The use of muscle strength assessed with handheld dynamometers as a non-invasive biological marker in myotonic dystrophy type 1 patients: a multicenter study

<p>Abstract</p> <p>Background</p> <p>Myotonic dystrophy type 1 (DM1) is a multisystem disorder that demonstrates variable symptoms and rates of progression. Muscle weakness is considered one of the main problems with a clinical picture that is characterized by distal weakness of the limbs progressing to proximal weakness. The main objective of this study was to characterize the maximal strength of ankle eversion and dorsiflexion in DM1 patients. Manual and handheld dynamometer (HHD) muscle testing were also compared.</p> <p>Methods</p> <p>The maximal strength of 22 patients from Quebec (mean age = 41,1 ± 13,8) and 24 from Lyon (mean age = 41,6 ± 10,2) were compared to 16 matched controls.</p> <p>Results</p> <p>With the use of HHD, an excellent reproducibility of the torque measurements was obtained for both centers in eversion (R²= 0,94/Quebec; 0,89/Lyon) and dorsiflexion (R²= 0,96/Quebec; 0,90/Lyon). The differences between 3 groups of DM1 (mild, moderate, severe) and between them and controls were all statistically significant (p < 0,001). No statistical differences between sites were observed (p > 0.05). The degree of muscle strength decline in dorsiflexion (eversion) were 60% (47%), 77% (71%), and 87% (83%) for DM1 with mild, moderate, and severe impairments, respectively. The smallest mean difference between all DM1 patients taking together was 2.3 Nm, a difference about twice than the standard error of measurement. There was a strong relationship between eversion and dorsiflexion strength profiles (R²= 0,87;Quebec/0,80;Lyon). Using a 10-point scale, manual muscle testing could not discriminate between the 3 groups of DM1 patients.</p> <p>Conclusions</p> <p>The HHD protocol showed discriminative properties suitable for multicentre therapeutic trial. The present results confirmed the capacity of quantitative muscle testing to discriminate between healthy and DM1 patients with different levels of impairments. This study is a preliminary step for the implementation of a valid, reliable and responsive clinical outcome for the measurement of muscle impairments with this population.</p

Intra-rater reliability and concurrent validity of quantified muscle testing for maximal knee extensors strength in men with myotonic dystrophy type 1

Background : Myotonic dystrophy type 1 (DM1) is the most prevalent degenerative neuromuscular disease in adults. Knee extensor (KE) maximal strength loss is a strong indicator of physical limitations in DM1. A reliable, precise and accessible maximal strength evaluation method needs to be validated for this slowly progressive disease. Objective : This paper aims to assess the intra-rater reliability, the standard error of measurement (SEM), the minimal detectable change (MDC), and the concurrent validity of quantified muscle testing (QMT) using a handheld dynamometer with a gold standard: the Biodex isokinetic device. Methods:Nineteen men with the adult form of DM1 participated in this study by attending 2 visits spaced by one week. The evaluation of KE muscle strength with QMT was completed on the first visit and the same QMT evaluation in addition to the maximal muscle strength evaluation using an isokinetic device were performed on the second visit. Results : The intra-rater reliability was excellent with an intraclass correlation coefficient (ICC) of 0.98 (0.96–0.99 : 95% confidence interval). SEM and MDC values were 1.05 Nm and 2.92 Nm, respectively. Concurrent validity of QMT of KE muscle group with the Biodex was also excellent with a Spearman’s correlation of ρ= 0.98. Conclusions : The excellent concurrent validity and intra-rater reliability, and the small SEM and MDC of the QMT make this test a method of choice, in either a clinical or research setting, to precisely evaluate muscle strength impairments of the KE in men with DM1

The effects of a 12-week strength training program on skeletal muscle impairments and physical limitations in men with myotonic dystrophy type 1

Background/rationale: Myotonic dystrophy type 1 (DM1) is a genetic multisystemic degenerative disease and represents the most prevalent myopathy in adults. Skeletal muscles are particularly affected, as demonstrated by muscle weakness and atrophy experienced by affected people, which limit their social participation. Purpose/research objectives: The aim of this project is to determine the effects of a 12-week strength training program on skeletal muscle impairments and physical limitations in men with DM1. Relevance: Strength training has been shown to be safe in this population, but it remains unknown if it can trigger muscle hypertrophy process, thus slowing or reversing the significant muscle impairments that characterize this disease. Methods: In this before-after study, a 12-week strength training program (twice a week) of 6 to 8 maximal repetitions (RM) of five different lower limb exercises was completed by 11 men with DM1. The evaluation included: 10 meter walk test (comfortable and maximal speed), 30 second sit-to-stand test, quantitative muscle strength assessment of knee extensors muscle group, 1-RM test for all exercises and an interview about perceived changes. Results: Results showed significant maximal muscle strength increases as well as improvement in all functional tests (p<0.05). Patients also reported many positive changes after the training program such as an improved confidence in their legs and that they had ceased falling. Conclusion: Many positive changes have resulted from this training program showing that a well standardized strength training is an efficient and promising treatment option to reduce skeletal muscle impairments and physical limitations in people with DM1

Effets d’un entraînement en résistance de 1 semaines sur le muscle squelettique d’hommes atteints de dystrophie myotonique de type 1

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Psychometric properties of a standardized protocol of muscle strength assessment by hand-held dynamometry in healthy adults: a reliability study

Background Maximal isometric muscle strength (MIMS) assessment is a key component of physiotherapists’ work. Hand-held dynamometry (HHD) is a simple and quick method to obtain quantified MIMS values that have been shown to be valid, reliable, and more responsive than manual muscle testing. However, the lack of MIMS reference values for several muscle groups in healthy adults with well-known psychometric properties limits the use and the interpretation of these measures obtained with HHD in clinic. Objective To determine the intra- and inter-rater reliability, standard error of measurement (SEM) and minimal detectable change (MDC) of MIMS torque values obtained with HHD. Methods Intra and Inter-rater Reliability Study. The MIMS torque of 17 muscle groups was assessed by two independent raters at three different times in 30 healthy adults using a standardized HHD protocol using the MEDup™ (Atlas Medic, Québec, Canada). Participants were excluded if they presented any of the following criteria: 1) participation in sport at a competitive level; 2) degenerative or neuromusculoskeletal disease that could affect torque measurements; 3) traumatic experience or disease in the previous years that could affect their muscle function; and 4) use of medication that could impact muscle strength (e.g., muscle relaxants, analgesics, opioids) at the time of the evaluation. Intra- and inter-rater reliability were determined using two-way mixed (intra) and random effects (inter) absolute agreement intraclass correlation coefficients (ICC: 95% confidence interval) models. SEM and MDC were calculated from these data. Results Intra- and inter-rater reliability were excellent with ICC (95% confidence interval) varying from 0.90 to 0.99 (0.85–0.99) and 0.89 to 0.99 (0.55–0.995), respectively. Absolute SEM and MDC for intra-rater reliability ranged from 0.14 to 3.20 Nm and 0.38 to 8.87 Nm, respectively, and from 0.17 to 5.80 Nm and 0.47 to 16.06 Nm for inter-rater reliability, respectively. Conclusions The excellent reliability obtained in this study suggest that the use of such a standardized HHD protocol is a method of choice for MIMS torque measurements in both clinical and research settings. And the identification of the now known metrological qualities of such a protocol should encourage and promote the optimal use of manual dynamometry

The reliability of three-dimensional scapular attitudes in healthy people and people with shoulder impingement syndrome

<p>Abstract</p> <p>Background</p> <p>Abnormal scapular displacements during arm elevation have been observed in people with shoulder impingement syndrome. These abnormal scapular displacements were evaluated using different methods and instruments allowing a 3-dimensional representation of the scapular kinematics. The validity and the intrasession reliability have been shown for the majority of these methods for healthy people. However, the intersession reliability on healthy people and people with impaired shoulders is not well documented. This measurement property needs to be assessed before using such methods in longitudinal comparative studies. The objective of this study is to evaluate the intra and intersession reliability of 3-dimensional scapular attitudes measured at different arm positions in healthy people and to explore the same measurement properties in people with shoulder impingement syndrome using the Optotrak Probing System.</p> <p>Methods</p> <p>Three-dimensional scapular attitudes were measured twice (test and retest interspaced by one week) on fifteen healthy subjects (mean age 37.3 years) and eight subjects with subacromial shoulder impingement syndrome (mean age 46.1 years) in three arm positions (arm at rest, 70° of humerothoracic flexion and 90° of humerothoracic abduction) using the Optotrak Probing System. Two different methods of calculation of 3-dimensional scapular attitudes were used: relative to the position of the scapula at rest and relative to the trunk. Intraclass correlation coefficient (ICC) and standard error of measure (SEM) were used to estimate intra and intersession reliability.</p> <p>Results</p> <p>For both groups, the reliability of the three-dimensional scapular attitudes for elevation positions was very good during the same session (ICCs from 0.84 to 0.99; SEM from 0.6° to 1.9°) and good to very good between sessions (ICCs from 0.62 to 0.97; SEM from 1.2° to 4.2°) when using the method of calculation relative to the trunk. Higher levels of intersession reliability were found for the method of calculation relative to the trunk in anterior-posterior tilting at 70° of flexion compared to the method of calculation relative to the scapula at rest.</p> <p>Conclusion</p> <p>The estimation of three-dimensional scapular attitudes using the method of calculation relative to the trunk is reproducible in the three arm positions evaluated and can be used to document the scapular behavior.</p

Effet de l'exercice aigu sur la synthèse et dégradation protéique du muscle squelettique chez les personnes atteintes de dystrophie myotonique de type 1: Étude de séries de cas / Effect of acute eccentric exercise on skeletal muscle hypertrophy and atrophy signalling pathways in men with myotonic dystrophy type 1

INTRODUCTION: La dystrophie myotonique de type 1 (DM1) est une maladie génétique multisystémique. L'atrophie musculaire constitue un symptôme majeur et le renforcement musculaire est souvent utilisé pour contrer sa progression qui évolue au fil des ans. Toutefois, il demeure inconnu si ce stimulus déclenche des mécanismes cellulaires et moléculaires menant à l'hypertrophie, tels qu'observés chez une population saine. OBJECTIF: Évaluer l’effet de l'exercice aigu en résistance sur les adaptations musculaires chez les DM1. MÉTHODOLOGIE: Dix hommes atteints de DM1 ont participé à une séance unique d'exercice excentrique en résistance des muscles extenseurs du genou sur biodex. Une biopsie musculaire a été prélevée une semaine avant et 24 heures après l’intervention. Certains acteurs de la cascade de synthèse (AKT et mTOR) et de dégradation (Atrogin-1 et MuRF) protéique du muscle ont été évalués par immunobuvardage. RÉSULTATS: Nos résultats préliminaires démontrent que les patients présentent une grande variabilité dans la réponse à l'exercice. Les formes totales des protéines activées par phosphorylation (AKT et mTOR) varient. De plus, la forme phosphorylée d'AKT semble absente, ce qui concorde avec les altérations du récepteur à l'IGF déjà connues chez la DM1. Les protéines ne nécessitant pas de phosphorylation (Atrogin-1 et MuRF) présentent aussi une variation hétérogène post exercice. Finalement, pour les 10 patients étudiés, il n’y a pas de corrélation entre la réponse à l'exercice et la sévérité de la maladie. CONCLUSION: L'augmentation du nombre de patients (N=20) permettra une meilleure compréhension de la réponse à l'entraînement chez les DM1 et une clarification potentielle quant à la pertinence d'individualiser les protocoles d'entraînement à chaque patient

Real-time modulation of visual feedback on human full-body movements in a virtual mirror: development and proof-of-concept

BACKGROUND: Virtual reality (VR) provides interactive multimodal sensory stimuli and biofeedback, and can be a powerful tool for physical and cognitive rehabilitation. However, existing systems have generally not implemented realistic full-body avatars and/or a scaling of visual movement feedback. We developed a "virtual mirror" that displays a realistic full-body avatar that responds to full-body movements in all movement planes in real-time, and that allows for the scaling of visual feedback on movements in real-time. The primary objective of this proof-of-concept study was to assess the ability of healthy subjects to detect scaled feedback on trunk flexion movements. METHODS: The "virtual mirror" was developed by integrating motion capture, virtual reality and projection systems. A protocol was developed to provide both augmented and reduced feedback on trunk flexion movements while sitting and standing. The task required reliance on both visual and proprioceptive feedback. The ability to detect scaled feedback was assessed in healthy subjects (n = 10) using a two-alternative forced choice paradigm. Additionally, immersion in the VR environment and task adherence (flexion angles, velocity, and fluency) were assessed. RESULTS: The ability to detect scaled feedback could be modelled using a sigmoid curve with a high goodness of fit (R2 range 89-98%). The point of subjective equivalence was not significantly different from 0 (i.e. not shifted), indicating an unbiased perception. The just noticeable difference was 0.035 +/- 0.007, indicating that subjects were able to discriminate different scaling levels consistently. VR immersion was reported to be good, despite some perceived delays between movements and VR projections. Movement kinematic analysis confirmed task adherence. CONCLUSIONS: The new "virtual mirror" extends existing VR systems for motor and pain rehabilitation by enabling the use of realistic full-body avatars and scaled feedback. Proof-of-concept was demonstrated for the assessment of body perception during active movement in healthy controls. The next step will be to apply this system to assessment of body perception disturbances in patients with chronic pain

L’entraînement en résistance induit des adaptations dans le muscle squelettique chez les personnes atteintes de dystrophie myotonique de type 1

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Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities : a systematic literature review

Objective: Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities. Methods: We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted. Results: Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy (n = 11), occupational therapy (n = 2), prosthetics (n = 1), exercise physiology (n = 1) and multidisciplinary (n = 4) services. The methodological quality varied (n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services. Conclusions: This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities