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Background: This study evaluated the effectiveness of radio electric asymmetric conveyer (REAC) neurobiological optimization treatments on muscle strength (MS) in individuals with post-polio syndrome (PPS), a condition causing new muscle weakness in polio survivors. Traditional treatments focus on symptom management, whereas REAC technology uses radio electric symmetric conveyed fields to modulate neurotransmission and cellular function. Methods: This open-label study involved 17 PPS patients who maintained their existing medications. The participants underwent four REAC treatment protocols: neuro-postural optimization (NPO), neuro-psycho-physical optimization (NPPO), neuro-psycho-physical optimization—cervical brachial (NPPO-CB), and neuromuscular optimization (NMO). MS was assessed using manual muscular tests (MMT) before and after each protocol. Results: A statistical analysis via repeated measures ANOVA showed significant MS improvements, particularly in the proximal muscles of the left lower limb (LLL), distal muscles of both lower limbs (LLs), and distal muscles of the left upper limb. The LLL, the most severely affected limb at this study's start, exhibited the greatest improvement. Conclusions: These results suggest REAC treatments could enhance MS in PPS patients, potentially reorganizing motor patterns and reducing functional overload on less affected limbs. [ABSTRACT FROM AUTHOR]

Study Design.: We conducted a retrospective review of data from patients who underwent surgical treatment for lumbosacral radiculopathy. Objective.: To assess the effectiveness of the foot tapping test (FTT) in evaluating lower limb motor function in patients with lumbosacral radiculopathy pre and postsurgery. Background.: Lumbosacral radiculopathy is becoming increasingly common in aging populations. Despite standard treatments, paralysis often leads to incomplete postoperative recovery, necessitating early detection and interventions. Patients and Methods.: We enrolled individuals who underwent surgery for lumbosacral radiculopathy at our facility between 2009 and 2020. Patients with a history of lumbar surgeries, dialysis, rheumatoid arthritis, and transitional vertebrae were excluded. The FTT score was measured by having the sole of the foot tap as many times as possible for 10 seconds while keeping the heel in contact with the floor. The L4, L5, and S1 groups were assigned using the scores on the side of the radiculopathy, and the control group was assigned using the scores on the intact side. Data were analyzed using the Dunnett test for group comparisons and paired t -tests for pre and postsurgery comparisons. Results.: Of the 522 eligible patients, 80 (159 nerve roots, 1 patient with hemi-prosthetic leg) were analyzed. The preoperative FTT scores in the L4 and L5 groups were significantly lower than those in the control group, indicating functional impairment. One year postsurgery, all groups showed improvements in FTT scores, with the L5 group exhibiting significant improvements compared with the control; this was supported by the results of sensitivity analyses considering the effects of paralysis and pain. Conclusion.: The FTT is a valuable tool for the early detection of lower limb motor dysfunction in lumbosacral radiculopathy, particularly for L5 nerve root impairment, where it aids in timely surgical intervention and may improve postoperative outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Hirayama Disease (HD) is an infrequent condition. Due to its rarity and misdiagnosed nature, epidemiological data is limited. Therefore, the present study aimed to find the effectiveness of physiotherapy intervention in the symptomatic management of HD. The results of the present study provided evidence for the development of standardised protocol for treatment to manage the symptoms of HD. Hereby. the authors present a case of a 20-year-old male, who presented with the chief complaint of weakness in bilateral hands for the past 3 years. The patient was examined for upper limb motor functions using Nerve Conduction Velocity (NCV), Manual Muscle Testing (MMT), Patient-related Wrist Evaluation (PRWE) and Patientrelated Hand Evaluation, Quality of Life (QoL) Scale, Handheld Dynamometer (HHD) and Pinchmeter. Pre and post-intervention analysis of outcome measures were used to show the differences in the improvement of the patient’s symptoms. There was a clinical and symptomatic improvement in the scoring of PRWE from 29 to 6, NCV (30.17 m/s to 35.80 m/s on right side median nerve, 28.23 m/s to 32.06 m/s on right side ulnar nerve, 32.87 m/s to 37.23 m/s on left side median nerve, 32.13 m/s to 40.12 m/s on left ulnar nerve), MMT (from grade 2 or 3 to grade 3, 4 or 4+), QOL (72 to 99), HHD (0.3 lb to 0.5 lb of left side and 0.1 lb to 0.5 lb of right side) and Pinchmeter (0.5 lb to 3 lb of left and 0.2 lb to 1 lb of right side). The treatment given was effective in improving the patient's symptoms. The results can be used to conduct further studies to add evidencebased literature in physiotherapy practice. [ABSTRACT FROM AUTHOR]

Objective: This study compared manual muscle testing with the objective measures of the Hand-Held dynamometer for detecting strength deficit across grades 4 and 5 in elbow flexors of young females. Materials and Methods: In this cross-sectional study, 300 young females in the age group of 18–39 years, having strength in grades 4 and 5, were recruited by non-probability convenient sampling. The strength of elbow flexors of dominant and non-dominant extremities was measured according to standard protocols of manual muscle testing and make test of Handheld dynamometry. The data were tabulated and analyzed by SPSS version 25. The tests used were independent sample t-tests to compare the mean of strength variation in the normal population. A comparison of both tools to predict the extent of variation in the variable of strength was made through Pearson correlation. Results: The weakness in elbow flexors was revealed by grade 4 of manual muscle testing in the young healthy female population. Quantified strength by dynamometer presented a varied range of strength, with overlap in strength in grades 4 and 5. There was a significantly weaker correlation in both techniques (0.242 on the non-dominant side and 0.317 on the dominant side) in the detection of strength differences at a p-value of 0.00. Conclusion: This study quantified the strength variation across the subjective realm of grades 4 and 5 through dynamometric measures in the elbow flexors of young females. The comparison of strength across both grades showed a weak correlation for the quantification of strength measured through a dynamometer. [ABSTRACT FROM AUTHOR]

Quantifying muscle strength is an important measure in clinical settings; however, there is a lack of practical tools that can be deployed for routine assessment. The purpose of this study is to propose a deep learning model for ankle plantar flexion torque prediction from time-series mechanomyogram (MMG) signals recorded during isometric contractions (i.e., a similar form to manual muscle testing procedure in clinical practice) and to evaluate its performance. Four different deep learning models in terms of model architecture (based on a stacked bidirectional long short-term memory and dense layers) were designed with different combinations of the number of units (from 32 to 512) and dropout ratio (from 0.0 to 0.8), and then evaluated for prediction performance by conducting the leave-one-subject-out cross-validation method from the 10-subject dataset. As a result, the models explained more variance in the untrained test dataset as the error metrics (e.g., root-mean-square error) decreased and as the slope of the relationship between the measured and predicted joint torques became closer to 1.0. Although the slope estimates appear to be sensitive to an individual dataset, >70% of the variance in nine out of 10 datasets was explained by the optimal model. These results demonstrated the feasibility of the proposed model as a potential tool to quantify average joint torque during a sustained isometric contraction.

Background & Objective: Cerebrovascular Accident (CVA) or stroke, Spinal Cord injury can lead to neurological diseases resulting in major loss in motor function causing hemiplegia or tetraplegia. In 2019, according to The Global Burden of Diseases (GBD) CVA/Stroke is the second leading cause of death and the third leading cause of death and disability combined, globally. Its prevalence vary drastically among South Asian countries. The objective of this study was to determine the effectiveness of Functional Electrical Stimulation (FES) machine on neurologically impaired patients at the Physical Therapy department at IHHN, Karachi, Pakistan. Method: In this retrospective study data was extracted from August 2016 to February 2022 on patients with neurological symptoms i.e. hemiplegia or paraplegia with muscle power of two or less on Manual Muscle Testing (MMT). The parameters for evaluating patients progress pre and post treatment were MMT results and their mobility status. The number of sessions ranged between 40 to 100 sessions of Functional Electrical Stimulation (FES) provided on alternate days according to the patient's need. Result: Data of 51 patients who had completed their treatment were extracted and analyzed. The mean age of patients who completed treatment was 49.62 ± 17.26 years. Out of 51(100%), 30 (58.8%) were male and 21 (41.2%) were female. Pre-and post-treatment median (IQR) showed remarkable improvement in MMT of upper limb muscle (from 1.0 to 4.0) and lower limb muscle (from 2.0 to 4.0). Conclusion: FES cycling is an effective treatment for patients with neurological impairments, as it resulted in improvement in both upper and lower limb muscle strength, along with mobility status. [ABSTRACT FROM AUTHOR]

Post-Polio Syndrome (PPS) is a chronic condition characterized by the emergence of new symptoms and functional decline in individuals who previously had polio. Despite advances in medical understanding, management of PPS remains challenging. This study aimed to evaluate the use of neurobiological modulation treatments using Radio Electric Asymmetric Conveyer (REAC) technology on fatigue and muscle strength. An open-label study was conducted with 17 patients submitted to four neuromodulation protocols: Neuro Postural Optimization (NPO), Neuro Psycho Physical Optimization (NPPO), Neuro Psycho Physical Optimization—Cervico Brachial (NPPO-CB), and Neuromuscular Optimization (NMO). The Time Up and Go (TUG) test, Handgrip Strength Test, and Revised Piper Fatigue Scale (RPFS) were used to assess participants' fatigue and muscle strength, being applied at the beginning and end of each protocol. The results obtained from the improvement in strength, physical endurance, and particularly the RPFS behavioral dimension, affective dimension, and psychological sensory dimension, through the utilization of REAC neurobiological modulation treatments, highlight this correlation. These results suggest that these treatments could be considered as a potential therapeutic approach for PPS. [ABSTRACT FROM AUTHOR]

An accurate and reliable neurological examination is pivotal in diagnosing patients with neurological and neurosurgical conditions. Despite the advancement of neuroscientific knowledge and the ever-progressing technologies and modalities that are being adopted to help achieve the challenge of accurate diagnosis, the neurologic examination is still crucial in both ambulatory and emergency settings. It provides the physician a tool to recognise neurologic involvement in certain disease states, and thereby allow proper work-up and treatment for patients. A basic neurologic examination can be performed rapidly with practice. Manual muscle testing of the lower limbs was carried out in accordance with a bedside clinical examination involving a clinical personnel examiner and a patient. This testing was performed in a rostro-caudal manner, starting from the hip and progressing to the toes. The neurological exam can be intimidating to perform for a lot of physicians. Deficiencies in accurate muscle testing have always presented a challenge for medical students and clinicians. By referring to the examination methods mentioned in our text and with the help of related video, it is our aim to improve the quality of neurological examination among medical personnel so that diseases may be recognised and managed earlier in their course. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine which stratification (anatomical versus functional) forms a better construct for classification of para surfers with spinal cord injury; to assess the groupings of these para surfers; and to evaluate the strength of association between manual muscle testing and surfing performance. Cross-sectional. Archived data from classification records including demographics, spinal cord injury levels, trunk strength, and limb strength were compared to judged wave scores and competition rankings. Participants (n = 70, male n = 56; female n = 14) met inclusion criteria and were classified into Para Surfing Kneeling (n = 9); Sit (n = 11); Prone 1 (n = 25); and Prone 2 (n = 25) sport classes. Reliability statistics showed that functional grouping (Cronbach's α = 0.759) is better grouped with strength testing and rankings compared to anatomical grouping (Cronbach's α = 0.721). Under exploratory factor analysis with 2 fixed components, based on the factor loadings (rank and strength) functional stratification (0.978) is better aligned compared to anatomical stratification (0.785) for grouping of surfers. Further, the association and impact of strength with functional spinal cord level stratification were confirmed using regression analysis (chi-square of 74.06 with p-value <.0001). Trunk and limb strengths have been shown to influence wave riding performance in surfers with spinal cord injury. Surfers with spinal cord injury can equitably be classified into one of the four para surfing sport classes. The use of functional stratification of spinal cord injury with trunk and limb strengths should be considered as an integral component in para surfing athlete sport classification. [ABSTRACT FROM AUTHOR]

Context: A winged scapula (WS) is associated with faulty posture caused by weakness of the serratus anterior (SA), which mainly acts as a scapular stabilizer muscle. It is important to accurately assess and train the SA muscle with a focus on scapula stabilizers during musculoskeletal rehabilitation of individuals with a WS. Objective: The authors examined muscle activity in the SA and pectoralis major (PM), upper trapezius (UT), and anterior deltoid (AD) as well as shoulder protraction strength during isometric shoulder protraction in individuals with and without a WS. Design: Cross-sectional study. Setting: A clinical biomechanics laboratory. Participants: In total, 27 males with no shoulder, neck, or upper-extremity pain participated. Main Outcome Measures: Isometric shoulder protraction strength was collected and surface electromyography used to measure the activity of the SA, PM, UT, and AD muscles and selective SA activity ratio to other shoulder muscles. Results: Electromyography activity of the SA muscle and shoulder protraction strength were significantly lower in individuals with a WS compared with the non-WS group (P <.05). In contrast, PM muscle activity and the PM-to-SA, UT-to-SA, and AD-to-SA ratios were significantly greater in individuals with a WS than in individuals without winging (P <.05). Conclusions: Isometric shoulder protraction for measuring SA strength in individuals with a WS should focus on isolated muscle activity of the SA, and SA strengthening exercises are important for individuals with a WS. [ABSTRACT FROM AUTHOR]

It was argued that researchers and clinicians are not able to make judgments between most categories of the original Medical Research Council (MRC) scale and that a modified short version would reach higher agreement levels. We aimed to assess the inter‐rater reliability for both the original and the Rasch‐modified MRC scoring criteria of Manual Muscle Strength tests (MMSt) in patients with neuromuscular diseases. Two MRC scoring criteria were used to score muscle strength using MMSt in 40 muscle groups of the upper and lower limbs in patients with neuromuscular disorders. Three investigators performed the evaluations; the order of the MMSt and the use of the scales were performed according to the preferences of the investigators. The agreement coefficient (Gwet's AC2) was used to compute the reliability. Sixty patients (mean age of 39.3 years ± 15.2) with neuromuscular diseases were included. The mean AC2 for the muscle groups of the upper limbs ranged from 0.82 to 0.96 using the modified MRC scale and from 0.86 to 0.96 using the original MRC scale. The AC2 for the lower limb muscle groups ranged from 0.80 to 0.91 (modified MRC scale) and from 0.87 to 0.93 (original MRC scale). These values might be interpreted as "almost perfect agreement" with no significant differences between the scales. The results indicate that both MRC scoring criteria have significant reliability among trained observers. Moreover, the Rasch‐modified MRC scale is as reliable as the original MRC scale and can be used in future clinical studies. [ABSTRACT FROM AUTHOR]

Neurological examination is an important tool in diagnosing patients with neurological and neurosurgical conditions. As the complexity and knowledge of neurological and neurosurgical conditions increases, we are now required to learn and indoctrinate our peers and students with the correct skills and methods of examination. Emphasis on the correct techniques of testing muscle strength is essential to avoid errors in recording muscle power and in testing specific muscles which may have overlapping functions. The manual muscle testing of muscles of scapula and upper limbs was performed as to mimic a bedside clinical examination and involved an examiner, a patient and a videographer. The manual muscle testing has been performed in rostrocaudal manner starting from the scapula and ending with the thumbs. A reliable and consistent method of manual muscle testing is lacking among students and clinicians. By adhering to the methods delineated in our text and accompanying video, we hope to reduce inter-examiner variability and increase the reliability and validity of this important examination. [ABSTRACT FROM AUTHOR]

Cervical radiculopathy is common in clinical practice. It is the main reason to neck pain. Depending on the severity, neck pain can interfere with daily activities. In this regard, in order to identify the symptoms and to undertake optimal treatment of the problem, a full clinical and functional examination must be performed. The most commonly used and imposed test in practice to assess the condition of the muscles is manual muscle testing (MMT). Recent studies of muscle dysfunction in various neuromuscular disorders have focused on the use of apparatus methods to assess and monitor functional recovery. For this reason, based on the successful results of the use of a manual electronic dynamometer, we applied in a clinical setting testing with Hand-Held Dynamometer (HHD) to monitor functional recovery in patients with cervical radiculopathy. Aim: The aim of the study was: to monitor and compare changes in muscle strength during functional recovery in patients with cervical radiculopathy using standard Manual Muscle Testing and Hand-Held Dynamometer. Materials and methods: The study was conducted in the period from December 2019 to April 2020. They were selected 16 patients of different origins of pain in the neck portion (osteochondrosis, spondylosis, disk herniation). Functional, hardware and statistical methods were used to monitor and evaluate the results. HDD-muscle testing was also included in the experimental group. Results: The practical experience of using a Hand-Held electronic dynamometer proved to be facilitation not only for the researcher but also for the patients. The inclusion of an HHD in the conducted research allowed fast and accurate assessment of the physical function and the weakened muscle groups. This allowed individual dosing and targeted exercise of weakened muscle groups in each individual patient. Conclusion: The use of HHD to assess muscle strength leads to objectification and a more rational presentation of the results of muscle strength testing.

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PURPOSE: Functional level of lesion (FLOL) is a grading of the level of neurological function in patients with myelomeningocele and other forms of spina bifida. It has been widely used as an independent variable in studies of spina bifida, but its inter-rater reliability has not previously been tested. The purpose of this study was to measure inter-rater reliability of FLOL testing and compare testing performed by a non-medically trained research associate to testing performed by a pediatric rehabilitation medicine specialist. METHODS: Children in a multi-disciplinary spina bifida clinic underwent FLOL grading by a non-medically trained research associate. On the same day, these children were also graded by a pediatric rehabilitation medicine specialist. Cohen's weighted kappa statistic was used to compare grading, with the rehabilitation medicine specialist considered the gold standard. RESULTS: A total of 71 patients participated. FLOL was graded for left and right leg for each participant, resulting in 142 measurements. Cohen's weighted kappa was κ= 0.809, with a standard error of 0.034 and 95% confidence interval 0.723–0.875, indicating substantial agreement. CONCLUSION: FLOL as measured according to the instructions of the National Spina Bifida Patient Registry by a non-medically trained researcher is a reliable method to grade lower extremity function in spina bifida. [ABSTRACT FROM AUTHOR]

Introduction: Chronic mechanical low back pain is generally nociceptive in nature. Strain counter strain technique is a passive technique used to relieve musculoskeletal pain by relaxing shortened tissues. This study was designed to determine the effects of strain counter strain in terms of relieving pain, increasing ROM, MMT and disability in the treatment of chronic low back pain. Material & Methods: A randomized, single-blinded, parallel controlled trial was conducted. A total of 40 patients met the inclusion criteria and were randomly equally divided into 2 groups. Due to the lack of one patient’s follow-up in the experimental group, data of 39 patients were analysed. A structured questionnaire was used and the data was analysed at baseline and after 8 sessions by using IBM SPSS 21. Outcomes were measured by inclinometer, manual muscle testing, Modified Oswestry Disability Index and NPRS. Results: Intragroup comparison of pre to post value of NPRS, ROM, MMT & MODI showed significant p-value (0.000***) for both groups. Intergroup comparison of baseline to end value showed significant improvement in Lumbar Flexion (p value=0.001) and left side bending (p value=0.003) while lumbar extension, right side bending, MMT of trunk flexors, trunk extensors and NPRS showed non-significant p-value of 0.088, 0.066, 0.484, 0.753 and 0.177 respectively. MODI Intergroup comparison showed significant improvement on post-intervention scores (p value=.000***). Conclusion: Strain counter strain has positive effects by increasing range of motion and improving functional status in patients with chronic low back pain.

Introduction: Decreased muscle strength in fracture patients can be caused by postoperative immobilization, thus requiring early immobilization to accelerate the fracture healing process. The principle of early immobilization is the same as the assessment of muscle strength, namely flexion, extension, and rotation to determine muscle strength in fracture patients. Objectives: To determine the decrease in muscle strength with the Manual Muscle Testing (MMT) method in fractured and non-fractured patients. Methods: Narrative literature review was chosen in this research design. Literature search through seven databases with keywords using boolean operators and found 6533 articles. The selection process is based on several criteria: the publication year 2015-2020, full-text access, National (SINTA) / International (Scimagojr) indexed articles, in English or Indonesian, so that 11 articles were reviewed in this study. Results: MMT is a reliable measurement tool, does not require additional tools to assess muscle strength and is universal (can assess muscle strength in fractures and non-fractures). Discussion: MMT examination needs to be performed on fracture patients to determine muscle strength to accelerate the muscle recovery process. ABSTRAK Pendahuluan: Penurunan kekuatan otot pada pasien fraktur disebabkan imobilisasi post operasi, sehingga memerlukan early immobilization untuk mempercepat proses penyembuhan fraktur. Prinsip early immobilization sama dengan penilaian kekuatan otot yaitu melakukan fleksi, ekstensi, dan rotasi guna mengetahui kekuatan otot pada pasien fraktur. Tujuan: Untuk mengetahui adanya penurunan kekuatan otot dengan metode Manual Muscle Testing (MMT) pada pasien fraktur dan non fraktur. Metode:Narrative literature review dipilih dalam desain penelitian ini. Pencarian literatur melalui tujuh database dengan kata kunci menggunakan boolean operator dan ditemukan 6533 artikel. Proses seleksi berdasarkan beberapa kriteria: tahun publikasi 2015-2020, akses full text, artikel terindeks Nasional (SINTA)/Internasional (Scimagojr), berbahasa Inggris atau bahasa Indonesia, sehingga didapatkan sebanyak 11 artikel yang direview pada penelitian ini. Hasil : MMT merupakan alat ukur yang reliable, tidak memerlukan alat tambahan untuk melakukan penilaian kekuatan otot, dan universal (dapat menilai kekuatan otot pada fraktur maupun non fraktur). Diskusi : Pemeriksaan MMT perlu dilakukan pada pasien fraktur untuk mengetahui tingkat kekuatan otot sehingga mempercepat proses recovery otot.

The article presents the history of one of the relatively new areas in medicine - applied kinesiology, which is actively developing in the United States, West Europe and is popularized and actively implemented in Ukraine. The authors present the basic principles of kinesiological influence, concepts and statements underlyingapplied kinesiology. Considerable attention is paid to the characteristics of the main diagnostic method of applied kinesiology, which is manual muscle testing (MMT). The uniqueness of this diagnostic method, which can help in the diagnosis of neuro-musculoskeletal dysfunction before the signs of chronicity of such processes, has been stated in the article. It is noted that MMT is a very important diagnostic tool, which is increasingly being used in combination with other clinical research methods. The article emphasizes the constantly growing interest in the methods of applied kinesiology in Ukraine. Conclusions are made about the possibility and necessity of integrating the course on the basics of Professional Applied Kinesiology into educational programs of higher education institutions in the field of "Health Care" (III-IV level of accreditation) which will increase the level of clinical training of medical professionals, allow the implementation of these methods in clinical practice and significantly improve preventive and diagnostic processes.

A 36-year-old male patient presented to the neuro-physiotherapy Outpatient Department (OPD) with the complaint of pain in left lower limb and difficulty in weight-bearing on left lower limb from the past two weeks. Patient had a history of accidental trauma to sciatic nerve while taking an injection on the gluteal region. The patient underwent lower limb function assessment using motor and sensory examinations, Foot and Ankle Disability Index (FADI), Stanmore Assessment Questionnaire (SAQ), and Visual Analogue Scale (VAS) and Nerve Conduction Velocity testing (NCV). Patient was having intact myotomes and dermatomes on both lower limbs. The Manual Muscle Testing (MMT) of left lower limb was found to be affected. A physiotherapy protocol including electrical stimulation, application of Transcutaneous Electrical Nerve Stimulation (TENS) over the distribution of sciatic nerve and strengthening of foot muscles was given for a duration of 5 times a week for 8-weeks. The given treatment showed improvement in MMT scores from 3 to 4 for hip flexors, 3- to 3+ for hip extensors, 3 to 3+ for knee flexors, 2- to 3 for ankle plantar flexion, 2+ to 3 for dorsiflexion, 2 to 3- for eversion and from +1 to 2+ for inversion, FADI scores decreased from 104 to 16, SAQ scores improved from 100 to 61 and VAS scores decreased from 9 to 3. Additionally, the motor nerve conduction velocity (MNCV) of the sciatic nerve increased from 42.4ms to 43.7ms in the left lower limb and tibial nerve from 36.3ms to 37.07. The provided treatment demonstrated effectiveness in alleviating the patient's symptoms. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study.Objective: To determine the risk factors for insufficient recovery from C5 palsy (C5P) following anterior cervical decompression and fusion (ADF).Summary Of Background Data: Postoperative C5P is a frequent but unsolved complication following cervical decompression surgery. Although most patients gradually recover, some recover only partially. When we encounter new-onset C5P following ADF, the question that often arises is whether the palsy will sufficiently resolve.Methods: We retrospectively reviewed consecutive patients who underwent ADF at our institution. We defined C5P as postoperative deterioration of deltoid muscle strength by two or more grades determined by manual muscle testing (MMT). We evaluated the following demographic data: patient factors, surgical factors, and radiological findings. C5P patients were divided into two groups: sufficient recovery (MMT grade≧4) and insufficient recovery (MMT grade < 4). Each parameter was compared between the two groups.Results: Of 839 patients initially included in the study, 57 experienced new-onset C5P (6.8%). At the final follow-up (mean, 55 ± 17 months), 41 patients experienced sufficient recovery, whereas 16 (28%) still exhibited insufficient recovery. Compared with the sufficient recovery group, patients with insufficient recovery exhibited a higher decompression combination score, a larger anterior shift in preoperative cervical sagittal balance, less lordosis of the pre- and postoperative C4/C5 segment, more frequent stenosis at the C3/C4 segment, lower deltoid strength at C5P onset, more frequent co-occurrence of biceps weakness, greater postoperative expansion of the dura mater, and more frequent presence of postoperative T2 high-intensity areas. Multivariate analysis revealed that co-occurrence of biceps muscle weakness, less lordosis at the preoperative C4/C5 segment, and postoperative expansion of the dura mater were independent predictors of insufficient recovery.Conclusion: The combination of unfavorable conditions, such as potential spinal cord disorder, cervical malalignment, and excessive expansion of the dura mater after corpectomy, predicts insufficient recovery from C5P.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Corticosteroids prolong ambulation and improve muscle power among boys with Duchenne muscular dystrophy (DMD). However, the optimal steroid regimen remains unclear. Hence, this study was undertaken to compare the efficacy of daily‐ versus intermittent‐steroid regimens in ambulatory boys with DMD. Methods: In this single‐center, open‐label randomized trial, 72 children were randomized to receive either daily prednisolone (0.75 mg/kg/day) or intermittent prednisolone (0.75 mg/kg/day, for first 10 days of every month). The primary outcome measure was the difference in average score on manual muscle testing (MMT) at baseline and after 6 mo of steroids. A difference of >0.2 was hypothesized to be significant. Secondary outcomes included changes in timed functions, muscular dystrophy‐specific functional‐rating scale score, peak torque, average power, and pulmonary function. Results: In the intention‐to‐treat analysis, the mean (SD) change in MMT scores was 0.17 (0.15) and 0.08 (0.10) for the daily and intermittent steroid groups, respectively. The mean difference between the two interventions was 0.10 (95% confidence interval [CI] = 0.04–0.16; P =.003), which although significant was less than the predefined value of 0.2. Statistically significantly improvements were observed with daily‐steroid regimen in the Gowers time (P =.01), nine‐metre walk test (P =.02) and average power (P =.02) as compared to intermittent‐steroid regimen. A total of 19/32 (52.8%) children in the daily‐steroid group and 8/29 (27%) children in the intermittent‐steroid group experienced some form of adverse effect (P =.02). Discussion: Over a short‐term period, the intermittent‐steroid regimen was non‐inferior to the daily‐steroid regime in preserving muscle strength among children with DMD. However, better improvement of functional measures was observed with daily‐steroid administration. The frequency of individual side effects was similar between the two groups. [ABSTRACT FROM AUTHOR]

Dravet Syndrome (DS) is a developmental and epileptic encephalopathy, characterized by drug resistant infantile onset seizures and cognitive and motor impairment. Walking problems progressively occur and crouch gait is frequently observed. Muscle weakness is hypothesized as contributing impairment. Yet, so far, no studies have performed strength measurements in patients with DS, most likely due to cognitive impairment. To determine the feasibility and validity of strength measurements in the framework of gait analysis and to outline strength problems in patients with DS. Manual muscle testing, dynamometry (hand grip strength and handheld dynamometry) and functional tests (underarm throwing, standing long jump, sit-to-stand, stair climbing) were performed in 46 patients with DS. Results were compared to age-related reference values from literature. Forty one percent (19/46) of the patients (aged 5.2–24.8 years, median: 15.8 years) accomplished all measurements and scored generally below the fifth percentile of norm values. The remaining 59% (27/46) was not able to complete all strength assessment due to cognitive, behavioural and motor difficulties. Handheld dynamometry seemed most sensitive and specific to detect isolated muscle strength. Validity of the functional tests was controversial, as motor proficiency, balance and coordination may interfere. Although measuring strength in patients with DS was challenging in the context of gait analysis, decreased muscle strength was observed in patients that could perform strength measurements. Handheld dynamometry is preferred over functional tests for future investigations of muscle strength and its interference with gait are required for better understanding of walking problems. • Strength measurements were performed in patients with Dravet Syndrome. • Manual muscle testing, dynamometry and functional tests were performed. • Feasibility was low due to cognitive, behavioural and motor impairments. • Patients with Dravet Syndrome showed below average muscle strength. [ABSTRACT FROM AUTHOR]

Hand held dynamometers (HHDs) are often the preferred choice for the clinical evaluation of muscle strength, although they can be inaccurate. The aim of this study was to quantitatively investigate the causes of deviation and error in the strength assessment of the hip joint. Twenty-two healthy adult participants were tested for hip extension and hip flexion strength by a 'make test' method. Forces and moments were measured by a multi component load cell held by an expert operator. Position and motion were concurrently recorded by an optoelectronic system. Ideally, neither the sensor nor the limbs should move during the measurements. The setup allowed to quantify the angular displacement of the sensor and the undesired motion. From such measurements, an estimation of accuracy and quality was derived. Observed accuracy was <4% for forces and <14% for moments. The overall quality of the measurements was ∼80% for both flexion and extension. The lower accuracy observed in hip moment was attributed to the method used to measure the lever arm. The quantitative measurement of the sources of inaccuracy showed that HHD hip assessment is reliable for both flexion and extension. Correct HHD positioning and correct measure of the lever arm are crucial. [ABSTRACT FROM AUTHOR]

Background/aims The effects of strengthening exercises in patients with Hirayama disease are not well documented. This case study examined the effect of strengthening exercises on hand functions in a patient with Hirayama disease. Methods An 18-year-old man with weakness in the right hand was given a hand-function strengthening programme consisting of 40 minutes of exercises, which were performed 5 days a week over an 8-week period. The patient used theraputty, a gel ball, finger dexterity board, gym kit and hand grip exerciser. The effects of the programme were evaluated using manual muscle testing, a hand-held dynamometer, pinchometer and the Minnesota Manual Dexterity Test. results The patient's manual muscle testing grades improved following the strengthening programme. Results from the Dynamometer, pinchometer and Minnesota Manual Dexterity Test objectively exhibited increased muscle strength and improved hand functions. Conclusions Strengthening exercises are effective in alleviating muscle weakness and improving hand functions associated with Hirayama disease. [ABSTRACT FROM AUTHOR]

Objectives:- To assess and compare the effectiveness of strengthening and strengthening with stretching in patients with nonspecific low back pain Methodology:- There were total 40 patients with low back pain in the study. This study was done to find and compare the effect of strengthening and strengthening with stretching in patients with nonspecific low back pain. The patients were assessed with Visual Analogue Scale for pain and Manual Muscle Testing for the strength before and after 12 weeks of treatment. Result: Strengthening and stretching of the muscles has effect on the pain reduction as well as strength of the muscles in patients with nonspecific low back pain. Conclusion: On the basis of the result of this study, it was concluded that the strengthening and stretching of the muscles has effect on the pain reduction as well as strength of the muscles in patients with nonspecific low back pain. [ABSTRACT FROM AUTHOR]

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The purpose of this study was to assess the relative and absolute reliability of a handheld dynamometer when used for examining elbow flexion power in patients with brachial plexus palsy. The assessment of the intra-rater and inter-rater reliability coefficients for the handheld dynamometer was done using the stationary Kin-Com® dynamometer as the reference standard. We determined the measurement errors and checked the systematic biases of the handheld dynamometer. The inter-rater and intra-rater reliabilities of the handheld dynamometer had a very high intraclass correlation coefficient. The values of handheld dynamometer readings had a high correlation to Kin-Com® readings. The Medical Research Council grading was a comparatively inaccurate method for quantitative assessment of motor power. We conclude that a handheld dynamometer measurement is more precise and reliable than the Medical Research Council grading for measuring recovery of elbow flexion in patients with brachial plexus palsy.Level of evidence: III [ABSTRACT FROM AUTHOR]

Abstract Study Design Cross-sectional study. Purpose of the Study The study aims to determine the effects of force direction and arm position in differentiating the clavicular (PMc) and sternal (PMs) parts of the pectoralis major (PM) muscle during maximal voluntary isometric contraction (MVIC) to provide basic evidence to support the clinical thinking behind muscle strength testing of PM. Methods Nine experimental conditions with 3 force directions of horizontal adduction (+30° oblique, horizontal, and −30° oblique to the transverse plane) and 3 arm rotation positions (0°, 45°, and 90° shoulder external rotation from the transverse plane) were randomly tested for 26 healthy male participants. The MVIC force level was monitored and measured with a fixed dynamometer, and the surface electromyographic (EMG) signals of the PMc, PMs, anterior deltoid, middle deltoid, and latissimus dorsi were collected during the test for each condition. The PMc/PMs EMG ratio and normalized EMG amplitude were used to quantify the contribution of the tested muscles. Results The MVIC force level significantly declined when the arm's external rotation increased (P <.01; the grand mean decreased from 106.7 N ± 27.8 N to 89.5 N ± 22.6 N). The PMc/PMs EMG ratio showed that the best test condition to differentiate the PMc and PMs was the force direction of +30° oblique to the transverse plane and the 45° arm rotation position. Other muscles contributed less than 40% of their MVIC activity levels, with a higher activation level found in the anterior deltoid muscle (P <.01). Conclusions Arm rotation position should be considered as a predominant factor when clinically examining the strength of horizontal adduction movement. All tested conditions failed to fully separate PMc and PMs activation during MVIC and suggested that functional differentiation of the PM might not be applicable to maximal exertion. Level of Evidence NA. [ABSTRACT FROM AUTHOR]

Amongst different approaches of complementary and alternative medicines used for treating any type of ailment, applied kinesiology (AK) claims to diagnose illness or select therapy by manual testing muscles for strength and weakness. Applications of AK in dental practice have given a complete assessment, reevaluation and understanding of a patient’s general health and wellbeing. AK provides dentists with a wide variety of options for enhancing their diagnostic and therapeutic strategies. The different aspects of structural integration, selection of dental materials, and the equipments used for muscle testing have been described in this article. An overview of literature reveals a positive response by many dental clinicians towards this tool. This article reviews regarding AK and its applications in dental practice.

The manual muscle test (MMT) is a flexible diagnostic tool, which is used in many disciplines, applied in several ways. The main problem is the subjectivity of the test. The MMT in the version of a “break test” depends on the tester’s force rise and the patient’s ability to resist the applied force. As a first step, the investigation of the reproducibility of the testers’ force profile is required for valid application. The study examined the force profiles of n = 29 testers (n = 9 experiences (Exp), n = 8 little experienced (LitExp), n = 12 beginners (Beg)). The testers performed 10 MMTs according to the test of hip flexors, but against a fixed leg to exclude the patient’s reaction. A handheld device recorded the temporal course of the applied force. The results show significant differences between Exp and Beg concerning the starting force (padj = 0.029), the ratio of starting to maximum force (padj = 0.005) and the normalized mean Euclidean distances between the 10 trials (padj = 0.015). The slope is significantly higher in Exp vs. LitExp (p = 0.006) and Beg (p = 0.005). The results also indicate that experienced testers show inter-tester differences and partly even a low intra-tester reproducibility. This highlights the necessity of an objective MMT-assessment. Furthermore, an agreement on a standardized force profile is required. A suggestion for this is given.

An accurate and reliable neurological examination is pivotal in diagnosing patients with neurological and neurosurgical conditions. Despite the advancement of neuroscientific knowledge and the ever-progressing technologies and modalities that are being adopted to help achieve the challenge of accurate diagnosis, the neurologic examination is still crucial in both ambulatory and emergency settings. It provides the physician a tool to recognise neurologic involvement in certain disease states, and thereby allow proper work-up and treatment for patients. A basic neurologic examination can be performed rapidly with practice. Manual muscle testing of the lower limbs was carried out in accordance with a bedside clinical examination involving a clinical personnel examiner and a patient. This testing was performed in a rostro-caudal manner, starting from the hip and progressing to the toes. The neurological exam can be intimidating to perform for a lot of physicians. Deficiencies in accurate muscle testing have always presented a challenge for medical students and clinicians. By referring to the examination methods mentioned in our text and with the help of related video, it is our aim to improve the quality of neurological examination among medical personnel so that diseases may be recognised and managed earlier in their course., Competing Interests: Conflict of Interest None., (© Penerbit Universiti Sains Malaysia, 2023.)

BACKGROUND: The diagnostic accuracy of manual muscle testing (MMT) has been examined- but not for grip strength. OBJECTIVE: Determine the diagnostic accuracy of MMT relative to grip dynamometry for identifying patients with weak grip strength. METHODS: This study involved the secondary analysis of grip strength data obtained from 61 patients managed in a home care setting. The concordance between weakness identified using MMT and grip dynamometry was examined. RESULTS: The agreement between MMT and dynamometry was about 70%. Kappa suggested fair agreement beyond chance. Sensitivity and specificity ranged from 66.7 to 73.4 percent. CONCLUSIONS: Grip strength measured using MMT lacks sufficient diagnostic accuracy to advocate its use – at least with patients seen in a home setting. [ABSTRACT FROM AUTHOR]

Background: Muscle strength testing of an injured infraspinatus muscle (IM) is confounded by actions of synergistic muscles such as the posterior deltoid (PD). Hypothesis/Purpose: The purpose of this study was to describe a condition for testing of the IM that results in less EMG activity of the PD musculature. The researchers hypothesized that greater inhibition of the PD could be achieved through active adduction (AA), creating reciprocal inhibition of the PD. Study Design: Prospective cohort descriptive study Methods: Thirty-four (19 females and 15 males) right-handed subjects between the ages of 22-31 (mean 24.2 years +/- 6.2) with no previous history of shoulder surgery or pathology participated. Surface electrodes were placed over the muscle bellies of the IM and PD of the right shoulder along with a ground electrode over the C7 spinous process. EMG activity was recorded during resisted external rotation in four different testing conditions (seated active and passive adduction, and side-lying active and passive adduction). The order of test positions was randomly assigned, and each subject completed all four positions with appropriate rest. During AA conditions, subjects were asked to adduct the humerus against a sphygmomanometer (using 80% maximum force output) while maximal effort external rotation was manually resisted. Results: PD activity was significantly less during AA than with no AA (p<0.05) in both test positions. No significant difference occurred between IM EMG activity in the various test conditions. Conclusion: The results of this study suggest that clinicians can reduce activity of the PD without reducing activity of the IM by using AA of the humerus before applying manual resistance to test the IM during manual muscle testing. Levels of Evidence: 1b. [ABSTRACT FROM AUTHOR]

To describe the use of oral cyclophosphamide (PO CYC) in a single center longitudinal cohort of patients with idiopathic inflammatory myopathies (IIM). Patients using PO CYC were identified through a retrospective chart review of a myositis cohort at a single academic center. PO CYC dose, duration, adverse events, and disease activity measures before and after CYC were analyzed. Disease activity measures included muscle enzymes, manual muscle testing (MMT8), 100-mm visual analog scale (VAS), and 1-4 Likert scale for physician global assessment. Fourteen patients were treated with PO CYC within the cohort between 2008 and 2017; 9 dermatomyositis (DM), 3 polymyositis (PM), and 2 with immune-mediated necrotizing myopathy (IMNM). Age was 51.1 (40-72) years and the cumulative dose of PO CYC was 41 (2-131) grams over duration of 12.4 (0.5-43) months, mean (range) for all. All patients had severe refractory IIM, 10 (72%) with ILD, 3 (21%) with cardiac involvement and 4 (29%) were dependent in most activities of daily living. Median number of prior failed therapies was 4.5 (range 3-6) including intravenous CYC in 5 patients. Disease activity measures significantly improved following CYC use and concomitant daily prednisone dose decreased. The most common adverse events during CYC therapy were infections. We report the first cohort study of PO CYC use in IIM patients with severe, treatment refractory disease. Further trials are needed to verify these results as well as to evaluate long-term safety outcomes. [ABSTRACT FROM AUTHOR]

Electromyography (EMG) is an important parameter in Clinical Gait Analysis (CGA), and is generally interpreted with timing of activation. EMG amplitude comparisons between individuals, muscles or days need normalization. There is no consensus on existing methods. The gold standard, maximum voluntary isometric contraction (MVIC), is not adapted to pathological populations because patients are often unable to perform an MVIC. The normalization method inspired by the isometric grade 3 of manual muscle testing (isoMMT3), which is the ability of a muscle to maintain a position against gravity, could be an interesting alternative. The aim of this study was to evaluate the within- and between-day reliability of the isoMMT3 EMG normalizing method during gait compared with the conventional MVIC method. Lower limb muscles EMG (gluteus medius, rectus femoris, tibialis anterior, semitendinosus) were recorded bilaterally in nine healthy participants (five males, aged 29.7±6.2years, BMI 22.7±3.3kgm-2) giving a total of 18 independent legs. Three repeated measurements of the isoMMT3 and MVIC exercises were performed with an EMG recording. EMG amplitude of the muscles during gait was normalized by these two methods. This protocol was repeated one week later. Within- and between-day reliability of normalization tasks were similar for isoMMT3 and MVIC methods. Within- and between-day reliability of gait EMG normalized by isoMMT3 was higher than with MVIC normalization. These results indicate that EMG normalization using isoMMT3 is a reliable method with no special equipment needed and will support CGA interpretation. The next step will be to evaluate this method in pathological populations. [ABSTRACT FROM AUTHOR]

Repetitive nerve stimulation (RNS) is a valuable diagnostic method for myasthenia gravis (MG). However, its association with clinical severity was scarcely studied. We reviewed medical records and retrospectively enrolled 121 generalized MG patients. Sensitivity of different muscles to RNS and clinical scoring systems was evaluated. RNS testing revealed facial muscles have the highest positive rate, followed by proximal muscles and distal muscles, with the palpebral portion of the orbicularis oculi muscle most sensitive. Amplitude decrement of compound muscle action potential (CMAP) in the palpebral portion of the orbicularis oculi muscle is related to quantitative myasthenia gravis (QMG) scores, MG-specific manual muscle testing (MMT) scores and myasthenia gravis-related activities of daily living (MG-ADL) scores. We suggest that RNS testing of the palpebral portion of the orbicularis oculi muscle is a potential assessment indicator in patients with generalized MG. [ABSTRACT FROM AUTHOR]