Survey of a pelvic health physiotherapy community of practice: a pilot study to gain member input to help sustain and advance the group.

PURPOSE: To gather input and perspectives from members of the Calgary Pelvic Health Physiotherapists' Community of Practice (PHPT CoP) to ensure common goals that help sustain and advance the group. METHOD: An online survey grounded in CoP theory was used to elicit feedback from 23 PHPTs. Descriptive statistics summarized survey results. RESULTS: The response rate was 96%; all respondents worked in women's pelvic health. Respondents expressed interest in continuing regular face-to-face meetings, a speaker series, case studies, and connecting with other PHPTs. CONCLUSION: The findings suggest continuation of regular meetings, with a focus on clinical skill development, and an annual Alberta PHPT conference. Members of this community of practice seek a strategy to promote PHPT to the public and develop referral sources.

Objet : Réunir des commentaires et des points de vue des membres du Collectif de pratique des physiothérapeutes en santé pelvienne de Calgary (CdP PTSP) afin d'assurer que des buts communs aident à appuyer et à faire progresser leur groupe. Méthode : On a utilisé un sondage en ligne reposant sur les théories du CdP afin de réunir des commentaires de 23 physiothérapeutes en santé pelvienne. Des statistiques descriptives ont résumé les résultats du sondage. Résultats : Le taux de réponse s'est établi à 96%. Tous les répondants travaillaient en santé pelvienne des femmes. Les répondants souhaitaient que l'on poursuive les réunions en personne périodiques, organise une série de conférences, réalise des études de cas et établisse des contacts avec d'autres physiothérapeutes en santé pelvienne. Conclusion : Les constatations indiquent qu'il vaudrait la peine de continuer à tenir des réunions périodiques axées sur le perfectionnement des techniques cliniques et de tenir un congrès annuel des PTSP de l'Alberta. Les membres de ce collectif de pratique cherchent une stratégie pour promouvoir les PTSP auprès de la population et créer des sources d'aiguillage.

Standardized Patients versus Volunteer Patients for Physical Therapy Students' Interviewing Practice: A Pilot Study.

PURPOSE: To compare the use of standardized patients (SPs) and volunteer patients (VPs) for physical therapy students' interviewing practice in terms of students' perception and overall costs. METHODS: Students in the Master of Physical Therapy programme (n=80) at a Canadian university were divided into 20 groups of 4 and were randomly assigned to interview either an SP (10 groups) or a VP (10 groups). Students completed a survey about their perception of the usefulness of the activity and the ease and depth of information extraction. Survey responses as well as costs of the interview exercise were compared between SP and VP groups. RESULTS: No statistically significant between-groups difference was found for the majority of survey items. The cost of using an SP was $148, versus $50 for a VP. CONCLUSIONS: Students' perceptions of the usefulness of the activity in helping them to develop their interview skills and of the ease and depth of extracting information were similar for both SPs and VPs. Because the cost of using an SP is about three times that of using a VP, using VPs seem to be a more cost-effective option.

Objet : Comparer le recours aux patients normalisés (PN) et aux patients bénévoles (PB) par des étudiants en physiothérapie qui s'exercent à réaliser des entrevues en ce qui concerne la perception des étudiants et les coûts généraux. Méthodes : Des étudiants à la maîtrise en physiothérapie (n=80) d'une université canadienne ont été divisés en 20 groupes de 4 personnes et on leur a aléatoirement attribué soit un PN (n=10 groupes), soit un PB (n=10 groupes) à interviewer. Les étudiants ont répondu à un sondage sur leur perception de l'utilité de cette activité, de la facilité avec laquelle l'information avait été obtenue et du niveau de détail de l'information obtenue. Les réponses au sondage ainsi que les coûts de l'exercice d'entrevue ont été comparés entre les groupes de PN et de PB. Résultats : Aucune différence importante sur le plan statistique entre les deux groupes n'a été relevée pour la majorité des points du sondage. Le cours du recours à un PN était de 148 $, tandis qu'il était de 50 $ pour un PB. Conclusions : La perception des étudiants en ce qui concerne l'utilité de l'activité pour les aider à parfaire leurs techniques d'entrevue ainsi que la facilité d'obtenir de l'information et le niveau de détail de l'information obtenue était similaire pour les patients normalisés et les patients bénévoles. Puisque le coût du recours à un PN est environ trois fois celui du recours à un PB, les patients bénévoles semblent être un choix plus rentable.

Effect of a novel movement strategy in decreasing ACL risk factors in female adolescent soccer players: a randomized controlled trial.

OBJECTIVE: To determine the effect of a novel movement strategy incorporated within a soccer warm-up on biomechanical risk factors for anterior cruciate ligament injury during 3 sport-specific movement tasks. DESIGN: Single-blind, randomized controlled clinical trial. SETTING: Laboratory setting. PARTICIPANTS: Twenty top-tier female teenage soccer players. INTERVENTIONS: Subjects were randomized to the Core Position and Control movement strategy (Core-PAC) warm-up or standard warm-up, which took place before their regular soccer practice over a 6-week period. The Core-PAC focuses on getting the centre of mass closer to the plant foot or base of support. MAIN OUTCOME MEASURES: Peak knee flexion angle and abduction moments during a side-hop (SH), side-cut, and unanticipated side-cut task after the 6 weeks with (intervention group only) and without a reminder to use the Core-PAC strategy. RESULTS: The Core-PAC group increased peak flexion angles during the SH task [mean difference = 6.2 degrees; 95% confidence interval (CI), 1.9-10.5 degrees; effect size = 1.01; P = 0.034] after the 6-week warm-up program without a reminder. In addition, the Core-PAC group demonstrated increased knee flexion angles for the side-cut (mean difference = 8.5 degrees; 95% CI, 4.8-12.2 degrees; ES = 2.02; P = 0.001) and SH (mean difference = 10.0 degrees; 95% CI, 5.7-14.3 degrees; ES = 1.66; P = 0.001) task after a reminder. No changes in abduction moments were found. CONCLUSIONS: The results of this study suggest that the Core-PAC may be one method of modifying high-risk soccer-specific movements and can be implemented within a practical, team-based soccer warm-up. The results should be interpreted with caution because of the small sample size.

The effect of a novel movement strategy in decreasing ACL risk factors in female adolescent soccer players.

There is a need to investigate the effect of specific movement strategies in reducing biomechanical risk factors for anterior cruciate ligament injury in young female athletes. The purpose of this study was (a) to determine the feasibility of implementing a novel movement strategy (Core-PAC) into a team warm-up before soccer training based on subject compliance and integration of the Core-PAC into the warm-up and (b) to determine whether the Core-PAC would improve peak knee flexion angles and peak abduction moments at the knee during a side cut (SC) and an unanticipated side cut (USC) before kicking a soccer ball, and a side hop (SH) task after immediate instruction and after a 4-week training program. A convenience sample of ten 14- to 16-year-old female soccer players were instructed in the Core-PAC immediately after baseline testing and during a training program consisting of a 20-minute warm-up, 2 times per week. The Core-PAC was understood and accepted by the subjects and incorporated into their warm-up activities with good compliance. After the immediate instruction, there were significant increases in peak knee flexion angles of a mean 6.4° during the SC (p = 0.001), 3.5° during the USC (p = 0.007), and 5.8° during the SH (p < 0.001) tasks. Peak knee abduction moments decreased by a mean of 0.25 N·m·kg(-1) during the SC (p < 0.03), 0.17 N·m·kg(-1) during the USC (p = 0.05), and 0.27 N·m·kg(-1) during the SH (p = 0.04) tasks. After the 4-week training program, some individuals showed improvement. The results of this study suggest that the Core-PAC may be 1 method of modifying high-risk movements for ACL injury such as side cutting and single-leg landing.

The placement of skin surface markers for non-invasive measurement of scapular kinematics affects accuracy and reliability.

Abnormal scapular movement is widely believed to be an important factor in clinical pathology of the shoulder joint complex. Validated non-invasive techniques for measuring scapular movement have been developed, but the effect of marker placement on accuracy is unknown. The objective of this study was to determine the accuracy and reliability of different groupings of markers to achieve the best accuracy and reliability for measuring scapular kinematics. Eight healthy young adult subjects were recruited. An optoelectronic marker grid was applied to the skin overlying the scapula. Two bone pins with optoelectronic marker carriers were inserted into the scapula. The accuracy of six surface marker configurations was determined by comparing the measured kinematics with scapular bone pins (the gold standard). Four humeral movements were tested: glenohumeral abduction, glenohumeral horizontal adduction, hand behind back, and forward reaching. All three rotations had a significant difference in the accuracy of the patches (p = 0.04 to p < 0.0001). For posterior tipping there was a significant effect of movement (p = 0.003) and a significant interaction (p < 0.0001). There was also a significant interaction for external rotation (p = 0.001). The marker grouping with the largest cranio-caudal spread had the highest accuracy for measuring posterior tilting (RMS 1.9°). Markers closer to the scapular spine were more accurate for tracking external rotation (RMS 2.0°) while an intermediate grouping of markers were most accurate for quantifying upward rotation (RMS 1.9°). The reliability between days ranged between 3.8° and 7.5° (based on RMS difference between trials) and there was a significant interaction between patch and movement (p < 0.0001). Intraclass correlation coefficients show moderate to good agreement for most arm movements and scapular rotations. Thus, there exists distinct optimal configurations of non-invasive marker locations for accurately measuring scapular kinematics.

Deficits in muscle strength, mass, quality, and mobility in people with chronic obstructive pulmonary disease.

PURPOSE: Midthigh intramuscular fat (IF), a feature of reduced muscle quality, is an important predictor of self-reported mobility loss in the elderly. This study compared measures of muscle strength, mass, IF, and mobility in patients with chronic obstructive pulmonary disease (COPD) and healthy subjects. Associations between measures of muscle strength, mass, IF, and mobility were explored. METHODS: Knee extensor muscle strength was assessed with an isokinetic dynamometer. Cross-sectional area and IF of the thigh muscles were measured with computerized tomography. Mobility was assessed with the repetitive sit-to-stand, self-selected gait speed, and 6-minute walk tests. RESULTS: Patients with COPD (n = 21, age 71.3 ± 8.1 years, and a percentage predicted force expiratory volume in 1 second of 47.2 ± 12.9) and 21 healthy subjects matched for age (67.4 ± 8.6 years), gender, and body mass participated in the study. Patients with COPD showed reduced average knee extensor strength (29%, P = .016) cross-sectional area of the thigh muscles (17%, P = .007) and mobility measures (~23%, P ≤ .001). Knee extensor and flexor IF was 2-folds greater in people with COPD (P ≤ .005). Measures of knee extensor muscle strength, mass, and IF were not associated with mobility measures. CONCLUSIONS: Compared with healthy controls, patients with moderate to severe COPD show marked deficits in muscle strength, mass, quality, and mobility. More studies with larger sample size are required to elucidate whether any of these muscle deficits can explain mobility impairments in COPD.

Associations of the Stair Climb Power Test with muscle strength and functional performance in people with chronic obstructive pulmonary disease: a cross-sectional study.

BACKGROUND: The Stair Climb Power Test (SCPT) is a functional test associated with leg muscle power in older people. OBJECTIVE: The purposes of this study were to compare the results of the SCPT in people with chronic obstructive pulmonary disease (COPD) and people who were healthy and to explore associations of the SCPT with muscle strength (force-generating capacity) and functional performance. DESIGN: The study was a cross-sectional investigation. METHODS: Twenty-one people with COPD and a predicted mean (SD) percentage of forced expiratory volume in 1 second of 47.2 (12.9) and 21 people who were healthy and matched for age, sex, and body mass were tested with the SCPT. Knee extensor and flexor muscle torque was assessed with an isokinetic dynamometer. Functional performance was assessed with the Timed "Up & Go" Test (TUG) and the Six-Minute Walk Test (6MWT). RESULTS: People with COPD showed lower values on the SCPT (28%) and all torque measures (∼ 32%), except for eccentric knee flexor muscle torque. In people with COPD, performance on the TUG and 6MWT was lower by 23% and 28%, respectively. In people with COPD, the SCPT was moderately associated with knee extensor muscle isometric and eccentric torque (r ≥.46) and strongly associated (r=.68) with the 6MWT. In people who were healthy, the association of the SCPT with knee extensor muscle torque tended to be stronger (r ≥.66); however, no significant relationship between the SCPT and measures of functional performance was found. LIMITATIONS: The observational design of the study and the use of a relatively small convenience sample limit the generalizability of the findings. CONCLUSIONS: The SCPT is a simple and safe test associated with measures of functional performance in people with COPD. People with COPD show deficits on the SCPT. However, the SCPT is only moderately associated with muscle torque and thus cannot be used as a simple surrogate for muscle strength in people with COPD.

Preservation of eccentric strength in older adults: Evidence, mechanisms and implications for training and rehabilitation.

Overall reductions in muscle strength typically accompany the aging process. However, older adults show a relatively preserved capacity of producing eccentric strength. The preservation of eccentric strength in older adults is a well-established phenomenon, occurring indiscriminately across different muscle groups, independent of age-related architectural changes in muscle structure and velocity of movement. The mechanisms for the preservation of eccentric strength appear to be mechanical and cellular in origin and include both passive and active elements regulating muscle stiffness. The age-related accumulation of non-contractile material in the muscle-tendon unit increases passive stiffness, which might offer mechanical advantage during eccentric contractions. In addition, the preserved muscle tension and increased instantaneous stiffness of old muscle fibers during stretch increase active stiffness, which might enhance eccentric strength. The fact that the preservation of eccentric strength is present in people with chronic conditions when compared to age-matched healthy controls indicates that the aging process per se does not exclusively mediate the preservation of eccentric strength. Physical inactivity, which is common in elderly and people with chronic conditions, is a potential factor regulating the preservation of eccentric strength. When compared to concentric strength, the magnitude of preservation of eccentric strength in older adults ranges from 2% to 48% with a mean value of 21.6% from all studies. This functional reserve of eccentric strength might be clinically relevant, especially to initiate resistance training and rehabilitation programs in individuals with low levels of strength.

Reliability and validity of observational risk screening in evaluating dynamic knee valgus.

STUDY DESIGN: Nonexperimental methodological study. OBJECTIVES: To determine the interrater and intrarater reliability and validity of using observational risk-screening guidelines to evaluate dynamic knee valgus. BACKGROUND: A deficiency in the neuromuscular control of the hip has been identified as a key risk factor for noncontact anterior cruciate ligament (ACL) injury in postpubescent females. This deficiency can manifest itself as a valgus knee alignment during tasks involving hip and knee flexion. There are currently no scientifically tested methods to screen for dynamic knee valgus in the clinic or on the field. METHODS: Three physiotherapists used observational risk-screening guidelines to rate 40 adolescent female soccer players according to their risk of ACL injury. The rating was based on the amount of dynamic knee valgus observed on a drop-jump landing. Ratings were evaluated for intrarater and interrater agreement using kappa coefficients. Sensitivity and specificity of ratings were evaluated by comparing observational ratings, with measurements obtained using 3-dimensional (3-D) motion analysis. RESULTS: Kappa coefficients for intrarater and interrater agreement ranged from 0.75 to 0.85, indicating that ratings were reasonably consistent over time and between physiotherapists. Sensitivity values were inadequate, ranging from 67% to 87%. This indicated that raters failed to detect up to a third of "truly high-risk" individuals. Specificity values ranged from 60% to 72%, which was considered adequate for the purposes of the screening. CONCLUSION: Observational risk screening is a practical and cost-effective method of screening for ACL injury risk. Rater agreement and specificity were acceptable for this method, but sensitivity was not. To detect a greater proportion of individuals at risk of ACL injury, coaches and clinicians should ensure that they include additional tests for other high-risk characteristics in their screening protocols.

Muscle torque preservation and physical activity in individuals with stroke.

BACKGROUND: A greater percent loss of concentric versus eccentric muscle torque (i.e., relative eccentric muscle torque preservation) has been reported in the paretic limb of individuals with stroke and has been attributed to hypertonia and/or cocontractions. Stroke provides a unique condition for examining mechanisms underlying eccentric muscle preservation because both limbs experience similar amounts of general physical activity, but the paretic side is impaired directly by the brain lesion. PURPOSE: The purpose of this study was to determine 1) whether eccentric preservation also exists in the nonparetic limb and 2) the relationship of eccentric or concentric torque preservation with physical activity in stroke. We hypothesized that the nonparetic muscles would demonstrate eccentric muscle preservation, which would suggest that nonneural mechanisms may also contribute to its relative preservation. METHODS: Eighteen patients who had stroke and 18 healthy control subjects (age- and sex-matched) completed a physical activity questionnaire. Maximum voluntary concentric and eccentric joint torques of the ankle, knee, and hip flexors and extensors were measured using an isokinetic dynamometer at 30 degrees x s(-1) for the paretic and nonparetic muscles. Relative concentric and eccentric peak torque preservations were expressed as a percentage of control subject torque. RESULTS: Relative eccentric torque was higher (more preserved) than relative concentric torque for paretic and nonparetic muscles. Physical activity correlated with paretic (r = 0.640, P = 0.001) and nonparetic concentric torque preservation (r = 0.508, P = 0.009) but not with eccentric torque preservation for either leg. CONCLUSIONS: The relative preservation of eccentric torque in the nonparetic muscles suggest a role of nonneural mechanisms and could also explain the preservation observed in other chronic health conditions. Loss of concentric, but not eccentric, muscle torque was related to physical inactivity in stroke.

A new subject-specific skin correction factor for three-dimensional kinematic analysis of the scapula.

Noninvasive measurement of scapular kinematics using skin surface markers presents technical challenges due to the relative movement between the scapula and the overlying skin. The objectives of this study were to develop a noninvasive subject-specific skin correction factor that would enable a more accurate measurement of scapular kinematics and evaluate this new technique via comparison with a gold standard for scapular movement. Scapular kinematics were directly measured using bone pins instrumented with optoelectronic marker carriers in eight healthy volunteers while skin motion was measured simultaneously with optoelectronic markers attached to the skin surface overlying the scapula. The relative motion between the skin markers and the underlying scapula was estimated over a range of humeral orientations by palpating and digitizing bony landmarks on the scapula and then used to calculate correction factors that were weighted by humeral orientation. The scapular kinematics using these correction factors were compared with the kinematics measured via the bone pins during four arm movements in the volunteers: abduction, forward reaching, hand behind back, and horizontal adduction. The root-mean-square (rms) errors for the kinematics determined from skin markers without the skin correction factors ranged from 5.1 deg to 9.5 deg while the rms errors with the skin correction factors ranged from 1.4 deg to 3.0 deg. This technique appeared to perform well for different movements and could possibly be extended to other applications.

Effects of Pilates exercises on shoulder range of motion, pain, mood, and upper-extremity function in women living with breast cancer: a pilot study.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the effects of Pilates exercises on shoulder range of motion (ROM), pain, mood, and upper-extremity (UE) function in women who had been treated for breast cancer. PARTICIPANTS: The participants were 4 women who had undergone axillary dissection and radiation therapy for stage I to IV breast cancer. METHODS: A nonconcurrent, multiple-baseline, single-subject research design was used to examine the effects of Pilates exercises on the 4 outcomes. RESULTS: Visual analyses of the data suggest a modest effect of the Pilates exercise program in improving shoulder abduction and external rotation ROM. Statistically significant improvement in shoulder internal and external rotation in the affected UE was shown for the one participant with pre-existing metastatic disease. The improving baselines seen for pain, mood, and UE function data made it impossible to assess the effects of Pilates exercises on those outcomes. No adverse events were experienced. DISCUSSION AND CONCLUSION: Pilates exercises may be an effective and safe exercise option for women who are recovering from breast cancer treatments; however, further research is needed.

Estimation of thigh muscle mass with magnetic resonance imaging in older adults and people with chronic obstructive pulmonary disease.

BACKGROUND AND PURPOSE: Quantifying muscle mass is an essential part of physical therapy assessment, particularly in older adults and in people with chronic conditions associated with muscle atrophy. The purposes of this study were to examine the relationship between muscle cross-sectional area (CSA) and volume by use of magnetic resonance imaging (MRI) and to compare anthropometric estimations of midthigh CSA with measurements obtained from MRI. SUBJECTS AND METHODS: Twenty older adults who were healthy and 20 people with chronic obstructive pulmonary disease (COPD), matched for age, sex, and body mass index, underwent MRI to obtain measurements of thigh muscle CSA and volume. Anthropometric measurements (skinfold thickness and thigh circumference) were used to estimate midthigh CSA. RESULTS: Muscle volumes were significantly lower in the people with COPD than in the older adults who were healthy. Moderate to high correlations were found between midthigh CSA and volume in both groups (r=.61-.94). Anthropometric measurements tended to overestimate midthigh CSA in both the people with COPD (estimated CSA=64.9+/-17.8; actual CSA=48.3+/-10.2 cm(2)) and the older adults who were healthy (estimated quadriceps femoris muscle CSA=65.0+/-14.0; actual CSA=56.8+/-13.5 cm(2)). Furthermore, the estimated quadriceps femoris muscle CSAs were not sensitive enough to detect a difference in muscle size between people with COPD and controls. Thigh circumference alone was not different between groups and showed only low to moderate correlations with muscle volume (r=.19-.47). DISCUSSION AND CONCLUSION: Muscle CSA measured from a single slice provides a good indication of volume, but the most representative slice should be chosen on the basis of the muscle group of interest. Thigh circumference is not correlated with muscle volume and, therefore, should not be used as an indicator of muscle size. The development of population-specific reference equations for estimating muscle CSA from anthropometric measurements is warranted.

Preservation of eccentric torque of the knee extensors and flexors in patients with COPD.

PURPOSE: The purpose of this study was to compare the concentric and eccentric torque of the knee extensors (KEs) and flexors (KFs) in persons with chronic obstructive pulmonary disease (COPD) with matched controls. Muscle volume and intramuscular fat infiltration of the thigh muscles were also compared between groups. METHODS: Twenty persons with moderate to severe COPD and 20 control participants, matched for age, sex, and body mass index, participated in the study. Concentric and eccentric isokinetic torque of the KEs and KFs were measured on a KinCom dynamometer. Muscle volume of the quadriceps, hamstrings, and adductors and intramuscular fat infiltration were estimated from T1-weighted magnetic resonance imaging. Muscle volume of the quadriceps and hamstrings was used to normalize torque measurements of the KEs and KFs, respectively. RESULTS: Absolute concentric and eccentric torque was lower in the COPD group than in controls. However, normalized eccentric torque was higher in persons with COPD (P < .05). Persons with COPD demonstrated lower muscle volume of all thigh muscle groups (P < .01) and greater intramuscular fat infiltration (P < .002) than controls. CONCLUSIONS: Although absolute torque of the KEs and KFs are lower in persons with COPD than in controls, normalized eccentric torque is actually higher in persons with COPD. A further examination of factors that contribute to the enhancement of eccentric torque in persons with COPD is warranted.

Three-dimensional rotation of the scapula during functional movements: an in vivo study in healthy volunteers.

The goal of this study was to measure 3-dimensional shoulder motion by use of a direct invasive technique during 4 different arm movements in healthy volunteers. Eight subjects with healthy shoulders were recruited. Optoelectronic marker carriers (ie, infrared light-emitting diodes) were mounted on bone pins, which were inserted into the lateral scapular spine. Subjects performed 4 different arm movements while the motion was being recorded by a precision optoelectronic camera. Joint angles were calculated in 3 dimensions. Intraclass correlation coefficients and root-mean-square differences were calculated as measures of reliability. During abduction, the scapula tipped posteriorly (44 degrees +/- 11 degrees), rotated upward (49 degrees +/- 7 degrees), and rotated externally (27 degrees +/- 11 degrees). For reaching, the scapula consistently rotated upward (17 degrees +/- 3 degrees) and rotated internally (18 degrees +/- 6 degrees) whereas tipping was generally less than 10 degrees (5 degrees +/- 2 degrees). Overall, the range of scapular movement for the hand behind the back was small and variable, with most rotations not exceeding 15 degrees. For horizontal adduction, the scapula tipped anteriorly (8 degrees +/- 3 degrees), rotated upward (5 degrees +/- 2 degrees), and rotated internally (27 degrees +/- 6 degrees). These scapular rotations provide normative data that will be useful for diagnosing scapular dysfunction.

Recovery of lower limb function following 6 weeks of non-weight bearing.

Skeletal muscle weakness and atrophy occur following an extended period of decreased use, including space flight and limb unloading. It is also likely that affected muscles will be susceptible to a re-loading injury when they begin return to earth or weight bearing. However, there is a paucity of literature evaluating the response of human unloaded muscle to exercise and return to activity. The purpose of this pilot study was to evaluate the soreness, function and strength response of muscle to re-loading in seven patients who were non-weight bearing for 6 weeks, compared to five healthy subjects. Function improved significantly over time for the patients but was still less than the healthy subjects over 12 weeks of physiotherapy. Concentric quadriceps muscle strength increased significantly over time for the patients. There was considerable variability in the patients' reports of muscle soreness but there were no significant changes over time or between groups.

Leg muscle strength is reduced in Parkinson's disease and relates to the ability to rise from a chair.

Individuals with Parkinson's disease (PD) have difficulties rising from a chair; however, factors contributing to this inability have never been investigated. We compared lower extremity strength between individuals with PD and healthy controls and quantified the relationships between strength and the ability to rise from a chair. Ten men with mild PD and 10 sex- and age-matched controls performed maximal concentric, isokinetic knee and hip extensor torque on an isokinetic dynamometer to quantify muscle strength. Subjects also rose from a chair at their comfortable pace without the use of their arms and the duration of this task provided a measure of sit-to-stand (STS) ability. Subjects with PD were tested in an on- and off-medication state on different days. Mean hip and knee extensor torques were lower in subjects with PD, with greater deficits found at the hip. Greater hip strength was related to better STS ability in subjects with PD while greater knee strength was related to better STS ability in controls. These results show that individuals with mild PD generate smaller extremity forces compared to controls. Reduced strength, particularly at the hip, may be one factor that contributes to the difficulty of persons with PD to rise from a chair.

Test-retest reliability of glenohumeral internal and external rotator strength.

OBJECTIVE: To establish test-retest reliability for a strength testing protocol of the glenohumeral internal and external rotator muscles using a KinCom (Chattanooga Group, Hixson, TN) isokinetic dynamometer. DESIGN: Prospective test-retest reliability study. SETTING: Rehabilitation research laboratory. PARTICIPANTS: Fourteen volunteers between the ages of 27 and 35 years participated in the study. Subjects had no history of traumatic shoulder injury and no overuse-based shoulder pain interfering with activity within the last 6 months. Nine of the 14 subjects were not participating in more than 6 hours weekly of arm-based sporting activities, while the remaining five subjects were involved in swim training at workout volumes of no greater than 3000 m per week. INTERVENTION: Subjects performed three test sessions of four maximal repetitions each of concentric and eccentric shoulder internal and external rotation bilaterally in a standardized sitting position. An average of 5.9 days occurred between consecutive test sessions (range, 2-21 days). MAIN OUTCOME MEASURES: Average torque data were collected for concentric and eccentric internal and external rotation tests bilaterally. Intraclass correlation coefficients were calculated to compare the data across sessions. Pearson product moment correlation coefficients were calculated to assess reliability between sessions. RESULTS: High test-retest reliability, ranging from 0.82 to 0.97, was demonstrated for all tests. CONCLUSIONS: The results indicate that a reliable test protocol has been determined for shoulder internal and external rotation strength testing on the KinCom isokinetic dynamometer.

Reliability of lower extremity strength measures in persons with chronic stroke.

OBJECTIVE: To determine the reliability of isokinetic concentric strength measures of both the hemiparetic and noninvolved limbs for flexion and extension motions of the hip, knee, and ankle joints in individuals who have had a stroke. DESIGN: Test-retest, repeated-measures intraobserver reliability design. SETTING: Tertiary rehabilitation center. PARTICIPANTS: Twenty community-dwelling individuals who have had a stroke, with motor deficits ranging from 3 to 6 on the Chedoke-McMaster Stroke Assessment; volunteer sample. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak torque and average torque (ie, mean over the range of motion tested) from an ensemble-averaged (3 trials) torque-angle curve during isokinetic concentric extension and flexion movements of the ankle, knee, and hip. RESULTS: Although peak and average torque were significantly less for the hemiparetic limb compared with the noninvolved limb, the intraclass correlation coefficients (ICCs) between the 2 test sessions were high (.95-.99 for peak torque,.88-.98 for average torque) for both limbs for all 3 joints. However, there was a learning effect, as observed by the slightly greater values attained from the second test session. CONCLUSIONS: Peak and average isokinetic torque can be used to assess reliably lower extremity strength in persons with chronic stroke. Practice sessions may be required before the actual test to reduce the effect of learning.