Gunnar Grimby

An 8‐year longitudinal study of muscle strength, muscle fiber size, and dynamic electromyogram in individuals with late polio

Twenty‐one subjects with polio 24 to 51 years prior to the first examination were studied on three occasions, each 4 years apart with measurements of muscle strength and endurance for knee extension, macro EMG, and muscle biopsy from vastus lateralis. On average the muscle strength decreased during the 8‐year follow‐up by 9–15%. Endurance decreased during the observation period. The muscle fiber area was markedly increased in most subjects. There was a decrease in the capillarization during the follow‐up. Macro EMG was increased in all subjects (range 3–42 times control) and increased in 20 legs during the 8‐year follow‐up, but showed a decrease in 8 of 9 legs with an approximative breakpoint when macro MUPs were around 20 times the normal size. Thus, evidence of on‐going denervation/reinnervation as well as of failing capacity to maintain large motor units was demonstrated. SFEMG showed a moderate degree of disturbed neuromuscular transmission.

Life after cardiac arrest; a retrospective study

AIM We decided to evaluate the life situation of the survivors after out-of-hospital cardiopulmonary resuscitation (CPR). METHOD CPR survivors who were 75 years or younger at the time and who were discharged alive from the hospital were identified consecutively. Average follow-up time was 25.5 months, and at follow-up 24% were deceased and 9% were lost. A questionnaire was completed by 93% and 71% were positive to an interview. RESULTS Cognitive functions were reduced as well as capacity to perform activities in daily living. This resulted in dependence on other persons for living (nursing homes) and a low return to work. Social isolation was a common complaint. The survivors also reported lower pain awareness than the reference population. As far as other aspects of health-related quality of life, this small group show many similarities with previously evaluated post-infarction patients. CONCLUSION Lower pain awareness should be taken into consideration when the CPR patients have ischemic heart disease. If possible, try to prevent social isolation.

Assessments of disability in women with rheumatoid arthritis in relation to grip force and pain

The aim of this study was to assess disability with the Health Assessment Questionnaire (HAQ) and to evaluate the relationships between grip force, pain and difficulty in daily activities. Twenty women with rheumatoid arthritis were assessed with measurements of grip force and pain before and after grip test. Both the original HAQ version and an alternative rating model, not taking the use of assistive devices into account, were used. All patients reported pain which significantly increased after grip test and with a significant inverse correlation to grip force. All patients had assistive devices, on average 15 devices (range 1-27). Ninety-one per cent of the patients devices were in continued use, most frequently in the categories; Eating, Grip and Hygiene. Disability was significantly correlated to pain, grip force and use of assistive devices. When using the alternative ratings of 20 questions in HAQ, 8 of the 20 questions showed significantly (p = 0.0003-0.0339) lower scoring, and the number of questions with significant correlations between grip force and disability increasing from 9 (r = 0.48-0.74, p = 0.039-0.001) to 14 questions (r = 0.47-0.74, p = 0.047-0.001). Difference between intrinsic disability (without assistive devices) and actual disability (with such assistance) is not reflected in original HAQ. The present study indicates that assessment of actual disability by the alternative rating model is more often correlated to impairment (grip force) than disability assessed by original HAQ and can be considered to give a better assessment of actual disability than the original HAQ model.

QUESTIONNAIRE TO EVALUATE THE EFFECTS OF ASSISTIVE DEVICES AND ALTERED WORKING METHODS IN WOMEN WITH RHEUMATOID ARTHRITIS

The objectives of the study were to identify perceived difficulty and reduction of difficulty when using assistive devices and altered working methods in performing daily activities and to detect which activities were unaffected by interventions. Twenty-one women aged 29–65 years with rheumatoid arthritis answered the Evaluation of Daily Activity Questionnaire (EDAQ), which contains 102 items divided into 11 dimensions of daily activities. The women rated their perceived difficulty twice: first when not using devices or altered methods and then when using them. The use of devices or altered methods led to a reduction in perceived difficulty in 42% of the ratings. The number of items that the women found difficult when not using devices/altered methods ranged between 13 and 99. With the interventions, the number of items still found difficult decreased to between 6 and 57, 91% of the devices provided were still in use. The dimensions Eating, Cooking and Toileting contained the most items affected by the use of devices such as lever taps, springy scissors, breadknife and wrist orthosis. Few effective devices were identified for the dimensions Dressing, Washing, Cleaning and Mobility Outdoors. It was concluded that the EDAQ represents a new approach to demonstrating difficulties in performing various daily activities, to describing the effects of assistive devices/altered methods, and to identifying areas not affected by interventions.

Upper motor neuron lesions: Their effect on muscle performance and appearance in stroke patients with minor motor impairment

OBJECTIVE To evaluate muscular performance and appearance in patients with prior stroke who were ambulatory. DESIGN Nonrandomized study. SETTING University hospital laboratory. SUBJECTS Sixteen persons (11 men, 5 women) with minor motor impairments, 6 to 24 months after stroke, were included. As reference, data were used from a population-based sample of 144 men and women. MAIN OUTCOME MEASUREMENTS Muscle performance was evaluated using a Kin-Com dynamometer in both the affected and the nonaffected leg. Peak isometric strength was measured at a 60 degree angle in both extension and flexion. Maximal isokinetic strength was measured at 60 degrees/sec and at 180 degrees/sec. Endurance was evaluated during isometric and dynamic knee extensions. Muscle biopsies were taken on nine patients and muscle tissue areas were determined with computed tomography. RESULTS The affected leg was weaker but not different in relative endurance compared with the nonaffected side. The performance of the nonaffected side was somewhat lower than that of a matched reference population. No major difference in fiber composition between the affected and nonaffected legs was noted, except for a lower degree of capillarization in the affected leg. CONCLUSION In well-functioning stroke patients with good motor performance, further muscle training that includes resistance exercise might be indicated.

Skeletal muscle fiber composition and capillarization in patients with chronic heart failure: Relation to exercise capacity and central hemodynamics

Patients with chronic heart failure have structural and metabolic changes in skeletal muscle, which may be of importance for symptomatology. The origin of these changes are still unknown. The relationship between fiber composition and capillarization in skeletal muscle with exercise capacity and central hemodynamic variables was examined. Biopsies from the lateral vastus muscle were taken in 12 patients with chronic heart failure. Samples from eight normal subjects served as control samples. All patients underwent maximal exercise tests. Central hemodynamic variables were measured during exercise in five patients. The patients had a higher percentage of type II B fibers (P = .03) and fewer capillaries per fiber (P = .02) than the controls subjects. VO2 max correlated with the percentage of type I fibers, whereas the correlation with the type II A fibers was inverse. Cardiac index and pulmonary capillary wedge pressure at submaximal and maximal exercise were related to fiber type composition and relative fiber areas. Skeletal muscle fiber type composition and capillarization was changed in patients with chronic heart failure. These changes might influence exercise capacity. There were relationships between central hemodynamic variables and skeletal muscle changes. What the cause and effects were need further investigation.

Muscular performance in heart failure

BACKGROUND Some of the major symptoms in patients with chronic heart failure are muscle weakness and fatigue. However, not much is known about muscle performance in these patients compared to healthy controls. METHODS AND RESULTS Activity level, gait speed, hand grip strength, muscle performance of the knee extensors and flexors along with the plantar and dorsal flexors of the foot were evaluated. Muscle biopsies from the lateral vastus lateralis were taken. Sixteen patients in New York Heart Association class II or III were tested and compared to 112 reference subjects. Compared to the reference subjects, there was a reduction in activity level, gait speed, isometric and isokinetic peak torque for knee extension at different velocities, hand grip strength, peak torque for plantar and dorsal flexion of the ankle and isometric and isokinetic endurance for the knee extension. Recovery was faster. There were small differences in fiber composition. 3-Hydroxy-acylCoA-dehydrogenase and citrate synthase were lower, and lactate dehydrogenase was increased. CONCLUSIONS Muscle performance is affected in terms of both strength and endurance, which might affect performance in everyday activities. The more pronounced reduction in hand grip compared to the other muscles tested could be an indication of intrinsic abnormalities in the skeletal muscle.

Reduction in thigh muscle cross-sectional area and strength in a 4-year follow-up in late polio

OBJECTIVE To study changes in cross-sectional thigh muscle area and muscle strength in late polio subjects over a 4-year period. DESIGN Longitudinal study of a cohort of polio survivors, comparing subjects who acknowledge (unstable) with those who do not acknowledge (stable) new muscle weakness. SETTING University hospital. SUBJECTS Eighteen subjects (6 men, 12 women) with polio-myelitis sequelae (39 to 46 years of age) were studied on two occasions 4 years apart; the first examination was 37 to 44 years after onset of polio. Subjects were recruited through hospital registers, newspaper advertisement, and a patient organization. OUTCOME MEASUREMENTS Thigh muscle and intermuscular and intramuscular adipose tissue (AT) cross-sectional areas were measured by computed tomography. Isometric muscle strength for knee extension and flexion was measured using a Kin-Com dynamometer. RESULTS Cross-sectional muscle area decreased on average 1.3 +/- 3.6 cm2 (1.4%, p < .05); the intermuscular and intramuscular AT area increased 1.8 +/- 3.4 cm2 (12.1%, p < .05). When divided by legs in which subjects reported (unstable) or did not report (unstable) or did not report (stable) increased muscle weakness, unstable legs showed significant reduction (p < .05) in muscle area, whereas stable legs did not. Estimated total thigh muscle strength decreased 7.8% +/- 2.9% (p < .01), with a significant (p < .001) reduction in unstable legs (13.4% +/- 4.3%) but not in stable legs. The reduction in strength appears to be greater than the reduction in cross-sectional muscle area, but there is still a significant correlation (r = .44, p < .05). CONCLUSION The present results demonstrate not only progress of muscle weakness, but also of muscle atrophy in postpolio subjects.

Comparison of muscle and tendon stiffness, jumping ability, muscle strength and fatigue in the plantar flexors

Svantesson U, Carlsson U, Takahashi H, Thomée R, Grimby G. Comparison of muscle and tendon stiffness, jumping ability, muscle strength and fatigue in the plantar flexors.

Assessment of walking, balance and sensorimotor performance of hemiparetic patients in the acute stage after stroke

The aims of the study were to assess the walking, balance and sensorimotor performance of hemiparetic patients in the acute stage (3-8 weeks) after stroke, and to determine the extent of correlation between these variables. Twenty-eight patients aged 55.0±9.3 years (mean±SD) with residual hemiparesis due to a first stroke were assessed. The average walking velocity for the 16 patients who were able to complete the 10-m walking test was 0.26 m/s, and they rated their difficulty in performing this test as ‘moderate’. The mean score (±SD) on the Berg Balance Scale was 23±16 and on the Fugl-Meyer Sensorimotor Assessment 153±36. Patients requiring a greater number of steps while walking 10 m tended to have lower extremity motor function and decreased balance function. Furthermore, patients with poorer balance had to exert themselves more when walking (rs = -0.73, P <0.01). The Berg Balance Scale and the ‘Balance’ subsection of the Fugl-Meyer Sensorimotor Assessment correlated significantly (r = 0.77, P <0.001)...