICUAW and highlights the current state and future opportunities of this promising diagnostic tool.

Resistance Training in Wilson Disease: A Case Study

A 15-year-old boy was diagnosed with Wilson disease and referred to a physiotherapy clinic for treatment. He received daily physical therapy exercises with resistance training three times a week for 70 minutes for 8 weeks. The performance of daily activities was evaluated using the Persian version of the disabilities of the arm, shoulder, and hand (DASH) questionnaire. Upper limb muscle strength was assessed using a manual muscle strength test. The DASH questionnaire score decreased from 67.24 before treatment to 46.55 after 4 weeks and 36.20 after 8 weeks. In addition, shoulder flexion and extension are improved. The analysis of resistance exercises to facilitate distal muscles through the use of manual muscle tests showed an improvement in the strength of both hands. The present study suggests that regular physical therapy and exercise may help improve daily activity and muscle strength in Wilson disease.

Effect of Alternative Therapeutic Exercise on the Older Adults – A Pilot Study

IntroductionRegular physical activity is essential for sedentary older adults (aged 65 years and above) who are at the risk for multiple comorbidities. By performing physical activity, older adults can maintain or improve their physical function and mobility that may help them to be independent for a long time and delay the occurrence of disability in the future.ObjectiveTo assess the effect of the eccentric exercises prior to tai chi and yoga performance in the activities of daily living (ADL), balance and gait, and muscle strength in older adults.MethodsNine sedentary independent older adults aged between 60 and 90 were recruited. The study included the medical pre‐protocol assessment, the eccentric (ECC) exercise protocol with and without tai chi and yoga, subjective (Health activities of daily living (ADL) difficulty scale), and objective (Tinetti balance and gait, muscle strength) assessments, and medical post‐protocol assessment.ResultsThe functional limitations, Tinetti balance and gait score, manual muscle strength testing, and active range of motion (AROM) were improved in the medical post‐protocol assessment. Muscle strength showed statistically significant differences on the shoulder abductors (P=0.035), the elbow extensors (P=0.046), the hip abductors (P=0.028) and the hip extensors (P=0.03).ConclusionsOur findings show low perceived exercises (ECC) prior to tai chi and yoga training are well suited to the sedentary independent older adults with chronic conditions.

Reproducible measurement conditions for knee extensor strength using an inexpensive, simple manual muscle strength test: An investigation of inter- and intra-examiner reliability and absolute reliability using generalizability theory

Reproducible measurement conditions for knee extensor strength using an inexpensive, simple manual muscle strength test: An investigation of inter- and intra-examiner reliability and absolute reliability using generalizability theory

A COMPARISON OF SOME ANTHROPOMETRIC AND MOTOR FEATURES OF VISUALLY IMPAIRED STUDENTS WHO PLAY SPORTS AND THOSE WHO DO NOT PLAY SPORTS IN SCHOOLS FOR THE VISUALLY IMPAIRED IN TURKEY

Purpose: The aim of this study is to compare certain anthropometric and motor features of visually impaired students who play sports and those who do not play sports in schools for the visually impaired in Turkey. It is thought that the sport has an important place in the rehabilitation of disabled people and also has an effect on their physical characteristics. Material and Methods: In this context, 98 visually impaired students who played sports regularly (72 male, 26 female) and 189 visually impaired students who did not play sports regularly (110 male, 79 female) participated in our study. In the study, participants’ gender, age, height, body weight, body mass index, girth, and motor features such as flamingo balance test, flexibility, standing long jump, sit-up, bent arm hang, 10 x 5m shuttlerun, grip strength, vertical jump, abdominal strength, back strength, hip flexion strength, hip extension strength, leg flexion strength, leg extension strength, arm strength and arm extension strength were measured. During the strength measurements, Lovett’s Manual Muscle Strength Test was utilised. Results: In the study, significant differences were found between visually impaired students who played sports and those who did not play sports in terms of age, height, grip strength, vertical jump, balance test, flexibility, long jump, sit-up, bent arm hang, 10 x 5m shuttle run, abdominal strength, back strength, hip flexion strength, hip extension strength, leg flexion strength, leg extension strength, arm flexion strength and arm extension strength (p<0.05). However, no significant differences were found in terms of body weight, body mass index or girth (p>0.05). Conclusion: Examination of the test results of the study reveals that visually impaired students who played sports had higher performance levels than those of students who did not play sports. It is recommended that visually impaired students, as well as being given physical education lessons, should take part in more mobility games and sporting activities, or that more mobility games and sporting activities should be included in course curricula. 
 
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Health-related quality of life and work impairment in idiopathic inflammatory myopathies in South Australia.

The idiopathic inflammatory myopathies (IIM) are rare autoimmune diseases that are usually chronic and often present with skeletal muscle inflammation and weakness. We sought to examine the impact of IIM in a cohort of 50 South Australian patients on health-related quality of life (HRQOL) and work productivity (WP). We uniquely categorized patients across gender, IIM subtypes, employment status, and also whether there was extramuscular involvement from IIM. Multiple modalities were used, as recommended by the International Myositis Assessment and Clinical Studies Group (IMACS), to assess the impact of IIM, including manual muscle strength testing (MMT-8), the Physician and Patient Global Activity Assessments (PHGAA, PTGAA), Myositis Disease Activity Assessment Tool (MDAAT), and serum creatinine kinase (CK) levels. The impacts of IIM on HRQOL and WP were analyzed using the Medical Outcomes Study 36-items Short Form (SF-36) and Work Productivity and Activity Impairment (WPAI) questionnaires, respectively. We found significantly lower HRQOL outcome scores in most of the SF-36 domains when compared to the most recent population norms (P≤.01). Physical health was predominantly affected with relative preservation of emotional health. There were also significant associations between MMT-8, PHGAA and PTGAA scores and HRQOL and WP. Our findings highlight the significant impact of IIM on HRQOL and WP in a well-characterized cohort of patients with IIM within Australia, and therefore the importance of a holistic approach to the management of these patients.

Three-Year Longitudinal Motor Function and Disability Level of Acute Flaccid Myelitis

BackgroundWe summarize the long-term motor outcome and disability level in a cluster of pediatric patients with acute flaccid myelitis (AFM) associated with the enterovirus D68 outbreak in 2015. MethodsThis is a nationwide follow-up questionnaire analysis study. Clinical data including the motor function (manual muscle strength test) and other neurological symptoms were collected at the acute (nadir), recovery (six months), and chronic (three years) stages. We use the Barthel index, which measures 10 variables describing activity of daily living and mobility to assess the disability level. ResultsClinical data of 33 patients with AFM (13 females, 20 males; median age = 4.1 years) were available. Among patients with tetraplegia or triplegia, paraplegia, and monoplegia at the acute stage, two of seven, four of thirteen, and two of thirteen exhibited complete recovery without paralysis; of those five of seven, eight of thirteen, and two of thirteen showed improvement with lesser limb involvement at the chronic stage, respectively. Nine patients (27%) demonstrated improvement at the recovery-to-chronic period. All six patients with positive isolation of enterovirus D68 from biological samples at the acute stage showed persistent motor deficits. Other neurological findings had better prognosis than motor weakness. Better Barthel index score at the chronic stage was observed (P < 0.001; median difference [95% confidence interval], 53 [40 to 63]), implying an improved disability level even in patients with persistent motor deficits. ConclusionsAFM has a high rate of persistent motor deficits showing one- to two-limb paralysis. Disability level of patients with AFM, however, generally improved at the three-year time point.

Diagnostic performance of the Strength and Pain Assessment (SPA) score for non-contact muscle injury screening in male soccer players

ABSTRACT Objectives The aims of this study were to develop a clinical-feature based scoring system for muscle injury screening and to assess its diagnostic accuracy when large number of injuries are suspected. Methods A prospective diagnostic accuracy study was performed according to the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. The diagnostic accuracy of the Strength and Pain Assessment (SPA) score (index test) was assessed in relation to muscle ultrasonography (reference standard). A large (n = 175) number of male soccer players met the inclusion/exclusion criteria: clinical assessment (i.e., evaluation of pain onset modality, location, distribution, impact on performance, and manual muscle strength testing) and ultrasonography were performed in all players after 48 hours from the sudden or progressive onset of muscle pain during or after a soccer competition. Results 91 of 175 cases (52%) were classified as functional muscle disorders, while signs of muscle tear were observed in the remaining 84 of 175 (48%) cases that were classified as structural muscle injuries. The median (1st – 3rd quartile) value of the SPA score was significantly (P < 0.001) lower in the functional disorder group [9 (9–10)] compared to the structural injury group [12 (12–13)]. The area under the Receiver Operating Characteristic curve for different cutoff points of the SPA score was 0.977 (95% confidence intervals: 0.957–0.998) and the optimal cutoff value of the SPA score providing the greatest sensitivity and specificity (respectively, 99% and 89%) was 11. Conclusion This study found that the SPA score has high diagnostic accuracy for structural muscle injuries and could be used as a valid screening tool in soccer players presenting with sudden or progressive onset of muscle pain during or after a competition.

Long-term efficacy of adding intravenous immunoglobulins as treatment of refractory dysphagia related to myositis: a retrospective analysis.

Dysphagia is a life-threating manifestation of idiopathic inflammatory myopathies (IIM). However, we lack a univocal protocol for its treatment. The aim of this retrospective analysis was to evaluate the effectiveness of a step-up strategy by adding a 1-day pulse of IVIGs to immunosuppressants in IIM patients with refractory dysphagia diagnosed by Eating Assessment Tool (EAT)-10 and fibreoptic endoscopic evaluation of swallowing (FEES). Dysphagia was defined as a pharyngo-oesophageal disturbance associated with EAT-10 score ≥3 and at least one FEES abnormality among propulsion failure, solid or liquid stasis. Eighteen out of 154 IIM patients had FEES-confirmed dysphagia and underwent 1 day IVIG 2 g/kg repeated 1 month apart for 3 months, because of dysphagia refractory to high-dose glucocorticoids with methotrexate and/or azathioprine. Clinical characteristics along with myositis-specific antibodies and muscle histopathological findings were studied in FEES-dysphagia IIM and IIM control patients. After three monthly doses of IVIG, EAT-10 score dropped with complete recover of defective propulsion and progressive decrease in percentage of both solid and liquid stasis. At 52-weeks' follow-up, reached in 12 patients, all these parameters were stable or further improved. An improvement in manual muscle strength test and a steroid-sparing effect of IVIG were also observed. Anti-PM/Scl 75/100 antibodies were much more frequent in the FEES-dysphagia group, while anti-Jo1 antibody was rarely detected. Our treatment schedule with 2 g/kg IVIG was effective for IIM-associated refractory dysphagia assessed by the combination of EAT-10 and FEES. These findings need to be prospectively tested in a larger cohort of IIM patients.

Hand Injury - Basketball

HISTORY: 16-year-old male presenting with left thumb injury. Patient presented due to thumb injury during basketball 5 weeks prior to presentation. He reported a basketball was thrown extremely hard and hit him on the lateral side of the thumb, pushing his thumb towards his 5th digit. Despite pain, he was able to finish the game. He had noticeable swelling when the game ended. Despite icing, he continued to have swelling in addition to pain with pinching items or texting. This led him to the urgent care 1 week prior to presentation. X-rays were obtained at the urgent care and he was sent to sports medicine clinic. PHYSICAL EXAMINATION: Examination of left hand showed noticeable deformity at MCPJ, with proximal phalanx appearing subluxed on MC. Flexible deformity on radial aspect of the thumb MCP joint. Tenderness to palpation over the radial side of the MCP joint where there is a prominence. No swelling or bruising. Full range of motion of the thumb without limitation. Strength 4/5 with thumb flexion, extension, abduction, adduction. Pain with thumb manual muscle strength testing. Stable to UCL stress at 0 and 30 degrees. RCL laxity at 0 and 30 degrees without clear endpoint. Normal thumbs up and okay sign. Normal thumb to pinky opposition. Normal grip. Neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1.Radial collateral ligament tear 2.Flexor pollicis brevis tear 3.1st proximal phalanx fracture 4. Sesamoid fracture TESTS AND RESULTS: XR Left Hand Impression: No fractures identified. Subluxation of thumb at MCP joint. MRI Left Hand Impression: Complete disruption of radial collateral ligament of the MCP joint of the thumb with ulnar subluxation of the phalanx compared to the metacarpal. Significant joint fluid. Ulnar deviation of the flexor policis longus and sesamoids. Some marrow edema of the distal metacarpal as well as subchondral bone of first phalanx. FINAL/WORKING DIAGNOSIS: Chronic radial collateral ligament rupture at metacarpal level TREATMENT AND OUTCOMES: 1.Surgical radial collateral ligament repair 2.Initially immobilized with thumb spica splint 3.Casted from 1-5 weeks post operatively 4.Out of cast at 5 weeks post op out; into OT formed hand-splint and range of motion exercises started 5.Follow up planned 9 weeks post-op. Work with OT to achieve full, painless ROM and normal strength prior to returning to basketball

Usefulness of Electromyography to Predict Future Muscle Weakness in Clinically Unaffected Muscles of Polio Survivors.

Post-polio syndrome-induced muscle weakness may develop in limbs that have had normal muscle strength and have been considered unaffected by polio. To investigate the utility of electromyography (EMG) for predicting future muscle weakness in clinically unaffected limb muscles of polio survivors. Retrospective study. Academic polio clinic. Polio survivors (N = 77) who underwent EMG between April 2008 and March 2010 and were followed for at least 2 years. Chart reviews were conducted to extract baseline EMG and manual muscle strength test (MMT) results to investigate the relationship between baseline EMG abnormalities and change in muscle strength over 2 years for various upper and lower limb muscles that control movement in the limb joints. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EMG findings for prediction of subsequent muscle weakness. EMG data were available for 44 deltoid, 59 biceps brachii, 60 triceps brachii, 59 vastus lateralis, 59 tibialis anterior, and 55 gastrocnemius (medial head) muscles. The percentage of muscles with an initial MMT of grade 5 that developed weakness over 2 years of follow-up was approximately 15% for most muscle types. Sensitivity of EMG to predict subsequent weakness was higher in the lower limbs (0.67-1.00). Specificity was higher in the biceps brachii (0.83). PPV was higher in the biceps brachii (0.50). NPV was higher in the lower limbs (0.89-1.00) but lower in the deltoid (0.75). EMG abnormalities were detected in some clinically normal muscles of polio survivors. EMG abnormalities predicted muscle weakness 2 years later, although the strength of this relationship varied depending on the muscle.

Impacts of a lower limb exoskeleton robot on the muscle strength of tibialis anterior muscle in stroke patients

This work aims to explore the impact of a proposed lower limb exoskeleton robot on the muscle strength of the tibialis anterior muscle in stroke patients. Firstly, 24 patients with stroke hemiplegia were divided into the robot group and the control group according to a random number table. Both groups received conventional rehabilitation treatments. Moreover, the robot group took the walking training with UG0210, a lower limb exoskeleton walking rehabilitation device developed by the Hangzhou RoboCT Technology Development Co., Ltd., once per day, 30 minutes per time, a total of 20 times of treatment. The control group took the conventional rehabilitation walking training, once per day, 30 mins per time, a total of 20 times of treatment. At the beginning of the trial, the manual muscle strength test (MMT) was used to assess the pre-trial muscle strength within the trial cycle. The efficacy of the two groups was compared. Results The muscle strength of the tibialis anterior muscle was higher than that without treatments in both groups (P&lt;0.05). The curative effect of the robot group was better than that of the control group (P&lt;0.05). Conclusions With the help of the designed lower limb exoskeleton robot, both tibialis anterior muscle strength and lower limb motor function of stroke patients were improved compared to the control group. The comparison shows the attractive potential and value of the robot assisted rehabilitation.

Short-Term Outcomes Following Endoscopic Proximal Hamstring Repair

The purpose of this study was to evaluate the outcomes of endoscopic proximal hamstring repair (ePHR), specifically: (1) functional and subjective outcomes, (2) effectiveness of treatment (preoperative-to-postoperative change), (3) complications, (4) acute versus chronic tears, and (5) partial versus complete tears. A retrospective case series of a single-surgeon database for all patients who underwent ePHR between November 2014 and January 2019 with a minimum 1-year follow-up (range, 12 to 48 months) was performed. Charts were analyzed for preoperative and postoperative passive range of motion (PROM), strength, VAS pain, UCLA activity, and modified Harris Hip Score (mHHS). Manual muscle strength testing based on standard grading scale of 0 to 5 was performed. Complications including re-tear of the repair site, infection, iatrogenic nerve injury, inability to return to work/sport at the same level as preinjury, persistent hamstring weakness, pain with sitting, and subsequent surgery were recorded. We identified 20 ePHR (6 males, 14 females) with a mean age of 46 years (range, 18 to 63 years). At most recent follow-up, mean VAS pain was 1.85 (SD 2), UCLA activity was 8 (SD 2), mHHS was 90.6 (SD 10.5), and PROM hip flexion of 121.7° (SD 14.5°). Effectiveness of treatment demonstrated significant improvement in objective hamstring strength, hip flexion PROM by 17.3°, UCLA activity by 3, and VAS pain by 3 points. Subjective hamstring weakness was reported in 8 (42.1%) and persistent pain with sitting in 3 (15.8%). Return to work and sport were 100% and 95%, respectively. mHHS was significantly higher postoperatively in patients with complete versus partial tears (95.5 versus 85.7). Endoscopic proximal hamstring repair is an effective approach that provides patients significant improvement in pain and function. IV, Case Series.

76-Year-Old Woman With Generalized Weakness

76-Year-Old Woman With Generalized Weakness

Proximal muscle weakness

A 38-year-old woman gave a 1-year history of difficulties climbing stairs and walking long distances, needing a wheelchair at times. More recently, she had also experienced weakness of her arms...