In persons with prior paralytic poliomyelitis, progressive muscle weakness can occur after a stable period of at least 15 years. Knowledge is limited about which factors influence changes in lower limb muscle strength in these persons. To... more
In persons with prior paralytic poliomyelitis, progressive muscle weakness can occur after a stable period of at least 15 years. Knowledge is limited about which factors influence changes in lower limb muscle strength in these persons. To assess changes in lower limb muscle strength annually over 4 years in persons with late effects of polio and to identify prognostic factors for changes in muscle strength. A prospective, longitudinal study. University hospital outpatient program. Fifty-two ambulant persons (mean age ± standard deviation: 64 ± 6 years) with verified late effects of polio. Mixed linear models were used to analyze changes in muscle strength and to identify determinants among the following covariates: gender, age, age at acute polio infection, time with late effects of polio, body mass index, and estimated baseline muscle weakness. Knee extensor and flexor and ankle dorsiflexor muscle strength were measured annually with a Biodex dynamometer. The men (n = 28) had significant linear change over time for all knee muscle strength measurements, from -1.4% (P < .05) per year for isokinetic knee flexion in the less-affected lower limb to -4.2% (P < .001) for isokinetic knee extension in the more-affected lower limb, and for 2 ankle dorsiflexor muscle strength measurements (-3.3%-1.4% per year [P < .05]). The women (n = 24) had a significant linear change over time only for ankle dorsiflexor measurements (4.0%-5.5% per year [P < .01]). Gender was the strongest factor that predicted a change in muscle strength over time. Over 4 years, men had a greater decline in muscle strength than did women, but the rate of decline did not accelerate. This finding indicates that gender could be a contributing factor to the progressive decline in muscle strength in persons with late effects of polio.
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ABSTRACT Objective: To assess whether gait performance indoors can predict walking ability outdoors in persons with late effects of polio. Design: Descriptive analyses of a convenience sample. Setting: A university hospital rehabilitation... more
ABSTRACT Objective: To assess whether gait performance indoors can predict walking ability outdoors in persons with late effects of polio. Design: Descriptive analyses of a convenience sample. Setting: A university hospital rehabilitation medicine outpatient department. Participants: Sixty-three individuals with prior polio (32 men and 31 women, mean age 68 ± 6 years). Main outcome measures: The 6-Minute Walk Test (6MWT) and a 340-m-long distance were used to assess gait performance indoors and walking ability outdoors, respectively. The Borg Rating of Perceived Exertion (RPE) Scale was used to assess perceived exertion after the gait performance tests. Results: Significant correlations (p < 0.01) were found between the 6MWT and the outdoor walking with regard to gait speed (r = 0.92) and perceived exertion (rho = 0.68). A majority of the participants walked significantly (p < 0.001) faster outdoors than indoors; the average gait speed was 1.3 ± 0.3 m/s outdoors and 1.2 ± 0.3 m/s indoors. There was no significant difference in perceived exertion; median RPE was 13 (range 11–19) after the outdoor walking and 13 (range 9–17) after the 6MWT. Conclusion: The strong relationship between gait speed indoors and gait speed outdoors indicates that the 6MWT is a useful test for physiotherapists to predict walking ability in everyday life in ambulatory persons with mild to moderate late effects of polio.
Muscle weakness in the upper limb is common in persons with late effects of polio. To be able to measure muscle strength and follow changes over time, reliable measurements are needed. To evaluate the intra-rater reliability of isometric... more
Muscle weakness in the upper limb is common in persons with late effects of polio. To be able to measure muscle strength and follow changes over time, reliable measurements are needed. To evaluate the intra-rater reliability of isometric and isokinetic arm and hand muscle strength measurements in persons with late effects of polio. A test-retest design. A university hospital outpatient clinic. Twenty-eight persons (mean age 67, SD 16 years) with late effects of polio in their upper limbs. Isometric shoulder abduction, isokinetic concentric elbow flexion and extension, isometric elbow flexion and isometric grip strength were measured twice, 14 days apart. Reliability was evaluated with the intra-class correlation coefficient (ICC2,1), the mean difference between the test sessions (d ¯ ) together with the 95% confidence intervals for d ¯ , the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and Bland &Altman graphs. A fixed dynamometer (Biodex...
To assess muscle strength in the knee extensors, knee flexors and ankle dorsiflexors in persons with late effects of polio, and determine how much muscle strength, gender, age and BMI are related to gait performance. Ninety... more
To assess muscle strength in the knee extensors, knee flexors and ankle dorsiflexors in persons with late effects of polio, and determine how much muscle strength, gender, age and BMI are related to gait performance. Ninety community-dwelling ambulant persons (47 men and 43 women; mean age 64 years SD 8) with late effects of polio participated. Isokinetic concentric knee extensor and flexor muscle strength was measured at 60°/s and ankle dorsiflexor muscle strength at 30°/s. Gait performance was assessed by the Timed "Up & Go", the Comfortable and Fast Gait Speed tests, and the 6-Minute Walk test. There were significant correlations between knee extensor and flexor muscle strength and gait performance (p < 0.01), and between ankle dorsiflexor muscle strength and gait performance (p < 0.05), for both lower limbs. Muscle strength in the knee extensors and flexors explained 7% to 37% and 9% to 47%, respectively, of the variance in gait performance. Strength in the ankle...
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Muscle weakness in the lower limbs and impeded gait performance are common in persons with late effects of polio. To assess self-reported walking ability in persons with late effects of polio and determine the relationship with... more
Muscle weakness in the lower limbs and impeded gait performance are common in persons with late effects of polio. To assess self-reported walking ability in persons with late effects of polio and determine the relationship with objectively assessed gait performance. One-hundred and twenty-two individuals with prior polio (65 women and 57 men, mean age 65 [SD ± 9] years) participated in the study. The main outcome measures were: Walk-12 (Swedish version) to assess self-reported walking ability, and Timed "Up & Go", Comfortable Gait Speed, Fast Gait Speed and 6-Minute Walk Tests to assess gait performance objectively. More than 50% of the participants reported limitations (moderately or quite a bit) related to standing or walking, climbing stairs, walking speed and distance, concentration and effort, and gait quality aspects. Half of the participants reported no need to use support when walking indoors or outdoors, but 58% reported that their ability to run was extremely lim...
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To assess self-reported walking ability in individuals with chronic stroke and to determine the relationship with gait performance tests. Descriptive analysis of a convenience sample. A university hospital rehabilitation medicine clinic.... more
To assess self-reported walking ability in individuals with chronic stroke and to determine the relationship with gait performance tests. Descriptive analysis of a convenience sample. A university hospital rehabilitation medicine clinic. Fifty ambulatory community-dwelling poststroke individuals (mean age, 64 years [range, 44-74 years] and mean time since stroke onset 42 months [range, 6-101 months]). The Walking Impact Scale (the Walk-12) to assess self-reported walking ability, and the Timed &amp;amp;quot;Up &amp;amp;amp; Go&amp;amp;quot; test, 10-m Comfortable Gait Speed and Fast Gait Speed tests, and 6-Minute Walk Test to assess gait performance. A majority of the participants (94%) reported limitations in their walking ability. The most common limitations were related to standing or walking, walking speed and distance, effort, and gait quality aspects. The ability to run was reported as most affected, whereas the need for support indoors or outdoors was least affected. Significant correlations (P &amp;amp;lt; .01) were found between the Walk-12 and the 4 gait performance tests (ρ = -0.60 to 0.60). Persons with chronic stroke perceive limitations in their walking ability. The relationship between the Walk-12 and the 4 gait performance tests indicates that self-reports and quantitative assessments are associated. Because the Walk-12 reflects broader dimensions than the gait performance tests, it can be a complementary tool when walking ability in persons with chronic stroke is evaluated.
Research Interests: Stroke, Humans, Walking, Female, Male, and 5 moreClinical Sciences, Aged, Middle Aged, Adult, and Self report
To evaluate the long-term benefits of progressive resistance training in chronic stroke. A 4-year follow-up of a randomized controlled trial of progressive resistance training. Eighteen women and men (mean age 66 (standard deviation 4)... more
To evaluate the long-term benefits of progressive resistance training in chronic stroke. A 4-year follow-up of a randomized controlled trial of progressive resistance training. Eighteen women and men (mean age 66 (standard deviation 4) from the original group of 24 post-stroke participants. The training group (n = 11) had participated in supervised progressive resistance training of the knee extensors and flexors (80% of maximum) twice weekly for 10 weeks, whereas the control group (n = 7) had continued their usual daily activities. Muscle strength was evaluated isotonically and isokinetically (60º/s; Biodex), muscle tone with the Modified Ashworth Scale, gait performance by the Timed Up and Go test, the Fast Gait Speed test and 6-Minute Walk test, and perceived participation with the Stroke Impact Scale (Participation domain). Four years after the intervention, the improvements in muscle strength in the training group were maintained, and there was no reduction in strength in the control group. Compared with baseline there were still significant between-group differences for both isotonic and isokinetic strength. No significant between-group differences were found in muscle tone, gait performance or perceived participation. The results indicate that there is a long-term benefit of progressive resistance training in chronic stroke. This implies that progressive resistance training could be an effective training method to improve and maintain muscle strength in a long-term perspective.
Research Interests:
To assess the reliability of 6 gait performance tests in individuals with chronic mild to moderate post-stroke hemiparesis. An intra-rater (between occasions) test-retest reliability study. Fifty men and women (mean age 58+/-6.4 years)... more
To assess the reliability of 6 gait performance tests in individuals with chronic mild to moderate post-stroke hemiparesis. An intra-rater (between occasions) test-retest reliability study. Fifty men and women (mean age 58+/-6.4 years) 6-46 months post-stroke. The Timed &amp;amp;amp;amp;amp;amp;amp;amp;quot;Up &amp;amp;amp;amp;amp;amp;amp;amp;amp; Go&amp;amp;amp;amp;amp;amp;amp;amp;quot; test, the Comfortable and the Fast Gait Speed tests, the Stair Climbing ascend and descend tests and the 6-Minute Walk test were assessed 7 days apart. Reliability was evaluated with the intraclass correlation coefficient (ICC(2,1)), the Bland &amp;amp;amp;amp;amp;amp;amp;amp;amp; Altman analysis, the standard error of measurement (SEM and SEM%) and the smallest real difference (SRD and SRD%). Test-retest agreements were high (ICC(2,1) 0.94-0.99) with no discernible systematic differences between the tests. The standard error of measurement (SEM%), representing the smallest change that indicates a real (clinical) improvement for a group of individuals, was small (&amp;amp;amp;amp;amp;amp;amp;amp;lt; 9%). The smallest real difference (SRD%), representing the smallest change that indicates a real (clinical) improvement for a single individual, was also small (13-23%). These commonly used gait performance tests are highly reliable and can be recommended to evaluate improvements in various aspects of gait performance in individuals with chronic mild to moderate hemiparesis after stroke.
Research Interests: Rehabilitation Medicine, Research Design, Activities of Daily Living, Gait, Stroke, and 13 moreHumans, Walking, Female, Male, Clinical Sciences, Aged, Middle Aged, Intraclass Correlation Coefficient, Reproducibility of Results, Outcome Assessment, Cerebrovascular Accident, Performance Test, and Activity of Daily Living
To assess the relation between knee muscle strength, gait performance, and perceived participation in subjects with chronic mild to moderate poststroke hemiparesis. Descriptive analysis of convenience sample. University hospital. Fifty... more
To assess the relation between knee muscle strength, gait performance, and perceived participation in subjects with chronic mild to moderate poststroke hemiparesis. Descriptive analysis of convenience sample. University hospital. Fifty men and women (mean age, 58+/-6.4y) 6 to 46 months poststroke. Not applicable. Isokinetic concentric knee extension and flexion strength was measured at 60 degrees /s. Gait performance was assessed by Timed Up &amp;amp;amp; Go, comfortable and fast gait speed, stair climbing ascend and descend, and 6-minute walk test. Perceived participation was assessed with the Stroke Impact Scale. There was a significant correlation (P &amp;amp;lt; .01) between knee muscle strength and gait performance for the paretic but not for the nonparetic lower limb. Strength for the paretic limb explained 34% to 50% of the variance in gait performance; the addition of strength for the nonparetic limb explained at most a further 11% of the variance in gait performance. There was a significant correlation (P &amp;amp;lt; .01) between gait performance and perceived participation; gait performance explained 28% to 40% of the variance in perceived participation. Knee muscle strength is a moderate to strong predictor of walking ability in individuals with chronic mild to moderate poststroke hemiparesis. Walking ability influences perceived participation, but the strengths of the relations indicate that other factors are also important.
Research Interests:
OBJECTIVE: To examine the relationship between physical activity (assessed subjectively and objectively), knee muscle strength, gait performance, age, gender, and body mass index (BMI) in persons with late effects of polio. DESIGN:... more
OBJECTIVE:
To examine the relationship between physical activity (assessed subjectively and objectively), knee muscle strength, gait performance, age, gender, and body mass index (BMI) in persons with late effects of polio.
DESIGN:
Cross-sectional.
SETTING:
A university hospital outpatient clinic.
PARTICIPANTS:
Seventy-seven community-dwelling ambulant persons with late effects of polio (42 men and 35 women; mean age 67 years [standard deviation 6, range 54-80]).
MAIN OUTCOME MEASURES:
Physical activity was described by the Physical Activity and Disability Survey and by a pedometer (number of steps/day). Isokinetic concentric knee extensor and flexor muscle strength was measured at 60°/s. Gait performance was assessed by the Timed "Up and Go" test, the Comfortable Gait Speed and Fast Gait Speed tests, and the 6-Minute Walk test.
RESULTS:
The Physical Activity and Disability Survey leisure subscale was significantly correlated with all knee muscle strength measurements (P < .01), the Comfortable Gait Speed test (P < .05), and the 6-Minute Walk test (P < .05), and the number of steps per day was significantly correlated with all knee muscle strength measurements and all gait performance tests (P < .01). In the linear regression analyses, knee muscle strength and gait performance explained 1% to 8% of the variance in the leisure subscale, and when the personal attributes (age, gender, and BMI) were added, they explained up to 14% of the variance. Knee muscle strength explained 16% and gait performance explained 15% to 31% of the variance in the number of steps per day, and when personal attributes (age, gender, and BMI) were added, they contributed at most an additional 3% of the variance.
CONCLUSIONS:
In ambulatory persons with late effects of polio, knee muscle strength and gait performance explain only a small portion of physical activity. Further studies are needed to increase our understanding of how other impairments, activity limitations, environmental factors, and personal factors are associated with physical activity in persons with late effects of polio.
To examine the relationship between physical activity (assessed subjectively and objectively), knee muscle strength, gait performance, age, gender, and body mass index (BMI) in persons with late effects of polio.
DESIGN:
Cross-sectional.
SETTING:
A university hospital outpatient clinic.
PARTICIPANTS:
Seventy-seven community-dwelling ambulant persons with late effects of polio (42 men and 35 women; mean age 67 years [standard deviation 6, range 54-80]).
MAIN OUTCOME MEASURES:
Physical activity was described by the Physical Activity and Disability Survey and by a pedometer (number of steps/day). Isokinetic concentric knee extensor and flexor muscle strength was measured at 60°/s. Gait performance was assessed by the Timed "Up and Go" test, the Comfortable Gait Speed and Fast Gait Speed tests, and the 6-Minute Walk test.
RESULTS:
The Physical Activity and Disability Survey leisure subscale was significantly correlated with all knee muscle strength measurements (P < .01), the Comfortable Gait Speed test (P < .05), and the 6-Minute Walk test (P < .05), and the number of steps per day was significantly correlated with all knee muscle strength measurements and all gait performance tests (P < .01). In the linear regression analyses, knee muscle strength and gait performance explained 1% to 8% of the variance in the leisure subscale, and when the personal attributes (age, gender, and BMI) were added, they explained up to 14% of the variance. Knee muscle strength explained 16% and gait performance explained 15% to 31% of the variance in the number of steps per day, and when personal attributes (age, gender, and BMI) were added, they contributed at most an additional 3% of the variance.
CONCLUSIONS:
In ambulatory persons with late effects of polio, knee muscle strength and gait performance explain only a small portion of physical activity. Further studies are needed to increase our understanding of how other impairments, activity limitations, environmental factors, and personal factors are associated with physical activity in persons with late effects of polio.
