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BACKGROUND: A novel way to evaluate muscle strength and functioning in the lower limbs is to measure how high a person could step up on a platform, the so called Maximal Step-up Test (MST). Studies of healthy persons and overweight women have shown that the maximal step-up height (MSH) is associated with both muscle strength and physical function, but no study has assessed persons after stroke. OBJECTIVE: To evaluate the relationship between isokinetic and isometric knee muscle strength and maximal step-up height after stroke. METHODS: A convenience sample of 21 ambulatory persons with stroke (13 men and eight women; mean age 63 +/- 12 years; mean time since stroke onset 26 +/- 36 months). Isokinetic concentric knee extension and knee flexion strength at 60 degrees/s and isometric knee extension strength at 90. were measured for both lower limbs with a Biodex dynamometer. Maximal step-up height was measured using a 40 cm x 60 cm platform, which could be raised from 3 cm to 45 cm with 3 cm intervals. The relationship between knee muscle strength (normalized to body weight) and the maximal step-up height was analysed with the Pearson's correlation coefficient (r). RESULTS: There were significant but only moderate relationships between the paretic isokinetic knee extension, and flexion, strength and maximal step-up height, r = 0.49; p < 0.05, and r = 0.57; p < 0.01, respectively. CONCLUSION: These moderate relationships indicate that muscle weakness is only partially associated with maximal step-up height after stroke. The MST may therefore have limited value in the assessment of muscle strength after stroke. (Less)

On May 2001, the International Classification of Functioning, Disability and Health (ICF) was presented by the World Health Organisation (WHO). The ICF has been developed from the International Classification of Impairments, Disabilities, and Handicaps (ICIDH), which was first published in 1980. Twenty years later, after systematic field trials and international consultation, ICF was endorsed by the 54th World Health Assembly for international use [1]. ICF provides a unified and standard language and serves as a framework for the description of health and health-related states (i.e., disability). It is a complement to the ICD-10 (International Classification of Diseases), where health conditions (diseases, disorders, injuries, etc.) are classified. ICF defines components of health and health-related components of well-being. It is described from the perspective of the body, the individual and society in different components: Body Functions and Structures; Activity and Participation; Environmental Factors and Personal Factors (Fig. 1). ICF systematically groups different domains for a person in a given health condition. Functioning is an umbrella term encompassing positive aspects of Body Functions and Structures, Activity and Participation; similarly, disability serves as an umbrella term for negative aspects, i.e., Impairments, Activity limitations and Participation restrictions (Table 1). ICF also lists environmental factors that interact with all these constructs. In this way, ICF enables the user to record useful pro

Diseases in the nervous system are among the most frequently occurring disabling conditions. A symptom common for these diseases is progressive muscular weakness, which can have a profound effect on a person's ability to perform activities of daily living. Measurements of muscle strength and interventions aiming at improving strength are two major components in the rehabilitation of individuals with diseases of the nervous system. Over the past decade, interest in the assessment of muscle function in various nervous system diseases has increased, and isokinetic dynamometry has been established as a valuable tool to understand the complexity of muscle function in these diseases and the effects of various rehabilitation interventions. In this review, we will present some of our experiences using isokinetic dynamometry to evaluate muscle function in neurological diseases, and how it has increased our knowledge about the effects of different rehabilitation interventions.

The aim of this study was to assess knee extensor and flexor muscle torque in individuals with hemiparesis after stroke and determine the relationship with muscle tone. Fifty individuals (mean age 58 +/- 6.4 years), 6 to 48 months after stroke, participated in the study. Maximal concentric knee extension and flexion torque at 60 degrees/s and 120 degrees/s and maximal eccentric knee extension contractions at 60 degrees/s were measured with a Biodex dynamometer. Muscle tone was assessed with the modified Ashworth Scale. The relative weakness in the paretic knee muscles ranged from 30% to 42% and was greater for the flexors and at higher velocities (p < 0.05). The knee flexion/extension torque ratio in the non-paretic lower limb was 0.53 for both velocities and significantly lower (p < 0.01) for the paretic lower limb (0.44 at 60 degrees/s and 0.39 at 120 degrees/s). The eccentric/concentric ratio in the paretic lower limb (1.66) was significantly higher (p < 0.05) than in the non-paretic lower limb (1.31). Concentric torque in the paretic lower limb was significantly correlated (p < 0.05) with muscle tone. In conclusion, post-stroke weakness of the knee muscles was most prominent in the flexors and at higher velocities, whereas eccentric strength seemed to be preserved. Strength was also associated with the spasticity that can occur after stroke. This post-stroke muscle weakness pattern could be of importance for gait performance and should therefore be accommodated when planning rehabilitation interventions. (Less)

Rehabilitation is often described as a process that starts when the diagnosis is made and continues as long as the person needs interventions. This process comprises four steps: assessment, goal setting, interventions and outcome measurement. In each step, the WHO International Classification of Functioning, Disability and Health (ICF) can be used and the results can be summarized in a rehabilitation plan.In this brief review, we describe the use of the ICF in the neurorehabilitation process in the form of an ICF based rehabilitation plan and how the rehabilitation plan can facilitate interdisciplinary team work in each of the four steps that comprise the rehabilitation process.An ICF based rehabilitation plan that comprises a common language, understood by team members, patients and their family, is a valuable tool in the rehabilitation of persons with injuries and diseases to the nervous system. The use of the ICF has thereby enabled the development of a common framework for our neurorehabilitation methodology, regardless of diagnosis or disability.