PHYSIOTHERAPY AND POST POLIO SYNDROME Dara Meldrum and Deirdre Fitzgerald Introduction Physiother... more PHYSIOTHERAPY AND POST POLIO SYNDROME Dara Meldrum and Deirdre Fitzgerald Introduction Physiotherapy is a cornerstone of management of prior ... Other lower motor neuron signsdecreased tone, reflexes and muscle atrophy According to the Halstead criteria, the ...
Surface electromyography (sEMG) is used to assess muscle activation during therapeutic exercise, ... more Surface electromyography (sEMG) is used to assess muscle activation during therapeutic exercise, but data are significantly affected by inter-individual variability and requires normalisation of the sEMG signal to enable comparison between individuals. The purpose of this study was to compare two normalisation methods, a maximal method (maximum voluntary isometric contraction (MVIC)) and non-maximal peak dynamic method (PDM), on gluteus medius (GMed) activation using sEMG during three weight-bearing exercises in people with hip osteoarthritis (OA) and healthy controls. Thirteen people with hip OA and 20 controls performed three exercises (Squat, Step-Up, Step-Down). Average root-mean squared EMG amplitude based on MVIC and PDM normalisation was compared between groups for both involved and uninvolved hips using Mann-Whitney tests. Using MVIC normalisation, significantly higher normalised GMed EMG amplitudes were found in the OA group during all Step-up and down exercises on the invo...
Amyotrophic lateral sclerosis and other motor neuron disorders : official publication of the World Federation of Neurology, Research Group on Motor Neuron Diseases, 2003
Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool fo... more Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool for the measurement of muscle strength. The purpose of this study was to investigate different aspects of reliability of MVIC and to determine if a learning effect existed in a relatively new user of the system. Two clinical investigators participated in the study. The inter- and intra-rater reliability of MVIC of 11 muscle groups was tested on healthy subjects (n=35). Intra-class correlation co-efficients (ICCs) were calculated and the statistical methods described by Bland and Altman were applied to the data. ICCs were higher for the more experienced investigator and a learning effect was demonstrated in a relatively new user of the system. Inter-rater reliability was acceptable but lower than intra-rater reliability. Upper limb tests generally yielded higher ICCs and lower ranges of error. The ICC was similar regardless of whether the maximum or average of the two values was taken in a ...
A sub-group of Chartered Physiotherapists in Education (CPE) was formed in 2004 to consider the a... more A sub-group of Chartered Physiotherapists in Education (CPE) was formed in 2004 to consider the adoption of a common assessment form (CAF) for assessing practice education placements for students studying physiotherapy in the Republic of Ireland. Following agreement from the four heads of departments, the needs of users (academic staff, practice tutors and practice educators) were established. As none of
Journal of Stroke and Cerebrovascular Diseases, 2003
The Oxfordshire Community Stroke Project (OCSP) classification clinically subdivides cerebral inf... more The Oxfordshire Community Stroke Project (OCSP) classification clinically subdivides cerebral infarction into total anterior circulation (TACS), partial anterior circulation (PACS), posterior circulation (POCS) and lacunar (LACS) syndromes. We compared the OCSP classification in patients presenting within 12 hours of onset of stroke with infarct site and size on computed tomography (CT) brain scan at 5 to 7 days. OCSP classification was prospectively assigned by 1 of 3 observers in 43 patients presenting within 12 hours of stroke. CT brain scan was performed on admission to exclude primary intracerebral hemorrhage. Repeat CT brain scan at 5 to 7 days was used to classify recent visible infarction as total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), lacunar circulation infarction (LACI), or posterior circulation infarction (POCI). For each OCSP subtype, sensitivity and specificity were calculated by using CT classification as a standard. Median (range) interval from onset of stroke symptoms to OCSP classification was 5.0 (1.5, 11.75) hours. Thirty-seven patients had ischemic stroke, with recent visible infarction in 34 (92%). Sensitivity and specificity of each OCSP subtype was TACS (0.80, 0.82), PACS (0.56, 0.79), LACS (0.33, 0.88), and POCS (1.00, 0.97). Overall, 65% of OCSP subtypes assigned were correct when compared to CT classification. In this small study, we have shown that the OCSP classification within 12 hours of ischemic stroke onset compares with CT classification at 5 to 7 days. Larger studies are required to evaluate the validity of the OCSP classification in the early hours of ischemic stroke in guiding appropriate patient selection for acute stroke therapy and interventions.
Gait impairment is one of the primary symptoms of cervical spondylotic myelopathy (CSM). Detailed... more Gait impairment is one of the primary symptoms of cervical spondylotic myelopathy (CSM). Detailed assessment is possible using three-dimensional gait analysis (3DGA), however the reliability of 3DGA for this population has not been established. The aim of this study was to evaluate the test-retest reliability of temporal-spatial, kinematic and kinetic parameters in a CSM population. Twelve patients with CSM (mean age 54 years) were consecutively recruited from a neurosurgery clinic. 3DGA was conducted on 2 separate days, less than 1 week apart, using the VICON(®) 250 Motion Analysis. The average of 10 gait cycles was analysed. Reliability was assessed using the one-way random intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and Bland-Altman limits of agreement (LOA). Temporal-spatial parameters showed excellent reliability, with ICCs above 0.9 for speed, cadence, stride length, double support time, and step width. ICCs for kinematic parameters ranged from acceptable (0.62, peak knee flexion in stance) to excellent (0.95, total hip sagittal plane motion). The SEM for all kinematic parameters was below 4°, with the exception of peak hip internal rotation (5.8°). Peak values were less reliable than the total range of motion in a plane. The majority of kinetic parameters showed excellent reliability (ICCs>0.85), with the exception of peak medio-lateral ground reaction force (ICC 0.12). This information will enhance the interpretation of gait scores for CSM patients, as an estimate of the change required to exceed measurement error is now available.
The aims of this study were to validate a computerised method to detect muscle activity from surf... more The aims of this study were to validate a computerised method to detect muscle activity from surface electromyography (SEMG) signals in gait in patients with cervical spondylotic myelopathy (CSM), and to evaluate the testretest reliability of the activation times ...
Gait impairment is an important feature of cervical sponydylotic myelopathy (CSM) as it can have ... more Gait impairment is an important feature of cervical sponydylotic myelopathy (CSM) as it can have a detrimental effect on function and quality of life. The aim of this study was to measure changes in gait in people with CSM following surgical decompression. Thirteen participants with clinical and radiological evidence of CSM underwent three-dimensional gait analysis, using a full lower limb kinematic, kinetic and electromyography protocol, before and 12 months after decompressive surgery. No significant post-operative changes were detected in temporal-spatial or kinematic parameters. Kinetic data showed significant improvements in knee power absorption [mean improvement, 0.42 watts per kilogram (W/kg)], ankle plantarflexor moment (0.1 Nm/kg) and ankle power generation (0.55 W/kg). Electromyography showed a 4.7 % increase in tibialis anterior activation time. These findings indicate that improvement in locomotor function can be achieved after surgery. Future studies should explore the potential for further recovery of gait through targeted neuro-rehabilitation.
Gait impairment is a primary symptom of cervical spondylotic myelopathy (CSM); however, little is... more Gait impairment is a primary symptom of cervical spondylotic myelopathy (CSM); however, little is known about specific kinetic and kinematic gait parameters. The objectives of the study were: (1) to compare gait patterns of people with untreated CSM to those of age- and gender-matched healthy controls; (2) to examine the effect of gait speed on kinematic and kinetic parameters. Sixteen patients with CSM were recruited consecutively from a neurosurgery clinic, and 16 healthy controls, matched to age (± 5 years) and gender, were recruited for comparison. Patients and controls underwent three-dimensional gait analysis using a Vicon(®) motion analysis system, at self-selected speed over a 10-m track. Controls were also assessed at the speed of their CSM match. At self-selected speed, the CSM group walked significantly more slowly, with shorter stride lengths and longer double support duration. They showed significant decreases in several kinematic and kinetic parameters, including sagittal range of motion at the hip and knee, ankle plantarflexion, anteroposterior ground reaction force (GRF) at toe-off, power absorption at the knee in loading response and terminal stance, and power generation at the ankle. At matched speed, the CSM group showed significant decreases in knee flexion during swing, total sagittal knee range of motion, peak ankle plantarflexion and anteroposterior GRF. The findings suggested that people with CSM have significant gait abnormalities that have not been previously reported. In particular, there are key differences in the motor strategies used in the terminal stance phase of gait that cannot be explained by speed alone.
To document upper limb recovery in stroke patients and investigate whether the Orpington Prognost... more To document upper limb recovery in stroke patients and investigate whether the Orpington Prognostic Score (OPS) performed within 48 hours of admission to hospital post ischaemic stroke was a predictor of upper limb function at six months and two years. Inception cohort design. Teaching Hospital. One hundred and fourteen patients hospitalized with acute ischaemic stroke were stratified into three groups based on their OPS within 48 hours of admission post stroke and underwent further assessments at two weeks, six months and two years after stroke onset. Rivermead Arm Score (RAS), Nine Hole Peg Test (NHPT) and grip strength (GS). Patients with a good OPS and intermediate OPS showed significant recovery in all outcome measures for up to six months post stroke (p < 0.05), while those with a poor OPS at 48 hours showed no significant improvement (p > 0.05). The OPS score at 48 hours was the most highly correlated variable with upper limb outcome at six months (r= -0.728) and at two years (r= -0.712) compared with other variables such as age, class of stroke, sensation, grip strength and RAS. Stroke patients demonstrate differential upper limb recovery patterns which need to be taken in consideration when designing studies that investigate efficacy of rehabilitation, and the OPS is highly correlated with upper limb recovery at six months and two years.
Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool fo... more Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool for the measurement of muscle strength. The purpose of this study was to investigate different aspects of reliability of MVIC and to determine if a learning effect existed in a relatively new user of the system. Two clinical investigators participated in the study. The inter- and intra-rater reliability of MVIC of 11 muscle groups was tested on healthy subjects (n=35). Intra-class correlation co-efficients (ICCs) were calculated and the statistical methods described by Bland and Altman were applied to the data. ICCs were higher for the more experienced investigator and a learning effect was demonstrated in a relatively new user of the system. Inter-rater reliability was acceptable but lower than intra-rater reliability. Upper limb tests generally yielded higher ICCs and lower ranges of error. The ICC was similar regardless of whether the maximum or average of the two values was taken in a single session. Utilising the statistical methods proposed by Bland and Altman allows estimation of the magnitude of error of MVIC and gives additional information to the ICC. These methods may be useful in the training of investigators and in clinical interpretation of MVIC values.
Motor fatigue is a common complaint of polio survivors and has a negative impact on activities of... more Motor fatigue is a common complaint of polio survivors and has a negative impact on activities of daily living. The aim of this study was to establish a normative database for hand grip strength and fatigue and to investigate differences between prior-polio subjects and normal controls. Static and dynamic hand grip fatigue and maximum voluntary isometric contraction (MVIC) of hand grip were measured in subjects with a prior history of polio (n = 44) and healthy controls (n = 494). A normative database of fatigue was developed using four indices of analysis. Compared with healthy controls, subjects with prior polio had significantly reduced hand grip strength but developed greater hand grip fatigue in only one fatigue index. Quantitative measurement of fatigue in the prior-polio population may be useful in order to detect change over time and to evaluate treatment strategies.
PHYSIOTHERAPY AND POST POLIO SYNDROME Dara Meldrum and Deirdre Fitzgerald Introduction Physiother... more PHYSIOTHERAPY AND POST POLIO SYNDROME Dara Meldrum and Deirdre Fitzgerald Introduction Physiotherapy is a cornerstone of management of prior ... Other lower motor neuron signsdecreased tone, reflexes and muscle atrophy According to the Halstead criteria, the ...
Surface electromyography (sEMG) is used to assess muscle activation during therapeutic exercise, ... more Surface electromyography (sEMG) is used to assess muscle activation during therapeutic exercise, but data are significantly affected by inter-individual variability and requires normalisation of the sEMG signal to enable comparison between individuals. The purpose of this study was to compare two normalisation methods, a maximal method (maximum voluntary isometric contraction (MVIC)) and non-maximal peak dynamic method (PDM), on gluteus medius (GMed) activation using sEMG during three weight-bearing exercises in people with hip osteoarthritis (OA) and healthy controls. Thirteen people with hip OA and 20 controls performed three exercises (Squat, Step-Up, Step-Down). Average root-mean squared EMG amplitude based on MVIC and PDM normalisation was compared between groups for both involved and uninvolved hips using Mann-Whitney tests. Using MVIC normalisation, significantly higher normalised GMed EMG amplitudes were found in the OA group during all Step-up and down exercises on the invo...
Amyotrophic lateral sclerosis and other motor neuron disorders : official publication of the World Federation of Neurology, Research Group on Motor Neuron Diseases, 2003
Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool fo... more Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool for the measurement of muscle strength. The purpose of this study was to investigate different aspects of reliability of MVIC and to determine if a learning effect existed in a relatively new user of the system. Two clinical investigators participated in the study. The inter- and intra-rater reliability of MVIC of 11 muscle groups was tested on healthy subjects (n=35). Intra-class correlation co-efficients (ICCs) were calculated and the statistical methods described by Bland and Altman were applied to the data. ICCs were higher for the more experienced investigator and a learning effect was demonstrated in a relatively new user of the system. Inter-rater reliability was acceptable but lower than intra-rater reliability. Upper limb tests generally yielded higher ICCs and lower ranges of error. The ICC was similar regardless of whether the maximum or average of the two values was taken in a ...
A sub-group of Chartered Physiotherapists in Education (CPE) was formed in 2004 to consider the a... more A sub-group of Chartered Physiotherapists in Education (CPE) was formed in 2004 to consider the adoption of a common assessment form (CAF) for assessing practice education placements for students studying physiotherapy in the Republic of Ireland. Following agreement from the four heads of departments, the needs of users (academic staff, practice tutors and practice educators) were established. As none of
Journal of Stroke and Cerebrovascular Diseases, 2003
The Oxfordshire Community Stroke Project (OCSP) classification clinically subdivides cerebral inf... more The Oxfordshire Community Stroke Project (OCSP) classification clinically subdivides cerebral infarction into total anterior circulation (TACS), partial anterior circulation (PACS), posterior circulation (POCS) and lacunar (LACS) syndromes. We compared the OCSP classification in patients presenting within 12 hours of onset of stroke with infarct site and size on computed tomography (CT) brain scan at 5 to 7 days. OCSP classification was prospectively assigned by 1 of 3 observers in 43 patients presenting within 12 hours of stroke. CT brain scan was performed on admission to exclude primary intracerebral hemorrhage. Repeat CT brain scan at 5 to 7 days was used to classify recent visible infarction as total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), lacunar circulation infarction (LACI), or posterior circulation infarction (POCI). For each OCSP subtype, sensitivity and specificity were calculated by using CT classification as a standard. Median (range) interval from onset of stroke symptoms to OCSP classification was 5.0 (1.5, 11.75) hours. Thirty-seven patients had ischemic stroke, with recent visible infarction in 34 (92%). Sensitivity and specificity of each OCSP subtype was TACS (0.80, 0.82), PACS (0.56, 0.79), LACS (0.33, 0.88), and POCS (1.00, 0.97). Overall, 65% of OCSP subtypes assigned were correct when compared to CT classification. In this small study, we have shown that the OCSP classification within 12 hours of ischemic stroke onset compares with CT classification at 5 to 7 days. Larger studies are required to evaluate the validity of the OCSP classification in the early hours of ischemic stroke in guiding appropriate patient selection for acute stroke therapy and interventions.
Gait impairment is one of the primary symptoms of cervical spondylotic myelopathy (CSM). Detailed... more Gait impairment is one of the primary symptoms of cervical spondylotic myelopathy (CSM). Detailed assessment is possible using three-dimensional gait analysis (3DGA), however the reliability of 3DGA for this population has not been established. The aim of this study was to evaluate the test-retest reliability of temporal-spatial, kinematic and kinetic parameters in a CSM population. Twelve patients with CSM (mean age 54 years) were consecutively recruited from a neurosurgery clinic. 3DGA was conducted on 2 separate days, less than 1 week apart, using the VICON(®) 250 Motion Analysis. The average of 10 gait cycles was analysed. Reliability was assessed using the one-way random intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and Bland-Altman limits of agreement (LOA). Temporal-spatial parameters showed excellent reliability, with ICCs above 0.9 for speed, cadence, stride length, double support time, and step width. ICCs for kinematic parameters ranged from acceptable (0.62, peak knee flexion in stance) to excellent (0.95, total hip sagittal plane motion). The SEM for all kinematic parameters was below 4°, with the exception of peak hip internal rotation (5.8°). Peak values were less reliable than the total range of motion in a plane. The majority of kinetic parameters showed excellent reliability (ICCs>0.85), with the exception of peak medio-lateral ground reaction force (ICC 0.12). This information will enhance the interpretation of gait scores for CSM patients, as an estimate of the change required to exceed measurement error is now available.
The aims of this study were to validate a computerised method to detect muscle activity from surf... more The aims of this study were to validate a computerised method to detect muscle activity from surface electromyography (SEMG) signals in gait in patients with cervical spondylotic myelopathy (CSM), and to evaluate the testretest reliability of the activation times ...
Gait impairment is an important feature of cervical sponydylotic myelopathy (CSM) as it can have ... more Gait impairment is an important feature of cervical sponydylotic myelopathy (CSM) as it can have a detrimental effect on function and quality of life. The aim of this study was to measure changes in gait in people with CSM following surgical decompression. Thirteen participants with clinical and radiological evidence of CSM underwent three-dimensional gait analysis, using a full lower limb kinematic, kinetic and electromyography protocol, before and 12 months after decompressive surgery. No significant post-operative changes were detected in temporal-spatial or kinematic parameters. Kinetic data showed significant improvements in knee power absorption [mean improvement, 0.42 watts per kilogram (W/kg)], ankle plantarflexor moment (0.1 Nm/kg) and ankle power generation (0.55 W/kg). Electromyography showed a 4.7 % increase in tibialis anterior activation time. These findings indicate that improvement in locomotor function can be achieved after surgery. Future studies should explore the potential for further recovery of gait through targeted neuro-rehabilitation.
Gait impairment is a primary symptom of cervical spondylotic myelopathy (CSM); however, little is... more Gait impairment is a primary symptom of cervical spondylotic myelopathy (CSM); however, little is known about specific kinetic and kinematic gait parameters. The objectives of the study were: (1) to compare gait patterns of people with untreated CSM to those of age- and gender-matched healthy controls; (2) to examine the effect of gait speed on kinematic and kinetic parameters. Sixteen patients with CSM were recruited consecutively from a neurosurgery clinic, and 16 healthy controls, matched to age (± 5 years) and gender, were recruited for comparison. Patients and controls underwent three-dimensional gait analysis using a Vicon(®) motion analysis system, at self-selected speed over a 10-m track. Controls were also assessed at the speed of their CSM match. At self-selected speed, the CSM group walked significantly more slowly, with shorter stride lengths and longer double support duration. They showed significant decreases in several kinematic and kinetic parameters, including sagittal range of motion at the hip and knee, ankle plantarflexion, anteroposterior ground reaction force (GRF) at toe-off, power absorption at the knee in loading response and terminal stance, and power generation at the ankle. At matched speed, the CSM group showed significant decreases in knee flexion during swing, total sagittal knee range of motion, peak ankle plantarflexion and anteroposterior GRF. The findings suggested that people with CSM have significant gait abnormalities that have not been previously reported. In particular, there are key differences in the motor strategies used in the terminal stance phase of gait that cannot be explained by speed alone.
To document upper limb recovery in stroke patients and investigate whether the Orpington Prognost... more To document upper limb recovery in stroke patients and investigate whether the Orpington Prognostic Score (OPS) performed within 48 hours of admission to hospital post ischaemic stroke was a predictor of upper limb function at six months and two years. Inception cohort design. Teaching Hospital. One hundred and fourteen patients hospitalized with acute ischaemic stroke were stratified into three groups based on their OPS within 48 hours of admission post stroke and underwent further assessments at two weeks, six months and two years after stroke onset. Rivermead Arm Score (RAS), Nine Hole Peg Test (NHPT) and grip strength (GS). Patients with a good OPS and intermediate OPS showed significant recovery in all outcome measures for up to six months post stroke (p < 0.05), while those with a poor OPS at 48 hours showed no significant improvement (p > 0.05). The OPS score at 48 hours was the most highly correlated variable with upper limb outcome at six months (r= -0.728) and at two years (r= -0.712) compared with other variables such as age, class of stroke, sensation, grip strength and RAS. Stroke patients demonstrate differential upper limb recovery patterns which need to be taken in consideration when designing studies that investigate efficacy of rehabilitation, and the OPS is highly correlated with upper limb recovery at six months and two years.
Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool fo... more Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool for the measurement of muscle strength. The purpose of this study was to investigate different aspects of reliability of MVIC and to determine if a learning effect existed in a relatively new user of the system. Two clinical investigators participated in the study. The inter- and intra-rater reliability of MVIC of 11 muscle groups was tested on healthy subjects (n=35). Intra-class correlation co-efficients (ICCs) were calculated and the statistical methods described by Bland and Altman were applied to the data. ICCs were higher for the more experienced investigator and a learning effect was demonstrated in a relatively new user of the system. Inter-rater reliability was acceptable but lower than intra-rater reliability. Upper limb tests generally yielded higher ICCs and lower ranges of error. The ICC was similar regardless of whether the maximum or average of the two values was taken in a single session. Utilising the statistical methods proposed by Bland and Altman allows estimation of the magnitude of error of MVIC and gives additional information to the ICC. These methods may be useful in the training of investigators and in clinical interpretation of MVIC values.
Motor fatigue is a common complaint of polio survivors and has a negative impact on activities of... more Motor fatigue is a common complaint of polio survivors and has a negative impact on activities of daily living. The aim of this study was to establish a normative database for hand grip strength and fatigue and to investigate differences between prior-polio subjects and normal controls. Static and dynamic hand grip fatigue and maximum voluntary isometric contraction (MVIC) of hand grip were measured in subjects with a prior history of polio (n = 44) and healthy controls (n = 494). A normative database of fatigue was developed using four indices of analysis. Compared with healthy controls, subjects with prior polio had significantly reduced hand grip strength but developed greater hand grip fatigue in only one fatigue index. Quantitative measurement of fatigue in the prior-polio population may be useful in order to detect change over time and to evaluate treatment strategies.
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