Dynamometry of the knee extensors; isometric and isokinetic testing in healthy subjects and patients

In rehabilitation medicine one is concerned with the consequences of diseases, congenital deformations and trauma. On the level of functions and structures the consequences consist of impairments of muscle strength, sensibility, co-ordination, etc. These impairments may cause disabilities like restricted ambulation, problems with self-care, etc. In rehabilitation one feels a need to measure the impairments in a reliable way, in order to assess the effects of certain training programmes or to registrate the course of a chronic disease objectively. The tests used to measure the impairment have to be reliable. The variability of a test is a usefull indication of the reliability. Furthermore, a test has to be valid, i.e. the test measures what it is supposed to measure. The validity of a test becomes acceptable if there is a relationship between the impairment itself and the consequences on the functional level. The object of this thesis is the testing of muscle strength of the knee extensors in healthy subjects and in patient

Upper limb activity over time in complex regional pain syndrome type 1 as objectively measured with an upper limb-activity monitor: an explorative multiple case study.

BACKGROUND: An upper limb-activity monitor (ULAM) has been developed to determine activity limitations in complex regional pain syndrome type 1 (CRPS1). The ULAM is based on 24h ambulatory monitoring of body segment accelerations and enables valid and objective quantification of mobility and upper limb activity in transversal studies. AIMS: To explore upper limb activity over time in acute upper limb CRPS1 a

Outcome measures for complex regional pain syndrome type I: an overview in the context of the international classification of impairments, disabilities and handicaps.

PURPOSE: To determine the availability of relevant and objective outcome measures concerning complex regional pain syndrome type I (CRPS I) for rehabilitation medicine. METHOD: Outcome measures were classified according to the International Classification of Impairments, Disabilities and Handicaps. For each outcome measure a description of concept, operationalization into variables and instrument was given. We performed a PUBMED MEDLINE search (1980-1998) using the following keywords: complex regional pain syndrome, reflex sympathetic dystrophy, impairment, disability, handicap, (long-term) outcome and effect/efficacy. RESULTS: Most outcome measures were concentrated on impairments, whereas measures at the level of disabilities and handicaps, the most relevant levels for rehabilitation medicine, were mentioned in very few studies. Objective outcome measures were merely found at the level of impairment. CONCLUSION: The results indicate a need for the development of relevant outcome measures at the level of disabilities and handicaps that can objectively measure treatment efficacy for CRPS I

Covid-19 and Post Intensive Care Syndrome: A Call for Action

Although we are currently overwhelmed by the astonishing speed of infection of the Covid-19 pandemic, and the daily onslaught of new, and ever-worsening predictions, it is vital that we begin to prepare for the aftershocks of the pandemic. Prominent among this will be the cohort of post-intensive case survivors who have been mechanically ventilated and will like experience short- and medium-term consequences of the experience. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion. Post Intensive Care Syndrome and other severe conditions will require not only adequate screening but early rehabilitation and other interventions. Action must be taken now to prepare for this inevitable shock to the healthcare system

Objective measurement of upper limb activity and mobility during everyday behavior using ambulatory accelerometry: the upper limb activity monitor.

Ambulatory accelerometry is a technique that allows objective measurement of aspects of everyday human behavior. The aim of our research has been to develop, validate, and apply this technique, which recently resulted in an upper limb activity monitor (ULAM). The ULAM consists of body-mounted acceleration sensors connected to a waist-worn data recorder and allows valid and objective assessment of activity of both upper limbs during performance of also automatically detected mobility-related activities: lying, sitting, standing, walking, cycling, and general movement. The ULAM can be used to determine (limitations of) upper limb activity and mobility in freely moving subjects with upper limb disorders. This article provides a detailed description of its characteristics, summarizes the results of a feasibility study and four application studies in subjects having upper limb complex regional pain syndrome, discusses the most important practical, technical, and methodological issues that were encountered, and describes current and future research projects related to measuring (limitatio

Oblique abdominal muscle activity in standing and in sitting on hard and soft seats

The activity of the oblique abdominal muscles was investigated with the trunk in unconstrained, symmetrical and static postures. Electromyographic recordings in six healthy subjects revealed that in all subjects the activity of both the internal and the external obliques is significantly higher in unconstrained standing than in supine posture. Activity of the internal oblique was higher than that of the external oblique abdominal. The sacrospinal, gluteus maximus and biceps femoris muscles showed practically no activity in unconstrained erect posture. During unconstrained sitting both oblique abdominals are active. In most subjects the activity of the oblique abdominals was significantly smaller when sitting on a soft car seat than when sitting on an office chair with a hard seat. The possibility is discussed that contraction of the oblique abdominals in unconstrained standing and sitting may help in stabilizing the basis of the spine and particularly the sacroiliac joints. During standing and sitting the oblique abdominal muscles apparently have a significant role in sustaining gravity loads

Understanding peripartum pelvic pain: Implications of a patient survey

Study Design. An analysis was made of the self-reported medical histories of patients with peripartum pelvic pain. Objectives. To compile an inventory of the disabilities of patients with peripartum pelvic pain, analyze factors associated with the risk for development of the disease, and to formulate a hypothesis on pathogenesis and specific preventive and therapeutic measures. Summary of Background Data. Pregnancy is an important risk factor for development of chronic low back pain. Understanding the pathogenesis of pelvic and low back pain during pregnancy and delivery could be useful in understanding and managing nonspecific low back pain. Methods. By means of a questionnaire, background data were collected among patients of the Dutch Association for Patients With Pelvic Complaints in Relation to Symphysiolysis. Results were compared with the general population. Subgroups were compared with each other. Results. Peripartum pelvic pain seriously interferes with many activities of daily living such us standing, walking, sitting, and all other activities in which the pelvis is involved. Most patients experience a relapse around menstruation and during a subsequent pregnancy. Occurrence of peripartum pelvic pain was associated with twin pregnancy, first pregnancy, higher ago at first pregnancy, larger weight of the baby, forceps or vacuum extraction, fundus expression, and a flexed position of the woman during childbirth; a negative association was observed with cesarean section. Conclusions. It is hypothesized that peripartum pelvic pain is caused by strain of ligaments in the pelvis and lower spine resulting from a combination of damage to ligaments (recently or in the past), hormonal effects, muscle weakness, and the weight of the fetus

Walking in postpoliomyelitis syndrome: The relationships between time-scored tests, walking in daily life and perceived mobility problems

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

Long-term outcome of muscle strength in ulnar and median nerve injury: Comparing manual muscle strength testing, grip and pinch strength dynamometers and a new intrinsic muscle strength dynamometer

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