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      The Comparison between Isokinetic Knee Muscles Strength in the Ipsilateral and Contralateral Limbs and Correlating with Function of Patients with Stroke

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          Abstract

          Objective The aim of this study is to compare the isokinetic knee muscles peak torque measurements and proprioception between the affected and intact limbs of patients with stroke, in addition to finding the correlation between knee muscles strength and lower limb function.

          Methods Twelve patients with stroke (mean age 64.33 ± 6.140 years), with 3 to 7 months poststroke who can walk 25 feet independently without using or using assistive devices and full passive range of motion were included in the study. Biodex isokinetic dynamometer was used for measuring isokinetic strength at 90°/s, 120°/s, and 150°/s and isometric strength at 60°/s in both flexors and extensors of the knee, whereas proprioception was measured at 45°/s knee flexion, all for affected and intact limbs. Functional measurements were assessed using the Fugl-Meyer Assessment for Lower Limb scale and Barthel Index (BI).

          Results The differences shown were found to be statistically significant between affected and intact limbs in isokinetic 90°/s flexion ( p = 0.005), extension ( p = 0.0013), and isometric at 60°/s flexion ( p < 0.0001) knee muscle strengths and also the proprioception ( p = 0.05). Significant positive correlation was found between isokinetic affected side knee flexion at 90°/s ( r = 0.903) with BI ( r = 0.704).

          Conclusion There is a significant difference in peak torque measurements between affected and normal lower limbs of poststroke patients, as well as a significant correlation between the knee strength and lower limb functions. Furthermore, it can also be concluded that the differences in knee proprioception between the affected and intact limbs were shown to be significant.

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          Most cited references22

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          Skeletal muscle changes following stroke: a systematic review and comparison to healthy individuals.

          Despite extensive study of the impact of stroke on muscle and functional performance, questions remain regarding the extent to which changes are due to the neurological injury vs. age-related loss of morphology and force production.
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            Quadriceps muscle weakness following acute hemiplegic stroke.

            To determine whether quadriceps muscle weakness develops on the side ipsilateral to the brain lesion in the first week following acute ischaemic hemiplegic stroke. A prospective study of muscle strength. Acute stroke unit (ASU) in a teaching hospital. Ten patients admitted within 48 hours of stroke onset, and 10 healthy age-matched controls. Repeat nonvolitional measurements of quadriceps muscle strength of the unaffected limb in patients and the right leg in normal subjects using magnetic femoral nerve stimulation (MS), prospectively one week apart. In addition the level of voluntary activation was assessed during a maximum voluntary contraction (MVC) manoeuvre. The Trunk Control Test (TCT) was measured in the patients. The median (95% confidence interval, (CI)) baseline quadriceps twitch tension (Tw Q) and MVC in the control group were 9.4 kg (6.1-12.5 kg) and 37.2 kg (23.8-54.6 kg), and in the stroke group were 7.6 kg (4.4-9.9 kg) and 12.15 kg (7.9-30.8 kg). The median (95% CI) change in Tw Q and MVC respectively between baseline and one week later were 1.75% (-9.8 to 8%) and 5.45% (-15.1 to 22.7%) (NS) in the control group and -16.2% (-6 to -25.9%) and -30.45% (0 to -78.6%) (p < 0.01) in the stroke patients. There was a significant correlation between the percentage fall in Tw Q and both change in TCT (rs = 0.83, p < 0.01) and percentage change in body weight (rs = 0.83, p < 0.01). In the first week after acute hemiplegic stroke, weakness develops in the unaffected leg.
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              Voluntary activation failure contributes more to plantar flexor weakness than antagonist coactivation and muscle atrophy in chronic stroke survivors.

              The contributions of nervous system muscle activation and muscle atrophy to poststroke weakness have not been evaluated together in the same subject. Maximal voluntary contraction (MVC) torque, voluntary activation (twitch interpolation), and electromyographic (EMG) amplitude were determined bilaterally in the plantar flexors of seven chronic stroke survivors (40-63 yr, 24-51 mo poststroke). Volumes of the plantar flexor muscles were determined bilaterally with magnetic resonance imaging (MRI). The mean (±SD) contralesional (paretic) MVC torque was less than one-half of the ipsilesional leg: 56.7 ± 57.4 vs. 147 ± 35.7 Nm (P = 0.006). Contralesional voluntary activation was only 48 ± 36.9%, but was near complete in the ipsilesional leg, 97 ± 1.9% (P = 0.01). The contralesional MVC EMG amplitude (normalized to the maximum M-wave peak-to-peak amplitude) of the gastrocnemii and soleus were 36.0 ± 28.5 and 36.0 ± 31.0% of the ipsilesional leg. Tibialis anterior (TA) EMG coactivation was not different between the contralesional (23.2 ± 24.0% of TA MVC EMG) and ipsilesional side (12.3 ± 5.7%) (P = 0.24). However, TA EMG coactivation was excessive (71%) in one subject and accounted for ~8% of her weakness based on the estimated antagonist torque. Relative (%ipsilesional leg) plantar flexor and gastrocnemii volumes were 88 ± 6% (P = 0.004) and 76 ± 15% (P = 0.01), respectively. Interlimb volume differences of the soleus, deep plantar flexors, and peronei were not significant. Preferred walking speed (0.83 ± 0.33 m/s) was related to the contralesional MVC torque (r(2) = 0.57, P = 0.05, N = 7), but the two subjects with the greatest weakness walked faster than three others. Our findings suggest that plantar flexor weakness in mobile chronic stroke survivors reflects mostly voluntary activation failure, with smaller contributions from antagonist activity and atrophy.
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                Author and article information

                Journal
                J Neurosci Rural Pract
                J Neurosci Rural Pract
                10.1055/s-00043281
                Journal of Neurosciences in Rural Practice
                Thieme Medical and Scientific Publishers (A-12, Second Floor, Sector -2, NOIDA -201301, India )
                0976-3147
                0976-3155
                October 2019
                24 October 2019
                : 10
                : 4
                : 683-689
                Affiliations
                [1 ]Department of Physical Therapy, Faculty of Medical Rehabilitation Science, King Abdulaziz University, Jeddah, Saudi Arabia
                [2 ]Department of Neurology, Government Medical College, Kottayam, Kerala, India
                Author notes
                Address for correspondence Haris Anjamparuthikal, MD, DM Department of Neurology, Government Medical College, Kottayam Kerala 686008india dr_aaharis@ 123456yahoo.com
                Article
                JNRP1800401
                10.1055/s-0039-1700612
                6906114
                31831990
                86ad4458-eaa3-4d8f-a304-94f820911858

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                Funding
                Funding None.
                Categories
                Case Series

                Neurosciences
                isokinetic knee muscle strength,lower limb function,proprioception,stroke
                Neurosciences
                isokinetic knee muscle strength, lower limb function, proprioception, stroke

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