Trunk Muscle Strength In Patients Research Articles

Neck and Trunk Muscle Strength in Children With Spinal Muscular Atrophy Is Lower Than in Healthy Controls and Depends on Disease Type.

Background: Neck and trunk muscle strength and relationship with motor function in individuals with spinal muscular atrophy (SMA) is not investigated well. Information on maximum muscle strength that children with SMA may develop considerably expands the possibilities of assessing the effectiveness of pharmacological treatment methods and therapeutic procedures. This study sought to assess neck and trunk muscle strength in patients with SMA and to compare it with values noted in healthy children.Methods: The study involved 56 individuals with SMA aged 5–16 not treated pharmacologically, including 9 patients with SMA type 1 (SMA1), 27 with SMA type 2 (SMA2), and 20 with SMA type 3 (SMA3). The control group included 111 healthy individuals aged 5–16. Neck and trunk muscle strength was assessed by means of a maximum voluntary isometric contraction method with the use of a handheld digital muscle tester MICROFET2. Moreover, relative strength was also calculated by standardising the maximum voluntary isometric contraction according to body mass. The Kruskal–Wallis test, Mann–Whitney U-test, and Spearman's rank correlation were used for statistical analysis.Results: The reliability of the neck and trunk muscle strength measurements with the handheld digital muscle tester was excellent with ICC > 0.9. The values of muscle strength in SMA groups were significantly lower than in the control group. The values of relative torque of the neck muscles expressed in percentage values calculated with regard to the control group were at the level of 47.6–51.6% in SMA1 group, 54.8–58.1% in SMA2 group and 80.6–90.3% in SMA3 group. The percentage values for upper and lower trunk muscle strength were at the level of 42.6–68.4% in SMA1 group, 56.9–75.4% in SMA2 group and 76.7–94.8% in SMA3 group.Conclusion: Handheld dynamometry provides reliable measures of neck and trunk muscle strength in SMA children. Neck and trunk muscle strength in children with SMA is lower than in healthy controls and depends on disease type, which confirms the theory based on clinical observations. Further, study is needed to investigate the effect of pharmacological treatment on the strength of the neck/trunk muscles, and relationship between neck and trunk muscle strength and motor capabilities.

EP.54Assessment of trunk muscle strength in patients with muscular dystrophies using stationary and hand-held dynamometry: a test-retest reliability study

EP.54Assessment of trunk muscle strength in patients with muscular dystrophies using stationary and hand-held dynamometry: a test-retest reliability study

P.497 - Axial myopathy in patients with neuromuscular diseases

Muscle atrophy and weakness of upper and lower extremity muscles are well characterized in neuromuscular diseases, but involvement of the axial muscles is poorly understood. Since the axial musculature stabilizes and moves the trunk and provides stability for movement of the extremities, knowledge about the axial musculature in patients with neuromuscular diseases is important. Studies have shown that the axial muscles are affected in a number of myopathies, such as RYR1-myopathy and facioscapulohumeral muscular dystrophy. However, axial myopathy has not been investigated in patients with limb-girdle and Becker muscular dystrophy, and Charcot-Marie-Tooth disease. The purpose of the study is; (1) to investigate the involvement of axial muscles in patients with neuromuscular diseases, (2) to evaluate psychometric properties of stationary dynamometry in patients with axial myopathy, and (3) to investigate the relationship between axial weakness and rigidity, posture, balance and pain. The design is an exploratory cross-sectional study. Fifty adult patients with limb-girdle and Becker muscular dystrophies and Charcot-Marie-Tooth disease and 50 healthy controls, matched for age, sex and body mass index, will be recruited. Patients will be examined in relation to range of motion, manual muscle test, hand-held dynamometry, isometric stationary dynamometry (Biodex System 4 Pro), magnetic resonance imaging, photographic posture analysis, Clinical Test of Sensory Integration and Balance (Biosway), Trunk Control Test, Fatigue Severity Scale, Low Back Pain Rating scale, and The Danish SF-36 Health Survey. This study will increase the understanding of axial muscle involvement in patients with neuromuscular diseases and contribute to diagnostic specificity. The evidence-basing of stationary dynamometry to measure trunk muscle strength in patients with axial myopathy is needed for clinical practice and clinical trial preparedness. Preliminary results will be presented at the poster.

Correlation between pain and muscle strength in patients with adult scoliosis

INTRODUCTION : In this study, we investigate the possible benefits of two different combinations of ex­ercise-based therapies in the treatment of adult idiopathic scoliosis. MATERIALS AND METHODS : A total of 62 patients (mean age 31.43 years) were selected to participate in the physiotherapy protocol. Pain and trunk muscle strength in patients with scoliosis (mean 10.93°Cobb) were measured in each subject prior to treatment intervention and 6 months following the intervention. The level of pain and trunk muscle strength was analyzed on each test, so pre- and post-comparisons could be made. RESULTS AND CONCLUSION : After 6 months of treatment, the experimental group averaged a 2.75 reduction in their levels of pain according to the visual analogue scale (VAS), and the control group aver­aged 1.88 reduction in their levels of pain. None of the patients had an increase of pain. The trunk muscle strength increased in both groups. The combined use of spinal mobilization and postural therapy appeared to significantly reduce the levels of pain and increase trunk muscle strength in all 62 subjects. These results warrant further testing of this protocol.

Hand-Held Dynamometer is a Reliable Tool to Measure Trunk Muscle Strength in Chronic Stroke.

Patients with chronic stroke show atypical coordination of trunk movement and they find difficulty during bed mobility and transfer skills due to weakness of trunk muscles. Routine bedside clinical examination fails to quantify the trunk muscle strength in patients with stroke. Handheld dynamometer is widely administered to quantify the strength of extremities, but its reliability on testing the trunk muscles strength is limited. This study aimed at examining the reliability of hand-held dynamometer to quantify the strength of trunk muscle groups in chronic stroke. This reliability study was conducted in outpatient clinical settings. Patients with chronic stroke aged between 30 and 80 years and an ambulatory capacity of 10-meter distance volunteered in the study. The strength of trunk flexors, extensors, rotators towards most and least affected sides and bilateral lateral flexors was examined by break test using hand-held dynamometer and the isometric strength was reported in pounds (lb.). These tests were carried out by two physical therapists independently at two time points and the assessment procedure was standardized. Pearson's correlation test was conducted to observe the reliability of dynamometer strength testing i.e., internal consistency of the measure and intra-class correlation coefficient (r). Of the 85 study participants, 51 of them had most trunk involvement on the left side and 34 had it on the right side. This study showed an excellent intra-rater (0.88-0.98) and inter-rater (0.84-0.96) reliability of trunk muscle strength testing using hand-held dynamometer. Hand-held dynamometer showed excellent intra and inter tester reliability to quantify the trunk muscle strength in patients with chronic stroke. So this tool can easily be administered in clinical and rehabilitation settings for diagnostic and prognostic purposes.

What's in the Literature?

One of the first questions asked by patients and family members when a diagnosis of amyotrophic lateral sclerosis is made is "what about stem cells?" The term "stem cells" has attractiveness to it, with the assumption that stem cell treatment (stem nerve cells) can replace lost nerve cells. There are perhaps 2 types of stem cell trials, those that are vetted by the Food and Drug Administration and those that have no official oversight and whose results are infrequently published. The issue of the latter was discussed in the last edition of this column. The results of one of the formal stem cell trials now in the United States have been reported. Spinal muscular atrophy is a form of motor neuron disease affecting children and has a genetic cause, which has led to a feasibility study giving antisense oligonucleotides, and the results have also been reported. Biomarkers of amyotrophic lateral sclerosis are being sought, and the presence of neurofilaments is promising. Inflammatory neuropathies are an important group because they are treatable. Intravenous immune globulin is a commonly used agent, but a number of questions persist: one is efficacy among brands, another is the probability of a response, and a third is optimum dosing and taper schedules. A number of recent articles address these issues. The predictive value of single-fiber electromyography in determining which patients with ocular myasthenia will develop generalized disease, the risk of crisis after thymectomy, and 2 papers discussing new forms of congenital myasthenic syndrome are discussed. The risk of brain tumors, quality of life, and the assessment of trunk muscle strength in patients with type 1 myotonic dystrophy is reviewed. An article describing the discovery of mutations in SCN4A as a cause of congenital myopathy is discussed, as is one describing the occurrence of rhabdomyolysis in a group of patients subsequently discovered to have various forms of muscular dystrophy. Finally, articles describing the features of patients with inflammatory myopathies and Jo-1 and either 3-hydroxy-3-methylglutaryl-conezymea reductase or to signal recognition particle antibodies are reviewed.

Patients Undergoing Lumbar Spine Fusion has Low Trunk Muscle Strength and Imbalance between Flexor and Extensor Muscles Preoperatively and still 1 Year after the Surgery

Introduction Lumbar spine fusion (LSF) may be performed in the treatment of several spinal disorders if conservative treatment fails. Decreased physical activity due to pain together with spinal fusion may cause muscle atrophy and therefore decrease the trunk muscle strength. Previously, the average trunk muscle strength in flexion and in extension were reported to be 564 and 629 N, respectively, in control population compared with those of 375 and 404 N in patients 2 months after disc herniation surgery (Häkkinen et al, 2003). In healthy people trunk extensor strength has been reported to be greater than flexor strength, that is, extensor/flexor strength ratio is more than 1 (Yahia et al, 2011). Objective The aim of the present study was to evaluate the influence of lumbar spine fusion to the flexion and extension strength of the trunk muscles at 1 year follow-up after the surgery. Material and Methods Altogether 195 patients (66% females, mean [SD] age 61 [12] years and body weight 78 [15] kg) undergoing instrumented LSF attended the present study. Indications for surgery were degenerative spondylolisthesis, spondylolysis, spinal stenosis, disc herniation or degeneration, postoperative conditions or scoliosis. The median (IQR) duration of preoperative back pain was 31 (18, 66) months. Isometric flexion and extension strength of the trunk muscles was measured using a strain-gauge dynamometer and back pain was measured using visual analogue scale (VAS 0–100 mm) preoperatively and at 1 year after surgery. Results Mean (SD) preoperative trunk flexion and extension strength levels were 295 (172) and 205 (144) N, respectively. A year after the surgery, mean (95% CI) trunk flexion strength increased by 69 (53–85) N ( p < 0.001) and extension strength by 53 (37–70) N ( p < 0.001). Mean (SD) preoperative extension/flexion strength ratio was 0.75 (0.38) and did not change during the follow-up. Flexion strength/body weight ratio increased from preoperative 0.38 (0.20) by 0.09 (0.07–0.11) and extension strength/body weight ratio from 0.27 (0.18) by 0.07 (0.05–0.09) ( p < 0.001) 1 year after the surgery. Mean (SD) back pain VAS decreased from preoperative 63 (27) to 25 (26) mm at 1 year and pain intensity during flexion and extension strength measurements decreased from 41 (29) to 11(21) mm and from 55 (29) to 14 (25) mm, respectively ( p < 0.001). No correlation between strength measurements and back pain was found at either time point. Conclusion The trunk muscle strength in patients with chronic back pain undergoing LSF is low. After LSF some improvement can be found, however, still 1 year after the surgery the trunk muscle strength remains low. Moreover, the flexion strength is better than extension strength, which is in contrast to results of healthy people in previous studies. Therefore, after the spinal fusion surgery the rehabilitation should aim at improving muscle strength and special attention should be paid to correct the imbalance between trunk flexion and extension muscles.

Trunk Muscle Strength in Patient with Low Back Pain

The purpose of this study was to clarify the characteristics of trunk muscle strength in patients with low back pain. The peak torques of isometric trunk flexion, extension, side bending, and rotation were compared. We found that the peak torque of rotation to the painful side was significantly lower than that to the no-pain side in patients with low back pain. No intra- or inter-group differences in peak torque were detected except for that of rotation. In the physical therapy regimens of patients with low back pain, it is best to keep these points in mind as the features of isometric muscle strength-the trunk flexors and extensors-are not always weak, and focus should be placed on strengthening the trunk rotators.

The effect of trunk muscle exercises in patients over 40 years of age with chronic low back pain

Previous studies of trunk muscle strength in patients with chronic low back pain (CLBP) have mainly reported on patients aged younger than 40 years. However, no such investigation has yet been done in middle-aged patients. Trunk muscle strength and the effect of trunk muscle exercises were investigated in patients with CLBP aged more than 40 years. Trunk muscle strengths were measured in a LBP group (52 patients) and a control group (60 volunteers) and the results for the two groups were compared. The LBP group was divided into three subgroups. Group A had only age-related spondylosis and group B had disk herniation and spondylolisthesis with age-related spondylotic change. Both these groups were able to continue exercises. Group C was made up of patients who had abandoned the exercise program. Trunk muscle strength and symptoms were assessed in each group. Both flexion and extension strength were decreased in the LBP group compared with the control group, with the reduction in extension strength being most marked. In both groups A and B, muscle strength increased and clinical symptoms improved. In contrast, no change was seen in group C. In older patients with CLBP, reduction of muscle strength was more marked in the spinal extensors than in the spinal flexors. It was confirmed that trunk muscle strengthening exercises are useful for increasing muscle strength and improving symptoms in such patients.

Trunk muscle strength in and effect of trunk muscle exercises for patients with chronic low back pain. The differences in patients with and without organic lumbar lesions.

Trunk muscle strength and the effect of trunk muscle exercises on chronic low back pain were investigated in patients with chronic low back pain. Patients with chronic low back pain include those with organic lumbar lesions and those without such lesions. This study analyzed the differences in trunk muscle strength and effect of trunk muscle exercises between these two groups of patients. Previous studies have reported lower trunk muscle strength in patients with chronic low back pain and higher efficacy of trunk muscle exercises for treating chronic low back pain. However, no analysis have yet been done of differences in these parameters between patients with chronic low back pain with and without organic lumbar lesions. One-hundred-twenty-three patients with chronic low back pain and 126 healthy individuals without low back pain (control group) underwent trunk muscle strength evaluation. The patients were further divided into two groups-- those in group 1 had detectable organic lumbar lesions and those in group 2 had no detectable organic lesions. Seventy-two of these patients performed trunk muscle exercises and the correlation between improvement in low back pain and increase in trunk muscle strength was analyzed. Trunk flexor and extensor strengths were significantly lower in both groups. However, the flexor/extensor ratio of maximum torque was significantly higher in group 1 than in the control group, but was not significantly different between group 2 and the control group. Trunk muscle exercises reduced low back pain in both groups, but were more effective in group 2 than in group 1. The degree of correlation between increase in trunk muscle strength and improvement of low back pain also was higher in group 2 than in group 1. This difference in flexor/extensor ratio may have been due to reduced extensor strength resulting from neurogenic muscle weakness induced by the organic lumbar lesions in group 1. The exercise-associated increase in trunk muscle strength did not completely eliminate the low back pain induced by the organic lumbar lesions in group 1. However, increasing trunk muscle strength was extremely effective in patients of Group 2, in which decreased trunk muscle strength was a major factor in chronic low back pain.

Concentric and eccentric strength of trunk muscles: Influence of test postures on strength and characteristics of patients with chronic low-back pain

The purpose of this study was to determine the influence of test postures on trunk muscle strength, and to clarify the difference between concentric and eccentric strength of healthy subjects and patients with chronic low-back pain (CLBP). Volunteered and controlled trials took place at a university hospital, which is a referral center and is also open to the general community. The patients were selected from the outpatient care in the university hospital. Fifty healthy subjects (25 men and 25 women; average age 25.7 years, ranging from 23 to 34 years) and 48 patients with CLBP (26 men and 22 women; average age 33.5 years, ranging from 26 to 39 years) volunteered for this study. The main outcome measures were flexor and extensor peak torque/body weight, and flexor/extensor peak torque ratio during concentric and eccentric contractions; Eccentric/concentric peak torque ratio in flexor and extensor. Trunk-muscle strength was significantly greater in the sitting posture when measured with the subjects' feet against the floor ( p < .05). Some patients complained of a slight low-back pain during testing, although the pain was not aggravated in any patients. In both concentric and eccentric contraction modes, the patients with CLBP had greater flexor/extensor ratios than the healthy subjects ( p < .01). This implies that extensors are more affected in these patients. However, a great imbalance between concentric and eccentric strength of the patients was found, not only in extensors, but also in flexors ( p < .01). The current study shows that one should consider the test posture carefully when measuring trunk-muscle strength. This study also suggests that characteristics of trunk-muscle strength in patients with CLBP is extremely complicated when being considered in terms of eccentric contraction mode.