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Background: Although grip and pinch strength provide a more global measure of a large number of digits and muscles, measuring strength of individual fingers or the thumb can provide additional and more detailed information regarding hand strength.Questions/purposes: We developed growth diagrams for individual finger strength in children.Patients and Methods: We measured thumb palmar abduction, thumb opposition, and thumb flexion in the metacarpophalangeal joint, and abduction of the index and little fingers in 101 children (4-12 years old) using a myometer. We recorded hand dominance, gender, height, and weight. All measurements were performed in a randomized order by the same researcher. We developed statistical models for drawing growth diagrams using estimated percentiles for each strength measurement. Separate models for dominant and nondominant hands of boys and girls were developed, in addition to a combined model.Results: Because there was no difference in strength between boys and girls and between dominant and nondominant hands, both hands and genders were combined in one growth diagram for each measurement. The normative data were presented in a table format and in growth diagrams for each myometer measurement.Conclusions: These diagrams can be used for pediatric patients such as patients with congenital malformations or neuromuscular disorders who receive interventions or therapy aimed at function of the hand, fingers, or thumb. The growth diagrams facilitate distinguishing between the effects of growth and intervention on strength development. [ABSTRACT FROM AUTHOR]

Purpose. Fatigue is a chronic problem in liver transplant recipients and may influence daily functioning and health-related quality of life (HRQoL). This study aimed to evaluate the effects of a fatigue-reducing physical rehabilitation programme on daily functioning, participation, HRQoL, anxiety and depression among liver transplant recipients. Method. Eighteen fatigued liver transplant recipients (mean age 51 years, 10 men/8 women) participated in a 12-week rehabilitation programme, which included supervised exercise training and daily physical activity counselling. We assessed pre- and post-programme health-related daily functioning, participation, HRQoL, anxiety and depression using questionnaires. Results. After the programme, patients showed improvements in daily functioning (23.6%, p = 0.007), the participation domain 'autonomy outdoors' (34.1%, p = 0.001), and the HRQoL domains 'physical functioning' (11.5%, p = 0.007) and 'vitality' (21.5%, p = 0.022). Anxiety and depression were unchanged post-programme. Conclusions. Rehabilitation using supervised exercise training and daily physical activity counselling can positively influence daily functioning, participation and HRQoL among fatigued liver transplant recipients. [ABSTRACT FROM AUTHOR]

Purpose. The study aimed to establish whether the manual ability classification system (MACS), a valid classification system for manual ability in children with cerebral palsy (CP), is applicable in young adults with CP and normal intelligence. Subjects. The participants ( n = 83) were young adults with CP and normal intelligence and had a mean age of 19.9 years. Method. In this study, inter observer reliability of the MACS was determined. We investigated relationships between the MACS level and patient characteristics (such as the gross motor function classification system (GMFCS) level, limb distribution of the spastic paresis and educational level) and with functional activities of the upper extremity (assessed with the Melbourne assessment, the Abilhand questionnaire and the domain self-care of the functional independence measure (FIM)). Furthermore, with a linear regression analysis it was determined whether the MACS is a significant determinant of activity limitations and participation restrictions. Results. The reliability was good (intraclass correlation coefficient 0.83). The Spearman correlation coefficients with GMFCS level, limb distribution of the spastic paresis and educational level were 0.53, 0.46, and 0.26, respectively. MACS level correlated moderately with outcome measures of functional activities (correlations ranging from −0.38 to −0.55). MACS level is, in addition to the GMFCS level, an important determinant for limitations in activities and restrictions in participation. Conclusion. We conclude that the MACS is a feasible method to classify manual ability in young adults with CP and normal intelligence with a good manual ability. [ABSTRACT FROM AUTHOR]

Unlabelled: Grip strength dynamometers often are used to assess hand function in children. The use of normative grip strength data at followup is difficult because of the influence of growth and neuromuscular maturation. As an alternative, infant welfare centers throughout the world use growth diagrams to observe normative growth. The aim of this study was to develop similar growth diagrams for grip strength in children. We measured the grip strength, hand dominance, gender, height, and weight of 225 children, 4 to 12 years old. We developed separate statistical models for both hands of boys and girls for drawing growth curves. Grip strength increased with age for both hands. For the whole group, the dominant hand produced higher grip strength than the nondominant hand and boys were stronger than girls. The grip strength of boys and girls differed between 2 and 19 N for the different age groups. Because grip strength measurements are accompanied by a rather large variance, the growth diagrams (presenting a continuum in grip strength) make it possible to better observe grip strength development with time corresponding to a more exact age. Depending on the accuracy needed, the use of one combined diagram could be considered.Level Of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Longitudinal single-cohort study. BACKGROUND: Athletes with longstanding groin pain associated with resisted hip adduction have been shown to have abnormal activation of the transversus abdominis (TA). Therefore, exercises targeting the TA to help stabilize the lumbopelvic area are generally used in the rehabilitation of these athletes. OBJECTIVES: To investigate if (1) changes in abdominal muscle resting thickness and changes in relative thickness during lower extremity tasks after 14 weeks of intervention are related to changes in clinical status and (2) the changes in abdominal muscle resting/relative thickness are significant postintervention. METHODS: In 21 athletes with longstanding groin pain associated with resisted hip adduction, ultrasound imaging of the abdominal musculature on the right side was performed at rest, during the active straight-leg raise (left and right), and during bilateral isometric hip adduction. Athletes then followed a 14-week rehabilitation protocol. Clinical outcome measured by self-reported sports restriction and change in abdominal muscle resting and relative thickness during lower extremity tasks were evaluated. RESULTS: There was an overall significant decrease in self-reported sports restriction after intervention for this group of athletes. Apart from a significant negative correlation for changes in TA resting thickness, no significant association between changes in abdominal muscle thickness and change in self-reported sports restriction were found. Postintervention, TA resting thickness was significantly increased but relative thickness during the lower extremity tasks was found not to be statistically different for all muscles, except for a decreased relative thickness of obliquus externus abdominus (OE) during the active straight-leg raise for the left lower extremity. CONCLUSION: There was no association between changes in abdominal muscle resting thickness and relative thickness during lower extremity tasks, and change in self-reported sports restriction after a period of physical therapy in athletes with longstanding groin pain associated with resisted hip adduction. Although this study was designed as a single-cohort longitudinal study, the data suggest that the intervention described can change TA resting thickness. The intervention did not influence abdominal muscle relative thickness during lower extremity tasks. LEVEL OF EVIDENCE: Therapy, level 4.J Orthop Sports Phys Ther 2009;39(10):724-732. doi:10.2519/jospt.2009.3068. [ABSTRACT FROM AUTHOR]

Purpose. To gain insight into the unmet needs and utilization of health care of young adults with cerebral palsy (CP) and to explore relations between unmet needs, health care utilization and subject characteristics. Method. A cross-sectional study was performed in 29 young adults with CP without severe learning disabilities (IQ > 70). Subject characteristics such as age, gender, limb distribution, level of gross motor functioning, level of education and perceived participation and autonomy were measured. Outcome measures were the Southampton Needs Assessment Questionnaire, Impact on Participation and Autonomy and a questionnaire on health care utilization. Results. Young adults with CP reported unmet needs mostly on information (79%), mobility (66%) and health care (66%). About half of the participants visited a rehabilitation physician (52%) or a physical therapist (55%) in the past year. Participants with lower levels of gross motor functioning were found to have more unmet needs and visited various health care professionals more often than young adults with higher levels of gross motor functioning. However, participants with higher levels of gross motor functioning still reported several unmet needs. Conclusions. Although young adults with CP frequently receive treatment from health care professionals, they indicate unmet needs with respect to several areas such as information on diagnosis, functional mobility and formal health care. In the treatment of young adults with CP, attention should be paid to these aspects. [ABSTRACT FROM AUTHOR]

Unlabelled: Limitation in daily physical activity is one of the reasons for total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning. We determined the effect of THA or TKA on patients' actual physical activity and body function (pain, stiffness), capacity to perform tasks, and self-reported physical functioning. We also assessed whether there are differences in the effect of the surgery between patients undergoing THA or TKA and whether the improvements vary between these different outcome measures. We recruited patients with long-standing end-stage osteoarthritis of the hip or knee awaiting THA or TKA. Measurements were performed before surgery and 3 and 6 months after surgery. Actual physical activity improved by 0.7%. Patients' body function, capacity, and self-reported physical functioning also improved. The effects of the surgery on these aspects of physical functioning were similar for THA and TKA. The effect on actual physical activity (8%) was smaller than on body function (80%-167%), capacity (19%-36%), and self-reported physical functioning (87%-112%). Therefore, in contrast to the large effect on pain and stiffness, patients' capacity, and their self-reported physical functioning, the improvement in actual physical activity of our patients was less than expected 6 months after surgery.Level Of Evidence: Level I, prospective study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of carrying the apolipoprotein epsilon 4 (APOE-in4) allele on global functional outcome, on activity limitations and participation restrictions, and on community integration at 3, 6, 12, 18, 24 and 36 months after traumatic brain injury.Method: The Glasgow Outcome Scale (GOS), the Sickness Impact Profile-68 (SIP-68) and the Community Integration Questionnaire (CIQ) were assessed in 79 moderate and severe traumatic brain injury patients at 3, 6, 12, 18, 24 and 36 months post injury. Repeated measures analyses of variance were performed with APOE-in4 status and time of measurement as independent variables and the GOS, SIP-68 and CIQ as dependent variables. Analyses were adjusted for baseline age, gender and Glasgow Coma Scale.Results: Patients with the APOE-in4 allele had a significantly better global functional outcome on the GOS than patients without the APOE-in4 allele. No significant associations were found between APOE-in4 status and the SIP-68 and CIQ.Discussion: In contrast to other studies, we found that carrying the APOE-in4 allele had a protective influence on outcome. Multiple mechanisms, and in some cases competitive mechanisms, may explain the variable relation between the APOE-in4 allele and outcome after traumatic brain injury. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of carrying the apolipoprotein epsilon 4 (APOE-ε4) allele on global functional outcome, on activity limitations and participation restrictions, and on community integration at 3, 6, 12, 18, 24 and 36 months after traumatic brain injury. Method: The Glasgow Outcome Scale (GOS), the Sickness Impact Profile-68 (SIP-68) and the Community Integration Questionnaire (CIQ) were assessed in 79 moderate and severe traumatic brain injury patients at 3, 6, 12, 18, 24 and 36 months post injury. Repeated measures analyses of variance were performed with APOE-ε4 status and time of measurement as independent variables and the GOS, SIP-68 and CIQ as dependent variables. Analyses were adjusted for baseline age, gender and Glasgow Coma Scale. Results: Patients with the APOE-ε4 allele had a significantly better global functional outcome on the GOS than patients without the APOE-ε4 allele. No significant associations were found between APOE-ε4 status and the SIP-68 and CIQ. Discussion: In contrast to other studies, we found that carrying the APOE-ε4 allele had a protective influence on outcome. Multiple mechanisms, and in some cases competitive mechanisms, may explain the variable relation between the APOE-ε4 allele and outcome after traumatic brain injury. [ABSTRACT FROM AUTHOR]

Purpose. To assess functional activities of the upper extremity of young adults with cerebral palsy (CP) and to determine their relations with participant characteristics and participation. Method. Assessment of functional activities of the upper extremity was performed on 103 participants (aged 16 - 20 years) with the Melbourne assessment and the Abilhand Questionnaire. Participation was measured with the Life Habits Questionnaire. Participant characteristics included age, gender, limb distribution of the spastic paresis, educational level and gross and fine motor function. Relations among these variables were studied by means of correlation coefficients and linear regression analysis. Results. Limitations in functional activities of the upper extremity were related to the limb distribution of the spastic paresis and were especially present in quadriplegic participants. Significant correlations between participant characteristics and measures of functional activities were present. Limitations in functional activities of the upper extremity, measured with the Abilhand Questionnaire, were an important determinant for participation, in addition to the gross motor function and educational level. Conclusion. Limitations in functional activities of the upper extremity are an important determinant for restrictions in participation in young adults with CP. It is recommended to include assessment of functional activities of the upper extremity in patients with CP. [ABSTRACT FROM AUTHOR]

PURPOSE: To assess the level and potential determinants of everyday physical activity and participation in various life areas of adults with hemiplegic cerebral palsy (CP) in comparison with healthy subjects. METHOD: In a cross-sectional study everyday physical activity was measured (Activity Monitor) in 16 adults with CP, aged 28 (3) years, and 16 age/gender matched healthy volunteers, aged 29 (3) years. Participation was assessed by means of validated questionnaires. Age, gender, body fat (skinfold thickness), muscle tone (Ashworth Scale), functional level and participation were assessed as potential determinants of everyday physical activity. RESULTS: In adults with CP mean (SD) duration of dynamic activities during a day (10.6 [3.5]%) was comparable to healthy subjects (11.2 4%) (p = 0.66). In most life areas the level of participation was comparable for both groups, although adults with CP spent more time on non-intensive leisure activities. Participation in sports appeared to be a determinant of everyday physical activity in both groups. CONCLUSIONS: The results indicate that the levels of everyday physical activity and community participation in adults with hemiplegic CP are comparable to levels in healthy comparison subjects. [ABSTRACT FROM AUTHOR]

PURPOSE: To explore whether cognitive functioning in patients with meningomyelocele (MMC) is related to level of everyday physical activity. METHOD: In a cross-sectional study in 14 patients with MMC (aged 14 - 26 years) a neuropsychological test battery was administered to each patient. Everyday physical activity of the patients was measured with an accelerometry-based Activity Monitor (AM), and compared to 14 healthy comparison subjects. RESULTS: Intellectual ability of 10 patients was in the normal range. For memory and verbal learning, executive functioning, divided attention and reaction speed subnormal scores were present in six or more patients. Time spent on dynamic activities was low in patients with MMC as compared to healthy subjects. After controlling for intellectual ability, we found that in patients with MMC (i) executive functioning was positively related, and (ii) word production was negatively related to everyday physical activity. CONCLUSION: We found some indication that specific impairments in executive functioning might be related to everyday physical activity of adolescents and young adults with MMC. [ABSTRACT FROM AUTHOR]

Purpose. Describing the epidemiology of cerebral palsy (CP), its impairments and risk factors. Method. Literature review 1965-2004. Search terms: Cerebral palsy, incidence, prevalence, impairments, risk factors. Results. In the last 40 years the prevalence of CP has risen to well above 2.0 per 1000 life births. In this time span the proportion of low-birthweight infants rose, the proportion of diplegia decreased, while the proportion of hemiplegia increased. CP is more prevalent in more deprived socio-economic populations. The majority of people with CP have the spastic syndrome of which the diplegic group is the smallest. Dependent on the subgroup of CP, 25-80% have additional impairments. A large proportion has some kind of cognitive impairment; the prevalence varies with the type of CP and especially increases when epilepsy is present. Epilepsy is present in 20-40%; it is most common among the hemi- and tetraplegics. Sensibility of the hands is impaired in about half. Chronic pain is reported by more than a quarter of the adults. Up to 80% have at least some impairment of speech. Low visual acuity is reported in almost three-quarters of all children. Half of all children have gastrointestinal and feeding problems. Stunted growth occurs in a quarter, while under- or overweight problems are present in half of the children. Almost 70% of people with spastic CP have abnormal brain CT findings; abnormal cranial ultrasounds is most strongly associated with hemiplegia, normal cranial ultrasounds with diplegia. The most important risk factors for CP are low birthweight, intrauterine infections and multiple gestation. [ABSTRACT FROM AUTHOR]

Purpose. Selection of appropriate functional tests and questionnaires to assess capacity (tests) and performance (questionnaires) of arm/hand functioning in children with congenital transverse or longitudinal (radius dysplasia) reduction deficiencies of the upper limb. Method. A PubMed Medline search was performed. Tests and questionnaires were evaluated according to three criteria: (1) items represent bimanual daily activities, (2a) quality of movement is scored (tests) or (2b) difficulty in performing a task (questionnaires), (3) instrument is attractive for children aged 4 - 12. Results. We found 14 functional tests and nine questionnaires to measure arm/hand functioning. Three tests, the Assisting Hand Assessment (AHA), Unilateral Below Elbow Test (UBET) and University of New Brunswick Test of prosthetic function (UNB Test) and two questionnaires, the Prosthetic Upper limb Functional Index (PUFI) and the children's version of the ABILHAND (ABILHAND-Kids) met the criteria. Conclusions. Two functional tests (AHA and UBET) and two questionnaires (ABILHAND-Kids and PUFI) were considered appropriate to assess arm/hand functioning in children with congenital reduction deficiencies of the upper limb, but require further study on psychometric properties for these patient groups. [ABSTRACT FROM AUTHOR]

Objective: To compare walking test results with walking in daily life, and to investigate the relationships between walking tests, walking activity in daily life, and perceived mobility problems in patients with post-poliomyelitis syndrome. Subjects: Twenty-four ambulant patients with post-poliomyelitis syndrome. Methods: Walking tests were performed at self-preferred and maximal speed. Walking activity was measured with an ambulatory activity monitor. Heart rate, step cadence and walking speed in the test and in daily life were compared. Walking speed in daily life was represented by the intensity of walking. Perceived mobility problems were assessed with the Nottingham Health Profile. Results: Heart rate during walking was lower in the test at self-preferred speed than in daily life (mean difference: 11.3±10.4; p =0.001). Self-preferred walking speed in the test and in daily life correlated significantly ( r =0.55; p= 0.04). In a sub-group with a test performance below the median value, test performance correlated significantly with walking activity. No significant correlation was found between perceived mobility problems and walking activity. Conclusion: Walking in daily life may be more demanding than walking under standardized conditions. Patients with post-poliomyelitis syndrome with the lowest test performance walked less in daily life. Patients do not necessarily match their activity pattern to their perceived mobility problems [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the place of a novel Upper Limb Activity Monitor in the field of instruments measuring functioning and health in upper limb complex regional pain syndrome type I, by exploring the correlation between the Upper Limb Activity Monitor and 4 questionnaires. METHOD: Subjects (n = 30) were measured at home and correlations were calculated between the Upper Limb Activity Monitor and 4 questionnaires; Sickness Impact Profile, RAND-36 Health Survey, Disabilities of Arm Shoulder Hand Questionnaire and Radboud Skills Questionnaire. RESULTS: Of the inter-questionnaire correlations 83% were significant, whereas 46% of the correlations between the Upper Limb Activity Monitor and the questionnaires were significant. The number and strength of the correlations between the Upper Limb Activity Monitor and questionnaires was dependent on the degree to which similar aspects of functioning were measured. CONCLUSION: The Upper Limb Activity Monitor has some correlation with other instruments related to functioning and health, but generally it does not measure the same areas. [ABSTRACT FROM AUTHOR]

There is no consensus on the optimal isokinetic dynamometry parameters to clinically assess shoulder disorders. Therefore, this study aimed to establish which parameters are best able to discriminate between shoulder patients and healthy subjects, focusing on peak torques and peak torque ratios.Isokinetic dynamometric measurements of both shoulders were made in 20 healthy subjects and these data were compared with baseline measurements in 9 patients with shoulder disorders. The different outcome measures were compared by testing for significant group differences between patients and healthy subjects and by scoring how the patient data compared to the normal range of values found in healthy subjects.Significant differences between patients and healthy subjects were found for the peak torques, but not for the agonist-antagonist peak torque ratios. In addition, there were significant differences for the dominant/non dominant ratios of the peak torques but not for the dominant/non dominant ratios of the peak torque ratios. The percentage of patients with a standard deviation score outside the 90% normal distribution of healthy subjects was largest (>78%) for the involved/uninvolved (I/U) ratio of the peak torques.It was concluded that bilateral comparison of peak torques is the most appropriate outcome parameter to distinguish patients from healthy subjects. [ABSTRACT FROM AUTHOR]

Objective: To compare the outcome of muscle strength with manual muscle strength testing grip and pinch strength measurements and a dynamometer which allows for measurements of the intrinsic muscles of the hand in isolation (the Rotterdam Intrinsic Hand Myometer, RIHM).Methods: Thirty-four patients more than 2 years after ulnar and/or median nerve injury. Muscle strength was evaluated using manual muscle strength testing (MMST), grip, pinch and intrinsic muscle strength measurements.Results: Manual muscle strength testing showed that most muscles recover to grade 3 or 4. Average grip strength recovery, as percentage of the uninjured hand, was 83%. Pinch strength recovery was 75%, 58% and 39% in patients with ulnar, median and combined nerve injuries, respectively. The RIHM measurements revealed a poor recovery of the ulnar nerve innervated muscles in particular (26-37%). No significant correlation (Pearson) was found between the measurements of the RIHM and grip strength. Pinch strength was significantly correlated with strength of the abduction of thumb and opposition of the thumb strength (r 0.55 and 0.72, p=0.026, 0.002) as measured with the RIHM.Conclusion: While manual muscle strength testing and grip strength measurements show a reasonable to good recovery, measurements of the intrinsic muscles by means of the RIHM showed poor recovery of intrinsic muscle strength after peripheral nerve injury. No correlation was found between the recovery of intrinsic muscle strength and grip strength measurements. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although clinical experience indicates that prolonged use of a prosthesis after transfemoral amputation (TFA) is related to a higher incidence of low back pain (LBP), few data are available to substantiate this impression. Therefore, in a TFA population, we investigated the prevalence of LBP and its relationship with years since amputation, as well as the level of daily physical activity and other prosthesis-related parameters. METHOD: Questionnaires were sent to 490 subjects with TFA. Of these, 240 questionnaires could be used for analysis. RESULTS: Trauma and tumours were the most frequent reasons for amputation. The majority of the study group was aged under 30 years at the time of surgery, had been using a prosthesis more than 10 years, and had a moderately active life. Serious LBP (i.e. frequent or permanent LBP) was reported in 26.3% of the participants. No relationship was found between LBP and years since amputation or physical activity. CONCLUSION: The data show that the prevalence of LBP in our study group is higher than in the general population, and higher in the female than in the male participants. The initial assumption that there is a higher and increasing length of time since amputation and physical activity level is not confirmed in this study. [ABSTRACT FROM AUTHOR]

PURPOSE: Present models in the literature, predicting that prostheses should not be too lightweight, are not supported by empirical evidence. Recent studies suggest that these models are incorrectly based on the assumption that the swing phase is uninfluenced by muscle activity. The purpose of the present study was to introduce a new mathematical model to predict the effect of mass properties on the gait of transtibial amputees, based on experimental findings that subjects adapt to mass perturbations by maintaining the same joint kinematics. METHOD: Effect of mass perturbations on the lower leg was evaluated in terms of muscular cost and forces between stump and socket, using a linked-segment model of the swing phase. Gait analysis and anthropometric data from 10 transtibial amputees were used as model input. RESULTS: Location of perturbation strongly influenced the muscular cost. Cost generally increased after distally adding mass but decreased after proximally adding mass to the lower leg. Stump-socket interface forces always increased after mass addition. CONCLUSIONS: A new model was introduced, predicting that the weight of distally located components (e.g. foot, ankle, shoe) strongly influence the estimated muscular cost, in contrast to proximal components. A comparison with experimental literature suggests this new model better describes the experimental data than existing models. [ABSTRACT FROM AUTHOR]