P. Calmels

Concentric and eccentric isokinetic assessment of flexorextensor torque ratios at the hip, knee, and ankle in a sample population of healthy subjects

OBJECTIVE To establish the relationship between the flexor/extensor torque ratios in the hip, knee, and ankle. DESIGN Case series. SETTING Laboratory of a university rehabilitation department. PARTICIPANTS From a group of 158 healthy volunteers, 138 subjects completed all the tests in concentric mode, and 65 in eccentric mode. MAIN OUTCOME MEASURE The flexor/extensor torque ratios of the hip, knee, and ankle were analyzed by means of isokinetic concentric and eccentric tests. Analysis of variance was carried out to compare the mean values of the ratios obtained between the male and female populations and between the right and left sides, and correlation analysis between the values of the joints. RESULTS The flexor/extensor torque ratios differed significantly according to sex and angular velocities, but not according to side except for the ankle. No significant relationship was found between the flexor/extensor torque ratios in the hip, knee, and ankle joints. CONCLUSIONS The flexor-extensor torque ratio of the knee and hip can be used as a reference point during rehabilitation of the contralateral side. Our results demonstrating the absence of correlation between the flexor/extensor torque ratio in each joint of the same limb, however, call for further longitudinal studies to be made under specific circumstances, such as training or immobilization of one joint, to follow the course of agonist/antagonist ratios and the synergistic activity between the joints.

Changes in the quality of life of hemiplegic stroke patients with time: a preliminary report.

To evaluate the influence of time on the quality of life of hemiplegic stroke patients living at home, we analyzed a sample of 45 outpatients. The sample was divided into two groups, according to the delay between the discharge time from hospital and the assessment (Group 1, fewer than 6 mo; Group 2, more than 6 mo after discharge). We hypothesized that patients in Group 2 would have a lower level of quality of life than patients in Group 1. Disability was assessed with the Functional Independence Measure, and the quality of life was assessed with the Reintegration to Normal Living Index. Both groups were comparable with regard to demographic and stroke characteristics. There was no statistically significant difference in Functional Independence Measure scores (global and subscales). Reintegration to Normal Living Index-perception of self subscale scores were significantly lower in Group 2. At the item level, quality of life scores were also significantly lower in Group 2 for indoor mobility (Mann-Whitney U test; P = 0.001), self-care needs (P = 0.005), personal relationships (P = 0.02), and the handling of life events (P = 0.05). These results confirm our hypothesis and suggest that quality of life may deteriorate in some domains over time, even when the disability level is unchanged, but these results need to be replicated in prospective studies with larger samples of stroke survivors.

Validity of the French-language version of the Quebec Back Pain Disability Scale in low back pain patients in France

OBJECTIVES The primary objectives were to evaluate the acceptability in France of the Quebec Back Pain Disability Scale (QBPDS) in its original French-language version and to study its correlational validity against indicators of impairment, pain, disability, psychological status, and perceived health status. MATERIAL AND METHODS Thirty-two patients with chronic low back pain were recruited at the rheumatology outpatient clinic of a French hospital. A physical examination was performed for determination of an impairment score, and scales were completed for pain (visual analog scale and Saint-Antoine Questionnaire), disability (QBPDS and Dallas Scale [DS]), perceived health status (Nottingham Health Profile, NHP), and psychological status (Hospital Anxiety and Depression Scale, HADS). RESULTS Acceptability, internal consistency, and content validity of the QBPDS were satisfactory. Investigation of correlational validity showed good agreement with the DPQ (r = 0.755) and NHP (r = 0.739) and fair agreement with the impairment score (r = 0.449), the VAS pain score (r = 0.448), and the HADS score (r = 0.473). The QBPDS showed good discriminating power. Validity of the QBPDS was confirmed. DISCUSSION Our results confirm the good measurement properties of the original French-language version of the QBPDS in French hospital-clinic patients with chronic low back pain. Comparison of the QBPDS and DPQ in this study shows that the QBPDS is better for evaluating disability, whereas the DPQ evaluates the overall, functional, psychological, and social impact of low back pain.

Shoulder Strength Imbalances as Injury Risk in Handball

This study was conducted to analyze whether internal (IR) and external (ER) rotator shoulder muscles weakness and/or imbalance collected through a preseason assessment could be predictors of subsequent shoulder injury during a season in handball players. In preseason, 16 female elite handball players (HPG) and 14 healthy female nonathletes (CG) underwent isokinetic IR and ER strength test with use of a Con-Trex® dynamometer in a seated position with 45° shoulder abduction in scapular plane, at 60, 120 and 240°/s in concentric and at 60°/s in eccentric, for both sides. An imbalanced muscular strength profile was determined using -statistically selected cut-offs from CG values. For HPG, all newly incurred shoulder injuries were reported during the season. There were significant differences between HPG and CG only for dominant eccentric IR strength, ER/IR ratio at 240°/s and for IRecc/ERcon ratio. In HPG, IR and ER strength was higher, and ER/IR ratios lower for dominant than for nondominant side. The relative risk was 2.57 (95%CI: 1.60-3.54; P<0.05) if handball players had an imbalanced muscular strength profile. In youth female handball players IR and ER muscle strength increases on the dominant side without ER/IR imbalances; and higher injury risk was associated with imbalanced muscular strength profile.

Cross-sectional study of muscle strength and bone mineral density in a population of 106 women between the ages of 44 and 87 years: relationship with age and menopause.

This study examined the correlations between isokinetic muscle strength of knee and elbow flexors and extensors with vertebral and femoral bone mineral density in a population of 106 women between the ages of 44 and 87 years. The absolute value of muscle strength correlated significantly with bone mineral density; muscle strength of the upper limb appeared to be more closely correlated with bone mass, while muscle strength in the lower limb was more specific for femoral mineral bone density. The most important finding that these results demonstrated was a concomitant decline in muscle strength of the upper limb and bone mineral density between the 5th and 6th decades. In contrast, they also showed a decline in muscle strength of the lower limbs after the 6th decade, occurring before the decline in bone mineral density observed between the 7th and 8th decades. From these results it would appear that other studies are required to examine the relationship between the essentially hormonal role in postmenopausal decline in muscle strength and the decline in physical activity during the senile period. These elements are important because they must be taken into account in physical exercise programmes designed to prevent osteoporosis.

Rotator Cuff Strength in Recurrent Anterior Shoulder Instability

BACKGROUND Although rotator-cuff muscle contraction plays an important role in stabilizing the glenohumeral joint, little is known about the role of these muscles in the pathophysiology of recurrent anterior instability. We intended to analyze the association between isokinetic internal rotator and external rotator muscle strength and glenohumeral joint instability in patients with recurrent anterior instability that was not previously treated surgically. METHODS We enrolled thirty-seven patients with unilateral recurrent anterior posttraumatic shoulder dislocation and eleven healthy nonathletic subjects in this controlled study. The association between internal rotator and external rotator strength and shoulder instability was analyzed by side-to-side comparisons and comparisons with a control group. Isokinetic internal rotator and external rotator strength was evaluated with a Con-Trex dynamometer, with the subject seated and the shoulder abducted 45° in the scapular plane. Tests were performed at 180°/s, 120°/s, and 60°/s in concentric mode for both sides. Peak torque normalized to body weight and external rotator to internal rotator ratio were calculated for each angular velocity. Clinical and isokinetic evaluation was done by the same rehabilitation physician. RESULTS The association between shoulder instability and internal rotator and external rotator strength was associated with side-to-side differences (p < 0.05). Compared with a control group, strength values were lower on the pathological shoulder side of the patients with shoulder instability than on the healthy contralateral shoulder of control subjects at 180°/s and 120°/s (p < 0.05). The side-to-side differences were increased when the nondominant upper-extremity side was involved and were decreased when the dominant side was involved. There was no association between glenohumeral joint instability and external rotator to internal rotator ratio. CONCLUSIONS Internal rotator and external rotator weakness was associated with recurrent anterior instability, and side-to-side differences depended on the side of hand dominance. Use of a control group may help in the analysis of the influence of constraints on shoulder strength. Further prospective studies are necessary to determine whether the weakness is a cause or an effect of the instability.

Relationship between maximal exercise capacity and walking capacity in adult hemiplegic stroke patients.

Courbon A, Calmels P, Roche F, Ramas J, Rimaud D, Fayolle-Minon I: Relationship between maximal exercise capacity and walking capacity in adult hemiplegic stroke patients. Am J Phys Med Rehabil 2006;85:436–442. Objective:To evaluate the relationship between maximal exercise capacity and walking capacity in hemiplegic stroke patients. Design:An uncontrolled observational study was conducted in the physical medicine and rehabilitation unit in an academic hospital. Participants were 21 hemiplegic stroke patients (18 men, 3 women; age, 18–70 yrs) whose stroke occurred >3 mos before the study and who could walk independently with or without walking aids. Main outcome measures were peak oxygen uptake, workload, walking capacity, and motor impairment. Results:There was a significant correlation between walking capacity (6-min-walk test) and both peak oxygen uptake (r = 0.602, P = 0.0032) and maximal power output (r = 0.867, P < 0.0001). Conclusions:Aerobic capacity and walking capacity are decreased in hemiplegic stroke patients and are correlated with each other. These results underscore the need for future studies, to confirm the role of fitness in relation to walking capacity, and to evaluate the benefit of integrating aerobic training into more traditional rehabilitation programs after stroke.

Benefits of interval‐training on fatigue and functional capacities in Charcot–Marie–Tooth disease

Exercise intolerance and undue fatigue are common complaints in patients with Charcot–Marie–Tooth (CMT) disease. Reduced physical ability is due directly to the disease, but it is also due to physical deconditioning. The aim of this study was to test whether 24 weeks of interval‐training exercise (ITE) cycling can significantly improve physiological, neuromuscular, and functional capacities and alleviate fatigue in CMT patients. Eight CMT patients (4 CMT1A and 4 CMT2) participated in ITE for 3 nonconsecutive days per week. Cardiovascular fitness, muscle strength, fatigue resistance, and functional capacities were measured before and after 12 weeks of supervised hospital training and again after another 12 weeks of unsupervised home training. Training was well tolerated. There were significant improvements in cardiorespiratory capacities, isokinetic concentric strength, and functional ability measurements. All patients experienced an improvement in their self‐reported visual analogic scale for fatigue and pain during training. However, there was no significant change in their isometric force production and indices of fatigue resistance after training. Although the improvement in exercise tolerance may be due in part to reversal of the deconditioning effect of their related sedentary lifestyle, this clinical trial suggests that ITE can benefit CMT patients especially in their functional performance and subjective perception of pain and fatigue. Moreover, the improvement observed at the end of the first supervised period ITE was maintained after the second unsupervised home period, although there was no further improvement in performance and tolerance. Muscle Nerve, 2008

Influence of Rugby Practice on Shoulder Internal and External Rotators Strength

Shoulder injuries are frequent in rugby, and muscular deficiency and/or imbalance of the internal (IR) and external (ER) shoulder rotators are considered as probable mechanisms of shoulder injuries. The purpose of this study was to investigate whether the rotators strength imbalances occur in rugby players by comparing IR and ER strength and ER/IR ratios between rugby players (RP) and nonathletic subjects. Fourteen RP and 19 healthy nonathletic subjects were evaluated in this cross-sectional controlled study with a Con-Trex ((R)) dynamometer. IR and ER isokinetic strength were performed at 60 degrees . s (-1) and 240 degrees . s (-1) in concentric, and 60 degrees . s (-1) in eccentric, for both sides. Strength values were higher for RP than nonathletic ones ( P<0.05), but if peak torque was normalised to body weight, there were no significant differences. There was no significant effect of laterality on the IR and ER peak torque, and no significant influence of rugby and/or laterality on the ER/IR ratio. In conclusions, our results reported no rotators muscles imbalance in RP as a possible risk factor of glenohumeral injury.

Enhancement of isokinetic muscle strength with a combined training programme in chronic heart failure

Background  Patients with congestive heart failure (CHF) exhibit an impaired exercised tolerance that dramatically limits their functional capacity and alters their quality of life.