Background and purpose: The leading hypothesis was that a relation exists between muscular strength and functional abilities. Therefore a study was undertaken to quantify such a relationship in a population of subjects with different muscular strengths. This population consisted of healthy subjects and subjects with slowly progressive neuromuscular disorders.
Methods: The study included 33 patients with myotonic dystrophy, 29 patients with Charcot–Marie–Tooth disease and 20 healthy subjects. Isokinetic and isometric knee torques were measured on an isokinetic dynamometer at various velocities. The following activities were timed: descending and ascending stairs, rising from a chair, rising from supine, walking at natural speed and walking at maximum speed.
Results: The population covered a wide range of the variables: whereas the healthy subjects performed best (i.e. had the highest knee torques and performed the activities most quickly), the myotonic dystrophy group included the subjects with the lowest knee torques. The natural logarithms (ln) of isokinetic extension torque at the highest velocity (120°/s) and those of the time taken to perform the described activities showed the highest levels of correlation. It was found that after correction for age and weight, 56% (walking at natural speed) to 73% (descending stairs) of the variance in the ln of the time taken could be attributed to the variance in the ln of the torques.
Conclusion and discussion: A strong relation between quadriceps strength and timed motor performances were demonstrated. The impact of strength reduction on time taken was most obvious in subjects with considerably decreased strength. Therefore, it is feasible to try to influence muscle strength in patients with relevant strength reduction in order to achieve better functional ability.
Get full access to this article
View all access options for this article.
References
1.
Berger RA, Henderson JM. Relationship of power to static and dynamic strength. Res Q1966; 37: 9–13.
2.
Allsop KG, Ziter F. Effectiveness of timed functional activities in Duchenne's muscular dystrophy. Phys Ther1980; 60: 584-584.
3.
Scott OM, Goddard C, Dubowitz V. Quantification of muscle function in children: a prospective study in Duchenne muscular dystrophy. Muscle Nerve1982; 5: 291–301.
4.
Cohen L, Morgan J, Babbs R, Karrison TG, Giacomoni M. Fast walking velocity in health and Duchenne muscular dystrophy: A Statistical Analysis. Arch Phys Med Rehabil1984; 65: 573–578.
5.
Goldfarb BJ, Simon SR. Gait patterns in patients with amyotrophic lateral sclerosis. Arch Phys Med Rehabil1984; 65: 61–65.
6.
Perry J, Mulroy SJ, Renwick SE. The relationships of lower extremity strength and gait parameters in patients with post-polio syndrome. Arch Phys Med Rehabil1993; 74: 165–169.
7.
Hamrin E, Eklund G, Hillgren A-K, Borges O, Hall J, Hellström O. Muscle strength and balance in poststroke patients. Uppsala J Med Sci1982; 87: 11–26.
8.
Nakamura R, Hosokawa T, Tsuji I. Relationship of muscle strength for knee extension to walking capacity in patients with spastic hemiparesis. Tohoku J Exp Med1985; 145: 335–340.
9.
Bohannon RW. Strength of lower limb related to gait velocity and cadence in stroke patients. Physiother Can1986; 38: 204–206.
10.
Lankhorst GJ, Stadt van de RJ, Korst van der JK, Hinlopen-Bonrath E, Griffioen FMM, Boer de W. Relationship of isometric knee extension torque and functional variables in osteoarthrosis of the knee. Scand J Rehabil Med1982; 14: 7–10.
11.
Lankhorst GJ, Stadt van de RJ, Korst van der JK. The relationships of functional capacity, pain, and isometric and isokinetic torque in osteoarthrosis of the knee. Scand J Rehabil Med1985; 17: 167–172.
12.
Danneskiold-Samsøe B, Grimby G. The relationship between the leg muscle strength and physical capacity in patients with rheumatoid arthritis, with reference to the influence of corticosteroids. Clin Rheumatol1986; 5: 468–474.
13.
Moffet H, Richards CL, Malouin F, Bravo G. Impact of knee extensor strength deficits on stair ascent performance in patients after medial meniscectomy. Scand J Rehabil Med1993; 25: 63–71.
14.
Salsich GB, Mueller MJ. Relationships between measures of function, strength and walking speed in patients with diabetes and transmetatarsal amputation. Clin Rehabil1997; 11: 60–67.
15.
McFadyen BJ, Winter DA. An integrated biomechanical analysis of normal stair ascent and descent. J Biomech1988; 21: 733–744.
16.
Ellis MI, Seedhom BB, Amis AA, Dowson D, Wright V. Forces in the knee joint whilst rising from normal and motorized chairs. Eng Med1979; 8: 33–40.
17.
Kotake T, Dohi N, Kajiwara T, Sumi N, Koyama Y, Miura T. An analysis of sit-to-stand movements. Arch Phys Med Rehabil1993; 74: 1095–1099.
18.
Versteegden EEF, Terpstra-Lindeman E, Adam JJ. Relationships between impairment and disability in patients with neuromuscular disease. J Rehabil Sci1989; 2: 72–75.
19.
Aniansson A, Rundgren A, Sperling L. Evaluation of functional capacity in activities of daily living in 70-year-old men and women. Scand J Rehabil Med1980; 12: 145–154.
20.
Woollacott MH, Shumway-Cook A. Changes in posture control across the life span. A systems approach. Phys Ther1990; 70: 799–807.
21.
VanSant AF. Life-span development in functional tasks. Phys Ther1990; 70: 788–789.
22.
Ikeda ER, Schenkman ML, Riley PO, Hodge WA. Influence of age on dynamics of rising from a chair. Phys Ther1991; 71: 473–481.
23.
Florence JM, Pandya S, King WM et al. Clinical trials in Duchenne dystrophy. Standardization and reliability of evaluation procedures. Phys Ther1984; 64: 41–45.
24.
Griggs RC, Pandya MS, Florence JM et al. Randomized controlled trial of testosterone in myotonic dystrophy. Neurology1989; 39: 219–222.
25.
Barr AE, Diamond BE, Wade CK et al. Reliability of testing measures in Duchenne or Becker muscular dystrophy. Arch Phys Med Rehabil1991; 72: 315–319.
Emery AEH. Population frequencies of inherited neuromuscular diseases – a world survey. Neuromusc Disorders1991; 1: 19–29.
28.
Lindeman E, Leffers P, Spaans F et al. Strength training in patients with myotonic dystrophy and hereditary motor and sensory neuropathy: a randomized clinical trial. Arch Phys Med Rehabil1995; 76: 612–620.
29.
Goslin BR, Charteris J. Isokinetic dynamometry: normative data for clinical use in lower extremity (knee) cases. Scand J Rehabil Med1979; 11: 105–109.
30.
Johnson J, Siegel D. Reliability of an isokinetic movement of the knee extensor. Res Q1987; 49: 88–89.
31.
Harper PS. Metabolic aspects of myotonic dystrophy. Myotonic dystrophy, second edition. Major Problems in Neurology1989; 21: 271–292.
32.
Mathieu J, Braekeleer de M, Prévost C, Boily C. Myotonic dystrophy: Clinical assessment of muscular disability in an isolated population with presumed homogeneous mutation. Neurology1992; 42: 203–208.
33.
Dyck PJ, Chance P, Lebo R, Carney JA. Hereditary motor and sensory neuropathies. In: Dyck PJ, Thomas PK, Griffin JW, Low PA, Poduslo JF eds. Peripheral neuropathy, Volume 57, third edition. Philadelphia: WB Saunders, 1993: 1094–1136.
34.
Roebroeck ME, Harlaar J, de Kreek JA. The development of valid function tests: a biomechanical approach. Ned T Fysioth1989; 99: 187–190.
35.
Allsop KG, Ziter FA. Loss of strength and functional decline in Duchenne's dystrophy. Arch Neurol1981; 38: 406–411.
36.
Vignos PJ. Physical models of rehabilitation in neuromuscular disease. Muscle Nerve1983; 6: 323–338.
37.
Griffiths RD. Controlling weight in muscle disease to reduce the burden. Physiotherapy1989; 75: 190–192.
38.
Johnson ER, Fowler WM Jr, Lieberman JS. Contractures in neuromuscular disease. Arch Phys Med Rehabil1992; 73: 807–810.
39.
Geurts ACH, Mulder TW, Nienhuis B, Mars P, Rijken RAJ. Postural organization in patients with hereditary motor and sensory neuropathy. Arch Phys Med Rehabil1992; 73: 569–572.
40.
Franzese A, Antonini G, Iannelli M et al. Intellectual functions and personality in subjects with noncongenital myotonic muscular dystrophy. Psychol Rep1991; 68: 723–732.
