scholarly journals REiNS: Reliability of Handheld Dynamometry to Measure Focal Muscle Weakness in Neurofibromatosis Types 1 and 2

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012439
Author(s):  
Srivandana Akshintala ◽  
Nashwa Khalil ◽  
Kaleb Yohay ◽  
Alona Muzikansky ◽  
Jeffrey Allen ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Muscle Strength ◽  
Intraclass Correlation ◽  
Rest Period ◽  
Neurofibromatosis Type ◽  
Muscle Group ◽  
Manual Muscle Testing ◽  
Reliable Technique ◽  
Muscle Testing ◽  
Weak Muscle

Objective:To determine a suitable outcome measure for assessing muscle strength in neurofibromatosis type 1 (NF1) and type 2 (NF2) clinical trials, we evaluated the intra-observer reliability of hand-held dynamometry (HHD) and developed consensus recommendations for its use in neurofibromatosis clinical trials.Methods:Patients ≥5 years with weakness in at least 1 muscle group by manual muscle testing (MMT) were eligible. Maximal isometric muscle strength of a weak muscle group and the biceps of the dominant arm were measured by HHD. An average of 3 repetitions per session was used as an observation, and 3 sessions with rest period between each were performed on the same day by a single observer. Intra- and inter-session intraclass correlation (ICC) and coefficient of variation (CV) were calculated to assess reliability and measurement error.Results:Twenty NF1 and 13 NF2 patients enrolled; median age was 12 years (interquartile range (IQR) 9-17) and 29 years (IQR 22-38) respectively. By MMT, weak muscle strength ranged from 2-/5 to 4+/5. Biceps strength was 5/5 in all patients. Inter-session ICC for the weak muscles were 0.98 and 0.99 in the NF1 and NF2 cohorts respectively and for biceps were 0.97 and 0.97 respectively. The median CV for average session strength were 5.4% (IQR 2.6%-7.3%) and 2.9% (IQR 2.0%-6.2%) for weak muscles and biceps respectively.Conclusion:HHD performed by a trained examiner with a well-defined protocol is a reliable technique to measure muscle strength in NF1 and NF2. Recommendations for strength testing in NF1 and NF2 trials are provided.

scholarly journals Mapping intended spinal site of care from the upright to prone position: an interexaminer reliability study

2014 ◽  
Vol 22 (1) ◽  
Author(s):  
Robert Cooperstein ◽  
Morgan Young
Keyword(s):  
Prone Position ◽  
Mean Squared Error ◽  
Thought Experiment ◽  
Spinous Process ◽  
Intraclass Correlation ◽  
Manual Muscle Testing ◽  
Muscle Testing ◽  
Interexaminer Reliability ◽  
Novel Method ◽  
The Mean

Abstract Background Upright examination procedures like radiology, thermography, manual muscle testing, and spinal motion palpation may lead to spinal interventions with the patient prone. The reliability and accuracy of mapping upright examination findings to the prone position is unknown. This study had 2 primary goals: (1) investigate how erroneous spine-scapular landmark associations may lead to errors in treating and charting spine levels; and (2) study the interexaminer reliability of a novel method for mapping upright spinal sites to the prone position. Methods Experiment 1 was a thought experiment exploring the consequences of depending on the erroneous landmark association of the inferior scapular tip with the T7 spinous process upright and T6 spinous process prone (relatively recent studies suggest these levels are T8 and T9, respectively). This allowed deduction of targeting and charting errors. In experiment 2, 10 examiners (2 experienced, 8 novice) used an index finger to maintain contact with a mid-thoracic spinous process as each of 2 participants slowly moved from the upright to the prone position. Interexaminer reliability was assessed by computing Intraclass Correlation Coefficient, standard error of the mean, root mean squared error, and the absolute value of the mean difference for each examiner from the 10 examiner mean for each of the 2 participants. Results The thought experiment suggesting that using the (inaccurate) scapular tip landmark rule would result in a 3 level targeting and charting error when radiological findings are mapped to the prone position. Physical upright exam procedures like motion palpation would result in a 2 level targeting error for intervention, and a 3 level error for charting. The reliability experiment showed examiners accurately maintained contact with the same thoracic spinous process as the participant went from upright to prone, ICC (2,1) = 0.83. Conclusions As manual therapists, the authors have emphasized how targeting errors may impact upon manual care of the spine. Practitioners in other fields that need to accurately locate spinal levels, such as acupuncture and anesthesiology, would also be expected to draw important conclusions from these findings.

scholarly journals Effect of Isometric and Isotonic Exercise Program on Increased Strength of Quardriceps Muscles in Osteoarthritis Patients in Singgasana Rama Physiotherapy Clinic Blitar

2021 ◽  
Vol 5 (1) ◽  
pp. 42-48
Author(s):  
Irwan Syahputra ◽  
Nurwijayanti Nurwijayanti
Keyword(s):  
Muscle Strength ◽  
Exercise Program ◽  
Quadriceps Strength ◽  
Manual Muscle Testing ◽  
Moderate Intensity ◽  
Rank Test ◽  
Control Group ◽  
Isometric Training ◽  
Muscle Testing ◽  
Isotonic Exercise

Background: Osteoarthritis is a disease of the joints that can cause disability and is progressive in the joints which cause changes in the water content, proteoglycin content, and collagen in the joints. One of the ways to improve functional ability in osteoarthritis cases is to use isotonic and isometric training exercise. Pain is a clinical symptom of knee osteoarthritis, limiting movement due to pain over time will cause rehabilitation problems such as impaired flexibility and stability, reduction of muscle mass (atrophy). Mild and moderate intensity quadriceps strength training is effective at achieving optimal muscle strength and function without causing significant muscle damage. Destination: The purpose of this study was to analyze the effect of isotonic and isometric exercises on muscle strength. Research methods: This study uses a pre-experimental research type using "One Group Pre - test and Post - Test". This research has carried out the first observation (pretest) so that researchers can test the changes that occur after the treatment, and the control group. Result: with the Wilcoxon signed rank test test the isometric and isotonic groups had p = 0.000 while the control group had a significance value of p = 1,000; and the 3 groups test has different values, namely: isotonic exercise has a value of 27.67; isometric; 28.60; and control 12.73. The conclusion that can be concluded that the value of isometric training has the highest value, namely 28.60 which means it is the most effective exercise to increase the value of Manual Muscle Testing. Conclusion: There is an effect of giving isometric and isotonic exercises in strengthening the quadriceps muscles.

Hand-held dynamometry for assessment of muscle strength in patients with inflammatory myopathies

Rheumatology ◽  
2020 ◽  
Author(s):  
Didem Saygin ◽  
Chester V Oddis ◽  
Siamak Moghadam-Kia ◽  
Bonny Rockette-Wagner ◽  
Nicole Neiman ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Disease Activity ◽  
Neuromuscular Disorders ◽  
Strong Association ◽  
External Validation ◽  
Manual Muscle Testing ◽  
Inflammatory Myopathies ◽  
University Of Pittsburgh ◽  
Muscle Testing ◽  
The University

Abstract Objectives Muscle weakness in idiopathic inflammatory myopathies (IIMs) is conventionally assessed using manual muscle testing (MMT). However, more objective tools must be developed to accurately and reliably quantify muscle strength in myositis patients. Hand-held dynamometry (HHD) is a quantitative, portable device with reported reliability in neuromuscular disorders. Our aim was to assess the reliability, validity and responsiveness of HHD in myositis. Methods Myositis patients [DM, necrotizing myopathy (NM), PM and anti-synthetase syndrome] evaluated at the University of Pittsburgh myositis centre were prospectively enrolled. Each patient was assessed at 0, 3 and 6 months for validated outcome measures of myositis disease activity and physical function. At each visit, muscle strength was assessed using both MMT and HHD (Micro FET2, Hoggan Health Industries, Draper, UT, USA). The reliability, validity and responsiveness of the HHD was assessed using standard statistical methods. Results Fifty IIM patients (60% female; mean age 51.6 years; 6 PM, 9 NM, 24 DM and 11 anti-synthetase syndrome) were enrolled. HHD showed strong test–retest intrarater reliability (r = 0.96) and interrater reliability (r = 0.98). HHD correlated significantly with the MMT score (r = 0.48, P = 0.0006) and myositis disease activity and functional measures. Longitudinal analysis showed a significant and strong association between the HHD and MMT as well as 2016 ACR/EULAR myositis response criteria (r = 0.8, P < 0.0001) demonstrating responsiveness. The mean effect size and standardized response mean of HHD was large: 0.95 and 1.03, respectively. MMT had a high ceiling effect compared with HHD. Conclusion HHD demonstrated strong reliability, construct validity and responsiveness in myositis patients. External validation studies are required to confirm these findings.

scholarly journals Large variation in effects during 10 years of enzyme therapy in adults with Pompe disease

Neurology ◽  
2019 ◽  
Vol 93 (19) ◽  
pp. e1756-e1767 ◽  
Author(s):  
Laurike Harlaar ◽  
Jean-Yves Hogrel ◽  
Barbara Perniconi ◽  
Michelle E. Kruijshaar ◽  
Dimitris Rizopoulos ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Pulmonary Function ◽  
Pompe Disease ◽  
Manual Muscle Testing ◽  
Controlled Clinical Trial ◽  
Walking Ability ◽  
Enzyme Replacement ◽  
Link Type ◽  
Muscle Testing

ObjectiveTo determine the effects of 10 years of enzyme replacement therapy (ERT) in adult patients with Pompe disease, focusing on individual variability in treatment response.MethodsIn this prospective, multicenter cohort study, we studied 30 patients from the Netherlands and France who had started ERT during the only randomized placebo-controlled clinical trial with ERT in late-onset Pompe disease (NCT00158600) or its extension (NCT00455195) in 2005 to 2008. Main outcomes were walking ability (6-minute walk test [6MWT]), muscle strength (manual muscle testing using Medical Research Council [MRC] grading), and pulmonary function (forced vital capacity [FVC] in the upright and supine positions), assessed at 3- to 6-month intervals before and after the start of ERT. Data were analyzed with linear mixed-effects models for repeated measurements.ResultsMedian follow-up duration on ERT was 9.8 years (interquartile range [IQR] 8.3–10.2 years). At the group level, baseline 6MWT was 49% of predicted (IQR 41%–60%) and had deteriorated by 22.2 percentage points (pp) at the 10-year treatment point (p < 0.001). Baseline FVC upright was 54% of predicted (IQR 47%–68%) and decreased by 11 pp over 10 years (p < 0.001). Effects of ERT on MRC sum score and FVC supine were similar. At the individual level, 93% of patients had initial benefit of ERT. Depending on the outcome measured, 35% to 63% of patients had a secondary decline after ≈3 to 5 years. Still, at 10 years of ERT, 52% had equal or better 6MWT and/or FVC upright compared to baseline.ConclusionsThe majority of patients with Pompe disease benefit from long-term ERT, but many patients experience some secondary decline after ≈3 to 5 years. Individual variation, however, is considerable.Classification of evidenceThis study provides Class IV evidence that for the majority of adults with Pompe disease, long-term ERT positively affects, or slows deterioration in, muscle strength, walking ability, and/or pulmonary function.

scholarly journals Assessing the Validity and Reliability of A Low-Cost Microcontroller-Based Load Cell Amplifier for Measuring Lower Limb and Upper Limb Muscular Force

Sensors ◽  
2020 ◽  
Vol 20 (17) ◽  
pp. 4999
Author(s):  
Julie Gaudet ◽  
Grant Handrigan
Keyword(s):  
Muscle Strength ◽  
Upper Limb ◽  
Low Cost ◽  
Load Cell ◽  
Manual Muscle Testing ◽  
Muscular Force ◽  
Validity And Reliability ◽  
Important Indicator ◽  
Muscle Testing ◽  
Isometric Muscle

Lower and upper limb maximum muscular force development is an important indicator of physical capacity. Manual muscle testing, load cell coupled with a signal conditioner, and handheld dynamometry are three widely used techniques for measuring isometric muscle strength. Recently, there is a proliferation of low-cost tools that have potential to be used to measure muscle strength. This study examined both the criterion validity, inter-day reliability and intra-day reliability of a microcontroller-based load cell amplifier for quantifying muscle strength. To do so, a low-cost microcontroller-based load cell amplifier for measuring lower and upper limb maximal voluntary isometric muscular force was compared to a commercial grade signal conditioner and to a handheld dynamometer. The results showed that the microcontroller-based load cell amplifier correlated nearly perfectly (Pearson's R-values between 0.947 to 0.992) with the commercial signal conditioner and the handheld dynamometer, and showed good to excellent association when calculating ICC scores, with values of 0.9582 [95% C.I.: 0.9297–0.9752] for inter-day reliability and of 0.9269 [95% C.I.: 0.8909–0.9533] for session one, intra-day reliability. Such results may have implications for how the evaluation of muscle strength measurement is conducted in the future, particularly for offering a commercial-like grade quality, low cost, portable and flexible option.

scholarly journals Relationship between Grade 3 Muscle Strength and the Maximum Muscle Strength in Manual Muscle Testing of Legs: Assessment of Flexion and Extension of the Hip and Knee Joints

2014 ◽  
Vol 29 (6) ◽  
pp. 861-865 ◽  
Author(s):  
Hideyuki USA ◽  
Masashi MATSUMURA ◽  
Daisuke OGAWA ◽  
Masafumi HATA ◽  
Kazuna ICHIKAWA ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Knee Joints ◽  
Manual Muscle Testing ◽  
Muscle Testing ◽  
Grade 3 ◽  
Flexion And Extension

scholarly journals [REiNS] Validating Techniques for Measurement of Cutaneous Neurofibromas: Recommendations for Clinical Trials

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012428
Author(s):  
Raquel Thalheimer ◽  
Vanessa Leigh Merker ◽  
Ina Ly ◽  
Amanda Champlain ◽  
Jennifer Sawaya ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Intraclass Correlation ◽  
Neurofibromatosis Type ◽  
Measurement Tool ◽  
High Frequency Ultrasound ◽  
Detectable Difference ◽  
3D Photography ◽  
Cutaneous Neurofibromas ◽  
Frequency Ultrasound

Objective:To assess the reliability and variability of digital calipers, 3D photography, and high frequency ultrasound (HFUS) for measurement of cutaneous neurofibromas (cNF) in patients with neurofibromatosis type 1 (NF1).Background:cNF affect virtually all patients with NF1 and are a major source of morbidity. Reliable techniques for measuring cNF are needed to develop therapies for these tumors.Methods:Adults with NF1 were recruited. For each participant, six cNF were assessed independently by three different examiners at five different timepoints using digital calipers, 3D photography, and HFUS. The intraclass correlation coefficient (ICC) was used to assess intra- and inter-rater reliability of linear and volumetric measurements for each technique, with ICC values >0.90 defined as “excellent” reliability. The coefficient of variation (CV) was used to estimate the minimal detectable difference (MDD) for each technique.Results:57 cNF across 10 participants were evaluated. The ICC for image acquisition and measurement was >0.97 within and across examiners for HFUS and 3D photography. ICC for digital calipers was 0.62–0.88. CV varied by measurement tool, linear vs. volumetric measurement, and tumor size.Conclusions:HFUS and 3D photography demonstrate “excellent” reliability whereas digital calipers have “good” to “excellent” reliability in measuring cNF. The MDD for each technique was used to create tables of proposed thresholds for investigators to use as guides for clinical trials focused on cNF size. These criteria should be updated as the performance of these endpoints are evaluated.

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