Christina Brogårdh

TENDER OR NOT TENDER: TEST-RETEST REPEATABILITY OF PRESSURE PAIN THRESHOLDS IN THE TRAPEZIUS AND DELTOID MUSCLES OF HEALTHY WOMEN

OBJECTIVE To examine the test-retest repeatability of pressure pain thresholds in the shoulder muscles of healthy women. DESIGN Four experimental sessions (days 1, 3, 28, 30), each including 4 consecutive pressure pain threshold measurements at 10-minute intervals. SUBJECTS Twenty-four healthy female volunteers, mean age 42 years. METHODS Two examiners measured pressure pain thresholds bilaterally over the trapezius and deltoid muscles with an electronic algometer. Students paired t-test, intraclass correlation coefficient, ANOVA repeated measures, 95% confidence interval and mean maximal absolute measurement error, were used for statistics. RESULTS Reliability for each point in all sessions was high; ICC range 0.70-0.94, mean maximal differences; 53-102 kPa (all 4 muscles), and between points in each muscle: ICC right trapezius 0.59-0.77, left 0.67-0.84, right deltoid 0.66-0.83, left 0.70-0.90. Mean maximal differences were 69-101 kPa and 65-111 kPa for the trapezius and deltoid muscles, respectively. The inter-individual variation was 5-fold (trapezius 88-574 kPa; deltoid 91-529 kPa). At the group level, the variation was limited when the first measurement was excluded. Inter-rater and intra-rater repeatability was high without significant differences. Only small side-to-side differences were seen. CONCLUSION Repeated measurements show stable intra-individual values. The method can be recommended when used by trained and experienced examiners.

Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use

Objective: (1) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome. Design: A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers. Setting: A university hospital rehabilitation department. Participants: Sixteen stroke patients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6-9 months post stroke) with moderate motor impairments in the contralateral upper limb. Intervention: Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2-3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment. Outcome measures: Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log. Results: The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59-2.28) points; P = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26-7.36) points; P = 0.037) but showed no sensory change in the Two-Point Discrimination Test (P = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (P B=0.001). However, no additional effect was seen from wearing a mitt for another three months. Conclusion: Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.

The Reproducibility of Berg Balance Scale and the Single-Leg Stance in Chronic Stroke and the Relationship Between the Two Tests

To assess the reproducibility of the Berg Balance Scale (BBS) and the Single‐leg Stance (SLS), and the validity of the SLS as an independent test of upright postural control in patients with chronic stroke.

Shortened constraint-induced movement therapy in subacute stroke - no effect of using a restraint : a randomized controlled study with independent observers

OBJECTIVE To examine the effect of using a mitt during shortened constraint-induced movement therapy for patients in the subacute phase after stroke. SUBJECTS Twenty-four patients with stroke (mean age 57.6 (standard deviation (SD) 8.5) years; average 7 weeks post-stroke) with mild to moderate impaired hand function. METHODS The patients were randomized to mitt use or no mitt use on the less affected hand for 90% of waking hours for 12 days. All patients received 3 h of arm and hand training per day for 2 weeks. Assessments were made by blinded observers using the modified Motor Assessment Scale, the Sollerman hand function test, the 2-Point Discrimination test and Motor Activity Log test. RESULTS Patients in both groups showed significant improvements in arm and hand motor performance and on self-reported motor ability after 2 weeks of therapy and at 3 months follow-up. However, no statistically significant differences between the groups were found in any measures at any point in time. CONCLUSION In this study, no effect of using a restraint in patients with subacute stroke was found. Thus, this component in the constraint-induced therapy concept seems to be of minor importance for the outcome.

Long-term benefits of progressive resistance training in chronic stroke: A 4-year follow-up.

OBJECTIVES To evaluate the long-term benefits of progressive resistance training in chronic stroke. DESIGN A 4-year follow-up of a randomized controlled trial of progressive resistance training. SUBJECTS Eighteen women and men (mean age 66 (standard deviation 4) from the original group of 24 post-stroke participants. METHODS 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). RESULTS 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. CONCLUSION 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.

A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke

OBJECTIVE To explore the long-term benefits of shortened constraint-induced movement therapy (CIMT) in the subacute phase poststroke. DESIGN A 1-year follow-up after shortened CIMT (3h training/d for 2 wk) where the participants had been randomized to a mitt group or a nonmitt group. SETTING A university hospital rehabilitation department. PARTICIPANTS Poststroke patients (N=20, 15 men, 5 women; mean age 58.8 y; on average 14.8 mo poststroke) with mild to moderate impairments of hand function. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Sollerman hand function test, the modified Motor Assessment Scale, and the Motor Activity Log test. Assessments were made by blinded observers. RESULTS One year after shortened CIMT, participants within both the mitt group and the nonmitt group showed statistically significant improvements in arm and hand motor performance and on self-reported motor ability compared with before and after treatment. No significant differences between the groups were found in any measure at any time. CONCLUSIONS Shortened CIMT seems to be beneficial up to 1 year after training, but the restraint may not enhance upper motor function. To determine which components of CIMT are most effective, larger randomized studies are needed.

No Effects of Whole-Body Vibration Training on Muscle Strength and Gait Performance in Persons With Late Effects of Polio: A Pilot Study.

OBJECTIVE To evaluate the feasibility and possible effects of whole-body vibration (WBV) training on muscle strength and gait performance in people with late effects of polio. DESIGN A case-controlled pilot study with assessments before and after training. SETTING A university hospital rehabilitation department. PARTICIPANTS People (N=5; 3 men, 2 women; mean age, 64+/-6.7y; range, 55-71y) with clinically and electrophysiologically verified late effects of polio. INTERVENTIONS All participants underwent 10 sessions of supervised WBV training (standing with knees flexed 40 degrees -55 degrees up to 60 seconds per repetition and 10 repetitions per session twice weekly for 5 weeks). MAIN OUTCOME MEASURES Isokinetic and isometric knee muscle strength (dynamometer), and gait performance (Timed Up & Go, Comfortable Gait Speed, Fast Gait Speed, and six-minute walk tests). RESULTS All participants completed the 5 weeks of WBV training, with no discernible discomfort. No significant changes in knee muscle strength or gait performance were found after the WBV training period. CONCLUSIONS This pilot study did not show any significant improvements in knee muscle strength and gait performance following a standard protocol of WBV training. Thus, the results do not lend support to WBV training for people with late effects of polio.

What is the long-term benefit of constraint-induced movement therapy? A four-year follow-up:

Objective: To evaluate the long-term benefits of constraint-induced movement therapy in chronic stroke. Design: A four-year follow-up after constraint-induced group therapy assessing arm and hand function and self-reported daily hand use. Subjects: Fourteen post-stroke individuals (six women and eight men; mean age 59.6 ± 12.7 years, range 23—75 years) with mild to moderate impairments of hand function. Outcome measures: The Sollerman hand function test and the Motor Activity Log test. Results: Four years after constraint-induced group therapy the participants had maintained their hand function, as measured by the Sollerman hand function test. The self-reported use and quality of movements of the more affected hand, as measured by the Motor Activity Log test, had decreased compared to post-treatment and three months follow-up (P<0.01), but was still significantly higher than pre-treatment (P<0.05). Conclusion: There seems to be a long-term benefit of constraint-induced group therapy. Hand function was maintained over time and daily hand use had increased compared to pre-treatment. To provide guidelines about the clinical use of constraint-induced movement therapy further, larger and controlled studies are needed.

Effects of Cardiorespiratory Fitness and Muscle-Resistance Training After Stroke

Stroke is a leading cause of long‐term disability. The physical and cognitive impairments after an ischemic or hemorrhagic stroke often lead to activity limitations and participation restrictions. Many persons after stroke have a sedentary lifestyle, are physically inactive, and have a low fitness level. Physical fitness training is known to be beneficial for persons with a number of comorbid conditions or risk factors for stroke. Although exercise and physical activity are considered valuable, the evidence of their benefits after stroke is still insufficient. In this review, we summarize published randomized controlled trials regarding the effects of cardiorespiratory fitness and muscle‐resistance training after stroke on physical function, activity, participation, life satisfaction, and mood. We discuss various barriers that can impede the ability to perform exercise, and the importance of reducing these barriers to increase physical fitness levels after the completion of usual stroke rehabilitation, thereby enhancing leisure, well‐being, and participation in society.

Isometric and isokinetic muscle strength in the upper extremity can be reliably measured in persons with chronic stroke.

OBJECTIVE To evaluate the test-retest reliability of isometric and isokinetic muscle strength measurements in the upper extremity after stroke. DESIGN A test-retest design. SUBJECTS Forty-five persons with mild to moderate paresis in the upper extremity > 6 months post-stroke. METHODS Isometric arm strength (shoulder abduction, elbow flexion), isokinetic arm strength (elbow extension/flexion) and isometric grip strength were measured with electronic dynamometers. Reliability was evaluated with intra-class correlation coefficients (ICC), changes in the mean, standard error of measurements (SEM) and smallest real differences (SRD). RESULTS Reliability was high (ICCs: 0.92-0.97). The absolute and relative (%) SEM ranged from 2.7 Nm (5.6%) to 3.0 Nm (9.4%) for isometric arm strength, 2.6 Nm (7.4%) to 2.9 Nm (12.6%) for isokinetic arm strength, and 22.3 N (7.6%) to 26.4 N (9.2%) for grip strength. The absolute and relative (%) SRD ranged from 7.5 Nm (15.5%) to 8.4 Nm (26.1%) for isometric arm strength, 7.1 Nm (20.6%) to 8.0 Nm (34.8%) for isokinetic arm strength, and 61.8 N (21.0%) to 73.3 N (25.6%) for grip strength. CONCLUSION Muscle strength in the upper extremity can be reliably measured in persons with chronic stroke. Isometric measurements yield smaller measurement errors than isokinetic measurements and might be preferred, but the choice depends on the research question.