Bette Ann Harris

Quadriceps muscle strength and dynamic stability in elderly persons

Several measures of dynamic stability during two functional activities correlated to quadriceps femoris muscle strength. A total of 34 disabled elders (aged 60-88) living in the Boston area consented to maximum isometric quadriceps muscle strength testing, chair rise and gait analysis. During chair rise, quadriceps strength significantly correlated with maximum upper body vertical linear momentum, r=0.53, P<0.005, anterior posterior linear momentum, r=0. 38, P<0.05, and the time to complete the chair rise, r=-0.48, P<0.05, n=29. Stride length and gait velocity correlated (r=0.56, P<0.001 and r=0.51, P<0.002, n=34) with quadriceps muscle strength. The maximum range of whole body anteroposterior (A/P) linear momentum during gait also correlated with quadriceps strength (r=0.47, P=0. 004, n=31). Dynamic stability during chair rise and gait, at preferred speed, correlates directly with quadriceps femoris muscle strength in functionally limited elderly individuals. In our sample, elders performed one of three movement strategies to arise from a chair, and quadriceps strength did not statistically differ between the chair rise strategy groups. However, persons with the greatest quadriceps strength values were more stable regardless of which chair rise strategy they performed. Our data indicate that clinicians should not suggest that patients use compensatory momentum inducing locomotor strategies unless the patient has sufficient strength to control these induced forces.

A home-based exercise program for nondisabled older adults

OBJECTIVES: This paper describes a videotaped, home‐based, strength training program, titled Strong‐for‐Life and reports on its effectiveness in improving muscle strength, psychological well‐being, and health status in a sample of older persons.

Hip fracture: a prospective study of hospital course, complications, and costs.

A prospective study of 79 patients with recent hip fracture revealed prior functional impairments with community mobility (49%), using a bathtub (40%), walking outdoors (26%), and stair-climbing (18%). Eighty-six per cent of patients (mean age 77.9 years) were admitted from home, with 95% surviving to discharge but only 28% returning directly home following surgical repair. In-hospital complications included confusion (49%), urinary tract infection (33%), and heart rhythm disturbance (26%). Mean length of stay was 21.7 days and mean hospital charges were

A cognitive-behavioural model for promoting regular physical activity in older adults

11,052. The outliers (15%) averaged 60.6 days in length of stay and

Rotational motion of the knee

28,190 in charges. Stepwise multivariate regression revealed that lengths of stay varied significantly with prefracture functional status, presence of intertrochanteric fractures, and in-hospital complications, but not with patient age. Examination of these findings in relation to prospective reimbursement led to the conclusion that hip fracture patients are particularly vulnerable in the era of new hospital strategies to avoid high-cost patients and curtail hospital costs.

Reliability of eccentric isokinetic knee flexion and extension measurements.

Abstract Although a lack of physical activity has been identified as a key health risk factor, the majority of older adults remain sedentary. Activity restriction is often rooted in misconceptions about the ageing process. Many adults believe that physical decrement is inevitable and irreversible with advancing age, i.e. uncontrollable. Thus, motivation is low because it is assumed that exercise will not do any good or may even cause harm. Based on research in the area of cognitive ageing, we propose a model of the relationship between control beliefs and ageing-related decrements, which specifies that interventions to encourage regular physical activity should focus on teaching skills as well as promoting a sense of control. We recommend that cognitive behavioural strategies be used to promote confidence in ones abilities to exercise (self-efficacy), to instil the belief that ones efforts will make a difference (outcome expectations), and to encourage adaptive responses in the face of difficulties (att...

Effect of patellectomy on the function of the quadriceps and hamstrings.

This study deals with the quantitation of axial rotation at the knee. Passive rotation of the knee was measured at various degrees of flexion on 17 subjects with normal knees and 19 patients with unilateral anterolateral ro tatory instability. Normal subjects were found to have bilateral sym metric rotational knee motion at each angle of flexion tested. When the knee is in a position of flexion be tween 30 and 90°, there are approximately 45° external and 25° internal rotation. Rotatory motion decreases with further extension and, at 5° of flexion, the knee has 23° external and 10° internal rotation. The knee with a torn anterior cruciate ligament and anterolateral rotatory instability was found to have an arc of rotation similar to the contralateral knee and to the control knees between 30 and 90° flexion. At 15° of flexion, a slightly greater arc of rotation was meas ured compared to normal knees. At 5° of flexion, a significantly greater range of external (to 41 °) as well as internal (to 14°) rotation was measured.

Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture: A Randomized Clinical Trial

This study assessed the test-retest reliability of knee isokinetic eccentric muscle performance in subjects with and without a history of tibio-femoral pathology. Nineteen adults were tested at 60 degrees/sec and 180 degrees/sec on three occasions using a standardized protocol that incorporates a same-session learning phase. Results revealed moderate to excellent reliability for average peak torque test-retest ICC (2,1) = .58 to .96, total work ICC = .63 to .93, and power ICC = .67 to .93. Joint angle at peak torque was unreliable (ICC = .01 to .69) for both muscle groups at both angular velocities. Knee flexion reliability was higher than extension reliability at both 60 degrees/sec and 180 degrees/sec. Subjects with tibio-femoral pathologies had ICC values lower than the healthy subjects. Reliable eccentric isokinetic measurements can be obtained for average peak torque, total work, and power. Clinicians should not assume the same degree of reliability in testing patients as in testing healthy subjects.

Knee rehabilitation following arthroscopic meniscectomy.

The Cybex-II isokinetic dynamometer was used to measure quadriceps and hamstrings function after unilateral patellectomy in twelve patients. The interval between surgery and testing averaged twenty-six months (range, fourteen to forty-two months). Data on isokinetic and isometric performance were compared with those of the untreated limb and with those of subjects who had not been operated on but who had been matched by age, sex, and weight. On the side that had been operated on, the peak torque of the quadriceps was significantly decreased whereas the peak torque of the hamstrings was preserved. Deficits in time factors related to the development of tension and high-speed performance were documented, revealing abnormalities in both muscle groups. Although patellectomy was successful in achieving relief of pain in these patients, the results of the study confirmed that the function of the knee muscles was compromised postoperatively. The objective findings documented alterations in muscle function that correlated well with the functional limitations described by the patients.

Examining Shibboleths of Hip Rehabilitation Protocols Using in vivo Contact Pressures from an Instrumented Hemiarthroplasty

IMPORTANCE For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. OBJECTIVE To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. INTERVENTIONS The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. MAIN OUTCOMES AND MEASURES Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function). RESULTS Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation. CONCLUSIONS AND RELEVANCE Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00592813.