Muscle Strength Of Upper Extremities Research Articles

VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION

Purpose: This study aimed to investigate the psychometric properties of the 6-minute pegboard ring test (6PBRT) in patients with pulmonary hypertension (PH). Methods: This study included 31 patients with PH. The upper extremity function was measured with the 6PBRT. Muscle strength was measured for shoulder flexor, shoulder abductor, elbow extensor, and elbow flexors muscles using with a digital dynamometer, and handgrip strength with the hand dynamometer. Limitation of the activities of daily living was evaluated with the Milliken Activities of Daily Living Scale. Intra-class correlation coefficient (ICC) was used to determine test-retest reliability. Results: The 6PBRT showed excellent test-retest reliability with the ICC=0.98 (95% CI: 0.82–0.99). The SEM and MDC were calculated as 5.9 and 16.4, respectively. The patients with NYHA Class III had significantly lower scores in the 6PBRT compared to the patients with Class II (p=0.005) showing the known-groups validity of the 6PBRT. The 6PBRT was significantly and strongly correlated with age (r=-0.628, p<0.001), functional class (r=-0.502, p=0.004), activities of daily living (r=0.522, p=0.003), moderately correlated with shoulder flexor (r=0.360, p=0.047), shoulder abductor (r=0.388, p=0.031), elbow flexor (r=0.406, p=0.036) and handgrip muscles strength (r=0.375, p=0.041). Conclusion: This study showed that the 6PBRT has excellent test-retest reliability and good validity, including known-groups and convergent in PH. The higher 6PBRT scores were significantly correlated with younger age, better functional class and performance in activities of daily living, and greater upper extremity muscle strength.

The Relationship Between Athletic Performance and Physiological Characteristics in Wheelchair Basketball Athletes

ABSTRACT Purpose: This study was aimed to investigate the relationship between athletic performance and physiological characteristics in wheelchair basketball (WB) athletes with different classification scores. Methods: Twenty-six (24 male and 2 female) WB athletes were involved into the study. The participants were divided into two functional categories (Category A:1.0–2.5 points, category B: 3.0–4.5 points) according to the IWBF rules. Shoulder internal (IR) and external rotation (ER) muscle strengths were evaluated with the ISOMED 2000® isokinetic dynamometer. Handgrip strength was evaluated with hydraulic hand dynamometer. Custom ramp protocol on treadmill was employed to measure aerobic capacity. Anaerobic capacity was evaluated with Wingate anaerobic power test in standard laboratory conditions. The athletic performance was assessed by 20 m Sprint test, Slalom Test, and Zone Shot tests. Results: Category B athletes achieved significantly better results in the measurements of shoulder IR and ER muscle strength, aerobic and anaerobic capacity, and athletic performance while the grip strength was found similar in the categories. There was a significant correlation between the athletic performance and shoulder IR and ER muscle strength, and aerobic and anaerobic capacities in two categories. There was no significant relationship between grip strength and athletic performance parameters in two categories. Conclusion: It was concluded that athletic performance in WB athletes with different classification scores is related to upper extremity muscle strength, aerobic, and anaerobic capacity. Additionally, upper limb muscle strength, athletic performance, aerobic and anaerobic capacity assessments to be made will contribute positively to the planning of individual training and exercise programs.

The Combination of Softball Handling Exercise and ROM Increases Upper Extremity Muscle Strength in Non-Haemoragic Stroke Patients

Background: Stroke is a brain tissues damage caused by blood supply disruption to the brain. Effects that often occurs in stroke patients is weakness in one side of the body, such as the upper extremity. Exercises to stimulate muscle hands strength can be a combination softball handling exercise and ROM. Purpose: This research aims to determine the effect of a combination softball handling exercise and ROM on muscle strength in non haemoragic stroke patients at Roemani Muhammadiyah Semarang Hospital.Methods: Type of research is Quasi Experiment with a non-rondomised control group pre-post test design. There were 32 respondents including in this research using purposive sampling to select the sample. The research data were analyzed using the Wilcoxon Test to determine the effect on the intervention group and control group, then tested using the Mann Whitney test to determine the effectiveness difference between a intervention group and control group.Results: the Wilcoxon Test showed that there was an effect of a combination softball handlingand ROM on muscle strength in non haemoragic stroke patients (p value 0.000), and there was an effect on the control group without intervention (p value 0.003). While the Mann Whitney test showed that the combination group was more effective in increasing the muscle strength p value = 0.001 (0.05).Conclusion: There is the effect of a combination of softball handling exercise and ROM on the strength of the extremity muscles over non haemoragic stroke pastients.

Effects of wheelchair Tai Chi ball exercise on physical and mental health and functional abilities among elderly with physical disability

ABSTRACT The purpose of this study was to examine the effect of a 12-week Wheelchair Tai Chi Ball (WTCB) intervention, a combination of mind-body exercise with strength training, on physical and mental health and functional abilities among elderly with disability. Twenty-six elderly persons participated in the study, nine WTCB group participants and ten control group participants completed the study. The WTCB group practised WTCB12 twice/week for one hour each time. The control group did their daily routine without WTCB intervention. The outcomes measures were: Pain Self-Efficacy Questionnaire (PSEQ), SF-36v2 for physical and mental health, heart rate, blood pressure, range of motion and muscle strength of the dominant arm at the shoulder, elbow and wrist joints. The Mixed Model ANOVA was employed to examine the differences between and within the two groups using pre-test and post-test scores. The results demonstrated the WTCB group had significant improvements on PSEQ, general physical health and had positive effects on maintaining muscle strength at the shoulder, elbow and wrist joints as compared to the control group. The WTCB12 exercise had positive effects on self-efficacy for pain management, general physical health, and maintain upper extremity muscle strength and is a feasible exercise for elderly with disability.

Effects of comprehensive and intensive pulmonary rehabilitation and nutritional support on quality of life and functional status in patients with chronic obstructive pulmonary disease.

ObjectiveTo investigate the effects of pulmonary rehabilitation (PR) and combined nutritional support therapy on quality of life (QoL) and functional status in patients with chronic obstructive pulmonary disease (COPD).MethodsThis pre-and post-intervention prospective exploratory study involved 64 patients with stable stage three to four COPD. Oral nutritional support and personalized diet were combined with an intense and comprehensive PR program. Baseline and 8-week follow-up scores were compared for the 6-minute walk test (6MWT), incremental shuttle walking test (ISWT), St. George’s Respiratory Questionnaire (SGRQ), pulmonary function tests (PFT), PImax-PEmax, arterial blood gas (ABG), respiratory rate (RR), handgrip strength, Borg and modified Medical Research Council dyspnoea scale scores and fat-free mass index.ResultsSignificant improvements were found in functional status (6MWT: 86.72 m, ISWT: 76.24 m), QoL (SGRQ total: 13.86), PFT, ABG, RR, dyspnoea, upper extremity muscle strength and hand-body composition.ConclusionNutritional support with comprehensive and intensive PR can significantly improve physical performance, QoL, dyspnoea and body composition in COPD. The improvement in QoL was greater than that reported in previous studies. Because two modalities were combined in this study, future randomized controlled studies are needed to confirm the extent and contribution of these modalities to the outcomes.

Effect of a period of cervical flexion on upper extremity muscle strength

Background: Technology is prevalent in almost every aspect of life, from handheld phones to computers. Increases in cervical flexion can cause a strain on the neck and muscles of the upper extremity.
 Objective: To examine the effect of 30 minutes of cervical flexion at 45 degrees. It was hypothesized that muscle strength will decrease after flexion, and there would be no significant differences between dominant and nondominant arms or genders.
 Study design: Twenty-four participants (12 male, 12 female) (n = 24; height = 173.1 + 9.3 cm; weight = 73.33 + 22.58kg) were measured before and after cervical flexion using a MicroFET2 Hand Held Digital Muscle Tester to test the middle deltoid, biceps brachii, and triceps brachii of each arm.
 Results: Compared to pre-measures significant differences were found in both middle deltoids and both biceps brachii, but not in either triceps brachii (p < 0.05). Overall no limited significant differences were found between genders of muscles of either arm. Significant differences (p < 0.05) were found in the dominant biceps brachii, non-dominant biceps brachii, dominant triceps brachii, dominant deltoid, and non-dominant deltoid.
 Conclusion: These results suggest that a normal daily degree of cervical flexion will decrease some upper extremity strength over the course of 30 minutes.

Characteristics of Upper Extremity Recovery in Acute Flaccid Myelitis: A Case Series.

Clinical characteristics and timing associated with nonsurgical recovery of upper extremity function in acute flaccid myelitis are unknown. A single-institution retrospective case series was analyzed to describe clinical features of acute flaccid myelitis diagnosed between October of 2013 and December of 2016. Patients were consecutively sampled children with a diagnosis of acute flaccid myelitis who were referred to a hand surgeon. Patient factors and initial severity of paralysis were compared with upper extremity muscle strength outcomes using the Medical Research Council scale every 3 months up to 18 months after onset. Twenty-two patients with acute flaccid myelitis (aged 2 to 16 years) were studied. Proximal upper extremity musculature was more frequently and severely affected, with 56 percent of patients affected bilaterally. Functional recovery of all muscle groups (≥M3) in an individual limb was observed in 43 percent of upper extremities within 3 months. Additional complete limb recovery to greater than or equal to M3 after 3 months was rarely observed. Extraplexal paralysis, including spinal accessory (72 percent), glossopharyngeal/hypoglossal (28 percent), lower extremity (28 percent), facial (22 percent), and phrenic nerves (17 percent), was correlated with greater severity of upper extremity paralysis and decreased spontaneous recovery. There was no correlation between severity of paralysis or recovery and patient characteristics, including age, sex, comorbidities, prodromal symptoms, or time to paralysis. Spontaneous functional limb recovery, if present, occurred early, within 3 months of the onset of paralysis. The authors recommend that patients without signs of early recovery warrant consideration for early surgical intervention and referral to a hand surgeon or other specialist in peripheral nerve injury. Risk, III.

Gender differences and relationships between upper extremity muscle strength, lower limb power and shuttle velocity in forehand smash and jump smash in badminton

The aim of the study was to investigate the relationships between shuttlecock velocity during a badminton forehand smash with and without jump (VmaxWJ and VmaxNJ), strength of upper limb muscles, vertical jump height and to analyze differences in these parameters for each gender. The study examined members of the Polish National Badminton Team seven women and seven men. A special torque meter was used to assess the strength of the upper limb muscles. Vertical jumps were performed on an AMTI force plate. Shuttlecock velocity was measured using Vicon motion capture system. Differences between the right and left limbs were observed in all muscle groups except shoulder flexion for both genders. The results of all measured parameters: torques, height of countermovement and spike jump (HACMJ, HCMJ, HSPJ), VmaxWJ and VmaxNJ, were greater for men than for women. No statistically significant differences were found between VmaxWJ (men: 83.27 ± 4.83 m/s; women: 67.57 ± 4.21 m/s) and VmaxNJ (men: 84.19 ± 6.05 m/s; women: 69.70 ± 6.53 m/s) within the same gender. Positive correlations were found between both HCMJ and HSPJ regarding VmaxWJ in men; the height of shuttlecock impact in jump smash (HWJ) and HSPJ in women; proving the importance of jumping ability in badminton. Negative correlations were found between HWJ and VmaxWJ for both genders. The jump before smash is not used in order to hit the shuttle from the highest point, but to gain time to correctly prepare the phase of stroke while being in the air.

Improvements in Grip and Pinch Strength and Patient-reported Outcomes After Anterior Cervical Discectomy and Fusion.

Prospective. To evaluate improvements in grip and pinch strength in patients with or without myelopathy and determine patient factors that are predictive of continued postoperative grip strength weakness. The degree to which cervical myelopathy can diminish upper extremity muscle strength has not been objectively characterized. Few studies have investigated the association between the expected improvements in patient-reported outcomes (PROs) and strength in grip and pinch after anterior cervical discectomy and fusion (ACDF). Patients were asked to perform grip and pinch strength tests both preoperatively and at 6-month follow-up. Patients were also administered PRO surveys, which included Neck Disability Index, Short-Form-12 physical composite score and mental composite score, and Visual Analog Scale neck and arm pain scores. Receiver operating characteristic (ROC) curve analysis was used to determine optimum cutoff values of preoperative patient factors to predict postoperative dominant handgrip weakness after ACDF. Patients with radiculopathy demonstrated a significantly greater improvement in Visual Analog Scale arm pain compared with patients with myelopathy. The ROC curve analysis determined the optimum cutoff for preoperative dominant handgrip strength to be 22 kgf. This value demonstrated a sensitivity of 0.89 and a specificity of 0.62. The area under the ROC curve value was 0.71 (95% confidence interval, 0.55-0.88), indicating fair prognostic accuracy of the cutoff for postoperative dominant handgrip weakness. In this prospective, observational study, postoperative increase in grip and pinch strength demonstrated an association with improvement of pain and disability of the neck and overall quality of health regardless of the presence of cervical myelopathy. Preoperative grip strength weakness was found to be predictive of postoperative grip strength deficiency after ACDF. Our investigation suggests the recovery of hand function may be correlated with improvement of PROs after ACDF.

요가와 댄스스포츠를 활용한 복합운동프로그램이 경도인지 장애 남성 노인의 기초체력 및 치매척도에 미치는 영향

The objective of this study was to understand the effects of combined exercise program using yoga and dance sport on the basal fitness, and dementia scale of the elderly with mild cognitive impairment. BR After randomly dividing total 24 male elders with mild cognitive impairment in their 65-year old or up into exercise group(N=7) and control group(N=7), the 60-minute exercise was performed twice a week for 12 weeks. Before performing the program, the basal fitness, and dementia scale of every subject were measured, and then, they were remeasured and compared 12 weeks later. Using the SPSS 20 Program, the mean and standard deviation of each group were calculated and charted. To verify the differences of mean of each group and time, the two-way ANOVA by the repeated measurement was conducted. For the analysis of interaction effect, the independent t-test between groups in each time and the paired t-test between times in each group were performed under the significance level(.05). In the results of analysis, first, the basal fitness in accordance with the program between groups showed significant differences in upper extremity muscle strength(p.006 ), l ower e xtremity m uscle strength (p.021), general endurance(p.002), upper extremity joint flexibility(p.003), lower extremity joint flexibility(p.007). Third, there were significant differences in the dementia scale between groups (p.004).BR Therefore, the results of this study revealed the positive effects of combined exercise program using yoga and dance sport on the improvement of basal fitness and dementia scale of the elderly with mild cognitive impairment.

Effect of a Period of Cervical Flexion on Upper Extremity Muscle Strength

Effect of a Period of Cervical Flexion on Upper Extremity Muscle Strength

A randomized pilot study comparing graft-first to fistula-first strategies in older patients with incident end-stage kidney disease: Clinical rationale and study design.

Timely placement of an arteriovenous (AV) vascular access (native AV fistula [AVF] or prosthetic AV graft [AVG]) is necessary to limit the use of tunneled central venous catheters (TCVC) in patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD). National guidelines recommend placement of AVF as the AV access of first choice in all patients to improve patient survival. The benefits of AVF over AVG are less certain in the older adults, as age-related biological changes independently modulate patient outcomes. This manuscript describes the rationale, study design and protocol for a randomized controlled pilot study of the feasibility and effects of AVG-first access placement in older adults with no prior AV access surgery. Fifty patients age ≥65 years, with incident ESKD on HD via TCVC or advanced kidney disease facing imminent HD initiation, and suitable upper extremity vasculature for initial placement of an AVF or AVG, will be randomly assigned to receive either an upper extremity AVG-first (intervention) or AVF-first (comparator) access. The study will establish feasibility of randomizing older adults to the two types of AV access surgery, evaluate relationships between measurements of preoperative physical function and vascular access development, compare vascular access outcomes between groups, and gather longitudinal assessments of upper extremity muscle strength, gait speed, performance of activities of daily living, and patient satisfaction with their vascular access and quality of life. Results will assist with the planning of a larger, multicenter trial assessing patient-centered outcomes.

Comparison of scapular position and upper extremity muscle strength in patients with and without lateral epicondylalgia: a case-control study

The symptoms of lateral epicondylalgia (LE) can be persistent, and recurrence is frequent. Recurrence can be related to proximal segment impairment of the kinetic chain. Knowledge of any relation in the kinetic chain in LE may help treatment. We aimed to investigate scapular position and upper extremity muscle strength in patients with LE and to compare them with controls. The study enrolled 51 patients with LE and 51 age-matched controls. We assessed scapular position asymmetry using the lateral scapular slide test and measured the strengthof the upper trapezius (UT), middle trapezius (MT), lower trapezius, and serratus anterior muscles in addition to shoulder abduction, external rotation, and internal rotation and grip strength. The percentage of participants with scapular asymmetry was greater in the patients than in the controls (P = .005). The involved side regarding shoulder external rotation among the patients was significantly weaker than in the controls (P = .016, P = .009). The involved side of the LE patients was significantly weaker than the uninvolved side in terms of shoulder abduction, external rotation, and internal rotation (P = .013, P = .048, P = .013). The UT/MT ratio on the nondominant side of the controls was significantly greater than that on the involved side of the LE patients (P = .016). Upper extremity muscle strength, grip strength, UT/MT ratio, and scapular position are affected in patients with LE. In addition to the elbow, focusing on the upper segments is essential in the management of LE.

The Effect of Early Passive Range of Motion Exercise on Motor Function of People with Stroke: a Randomized Controlled Trial.

Introduction: Frequent and regular exercises in the first six months of stroke may cause return of a significant portion of sensory and motor function of patients. This study aimed to examine the effects of passive range of motion exercise in the acute phase after stroke on motor function of the patients.Methods: A randomized controlled trial study was conducted. The patients with first ischemic stroke were randomly allocated to either experimental (n=33) or control (n=19) group. Passive range of motion exercises was performed in the experimental group during the first 48 hours of admission as 6 to 8 times of 30 minute exercise. Before intervention, and one and three months after intervention, motor function were measured by muscle strength grading scale (Oxford scale) and compared. SPSS version 13.0 for Windows was used for statistical analysis. Frequency distribution was used to describe the data. For comparisons, paired t-test, independent t-test was used, and repeated measures test was used.Results: In acute phase, the intervention in the experimental group led to significant improvement of motor function between the first and third month in both the upper and lower extremities. In control group, improvement was observed only in the muscle strength of upper extremity in the first and third month compared to pre-intervention measurement. The greatest improvement was observed in the interval from base to one month in the upper extremity, and base to the first month and the first to the third month in the lower extremity.Conclusion: It is recommended to use early passive range of motion exercise as part of care for people with stroke during the acute phase of the disease.

Peripheral muscle strength is associated with lung function and functional capacity in patients with cystic fibrosis.

AbstractPurposeCystic fibrosis (CF) is an inherited disease that causes important multisystemic impairments. The present study aimed to evaluate the association of peripheral muscle strength with lung function and functional capacity in adolescents and adults with CF.MethodsCross‐sectional study with prospective data of patients enrolled in the Program for Adults with CF at Hospital de Clínicas de Porto Alegre. The testing procedures included peripheral muscle strength testing, pulmonary function tests, and the 6‐minute walk test.ResultsThe sample consisted of 41 subjects (27 women) with a mean age of 24.6. Upper extremity muscle strength was associated with forced vital capacity and forced expiratory volume in the first second, and lower extremity muscle strength was associated with the distance covered in the 6‐minute walk test, oxygen saturation, forced expiratory volume in the first second, and forced vital capacity.ConclusionsMuscle strength was positively associated with lung function variable and functional capacity in patients with CF.

Reliability of maximum isometric arm, grip and pinch strength measurements in children (7–12 years) with unilateral spastic cerebral palsy

Purpose: To investigate test–retest and inter-rater reliability of maximum isometric arm muscle strength measurements using the hand-held dynamometer (HDD) and maximum isometric grip and pinch strength measurements using the Biometrics E-Link Evaluation System in children aged 7–12 years with unilateral spastic cerebral palsy.Materials and methods: All data were obtained using a test–retest study design. The study met the conditions of the COSMIN criteria to achieve good methodological quality.Results: For arm strength measurements, all test–retest reliability intraclass correlation coefficient (ICC) values and all but one inter-rater reliability ICC value indicated excellent reliability. For grip- and pinch strength measurements, all test–retest reliability and inter-rater reliability ICC values showed excellent reliability. The standard error of measurement values ranged from 4.97 to 11.36 N (HDD) and 0.37 to 1.81 kg (E-link). Smallest detectable change values ranged from 13.79 to 31.49 N (HDD) and 1.03 to 5.02 kg (E-link).Conclusions: The HDD and E-link system are usable measurement instruments for cross-sectional muscle strength measurements in children with unilateral spastic cerebral palsy. It is not clear if both instruments are usable to measure changes in muscle strength within an individual, especially if a child with unilateral spastic cerebral palsy has low muscle strength. Caution in the interpretation of changes in muscle strength is therefore necessary.Implications for RehabilitationThe hand-held dynamometer and E-Link Evaluation System are reliable measurement instruments to measure muscle strength of the arm and hand in children with unilateral spastic cerebral palsy, aged 7–12 years.Cross-sectional measurements; it is possible to measure upper extremity muscle strength in children with unilateral spastic cerebral palsy with the hand-held dynamometer and E-link system.Longitudinal measurements; changes in upper extremity muscle strength within one person should be interpreted with care, especially if a child with unilateral spastic cerebral palsy has low muscle strength.

The Effects of Muscle Strength and Muscle Endurance on Upper Extremity Functions of Lateral Epicondylitis Patients

Purpose: Lateral epicondylitis can cause limitations in upper extremity functions of patients due to the decrease in upper extremity muscle strength and endurance in patients. The aim of this study is to determine the effect of muscle strength and endurance on upper extremity functions in patients with lateral epicondylitis.Methods: Forty-five patients mean age: 47.60±3.22, 30 females, 15 male diagnosed with chronic lateral epicondylitis were included in the study. Upper extremity muscle endurance of the patients was evaluated with unsupported arm exercise test in 1st and 2nd diagonal pattern , upper extremity muscle strength of the patients was evaluated with Hand Held Dynamometer HHD , and upper extremity functions of the patients were evaluated with Lateral Epicondylitis Function Scale LEFS scores.Results: There was a moderate negative correlation between the unsupported arm exercise test endurance on the affected side and the LEFS scores of the patients with lateral epicondylitis p

Muscle strength and bone mass density in haemodialysis patients

IntroductionThe aim of the study was to examine muscle strength and bone density in patients with end stage renal disease on maintenance haemodialysis.MethodsThe study included 76 patients: 29 women and 47 men aged 42–90 years. The time on dialysis varied from 2 months to 13 years. Bone density was assessed with the dual-energy X-ray absorptiometry method, and muscle strength of upper and lower extremities with Rikli and Jones arm curl test and the 30-second sit-to-stand test.ResultsSignificant correlations between muscle strength and bone density were found. Results varied in relation to gender. A higher rate of upper extremity muscle strength loss was noted among men. A higher rate of lower extremity muscle strength loss was observed in the female group. A higher rate of bone density loss was reported among women than in men.ConclusionsThe relationship between muscle strength and bone mass density among haemodialysis patients warrants further study to clarify if physical exercise focused on muscle in those patients can improve bone mass density.

DUCHENNE MUSCULAR DYSTROPHY – IMAGING AND BIOMARKERS: P.37Upper extremity quantitative muscle ultrasound is related to disease severity in boys with Duchenne muscular dystrophy

With an increasing amount of non-ambulant boys with Duchenne muscular dystrophy (DMD), objective and child-friendly outcome measures are necessary to evaluate upper limb function in boys with DMD. The primary aim of this study was to assess the relation between upper extremity quantitative muscle ultrasound (QMUS) and disease severity in boys with DMD. Additionally, reference values of QMUS were collected in healthy boys and the effect of age on QMUS was compared between healthy boys and boys with DMD. Finally, reliability was assessed in a subgroup of both groups (12 healthy boys and 10 boys with DMD). Echo intensity (EI) and muscle thickness (MT) of the upper limb measured by QMUS were determined in 71 healthy boys and 43 boys with DMD (mean age 12.45 and 12.41 years). Clinical assessments (upper extremity muscle strength (MS), Brooke scale, Performance of upper limb (PUL) and Motor Function Measure Dimension 3 (MFM-D3)) were performed in boys with DMD only. The effect of age on QMUS was assessed using linear regression analysis. The relation between QMUS and clinical assessments was assessed using correlation coefficients. ICC's were constructed to determine inter-rater and test-retest reliability. EI was higher and increased with age in boys with DMD whereas in healthy boys EI was independent of age. MT increased with age in healthy boys whereas age did not influence MT in boys with DMD. A higher EI was related to decreased performance on Brooke scale, PUL and MS of shoulder abductors. A lower MT was related to decreased performance on Brooke scale and MS of shoulder abductors. This study found excellent inter-rater reliability of EI in healthy boys, which is in accordance with previous literature. Poor test-retest reliability of EI was found in both healthy boys and boys with DMD. QMUS of the upper extremity is related to disease severity in boys with DMD. Therefore, this study establishes QMUS of the upper extremity as an objective, relevant outcome measure in DMD which is not influenced by fatigue, verbal understanding or patient cooperation.

Effects of multidisciplinary therapy on physical function in Huntington's disease

The primary objective of this trial was to evaluate the effects of outpatient multidisciplinary therapy, compared to usual care, on measures of physical function and muscle strength in patients with manifest Huntington's disease (HD). Twenty-two patients with clinically verified HD were randomized to receive 36weeks of outpatient multidisciplinary therapy or usual care. Outpatient multidisciplinary therapy comprised 9months of supervised exercise, cognitive therapy and self-directed home-based exercise. Usual care consisted of standard medical care. Patients were assessed at 0 and 36weeks by blinded assessors. The primary outcome was changed in mobility as measured by the 10-m Timed Walk Test. Secondary outcome measures included changes in manual dexterity (Timed Nut and Bolt Test), balance (Berg Balance Scale), cardiorespiratory endurance (6-Minute Walk Test) and upper and lower extremity muscle strength (isokinetic and isometric muscle strength and 10 Repetition Sit-to-Stand Tests). Patients receiving outpatient multidisciplinary therapy demonstrated significantly enhanced manual dexterity (P<0.05) and lower extremity muscle strength (P<0.05) than patients receiving usual care. No significant differences in mobility, balance, cardiorespiratory endurance and upper extremity strength outcomes were observed between groups after the intervention period. There were no adverse events associated with multidisciplinary therapy. Our findings suggest that outpatient multidisciplinary therapy has positive effects on manual dexterity and muscle strength, but no meaningful effects on mobility, balance, cardiorespiratory endurance and upper extremity muscle strength in patients with HD. Larger randomized controlled trials are needed to confirm these preliminary findings.