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Objective: To evaluate inter- and intrarater reliability of isokinetic muscle strength measurements during knee extension and flexion in postmenopausal women with osteopenia., Design: Reliability study assessing inter- and intrarater reliability., Setting: General community., Participants: A convenience sample of 27 postmenopausal women (mean age ± SD, 68.2±7.3y) with defined osteopenia from a bone mineral density T score of less than 1.5 and a wrist fracture within the last 2 years., Interventions: Not applicable., Main Outcome Measures: Isokinetic concentric muscle strength during knee extension and flexion was measured for 2 test conditions: 5 repetitions at 60°/s, and 25 repetitions at 180°/s. Agreement between tests was evaluated with the intraclass correlation coefficient (ICC(2,1)). Mean difference between tests, standard error of measurement (SEM and SEM%), and smallest real difference (SRD and SRD%) were calculated with 95% confidence intervals. SRD% and SEM% are emphasized in the results to allow congruent comparisons between the different test conditions., Results: ICC(2,1) reflected high agreement both for inter- and intrarater reliability, with most of the values .90 or greater. There were no significant differences between the left and the right leg at any of the 3 tests. Some differences were apparent between the test sessions, but these were not systematic. Agreements were overall higher for assessments during knee extension than knee flexion. The SEM% was between 3.5% and 10.2% for knee extension, and 7.0% and 17.7% for knee flexion. SRD% was suggested to be between 15% and 20% for knee extension, and 25% and 30% for knee flexion., Conclusions: Isokinetic assessments of thigh muscle strength in postmenopausal women with osteopenia are of high reliability, with a level of agreement comparable to the levels found in previous reliability studies concerning both the healthy elderly and elderly with different health conditions. The measurement errors are small to moderate. The established SRD% provides thresholds for whether observed changes in strength in this patient group represent true change, which allows evaluations of minimal clinical importance in future studies., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the characteristics of long sitting (ie, sitting with legs extended) in patients with spinal cord injury (SCI) and to compare these results with able-bodied control subjects., Design: A kinematic study using a video camera and forceplate with a strain-gauge type load cell., Setting: A referral center for patients with SCI in Japan., Participants: Twenty-four subjects, including 11 able-bodied, matched control subjects and 13 SCI patients with complete paraplegia., Interventions: Not applicable., Main Outcome Measures: Sitting posture in the sagittal plane as well as the movement pattern and distance of the center of pressure (COP)., Results: Patients with SCI kept their pelvis tilted posteriorly and the lumbar spine was less lordotic during long sitting. The changing COP pattern during long sitting differed in able-bodied subjects as compared patients with SCI. During long sitting with arms outstretched over the thighs, COP movement in the subjects with SCI was significantly greater than that in the able-bodied subjects. When the arms were outstretched over the thighs, the COP shifted anteriorly in the able-bodied subjects and posteriorly in the patients with SCI., Conclusions: Long sitting in the paraplegic patients with SCI was unstable compared with the able-bodied subjects. The COP distribution pattern differed significantly between the 2 groups. The support and function of the upper extremities may influence balance during long sitting in the patients with SCI. The method of seating evaluation using a video camera and gravicorder was easy to use and appeared to provide an objective measurement of dynamic seating function in the patients with SCI.

Objective: To evaluate the effect of hip position and lumbar posture on the surface electromyographic activity of the trunk extensors during Roman chair exercise., Design: Descriptive, repeated measures., Setting: University-based musculoskeletal research laboratory., Participants: Twelve healthy volunteers (7 men, 5 women; age range, 18-35y) without a history of low back pain were recruited from a university setting., Interventions: Not applicable., Main Outcome Measures: Surface electromyographic activity was recorded from the lumbar extensor, gluteal, and hamstring musculature during dynamic Roman chair exercise. For each muscle group, electromyographic activity (mV/rep) was compared among exercises with internal hip rotation and external hip rotation and among exercises by using a typical lumbar posture (nonbiphasic) and a posture that accentuated lumbar lordosis (biphasic)., Results: For the lumbar extensors, electromyographic activity during exercise was 18% greater with internal hip rotation than external hip rotation (P< or =.05) and was 25% greater with a biphasic posture than with a nonbiphasic posture (P< or =.05). For the gluteals and hamstrings, there was no difference in electromyographic activity between internal and external hip rotation or between biphasic and nonbiphasic postures (P >.05)., Conclusion: The level of recruitment of the lumbar extensors can be modified during Roman chair exercise by altering hip position and lumbar posture. Clinicians can use these data to develop progressive exercise protocols for the lumbar extensors with a variety of resistance levels without the need for complex equipment., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

We report a fracture through the lateral femoral condyle of a paraplegic subject caused by electrical stimulation (ES). The subject was a 50-year-old man who 4 years earlier had sustained a complete spinal cord injury (SCI) at level T6. The fracture occurred during ES-induced measurement of maximal isometric torque of the quadriceps with the knee flexed at an angle of 90 degrees. ES was delivered through surface electrodes with biphasic square wave pulses from a constant current stimulator. The torque was calculated to be 93Nm, corresponding to 20.8kg at the ankle. The regional bone mineral density of the entire lower extremities was .83g/cm2, corresponding to 60% of sex- and age-matched able-bodied reference values. Several factors are suspected to have contributed to the fracture: maximal ES in combination with a muscle spasm, severe osteoporosis, increased muscular strength induced by regular ES cycling (twice a week), and testing position with the knee locked in 90 degrees flexion. The risk of fracture as well as various precautions are discussed and should be taken into consideration in future studies.

Objective: A recent prevalence study of 353 spinal cord injured (SCI) individuals in the greater Stockholm area showed problematic spasticity in 30% of this population. To treat spasticity, the evaluation becomes crucial. The modified Ashworth scale (MAS) is the clinically most-used scale to grade degree of spasticity. This study evaluated whether the MAS correlated with electromyographic (EMG) recordings of muscle activity., Study Design: This cross-sectional study was performed at an outpatient clinic that has the responsibility to do a standardized, yearly follow-up of all SCI patients in the greater Stockholm area. Thirty-eight SCI individuals met the inclusion criteria; 15 of the 38 were randomly selected for the study. They were all motor-complete tetraplegic men; mean age was 33 years and mean time since injury was 9 years. Spasticity evaluation was performed by flexing and extending the knees during simultaneous EMG recordings and MAS assessment of the thigh muscle activity., Results: Eighty percent of the individual EMG recordings correlated significantly with the corresponding Ashworth measurements. The spastic resistance, as measured both clinically and electromyographically, was stronger and lasted longer during extension than flexion movements. Spearman coefficients for correlation of quantitative spasticity measures with MAS grades were calculated. EMG and clinical measures of spasticity were more closely correlated for flexion movements. Among EMG parameters, duration of movement-associated electrical activity invariably correlated significantly with the MAS grades (p < .05). Furthermore, Ashworth measurements of movement-associated spasticity showed a positive correlation with the EMG parameters mean, peak, and start to peak of electrical activity. Each increasing grade on the MAS corresponded to increasing myoelectric activity levels for each movement., Conclusion: EMG parameters were significantly positively correlated with simultaneous MAS measurements of the spastic muscle contraction. The Ashworth scale may therefore accurately reflect the movement-provoked spasticity in motor-complete tetraplegic patients.

Objective: To evaluate the effects of one 10-minute stretch on muscle stiffness in subjects with short hamstrings., Design: Randomized control trial., Setting: Laboratory for human movement sciences in the department of rehabilitation of a university hospital., Subjects: Sixteen students from the Department of Human Movement Sciences participated with informed consent in the experiment. Subjects were limited to men and women without a history of neurological and orthopedic disorders. To select subjects with short hamstrings, the finger-ground distance had to be greater than 0cm (unable to touch the floor when bending forward) and the manual leg lifting was not to exceed 80 degrees. One group of 10 subjects performed static stretching exercises during 10 minutes interspersed with relaxing, whereas the untreated group of 6 subjects was used as a control., Main Outcome Measures: The instrumental straight-leg-raising set-up enables the measurement of the force needed to lift the leg, range of motion (ROM), pelvic-femoral angle, and the electromyogram of the hamstrings. These variables provide information about the stiffness, elongation, and state of activity of the hamstring muscles. RESULTS. One 10-minute sport stretch resulted in a significant increase in passive muscle moment, ROM, and elongation of the hamstrings. There was no significant change in the course of the passive muscle stiffness curve with respect to the prestretch stiffness curve., Conclusions: One session of static stretching does not influence the course of the passive muscle stiffness curve. The increased ROM, i.e., the extensibility of the hamstrings, results from an increase in the stretch tolerance.

Our purpose was to evaluate a test battery for measuring progress and the effect of interventions in patients with hereditary motor and sensory neuropathy (HMSN types I and II). For this purpose differences in upper leg strength and functional abilities between patients and healthy persons were quantified. Twenty patients participated in the study. They were matched with healthy control subjects with respect to gender, age, body weight, and height. Because of the high reproducibility and sensitivity of the method, muscle strength was quantified as isokinetic and isometric knee torques on an isokinetic dynamometer. Isokinetic knee extension and flexion torques were recorded for three movement velocities (120, 60, and 30 degrees/sec). An extension endurance test was performed at 80% of maximum voluntary contraction. Time scored activities (for instance, stair climbing) that are mainly related to leg function were measured to determine functional abilities. The torques were lower (p < 0.009) and endurance was less (p = 0.03) for patients than for controls. Time scores were higher (p < 0.013) in patients. A strength reduction in the knee extensors and flexors and a decrease in functional abilities was found even in mildly affected patients. Torques and time scores were correlated, although correlation coefficients were rather low. Our results indicate that both types of test are useful for monitoring lower limb function in HMSN patients.

Lateral release (division of the lateral retinaculum of the patella) is a common operative procedure to improve alignment of the patella in patients with chondromalacia patellae. We investigated the effects of lateral release using clinical follow-up and studied the changes in the radiologic measurements of the patellar alignment and electromyographic function of the stabilizing muscles of the knee, as well as using muscle-force tests of the thigh. The study included 75 patients. Diagnostic arthroscopy was done for all patients. In 42 patients with obvious incongruency of the patellofemoral joint observed at arthroscopy, open division of the lateral patellar retinaculum was performed in addition to arthroscopy. Four years after surgery, the results showed that although division of the lateral retinaculum of the patella reduced lateral patellar tilting and lateral patellar displacement, the postoperative physical capacity of the patients was not improved. Lateral release did not impair the electrical activity of thigh muscles. The Lysholm scores of the lateral release group and the control group were equal after four years.