Reliability of manual muscle testing: A systematic review

Neuro-orthopaedic check-up and walking in people with multiple sclerosis: toward a more specific assessment to improve rehabilitation results

The rehabilitation process of people with multiple sclerosis (PwMS) is a challenge, and decision-making requires a thorough assessment to increase the chances of success in rehabilitation planning. The aim of this study was to investigate the importance of the neuroorthopaedic check-Up (NOChU) for gait prognosis. Participated in the study 105 PwMS with different levels of impairment. The NOChU includes measurements of passive range of motion (ROM), muscle strength, and spasticity. Additionally, was carried out the spatial-temporal analysis of the walking, Timed Up and Go test, and 6-min walk test. ROM remained relatively preserved to perform daily life activities except for ankle dorsiflexion. Muscle strength was also relatively preserved. Spasticity affected especially the ankle muscles, clearly the sural triceps. Among the NOChU measurements the catch seemed to have the most impact on walking on its different phases and on other activities. Accurate NOChU measurements play a crucial role in clinical settings, guiding informed decisions in rehabilitation planning. Future research endeavours could focus on exploring the correlations between NOChU deficiencies and the decline in walking capabilities among PwMS, with the goal of proposing personalized treatment strategies that address their specific requirements.

A portable articulated dynamometer for ankle dorsiflexion and plantar flexion strength measurement: a design, validation, and user experience study

Monitoring ankle strength is crucial for assessing daily activities, functional ability, and preventing lower extremity injuries. However, the current methods for measuring ankle strength are often unreliable or not easily portable to be used in clinical settings. Therefore, this study proposes a portable dynamometer with high reliability capable of measuring ankle dorsiflexion and plantar flexion. The proposed portable dynamometer comprised plates made of aluminum alloy 6061 and a miniature tension-compression load cell. A total of 41 healthy adult participants applied maximal isometric dorsiflexor and plantar flexor forces on a Lafayette Handheld Dynamometer (HHD) and the portable dynamometer. The results were cross-validated, using change in mean, and two independent examiners evaluated the inter-rater and test-retest reliabilities in separate sessions using intraclass correlation coefficients, standard error of measurement, and minimal detectable change. Both dorsiflexion and plantar flexion measurements demonstrated a strong correlation with the HHD (r = 0.827; r = 0.973) and showed high inter-rater and test-retest reliabilities. Additionally, the participant responses to the user experience questionnaire survey indicated vastly superior positive experiences with the portable dynamometer. The study findings suggest that the designed portable dynamometer can provide accurate and reliable measurements of ankle strengths, making it a potential alternative to current methods in clinical settings.

Development and validation of a portable articulated dynamometry system to assess knee extensor muscle strength

Muscle strength assessment is important in predicting clinical and functional outcomes in many disorders. Manual muscle testing, although commonly used, offers suboptimal accuracy and reliability. Isokinetic dynamometers (IKDs) have excellent accuracy and reliability; but are bulky and expensive, offering limited accessibility. This study aimed to design a portable dynamometer that is accessible, accurate and reliable, and to validate the device in a general population. The portable articulated dynamometry system (PADS) is a portable device with an embedded high-precision load cell, designed to measure muscle strength with optimal accuracy. Seventy-two participants underwent maximal isometric and isokinetic knee extensor torque measurement with the PADS and IKD, respectively. The PADS results were cross-validated against IKD results using change in mean (CIM). Interrater and intra-rater reliabilities were assessed using intraclass correlation coefficients, standard error of measurement, and minimal detectable change. The PADS maximal knee extensor strength results were not significantly different from those by IKD (CIM: - 2.13 Nm; 95% CI - 4.74, 0.49 Nm). The PADS showed interrater reliability (Pearson's r: 0.958; ICC: 0.979; SEM: 5.51%) and excellent intra-rater reliability (Pearson's r: 0.912; ICC: 0.954; SEM: 8.38%). The proposed PADS may be an effective alternative to IKD, offering good accuracy, reliability, and potentially better accessibility.

Do the Testing Posture and the Grip Modality Influence the Shoulder Maximal Voluntary Isometric Contraction?

Assessing and monitoring shoulder strength is extremely important during rehabilitation. A fixed dynamometer represents a valid and inexpensive assessment method. However, it has not been studied whether posture and grip modality influence shoulder muscle strength. The aim of this study was to compare shoulder strength values between sitting and standing positions and between the handle and cuff grip modalities. A total of 40 volunteers were divided into a posture (PG) and a handle-cuff group (HCG). Participants in the PG were asked to perform a maximum voluntary isometric contraction (MVIC) for shoulder flexion, extension, ab-adduction, and intra-extra rotation in standing and sitting positions. The HCG participants were tested in a standing position while holding a handle or with a cuff around their wrist. PG showed higher forces in the standing position for shoulder flexion (p = 0.009); internal rotation showed higher values in the sitting position (p = 0.003). ER/IR ratio was significantly higher in the standing position (p < 0.001). HCG showed higher significant forces during cuff modality in all positions and grip modalities, including the ER/IR ratio (p < 0.05). Different body positions and grip modalities influenced the assessment of shoulder strength as recorded by a fixed dynamometer; therefore, these factors should be carefully considered when carrying out a shoulder strength assessment, and we encourage the development of assessment guidelines to make future clinical trial results comparable.

Laboratory-Based Examination of the Reliability and Validity of Kinematic Measures of Wrist and Finger Function Collected by a Telerehabilitation System in Persons with Chronic Stroke

We have developed the New Jersey Institute of Technology-Home Virtual Rehabilitation System (NJIT-HoVRS) to facilitate intensive, hand-focused rehabilitation in the home. We developed testing simulations with the goal of providing richer information for clinicians performing remote assessments. This paper presents the results of reliability testing examining differences between in-person and remote testing as well as discriminatory and convergent validity testing of a battery of six kinematic measures collected with NJIT-HoVRS. Two different groups of persons with upper extremity impairments due to chronic stroke participated in two separate experiments. Data Collection: All data collection sessions included six kinematic tests collected with the Leap Motion Controller. Measurements collected include hand opening range, wrist extension range, pronation-supination range, hand opening accuracy, wrist extension accuracy, and pronation-supination accuracy. The system usability was evaluated by therapists performing the reliability study using the System Usability Scale. When comparing the in-laboratory collection and the first remote collection, the intra-class correlation coefficients (ICC) for three of the six measurements were above 0.900 and the other three were between 0.500 and 0.900. Two of the first remote collection/second remote collection ICCs were above 0.900, and the other four were between 0.600 and 0.900. The 95% confidence intervals for these ICC were broad, suggesting that these preliminary analyses need to be confirmed by studies with larger samples. The therapist's SUS scores ranged from 70 to 90. The mean was 83.1 (SD = 6.4), which is consistent with industry adoption. There were statistically significant differences in the kinematic scores when comparing unimpaired and impaired UE for all six measures. Five of six impaired hand kinematic scores and five of six impaired/unimpaired hand difference scores demonstrated correlations between 0.400 and 0.700 with UEFMA scores. Reliability for all measures was acceptable for clinical practice. Discriminant and convergent validity testing suggest that scores on these tests may be meaningful and valid. Further testing in a remote setting is necessary to validate this process.

Tendon Transfers and Their Role in Cavus Foot Deformity

Management of the cavus foot is a difficult task for the foot and ankle surgeon. Tendon transfers have been a longstanding accepted treatment for the flexible cavus foot. Performing tendon transfers requires an in-depth understanding of the patient's medical history, factors leading to the development of deformity, as well as the deforming forces contributing to the deformity. Evaluation of the patient for rigid, progressive, and/or spastic deformities is critical to avoid postoperative complications. Educating the patient on postoperative rehabilitation, potential complications, and postoperative expectations is essential to ensure appropriate surgical outcomes.

A structural equation model of falls at home in individuals with chronic stroke, based on the international classification of function, disability, and health

PURPOSE

To use structural equation model (SEM) to explain falls at home in individuals with chronic stroke, based on the International Classification of Functioning, Disability and Health (ICF).

MATERIALS AND METHODS

A cross sectional observation study was conducted in home-dwelling individuals with chronic stroke (N = 236; 148 non-fallers, 88 fallers). Participants were assessed; structural impairments using Modified Ashworth Scale, Fugl-Meyer Assessment upper (FMA-UE), lower (FMA-LE), and sensory function, ankle plantarflexor strength; activity limitations using Timed Up and Go Test, Step Test, Berg Balance Scale, Barthel Index (BI); participation restrictions using Stroke Impact Scale-participation (SIS-P); and contextual factors using home hazard environments, home safety surroundings, risk behaviors, and Fall-related Self Efficacy. The measurement model was analyzed by confirmatory factor analysis. The SEM was conducted to analyze a structural model of falls at home.

RESULTS

FMA-UE was significantly (p<0.01) associated with FMA-LE, combining as one variable in the structural impairments. In the measurement model, variables were fit to their domains, except variables of contextual factors, but the ICF domains did not correspond to disability. A structural model of falls at home demonstrated a significant (p<0.01) direct path of contextual factors and activity limitations with falls at home. The structural impairments showed a significant (p<0.01) direct path with activity limitations. All variables, except BI, SIS-P and risk behaviors, related to their domains in the structural model.

CONCLUSIONS

A structural model of falls at home proposes contextual factors being the strongest association with falls at home that home hazard environments seem the most influence in its domain. The activity limitations presented by balance ability are directed to falls at home. The structural impairments are associated with falls at home through activity limitations. Home assessment to decrease home hazard environments is suggested to prevent falls at home for individuals with chronic stroke.

Considerations and Practical Options for Measuring Muscle Strength: A Narrative Review

Muscle strength impairments are related to mobility limitations and other untoward outcomes. This narrative review, therefore, describes considerations relative to the definition and measurement of muscle strength. Thereafter, practical options for measuring muscle strength are described and their clinimetric properties are delineated. Information provided herein may help students, clinicians, and researchers select the strength tests best suited to their research needs and limitations.