Toward Consensus in Assessing Upper Limb Muscle Strength and Pinch and Grip Strength in People With Tetraplegia Having Upper Limb Reconstructions

2021 ◽  
Author(s):  
Jennifer A. Dunn ◽  
Sabrina Koch-Borner ◽  
M. Elise Johanson ◽  
Johanna Wangdell
Keyword(s):  
Grip Strength ◽  
Upper Limb ◽  
Manual Muscle Testing ◽  
Pinch Strength ◽  
Consensus Methods ◽  
Serratus Anterior ◽  
Multicenter Studies ◽  
International Consensus ◽  
Muscle Testing ◽  
Upper Limb Surgery

Objectives: To reach agreement on standardized protocols for assessing upper limb strength and grip and pinch force for upper limb reconstructive surgery for tetraplegia. Methods: Selected members of an expert panel composed of international therapists formed at the 2018 International Congress for Upper Limb Surgery for Tetraplegia conducted a literature review of current practice that identified gaps and inconsistencies in measurement protocols and presented to workshop attendees. To resolve discrepancies, a set of questions was presented to workshop attendees who voted electronically. Consensus was set at 75% agreement. Results: For manual muscle testing, consensus was reached for using the Medical Research Council scale, without plus or minus, and the use of resistance through range when testing grade 4 and grade 5 strength. Pectoralis major and serratus anterior should be routinely tested, however there was no consensus on other shoulder muscles. Grip and pinch strength should be tested according to the American Society of Hand Therapists positioning. For grip strength, either the Jamar or Biometrics dynamometer expressed in kilograms should be used. For grip and pinch strength, three measurements should be performed at each testing. No consensus was reached on a device for pinch strength. Conclusion: This work is an important step to enable comparable data in the future. Further consensus methods will work toward developing more comprehensive guidelines in this population. Building international consensus for pre- and postoperative measures of function supports objective evaluation of novel therapies and interpretation of multicenter studies.

scholarly journals Global Muscle Strength But Not Grip Strength Predicts Mortality and Length of Stay in a General Population in a Surgical Intensive Care Unit

2012 ◽  
Vol 92 (12) ◽  
pp. 1546-1555 ◽  
Author(s):  
Jeanette J. Lee ◽  
Karen Waak ◽  
Martina Grosse-Sundrup ◽  
Feifei Xue ◽  
Jarone Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Grip Strength ◽  
Muscle Weakness ◽  
Manual Muscle Testing ◽  
Surgical Intensive Care Unit ◽  
Muscle Testing

Background Paresis acquired in the intensive care unit (ICU) is common in patients who are critically ill and independently predicts mortality and morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have been used to evaluate muscle weakness in patients in a medical ICU, but similar data for patients in a surgical ICU (SICU) are limited. Objective The purpose of this study was to evaluate the predictive value of strength measured by MMT and handgrip dynamometry at ICU admission for in-hospital mortality, SICU length of stay (LOS), hospital LOS, and duration of mechanical ventilation. Design This investigation was a prospective, observational study. Methods One hundred ten patients were screened for eligibility for testing in the SICU of a large, academic medical center. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, diagnoses, and laboratory data were collected. Measurements were obtained by MMT quantified with the sum (total) score on the Medical Research Council Scale and by handgrip dynamometry. Outcome data, including in-hospital mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation, were collected for all participants. Results One hundred seven participants were eligible for testing; 89% were tested successfully at a median of 3 days (25th–75th percentiles=3–6 days) after admission. Sedation was the most frequent barrier to testing (70.6%). Manual muscle testing was identified as an independent predictor of mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation. Grip strength was not independently associated with these outcomes. Limitations This study did not address whether muscle weakness translates to functional outcome impairment. Conclusions In contrast to handgrip strength, MMT reliably predicted in-hospital mortality, duration of mechanical ventilation, SICU LOS, and hospital LOS.

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 The Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Functional Indices of Affected Upper Limb in Patients with Subacute Stroke

2018 ◽  
Author(s):  
F Moslemi Haghighi ◽  
A Kordi Yoosefinejad ◽  
M Razeghi ◽  
A H Shariat ◽  
Z Bagheri ◽  
...  
Keyword(s):  
Grip Strength ◽  
Upper Limb ◽  
High Frequency ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Pinch Strength ◽  
Control Group ◽  
Subacute Phase ◽  
Functional Indices ◽  
Experimental Group

Background: Repetitive transcranial magnetic stimulation (rTMS) is a novel technique that may improve recovery in patients with stoke, but the role of rTMS as an applied and practical treatment modality for stroke rehabilitation has not been established yet.Objective: This study was conducted to determine the effects of a rehabilitation program (RP) in conjunction with rTMS on functional indices of the paretic upper limb in the subacute phase of stroke.Material and Methods: Twenty patients in the subacute phase of stroke were randomly assigned into two groups: The high frequency rTMS (HF-rTMS) in conjunction with RP (experimental group), and the RP group (control group). The experimental group received 10 sessions of 20 Hz rTMS on the affected primary motor cortex and the other group received 10 sessions of RP. In experimental group, RP for the paretic hand was conducted following rTMS session. Box and block test (BBT), Fugl-Meyer Motor Assessment for upper limb (FMA-UL), grip strength and pinch strength were used to assess motor function before the first session and after  the last session of treatment.Results: Significant improvement in BBT, FMA-UL, grip strength and pinch strength was observed in both groups. Improvement of BBT and grip strength was significantly greater in the experimental group rather than the control group (p<0.05). FMA-UL score and the pinch strength were greater in the experimental group, although the differences were not statistically significant. Conclusion: HF-rTMS in conjunction with RP is effective to improve the function of upper limb. It seems HF-rTMS is a novel feasible and safe technique for hemiparesis patients in the subacute phase of stroke.

scholarly journals The Effect of Trunk Stability Training Based on Visual Feedback on Trunk Stability, Balance, and Upper Limb Function in Stroke Patients: A Randomized Control Trial

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 532
Author(s):  
Seok-Hui Yang ◽  
Eun-Jung Chung ◽  
Jin Lee ◽  
Su-Hyun Lee ◽  
Byoung-Hee Lee
Keyword(s):  
Support Group ◽  
Visual Feedback ◽  
Upper Limb ◽  
Manual Muscle Testing ◽  
Triceps Brachii ◽  
Limb Function ◽  
Trunk Stability ◽  
Upper Limb Function ◽  
Muscle Testing ◽  
Stability Training

This study aimed to investigate the effects of trunk stability training based on visual feedback on trunk stability, balance, and upper limb function in patients with stroke. Twenty-eight patients with chronic stroke were randomly assigned to either a trunk support group (n = 14) or a trunk restraint group (n = 14) that practiced upper limb training with trunk support and trunk restraint, respectively, based on visual feedback for 30 min per day, three times per week, for 4 weeks. The postural assessment scale for stroke (PASS) was used to assess the stability of patients, and the functional reaching test (FRT) was performed to assess balance. To assess upper extremity function, a range of motion (ROM) test, manual muscle testing (MMT), and Fugl–Meyer assessment-upper limb (FMA-upper limb) were performed. Consequently, both groups showed significant differences before and after training in the PASS, FRT, shoulder flexion ROM, triceps brachii MMT, and FMA-upper limb (p < 0.05), while the trunk support group showed more significant improvements than the trunk restraint group in the PASS, FRT, and FMA-upper limb (p < 0.05). Trunk support-based upper limb training effectively improved trunk stability, balance, and upper limb function and is beneficial as an upper limb training method. Providing trunk support is more effective than restricting the trunk; trunk support-based upper limb training is expected to promote voluntary participation when combined with visual feedback.

scholarly journals Changes in Function and Muscle Strength of Encephalitis Survivors After Inpatient Rehabilitation

2021 ◽  
Vol 45 (6) ◽  
pp. 422-430
Author(s):  
Tayeun Kim ◽  
In Yae Cheong
Keyword(s):  
Muscle Strength ◽  
Grip Strength ◽  
Autoimmune Encephalitis ◽  
Inpatient Rehabilitation ◽  
Berg Balance Scale ◽  
Manual Muscle Testing ◽  
Korean Version ◽  
Muscle Testing ◽  
Before And After ◽  
Motor Strength

Objective To investigate the clinical demographics and rehabilitative assessments of encephalitis survivors admitted to a rehabilitation center, and to confirm the effects of inpatient rehabilitation manifested by changes in muscle strength and function after hospitalization.Methods Data of encephalitis survivors who received rehabilitation at our institution from August 2009 to August 2019 were reviewed. Medical charts were retrospectively reviewed, and motor, functional, and cognitive assessments were collected. Manual muscle testing (MMT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), Korean version of Modified Barthel Index (K-MBI), grip strength, Box and Block Test (BBT), and Korean version of Mini-Mental State Examination (K-MMSE) were performed, and the results upon admission and discharge were compared and analyzed.Results Most of the patients with encephalitis admitted to our institution had viral or autoimmune etiologies. The assessment results of 18 encephalitis patients upon admission and discharge were compared. The total K-MBI score, FAC, grip strength, and BBT significantly improved, but not the MMT and FMA. Subgroup analysis was performed for viral and autoimmune encephalitis, which are the main causes of the disease, but there was no difference in items with significant changes before and after hospitalization.Conclusion Encephalitis survivors showed a significant improvement in functional assessment scale during their hospital stay through rehabilitation, without significant changes in motor strength. Hence, we can conclude that encephalitis survivors benefit from inpatient rehabilitation, targeting functional gains in activities of daily living training more than motor strength.

The Effects of Myofascial Release Technique on Depression Following Pain Reduction in a Depressive Patient Suffering from Frozen Shoulder: A Case Report

2017 ◽  
Vol 27 (06) ◽  
pp. 359-361
Author(s):  
Amin Kordi Yoosefinejad ◽  
Mahbobeh Samani ◽  
Fatemeh Jabarifard
Keyword(s):  
Case Report ◽  
Frozen Shoulder ◽  
Pain Reduction ◽  
Beck Depression Inventory Score ◽  
Manual Muscle Testing ◽  
Serratus Anterior ◽  
Myofascial Release ◽  
Muscle Testing ◽  
Shoulder Flexion ◽  
Release Technique

Abstract Introduction Chronic pain and depression are known to interact, possibly through common neurotransmitters and pathways. Frozen shoulder is among the most debilitating musculoskeletal disorders, with a prevalence of 2–5%. Managing one of these disorders may induce dramatic effects on the other. The aim of this study was to investigate the effects of myofascial release on the attenuation of depression following pain reduction in a patient with depression and frozen shoulder. Case report/Method A 49-year-old woman with a history of depression for the previous 6 years was referred to us with a diagnosis of left side frozen shoulder. Initial range of shoulder flexion and abduction were 95 and 80 degrees respectively, and pain intensity on a visual analog scale was 10/10. Debilitating pain disturbed her sleep. Muscle weakness was documented with manual muscle testing. The myofascial release technique for the serratus anterior was applied in 5 sessions. Results Shoulder pain was considerably attenuated and range of motion improved notable following treatment. The patient’s Beck Depression Inventory score improved by15 points. Discussion These improvements might be attributed to the interrelationship between pain and depression.

A longitudinal physical profile assessment of skeletal muscle manifestations in myotonic dystrophy

1999 ◽  
Vol 13 (1_suppl) ◽  
pp. 64-73 ◽  
Author(s):  
JC Nitz ◽  
YR Burns ◽  
RV Jackson
Keyword(s):  
Skeletal Muscle ◽  
Myotonic Dystrophy ◽  
Upper Limb ◽  
Normal Subjects ◽  
Respiratory Function Tests ◽  
Forced Expiratory Volume ◽  
Manual Muscle Testing ◽  
Pinch Grip ◽  
Muscle Testing ◽  
Physical Profile

Objectives: To develop an assessment that describes the skeletal muscle manifestations in myotonic dystrophy subjects and then use it to quantify the presentation of skeletal muscle disability and to show change over time. Design: A quantified skeletal muscle assessment was developed and applied three times over a two-year period at intervals around 12 months. Thirty-six subjects with myotonic dystrophy and 20 subjects without neuromuscular disability were evaluated. The assessment comprised manual muscle testing of five pairs of muscles, measuring neck flexor strength with a strain gauge, respiratory function tests, power and lateral pinch grip strength, all tests of impairment. Assessment of the ability to move from sitting to standing and fasten buttons tested disability. Results: Results from subjects with myotonic dystrophy were compared to the normal data. The subjects with myotonic dystrophy were significantly weaker in proximal upper limb muscles, quadriceps, tibialis anterior muscles and neck flexor muscles as well as power and lateral pinch grips. There was also significant reduction in forced expiratory volume at one second (FEV1) and forced vital capacity (FVC). Significant disability was seen in the myotonics in moving from sitting to standing and in fastening buttons. Over the two-year study period proximal upper limb and lower limb muscle strength, FVC and sit-to-stand ability declined significantly. Power grip declined but lateral pinch grip and FEV1 improved significantly. Button fastening ability improved significantly. Conclusion: The test developed was shown to be reliable and sensitive to the change in skeletal muscle manifestations in subjects with myotonic dystrophy who were shown to be significantly weaker than normal subjects.

Subterminal key pinch dynamometry: a new method to quantify strength deficit in ulnar nerve paralysis

2020 ◽  
Vol 45 (8) ◽  
pp. 813-817
Author(s):  
Jayme Augusto Bertelli
Keyword(s):  
Ulnar Nerve ◽  
Nerve Repair ◽  
Applied Pressure ◽  
Manual Muscle Testing ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Nerve Paralysis ◽  
Quality Of Recovery ◽  
Muscle Testing

Precise pre- and postoperative assessments are fundamental to recording the quality of recovery after ulnar nerve repair. Because of its imprecision, manual muscle testing is being replaced by dynamometry to measure grasping and key-pinch strengths. However, both grasping and key pinch are dependent not only on the ulnar nerve but also the median and radial nerves. We propose to measure strength using a new sort of pinch, called the ‘subterminal key pinch’. Strength was measured using a commercially available pinch meter. Patients applied pressure on the dynamometer with the interphalangeal joint of the thumb, maintaining the joint in extension to avoid enhancement of strength by the flexor pollicis longus. We examined 17 patients before ulnar nerve repair. Preoperatively, grasping strength was 46% of normal, while key pinch was 58%, pinch-to-zoom strength was 26% and subterminal key pinch only 7%. Subterminal key pinch was the most affected pinch with a strength deficit of over 90%. Level of evidence: IV

Quick Reference: Chapter 3: The Musculoskeletal System and Chapter 4: The Nervous System

2000 ◽  
Vol 5 (3) ◽  
pp. 4-4
Keyword(s):  
Nervous System ◽  
Lower Extremity ◽  
Musculoskeletal System ◽  
Multistep Method ◽  
Manual Muscle Testing ◽  
Motor Deficits ◽  
Lower Extremity Weakness ◽  
Residual Symptoms ◽  
Muscle Testing ◽  
Almost All

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, divides PNS deficits into sensory and motor and includes pain in the former. This article, which regards rating sensory and motor deficits of the lower extremities, is continued from the March/April 2000 issue of The Guides Newsletter. Procedures for rating extremity neural deficits are described in Chapter 3, The Musculoskeletal System, section 3.1k for the upper extremity and sections 3.2k and 3.2l for the lower limb. Sensory deficits and dysesthesia are both disorders of sensation, but the former can be interpreted to mean diminished or absent sensation (hypesthesia or anesthesia) Dysesthesia implies abnormal sensation in the absence of a stimulus or unpleasant sensation elicited by normal touch. Sections 3.2k and 3.2d indicate that almost all partial motor loss in the lower extremity can be rated using Table 39. In addition, Section 4.4b and Table 21 indicate the multistep method used for spinal and some additional nerves and be used alternatively to rate lower extremity weakness in general. Partial motor loss in the lower extremity is rated by manual muscle testing, which is described in the AMA Guides in Section 3.2d.

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