Distribution and severity of weakness among patients with polymyositis, dermatomyositis and juvenile dermatomyositis.

OBJECTIVE: To describe the distribution and severity of muscle weakness using manual muscle testing (MMT) in 172 patients with PM, DM and juvenile DM (JDM). The secondary objectives included characterizing individual muscle group weakness and determining associations of weakness with functional status and myositis characteristics in this large cohort of patients with myositis. METHODS: Strength was assessed for 13 muscle groups using the 10-point MMT and expressed as a total score, subscores based on functional and anatomical regions, and grades for individual muscle groups. Patient characteristics and secondary outcomes, such as clinical course, muscle enzymes, corticosteroid dosage and functional status were evaluated for association with strength using univariate and multivariate analyses. RESULTS: A gradient of proximal weakness was seen, with PM weakest, DM intermediate and JDM strongest among the three myositis clinical groups (P < or = 0.05). Hip flexors, hip extensors, hip abductors, neck flexors and shoulder abductors were the muscle groups with the greatest weakness among all three clinical groups. Muscle groups were affected symmetrically. CONCLUSIONS: Axial and proximal muscle impairment was reflected in the five weakest muscles shared by our cohort of myositis patients. However, differences in the pattern of weakness were observed among all three clinical groups. Our findings suggest a greater severity of proximal weakness in PM in comparison with DM.

Biomechanical comparison of the energy-storing capabilities of SACH and Carbon Copy II prosthetic feet during the stance phase of gait in a person with below-knee amputation.

In this study, the energy-storing capabilities of solid-ankle cushion heel (SACH) and Carbon Copy II prosthetic feet during the stance phase of gait were compared. A person with a unilateral below-knee amputation served as a component of the instrumentation to test the feet under dynamic loads. Ten trials per foot of bilateral stride at "free" velocity were collected with a video-based, three-dimensional data-acquisition system and two force plates. There were no differences between the prosthetic conditions in step length, single-limb support time, and swing period (analysis of variance) or in double-limb support time, cadence, and velocity (Student's t test). Angular kinematics and moments of the hip and knee were unaffected bilaterally by the type of foot. The progression of the center of pressure under the Carbon Copy II was delayed from 15% to 80% of stance as compared with the SACH foot. The Carbon Copy II showed slower unloading in late stance and a later peak propulsive force than did the SACH foot. The Carbon Copy II performed greater work in both the energy-storage (Carbon Copy II = 2.33 J, SACH = 1.16 J) and energy-return (Carbon Copy II = 1.33 J, SACH = 0.34 J) phases of stance and returned energy with 57% efficiency. Although the energy returned by the Carbon Copy II was clinically insignificant during level walking, these results confirm that it performs as an energy-storing device.

Interrater reliability of videotaped observational gait-analysis assessments.

The purpose of this study was to determine the interrater reliability of videotaped observational gait-analysis (VOGA) assessments. Fifty-four licensed physical therapists with varying amounts of clinical experience served as raters. Three patients with rheumatoid arthritis who demonstrated an abnormal gait pattern served as subjects for the videotape. The raters analyzed each patient's most severely involved knee during the four subphases of stance for the kinematic variables of knee flexion and genu valgum. Raters were asked to determine whether these variables were inadequate, normal, or excessive. The temporospatial variables analyzed throughout the entire gait cycle were cadence, step length, stride length, stance time, and step width. Generalized kappa coefficients ranged from .11 to .52. Intraclass correlation coefficients (2,1) and (3,1) were slightly higher. Our results indicate that physical therapists' VOGA assessments are only slightly to moderately reliable and that improved interrater reliability of the assessments of physical therapists utilizing this technique is needed. Our data suggest that there is a need for greater standardization of gait-analysis training.