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Background Muscle weakness in one or both upper limbs is common in persons with previous polio, but there is very limited knowledge how it influences daily life. Objective To assess muscle weakness and self-perceived disability of the upper limbs in persons with late effects of polio and evaluate their association. Design Cross-sectional study. Settings University hospital outpatient clinic. Participants Twenty-eight persons (mean age 67, SD 16 years) with late effects of polio in their upper limbs. Main Outcome Measures A fixed dynamometer (Biodex System 3 PRO dynamometer (Biodex Medical Systems Inc, Shirley, NY) was used to measure isometric shoulder abduction and elbow flexion, as well as isokinetic concentric elbow flexion and extension. A hand-held dynamometer (Grippit, Hagersten, Sweden) was used to measure isometric grip strength. The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire was used to assess self-perceived disability of the upper limbs. The relationships between the measures were analyzed with the Spearman rank correlation coefficients (rho). Results The participants were 20%-31% weaker in their more-affected upper limb compared with their less-affected limb. The DASH score was on average 33.5 (SD 18.6), indicating a mild-to-moderate disability of their upper limbs. Changing a lightbulb overhead, carrying a heavy object, and performing recreational activities that required muscle force with the arms were perceived as most difficult. The correlations (rho) between the muscle strength measurements and DASH scores ranged from −0.46 (95% confidence interval [95% CI] −0.10 to −0.71) to −0.61 (95% CI −0.31 to −0.80) for the more affected upper limb, and from −0.54 (95% CI −0.21 to −0.76) to −0.68 (95% CI −0.41 to −0.84) for the less affected upper limb ( P Conclusions Persons with previous polio and muscle weakness in their upper limbs perceive difficulties to use their arms in daily life, especially when performing activities above their head and strenuous household or leisure activities. The fair-to-moderate correlations of muscle strength with self-perceived disability imply that the weakness can only partially explain the perceived disabilities of arm, shoulder and hand. Other factors are therefore important to consider in the rehabilitation of persons with late effects of polio and upper limb disability.

BACKGROUND: Reduced gait performance is common in persons with late effects of polio. OBJECTIVE: To identify predictors of change in gait performance over four years in persons with late effects of polio. METHODS: Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed "Up & Go" (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength. RESULTS: There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; p

Background: Falls and fear of falling (FOF) are common in persons with late effects of polio, but there is limited knowledge of associated factors. Objective: To determine how knee muscle strength, dynamic balance, and gait performance (adjusted for gender, age, and body mass index) are associated with falls and FOF in persons with late effects of polio. Design: A cross-sectional study. Setting: A university hospital outpatient clinic. Participants: Eighty-one ambulatory persons with verified late effects of polio (43 men; mean age 67 years). Main Outcome Measurements: Number of falls the past year, Falls Efficacy Scale-International to assess FOF, a Biodex dynamometer to measure knee muscle strength, the Timed Up & Go test to assess dynamic balance, and the 6-Minute Walk test to assess gait performance. Univariate and multivariate logistic regression analyses were used for falls (categorical data) and linear regression analyses for FOF (continuous data) as dependent variables. Results: Fifty-nine percent reported at least 1 fall during the past year, and 79% experienced FOF. Reduced knee muscle strength in the more affected limb and gait performance were determinants of falls. An increase of 10 Nm in knee flexor and knee extensor strength reduced the odds ratio between 0.70 and 0.83 (. P = .01), and an increase of 100 m in 6-Minute Walk test reduced the odds ratio to 0.41 (. P = .001). All factors were determinants of FOF; reduced knee muscle strength in the more and less affected limbs explained 17%-25% of the variance in FOF, dynamic balance 30%, and gait performance 41%. Gender, age, and body mass index only marginally influenced the results. Conclusions: Reduced gait performance, knee muscle strength, and dynamic balance are to a varying degree determinants of falls and FOF in ambulatory persons with late effects of polio. Future studies need to evaluate whether rehabilitation programs targeting these factors can reduce falls and FOF in this population.

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.

Objective To assess self-reported walking ability in individuals with chronic stroke and to determine the relationship with gait performance tests. Design Descriptive analysis of a convenience sample. Setting A university hospital rehabilitation medicine clinic. Participants Fifty ambulatory community-dwelling poststroke individuals (mean age, 64 years [range, 44-74 years] and mean time since stroke onset 42 months [range, 6-101 months]). Main Outcome Measures The Walking Impact Scale (the Walk-12) to assess self-reported walking ability, and the Timed "Up & Go" test, 10-m Comfortable Gait Speed and Fast Gait Speed tests, and 6-Minute Walk Test to assess gait performance. Results A majority of the participants (94%) reported limitations in their walking ability. The most common limitations were related to standing or walking, walking speed and distance, effort, and gait quality aspects. The ability to run was reported as most affected, whereas the need for support indoors or outdoors was least affected. Significant correlations ( P Conclusions Persons with chronic stroke perceive limitations in their walking ability. The relationship between the Walk-12 and the 4 gait performance tests indicates that self-reports and quantitative assessments are associated. Because the Walk-12 reflects broader dimensions than the gait performance tests, it can be a complementary tool when walking ability in persons with chronic stroke is evaluated.

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)

OBJECTIVE: To evaluate the effects of whole-body vibration (WBV) training in individuals after stroke. DESIGN: A double-blind randomized controlled study with assessments pre- and posttraining. SETTING: A university hospital rehabilitation department. PARTICIPANTS: Participants (N=31; mean age ± SD, 62±7y; 6-101mo poststroke) were randomized to an intervention group or a control group. INTERVENTIONS: Supervised WBV training (2 sessions/wk for 6wk; 12 repetitions of 40-60s WBV per session). The intervention group trained on a vibrating platform with a conventional amplitude (3.75mm) and the control group on a "placebo" vibrating platform (0.2mm amplitude); the frequency was 25Hz on both platforms. All participants and examiners were blinded to the amplitudes of the 2 platforms. MAIN OUTCOME MEASURES: Primary outcome measures were isokinetic and isometric knee muscle strength (dynamometer). Secondary outcome measures were balance (Berg Balance Scale), muscle tone (Modified Ashworth Scale), gait performance (Timed Up & Go, comfortable gait speed, fast gait speed, and six-minute walk tests), and perceived participation (Stroke Impact Scale). RESULTS: There were no significant differences between the 2 groups after the WBV training. Significant but small improvements (P CONCLUSIONS: Six weeks of WBV training on a vibration platform with conventional amplitude was not more efficient than a placebo vibrating platform. Therefore, the use of WBV training in individuals with chronic stroke and mild to moderate disability is not supported.

The aim of this study was to assess the reproducibility of isokinetic and isometric ankle dorsiflexor strength measurements in individuals with post-polio syndrome (PPS). Thirty-one men and women (mean age 63 +/- 7.0 years) with verified PPS, participated in an intra-rater test-retest reproducibility study. Strength of the ankle dorsiflexor muscles in both lower limbs were measured twice, seven days apart, with a Biodex dynamometer (isokinetic concentric; 30 degrees/s and isometric; ankle plantar flexion angle 10 degrees). Reproducibility was evaluated with the intraclass correlation coefficient (ICC2,1), the mean difference between the test sessions ((d) over bar) and the 95% confidence intervals for (d) over bar, the standard error of measurement (SEM, 95% SEM and SEM%) and Bland & Altman graphs. All 31 individuals completed the measurements in the less affected lower limb, but only 14 in the more affected lower limb due to severe weakness and/or joint stiffness. The analysis was therefore based on data from the two lower limbs separately. The test-retest agreements were high, (ICC2,1 0.85 to 0.94) and measurement errors generally small, and there was no discernible difference between the less and more affected lower limbs. The mean isokinetic and isometric peak torque (Nm) for the two lower limbs from the two test sessions ranged from 22.7 to 25.8. The SEM, which represents the limit for the smallest change that indicates a real change for a group of individuals, ranged from 2.51 to 3.74 Nm. In conclusion, isokinetic and isometric muscle strength measurements of the ankle dorsiflexor muscles in individuals with PPS are reproducible and can be used to detect changes over time or after an intervention for groups of individuals. (Less)

Objective: An inability of the nervous system to fully activate the muscle is one factor that can contribute to age-related muscle weakness. Superimposed electrical stimulation can be used to determine voluntary muscle activation (VA). The aim of this study was to assess VA of the quadriceps muscle in healthy older and younger subjects. Design: Electrical stimulation causes moderate discomfort in younger subjects, but no study has assessed discomfort in older subjects. The quadriceps muscle In 20 moderately active older subjects (mean age, 75 yrs) and 12 younger subjects (mean age, 25 yrs) was stimulated during two maximal voluntary contractions using a 100-Hz pulse train. A visual analog scale for pain (VAS-pain) was used to evaluate discomfort. Results: Ability to activate the quadriceps muscle was generally very high, and there was no significant difference between the older (mean, 0.96) and younger (mean, 0.98) subjects. Discomfort did not differ between the older (mean VAS-pain score, 41 mm) and younger (mean VAS-pain score, 37 mm) subjects. Conclusions: Our results indicate that healthy, moderately active older subjects have the ability to almost complete VA of the quadriceps muscle and that discomfort during electrical stimulation is generally moderate. (Less)

The purpose of this study was to determine the association between physical activity and self-reported disability in ambulatory persons with mild to moderate late effects of polio (N = 81, mean age 67 years). The outcome measures were: Physical Activity and Disability Survey (PADS), a pedometer, Self-Reported Impairments in Persons with Late Effects of Polio Scale (SIPP), Walking Impact Scale (Walk-12), Falls Efficacy Scale-International (FES-I), and self-reported incidence of falls. The participants were physically active on average 158 min per day and walked 6,212 steps daily. Significant associations were found between PADS and Walk-12 (r = −.31, p < .001), and between the number of steps and SIPP, Walk-12, and FES-I (r = −.22 to −.32, p < .05). Walk-12 and age explained 14% of the variance in PADS and FES-I explained 9% of the variance in number of steps per day. Thus, physical activity was only weakly to moderately associated with self-reported disability.

In persons with prior paralytic poliomyelitis, progressive muscle weakness can occur after a stable period of at least 15 years. Knowledge is limited about which factors influence changes in lower limb muscle strength in these persons. Objective. To assess changes in lower limb muscle strength annually over 4 years in persons with late effects of polio and to identify prognostic factors for changes in muscle strength. A prospective, longitudinal study. University hospital outpatient program. Fifty-two ambulant persons (mean age ± standard deviation: 64 ± 6 years) with verified late effects of polio. Mixed linear models were used to analyze changes in muscle strength and to identify determinants among the following covariates: gender, age, age at acute polio infection, time with late effects of polio, body mass index, and estimated baseline muscle weakness. Knee extensor and flexor and ankle dorsiflexor muscle strength were measured annually with a Biodex dynamometer. The men (n = 28) had significant linear change over time for all knee muscle strength measurements, from −1.4% (P < .05) per year for isokinetic knee flexion in the less-affected lower limb to −4.2% (P < .001) for isokinetic knee extension in the more-affected lower limb, and for 2 ankle dorsiflexor muscle strength measurements (−3.3%-1.4% per year [P < .05]). The women (n = 24) had a significant linear change over time only for ankle dorsiflexor measurements (4.0%-5.5% per year [P < .01]). Gender was the strongest factor that predicted a change in muscle strength over time.Over 4 years, men had a greater decline in muscle strength than did women, but the rate of decline did not accelerate. This finding indicates that gender could be a contributing factor to the progressive decline in muscle strength in persons with late effects of polio.

Background Muscle weakness in the upper limb is common in persons with late effects of polio. To be able to measure muscle strength and follow changes over time, reliable measurements are needed. Objective To evaluate the intra-rater reliability of isometric and isokinetic arm and hand muscle strength measurements in persons with late effects of polio. Design A test-retest design. Settings A university hospital outpatient clinic. Participants Twenty-eight persons (mean age 68 years, SD 11 years) with late effects of polio in their upper limbs. Methods Isometric shoulder abduction, isokinetic concentric elbow flexion and extension, isometric elbow flexion, and isometric grip strength were measured twice, 14 days apart. Reliability was evaluated with the intra-class correlation coefficient, the mean difference between the test sessions ( d ¯ ), together with the 95% confidence intervals for d ¯ , the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%), and Bland-Altman graphs. Main Outcome Measurements A fixed dynamometer (Biodex) was used to measure arm strength and an electronic dynamometer (GRIP-it) was used to measure grip strength. Results Intra-rater reliability was high, with intra-class correlation coefficients between 0.87 and 0.98. The SEM%, representing the smallest change for a group of persons, ranged from 7%-24% for all strength measurements, and the SRD%, representing the smallest change for an individual person, ranged from 20%-67%. Conclusion Muscle strength in the upper limbs can be reliably measured in persons with late effects of polio. However, the measurement errors indicate that the method is more suitable to detect changes in muscle strength for a group of persons than for an individual person.

Background: The healthcare sector needs to deliver evidence-based care and be cost-effective. This can be monitored in part via a national quality registry containing individualized data concerning patient problems, medical interventions, outcomes of treatment, and patient-reported outcomes. With this aim, Web Rehab Sweden was launched in 1997 and has been available online since 2007. The aim of this paper is to discuss the design, some results, and possible use of such a registry. Methods: Data entered into the registry online since 2007 were used in this paper. The registry contains information from 7,458 patients. Data from the first 3 years were used to show differences between genders and among diagnostic groups. Non-parametric statistics were used to analyse the differences between groups. Results: The registry coverage of the country is 95%, and completeness is 81%. Data from hospitals/units have been accessible to the general public since 2009, but no data from individuals can be accessed. Length of stay has varied over the years, becoming significantly shorter between 2007 and 2012. Conclusion: A quality registry presents an opportunity to improve rehabilitation processes at participating units, provides data for use in benchmarking between units, and enables hospital management to utilize resources wisely. (Less)

To examine the relationship between physical activity (assessed subjectively and objectively), knee muscle strength, gait performance, age, gender, and body mass index (BMI) in persons with late effects of polio.Cross-sectional.A university hospital outpatient clinic.Seventy-seven community-dwelling ambulant persons with late effects of polio (42 men and 35 women; mean age 67 years [standard deviation 6, range 54-80]).Physical activity was described by the Physical Activity and Disability Survey and by a pedometer (number of steps/day). Isokinetic concentric knee extensor and flexor muscle strength was measured at 60°/s. Gait performance was assessed by the Timed "Up and Go" test, the Comfortable Gait Speed and Fast Gait Speed tests, and the 6-Minute Walk test.The Physical Activity and Disability Survey leisure subscale was significantly correlated with all knee muscle strength measurements (P.01), the Comfortable Gait Speed test (P.05), and the 6-Minute Walk test (P.05), and the number of steps per day was significantly correlated with all knee muscle strength measurements and all gait performance tests (P.01). In the linear regression analyses, knee muscle strength and gait performance explained 1% to 8% of the variance in the leisure subscale, and when the personal attributes (age, gender, and BMI) were added, they explained up to 14% of the variance. Knee muscle strength explained 16% and gait performance explained 15% to 31% of the variance in the number of steps per day, and when personal attributes (age, gender, and BMI) were added, they contributed at most an additional 3% of the variance.In ambulatory persons with late effects of polio, knee muscle strength and gait performance explain only a small portion of physical activity. Further studies are needed to increase our understanding of how other impairments, activity limitations, environmental factors, and personal factors are associated with physical activity in persons with late effects of polio.

To promote a healthy and active lifestyle there is a need to increase our knowledge of the level of physical activity (PA) among people with late effects of polio.To examine PA in people with late effects of polio and to assess the relationship between PA, life satisfaction and various sociodemographic factors.PA was assessed in 81 persons with late effects of polio using the Physical Activity and Disability Survey (PADS) and by a pedometer. Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11).The amount of PA varied considerably but on average the participants were physically active almost 3 h per day, mostly in household activities. The mean value of the pedometer counts was 6212 steps per day (SD = 3208). Sixty-nine percent of the participants rated themselves as satisfied with life as a whole. The sum of PADS was positively and significantly related to the number of steps (r = 0.39, p 0.001), increasing age (r = 0.26, p 0.05) and to the level of global satisfaction with life (rho = 0.23, p 0.05). The number of steps was also positively and significantly associated with level of global satisfaction with life (rho = 0.37, p 0.001).Despite a progressive physical disability, people with late effects of polio are physically active, but much of the activities are performed as part of their household activities and not as traditional exercise. The relationship between PA, life satisfaction and age further supports the general contention that an active lifestyle is an important factor for perceived well-being among older people.

Purpose: To assess self-perceived performance and satisfaction with performance of daily activities in persons with multiple sclerosis (MS) on admission to and at discharge from interdisciplinary rehabilitation. Method: A retrospective study with a pre-post design. Twenty-seven women and 16 men with MS (mean age 51 years; median EDSS 6.5) participated in an individualised, goal-oriented, interdisciplinary, rehabilitation programme (average length 4 weeks). The Canadian Occupational Performance Measure (COPM) was used on admission to rehabilitation and at discharge. Results: On admission, the persons prioritised 216 activities that they perceived difficult to perform (mean number 3, range 2-8). Of these, 136 (63%) were in the COPM area of self-care, 52 (24%) in productivity and 28 (13%) in leisure. The lowest mean ratings of performance were found in the subgroups active recreation, community management and socialisation, and for satisfaction in the subgroup socialisation. For about 60% of the 216 prioritised activities, ratings of COPM performance as well as satisfaction were higher at discharge than on admission. For 18 (42%) and 24 (56%) persons, respectively, the mean change scores of performance and of satisfaction were equal to or greater than 2.0 at discharge, indicating a clinically significant change. Conclusions: Persons with MS can experience problems with all types of daily activities upon admission to rehabilitation, but also perceive improvements in their performance and satisfaction with performance in these activities at discharge from rehabilitation. Using patient-reported outcome measures, such as the COPM, may contribute to a broader understanding of the benefits of interdisciplinary rehabilitation in persons with MS. Implications for Rehabilitation Persons with MS can perceive problems with all types of daily activities which have to be considered during interdisciplinary rehabilitation. Following interdisciplinary rehabilitation, persons with MS can perceive improvements in their performance and satisfaction with performance in all types of daily activities. Patient-reported outcome measures can contribute to a broader understanding of the benefits of interdisciplinary rehabilitation in persons with MS.

To assess muscle strength in the knee extensors, knee flexors and ankle dorsiflexors in persons with late effects of polio, and determine how much muscle strength, gender, age and BMI are related to gait performance.Ninety community-dwelling ambulant persons (47 men and 43 women; mean age 64 years SD 8) with late effects of polio participated. Isokinetic concentric knee extensor and flexor muscle strength was measured at 60°/s and ankle dorsiflexor muscle strength at 30°/s. Gait performance was assessed by the Timed "UpGo", the Comfortable and Fast Gait Speed tests, and the 6-Minute Walk test.There were significant correlations between knee extensor and flexor muscle strength and gait performance (p0.01), and between ankle dorsiflexor muscle strength and gait performance (p0.05), for both lower limbs. Muscle strength in the knee extensors and flexors explained 7% to 37% and 9% to 47%, respectively, of the variance in gait performance. Strength in the ankle dorsiflexors explained 4% to 24%, whereas gender, age and BMI contributed at most an additional 9%.Knee muscle strength, and to some extent ankle dorsiflexor muscle strength, are predictors of gait performance in persons with late effects of polio, but the strength of the relationships indicates that other factors are also important.

Muscle weakness in the lower limbs and impeded gait performance are common in persons with late effects of polio.To assess self-reported walking ability in persons with late effects of polio and determine the relationship with objectively assessed gait performance.One-hundred and twenty-two individuals with prior polio (65 women and 57 men, mean age 65 [SD ± 9] years) participated in the study. The main outcome measures were: Walk-12 (Swedish version) to assess self-reported walking ability, and Timed "UpGo", Comfortable Gait Speed, Fast Gait Speed and 6-Minute Walk Tests to assess gait performance objectively.More than 50% of the participants reported limitations (moderately or quite a bit) related to standing or walking, climbing stairs, walking speed and distance, concentration and effort, and gait quality aspects. Half of the participants reported no need to use support when walking indoors or outdoors, but 58% reported that their ability to run was extremely limited. Significant correlations (P0.01) were found between the Walk-12 and the four gait performance tests (rho -0.66 to 0.63).The strength of the relationship implies that Walk-12 reflects broader dimensions than the objective gait performance tests and can be a complement when the walking ability in persons with late effects of polio is evaluated.

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.

OBJECTIVE: 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. DESIGN: An intra-rater test-retest reproducibility study. The BBS and the SLS were assessed twice, 7 days apart. SETTING: A university hospital. PARTICIPANTS: Fifty individuals; 6-46 months after a stroke. MAIN OUTCOME MEASUREMENTS: The reproducibility of the BBS and the SLS was evaluated with intraclass correlation coefficient (ICC(2,1)), the mean difference between the 2 test sessions (d̄) with 95% confidence interval (95% CI), the standard error of measurement (standard error of measurement [SEM]%), the smallest real difference (SRD%), and the Bland-Altman graphs. To assess validity of SLS, the relationship between the SLS and the BBS was analyzed by the Pearson correlation coefficient. RESULTS: The ICC(2,1) was 0.88 for the BBS, and the ICC(2,1) values were 0.88 for the nonparetic limb and 0.92 for the paretic lower limb for the SLS. The smallest change that indicates a real improvement for a group of individuals, SEM%, was 3% for BBS, 15% for the nonparetic limb and 27% for the paretic limb for SLS. The smallest real difference for a single individual was 8% for BBS but was higher for SLS, at 42% for the nonparetic limb, and 74% for the paretic limb. There was a significant relationship between the SLS and the BBS (r = 0.65-0.79; P < .001). CONCLUSIONS: The BBS and the SLS are reproducible measurements in patients with chronic stroke, but only the BBS is sensitive enough to follow changes over time or after an intervention. The SLS is strongly related to the BBS and can be used as an independent test to measure upright postural control after a stroke.

Brogårdh C, Flansbjer U-B, Lexell J. No effects of whole-body vibration training on muscle strength and gait performance in people 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.

OBJECTIVE: To assess the reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio. DESIGN: A test-retest reliability study. SUBJECTS: Thirty men and women (mean age 63 (standard deviation 6.4) years) with verified late effects of polio. METHODS: Knee extensor and flexor muscle strength in both lower limbs were measured twice 7 days apart using a Biodex dynamometer (isokinetic concentric contractions at 60 degrees /sec and isometric contractions with knee flexion angle 90 degrees) and a Leg Extension/Curl Rehab exercise machine with pneumatic resistance (HUR) (isotonic contractions). Reliability was assessed with the intraclass correlation coefficient (ICC1,1), the mean difference between the test sessions (d) together with the 95% confidence intervals for d, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and Bland-Altman graphs. RESULTS: Test-retest agreements were high, (ICC1,1 0.93-0.99) and measurement errors generally small. The SEM% was 4-14% and the SRD% 11-39%, with the highest values for the isokinetic measurements. CONCLUSION: Knee muscle strength can be measured reliably and can be used to detect real changes after an intervention for a group of persons with late effects of polio, whereas the values may be too high for single individuals or to detect smaller short-term changes over time for a group of individuals. (Less)

OBJECTIVE: To assess the reliability of 4 gait performance tests in individuals with late effects of polio. DESIGN: An intrarater (between occasions) test-retest reliability study. SETTINGS: University hospital. PARTICIPANTS: Thirty men and women (mean age 63 +/- 6.4 years) with clinically and electrophysiologically verified late effects of polio. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The Timed "Up & Go" test, the Comfortable and the Fast Gait Speed tests, and the 6-Minute Walk test were assessed 7 days apart. Reliability was evaluated with the intraclass correlation coefficient (ICC(2,1)), the mean difference between the test sessions (d), and the 95% confidence intervals for d, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and the Bland & Altman graphs. RESULTS: Test-retest agreements were high (ICC(2,1) 0.82-0.97) and measurement errors generally small. The standard error of measurement (SEM%), representing the smallest change that indicates a real (clinical) improvement for a group of individuals, was small (4%-7%). The smallest real difference (SRD%), representing the smallest change that indicates a real (clinical) improvement for a single individual also was small (12%-21%). CONCLUSION: These commonly used gait performance tests are highly reliable and can be recommended to evaluate improvements in various aspects of gait performance in groups of individuals as well as single individuals with late effects of polio.

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 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.

OBJECTIVE: To evaluate the effects of progressive resistance training on muscle strength, muscle tone, gait performance and perceived participation after stroke. DESIGN: A randomized controlled trial. SUBJECTS: Twenty-four subjects (mean age 61 years (standard deviation 5)) 6-48 months post-stroke. METHODS: The training group (n = 15) participated in supervised progressive resistance training of the knee muscles (80% of maximum) twice weekly for 10 weeks, and the control group (n = 9) continued their usual daily activities. Both groups were assessed before and after the intervention and at follow-up after 5 months. Muscle strength was evaluated dynamically and isokinetically (60 degrees /sec) and muscle tone by the Modified Ashworth Scale. Gait performance was evaluated by Timed "Up & Go", Fast Gait Speed and 6-Minute Walk tests, and perceived participation by Stroke Impact Scale. RESULTS: Muscle strength increased significantly after progressive resistance training with no increase in muscle tone and improvements were maintained at follow-up. Both groups improved in gait performance, but at follow-up only Timed "Up & Go" and perceived participation were significantly better for the training group. CONCLUSIONS: Progressive resistance training is an effective intervention to improve muscle strength in chronic stroke. There appear to be long-term benefits, but further studies are needed to clarify the effects, specifically of progressive resistance training on gait performance and participation. (Less)

To assess the relation between knee muscle strength, gait performance, and perceived participation in subjects with chronic mild to moderate poststroke hemiparesis.Descriptive analysis of convenience sample.University hospital.Fifty men and women (mean age, 58+/-6.4y) 6 to 46 months poststroke.Not applicable.Isokinetic concentric knee extension and flexion strength was measured at 60 degrees /s. Gait performance was assessed by Timed UpGo, comfortable and fast gait speed, stair climbing ascend and descend, and 6-minute walk test. Perceived participation was assessed with the Stroke Impact Scale.There was a significant correlation (P.01) between knee muscle strength and gait performance for the paretic but not for the nonparetic lower limb. Strength for the paretic limb explained 34% to 50% of the variance in gait performance; the addition of strength for the nonparetic limb explained at most a further 11% of the variance in gait performance. There was a significant correlation (P.01) between gait performance and perceived participation; gait performance explained 28% to 40% of the variance in perceived participation.Knee muscle strength is a moderate to strong predictor of walking ability in individuals with chronic mild to moderate poststroke hemiparesis. Walking ability influences perceived participation, but the strengths of the relations indicate that other factors are also important.

Objective: To assess the reliability of 6 gait performance tests in individuals with chronic mild to moderate post-stroke hemiparesis. Design: An intra-rater (between occasions) test-retest reliability study. Subjects: Fifty men and women (mean age 58 6.4 years) 6–46 months post-stroke. Methods: The Timed “Up & Go” test, the Comfortable and the Fast Gait Speed tests, the Stair Climbing ascend and descend tests and the 6-Minute Walk test were assessed 7 days apart. Reliability was evaluated with the intraclass correlation coefficient (ICC 2,1), the Bland & Altman analysis, the standard error of measurement (SEM and SEM%) and the smallest real difference (SRD and SRD%). Results: Test-retest agreements were high (ICC2,1 0.94–0.99) with no discernible systematic differences between the tests. The standard error of measurement (SEM%), representing the smallest change that indicates a real (clinical) improvement for a group of individuals, was small (9%). The smallest real difference (SRD%), representing the smallest change that indicates a real (clinical) improvement for a single individual, was also small (13–23%). Conclusion: These commonly used gait performance tests are highly reliable and can be recommended to evaluate improvements in various aspects of gait performance in individuals with chronic mild to moderate hemiparesis after stroke.

Objective: To assess the intra-rater (between occasions) test-retest reliability of isokinetic knee muscle strength measurements in subjects with chronic poststroke hemiparesis and to define limits for the smallest change that indicates real (clinical) improvements for stroke patients. Subjects: Fifty men and women (mean age 589±6.4 years) 6=±46 months post stroke, able to walk at least 300 m with or without a unilateral assistive device. Methods: Maximal concentric knee extension and flexion contractions at 608/s and 1208/s, and maximal eccentric knee extension contractions at 608/s, with the paretic and nonparetic limbs, were performed seven days apart using a Biodex dynamometer. Measures: Reliability of the maximum peak torque measurements was evaluated with the intraclass correlation coefficient (ICC2,1), the Bland and Altman analyses, the standard error of measurement (SEM and SEM%) and the smallest real difference (SRD and SRD%). Results: Test retest agreements were high (ICC2,1 0.89-0.96) with no discernible systematic differences between limbs, angular velocities and modes. The SEM%, representing the smallest change that indicates a real (clinical) improvement for a group of subjects, was relatively small (8-20%). The SRD%, representing the smallest change that indicates a real improvement for a single subject ranged from 26% to 33% for concentric knee extension, from 39% to 55% for concentric knee flexion, and from 22% to 25% for eccentric knee extension. Conclusion: Isokinetic knee muscle strength can be reliably measured and used to detect real improvements following an intervention for single subjects as well as for groups of subjects with chronic mild to moderate hemiparesis after stroke.