ABSTRACT
We estimated the trial-to-trial variability and the test-retest reliability of several intracortical and corticomotor excitability parameters for the upper extremity in chronic stroke patients. Nine patients with hemiparesis of the upper extremity were enrolled 8-17 months after a unilateral stroke. Transcranial magnetic stimulation was used to obtain repeated measures over a two week interval of motor evoked potential (MEP) recruitment curves and cortical silent periods in the first dorsal interosseus muscle of each hand. Five trials would have provided accurate estimates of the MEP amplitude and silent period duration for the unlesioned side in all patients, but 25% of the datasets from the lesioned side provided poor estimates of MEP amplitude even with 10 trials. Intraclass correlations were >0.70 for all parameters obtained from the lesioned side and for the MEP amplitude, slope of the recruitment curve, silent period, and silent period slope from the unlesioned side. MEP amplitude varied across sessions within subject by 20% on both sides, whereas other parameters showed less variability on the unlesioned side relative to the lesioned side. The Fugl-Meyer upper extremity motor score and the time to complete the 6 fine-motor items from the Wolf Motor Function Test (WMFT) were also found to be highly reliable over this interval. We conclude that the functional and most of the excitability parameters are reliable across time in patients with variable lesions due to stroke. Due to high intrasubject variability, the use of some excitability parameters as indicators of functional neuroplasticity in response to treatment may be limited to interventions with large effect sizes.
Subject(s)
Evoked Potentials, Motor/physiology , Motor Cortex/physiopathology , Paresis/physiopathology , Pyramidal Tracts/physiopathology , Stroke/physiopathology , Aged , Female , Functional Laterality/physiology , Hand/innervation , Hand/physiopathology , Humans , Male , Middle Aged , Muscle, Skeletal/innervation , Muscle, Skeletal/physiopathology , Neuronal Plasticity/physiology , Observer Variation , Paresis/diagnosis , Paresis/etiology , Predictive Value of Tests , Recovery of Function/physiology , Stroke/complications , Stroke/diagnosis , Time Factors , Transcranial Magnetic Stimulation/methodsABSTRACT
BACKGROUND AND PURPOSE: The ability to perform 20 or more one-leg heel-rises is considered a "normal" grade for muscle strength (force-generating capacity of muscle) of the ankle plantar flexors, regardless of age and sex. Because muscle strength is closely related to age and sex, the "normal" test criterion was re-evaluated in different groups categorized by age and sex. SUBJECTS AND METHODS: One hundred eighty sedentary volunteers (21-80 years of age) without lower-limb lesions performed as many repetitions of one-leg heel-rise as possible. Lunsford and Perry criteria were used to determine completion of the test. RESULTS: The age and sex of the participants influenced the maximal repetitions of heel-rise, and the repetitions decreased with age and in female subjects. DISCUSSION AND CONCLUSION: The muscle strength of the ankle plantar flexors, as measured by manual muscle testing, varied with age and sex. Clinicians should consider the variances of age and sex when they perform manual muscle testing of the ankle plantar flexors.
Subject(s)
Ankle , Isometric Contraction , Muscle, Skeletal , Range of Motion, Articular , Adult , Age Factors , Aged , Aged, 80 and over , Aging , Ankle/physiology , Biomechanical Phenomena , Female , Humans , Isometric Contraction/physiology , Knee Joint/physiology , Male , Middle Aged , Movement/physiology , Muscle, Skeletal/physiology , Physical Therapy Modalities , Range of Motion, Articular/physiology , Reference Values , Regression Analysis , Sex Factors , TaiwanABSTRACT
OBJECTIVE: To assess the efficacy of a home exercise program in increasing hip muscle strength, walking speed, and function in patients more than 1.5 years after total hip replacement (THR). DESIGN: Randomized controlled trial. SETTING: Kinesiology laboratory. PARTICIPANTS: Fifty-three patients with unilateral THR were randomly assigned to the training (n=26) and control (n=27) groups. Patients in the training group were further divided into exercise-high (n=13) and exercise-low (n=13) compliance groups according to their practice ratio (high, > or =50%). INTERVENTION: The training group underwent a 12-week home program that included hip flexion range of motion exercises for both hip joints; strengthening exercises for bilateral hip flexors, extensors, and abductors; and a 30-minute walk every day. The control group did not receive any training. MAIN OUTCOME MEASURES: Strength of bilateral hip muscles, free and fast walking speeds while walking over 3 different terrains, and functional performance were assessed by using a dynamometer, videotape analysis, and the functional activity part of the Harris Hip Score, respectively, before and after the 12-week period. RESULTS: Subjects in the exercise-high compliance group showed significantly (P <.05) greater improvement in muscle strength for the operated hip, fast walking speed, and functional score than those in the exercise-low compliance and control groups. CONCLUSIONS: The designed home program was effective in improving hip muscle strength, walking speed, and function in patients after THR who practiced the program at least 3 times a week, but adherence to this home program may be a problem.
