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Respiratory Physiology & Neurobiology Jan 2022Critically ill mechanically ventilated (MV) patients develop significant muscle weakness, which has major clinical consequences. There remains uncertainty, however,...
Critically ill mechanically ventilated (MV) patients develop significant muscle weakness, which has major clinical consequences. There remains uncertainty, however, regarding the severity of leg weakness, the precise relationship between muscle strength and thickness, and the risk factors for weakness in MV patients. We therefore measured both diaphragm (PdiTw) and quadriceps (QuadTw) strength in MV patients using magnetic stimulation and compared strength to muscle thickness. Both PdiTw and QuadTw were profoundly reduced for MV patients, with PdiTw 19 % of normal and QuadTw 6% of normal values. There was a poor correlation between strength and thickness for both muscles, with thickness often remaining in the normal range when strength was severely reduced. Regression analysis revealed reductions in PdiTw correlated with presence of infection (p = 0.006) and age (p = 0.007). QuadTw best correlated with duration of MV (p = 0.036). Limb muscles are profoundly weak in critically ill patients, with a severity that mirrors the level of weakness observed in the diaphragm.
Topics: Age Factors; Critical Illness; Diaphragm; Humans; Intensive Care Units; Magnetic Fields; Muscle Weakness; Physical Stimulation; Quadriceps Muscle; Respiration, Artificial; Time Factors
PubMed: 34560292
DOI: 10.1016/j.resp.2021.103789 -
Critical Care Medicine Nov 2006Patients in the intensive care unit develop generalized weakness due to a number of factors. Neuromuscular weakness is a common cause of failure to wean from the... (Review)
Review
INTRODUCTION
Patients in the intensive care unit develop generalized weakness due to a number of factors. Neuromuscular weakness is a common cause of failure to wean from the ventilator and decreased limb movements. A rational approach to evaluation of weakness will help to identify most of the common causes of neuromuscular weakness in the intensive care unit.
AIMS
This review provides an analysis of neuromuscular weakness and a practical algorithm to assist in diagnostic evaluation.
CONCLUSIONS
The most common acquired causes of weakness in the critically ill patient in the intensive care unit are critical illness polyneuropathy and critical illness myopathy. In the intensive care unit setting, electrophysiological studies, biopsies, and imaging studies are often necessary to complement the clinical impression.
Topics: Algorithms; Critical Illness; Diagnosis, Differential; Humans; Intensive Care Units; Muscle Weakness; Neuromuscular Diseases
PubMed: 16932235
DOI: 10.1097/01.CCM.0000239436.63452.81 -
Journal of Postgraduate Medicine 2013
Topics: Diagnosis, Differential; Factitious Disorders; Humans; Lower Extremity; Muscle Weakness; Physical Examination; Reflex; Somatoform Disorders
PubMed: 24029200
DOI: 10.4103/0022-3859.118041 -
Revista de Neurologia Sep 2023Muscle weakness in persons with Parkinson disease (PD) has been frequently recognized as a nonspecific symptom. In other neurological conditions, lower limb weakness,...
INTRODUCTION
Muscle weakness in persons with Parkinson disease (PD) has been frequently recognized as a nonspecific symptom. In other neurological conditions, lower limb weakness, specifically quadriceps weakness, is the factor that causes greater gait disability. Little research has evaluated the relationship between lower limb muscle strength, using objective tools, in PD persons and gait performance. The aim of this study was to analyze the correlation between lower limb muscle strength, using an isokinetic dynamometer, and the spatiotemporal gait parameters in PD, compared with age- and sex- matched healthy controls.
SUBJECTS AND METHODS
The study was conducted with 7 persons with PD -Hoehn and Yahr (HY) between II-III- and 7 healthy controls. Isokinetic knee and ankle tests at 60 and 120°/s and the 10-meter walking test at comfortable and fast walking speed, were performed on all recruited subjects.
RESULTS
Significant differences in lower limb strength-related measures and gait parameters were observed between persons with PD and controls. Gait parameters showed excellent correlations (rho = 0.7) for both lower limb: ankle plantar flexion work/body wearing at 180°/s with number of steps (indirect) and stride (direct) at both speeds, and between the ankle plantar flexion peak torque/ body wearing at 180°/s with number of steps (indirect) and stride (direct) at maximum speed; and between knee extension work/body wearing at 60°/s) with stride (direct) at self-selected speed.
CONCLUSIONS
Persons with PD (HY II-III stages) lower limb muscle strength correlates excellently with gait pattern, showing lower isokinetic strength than healthy subjects of the same age and sex. This protocol showed safety to be performed in a larger sample.
Topics: Humans; Parkinson Disease; Pilot Projects; Gait; Muscle Strength; Lower Extremity; Muscle Weakness; Paresis
PubMed: 37612828
DOI: 10.33588/rn.7705.2023098 -
Physical Therapy Dec 2022To the best of the authors' knowledge, no data are available about the use of isokinetic resistance training for managing ankle plantarflexor spastic hypertonia in...
OBJECTIVE
To the best of the authors' knowledge, no data are available about the use of isokinetic resistance training for managing ankle plantarflexor spastic hypertonia in people with multiple sclerosis (MS). The aim of this proof-of-concept study was to explore the feasibility and effects of concentric contractions on spasticity-related resistance to passive motion, strength, and mobility in people with MS and ankle plantarflexor spasticity.
METHODS
In this pretest/posttest case series, 5 people with MS (mean age = 53.6 [SD = 8.8] years; median Expanded Disability Status Scale score = 5; Modified Ashworth Scale range = 1-4) received 6 weeks of isokinetic resistance training of the spastic plantarflexors. Before and after the intervention, the following outcomes were assessed: average peak torque during passive robotic mobilization, isometric strength, surface electromyography (sEMG) from the spastic muscles, time to complete the 10-m Walk Test, and the Timed "Up & Go" Test. The standardized effect size was used to test pretest and posttest effects at the individual level. Group-level analyses were also performed.
RESULTS
Following the training, the average peak torque recorded from the plantarflexors during passive motion at a velocity of 150 degrees per second was found to be decreased by at least 1 SD in all participants but 1, with a significant reduction at the group level of 23.8%. Conversely, no changes in sEMG activity were detected. Group-level analyses revealed that the maximal strength of the trained plantarflexors increased significantly (31.4%). Fast walking speed increased and time to complete the Timed "Up & Go" Test decreased in 4 participants, although not significantly at the group level.
CONCLUSION
Isokinetic resistance training proved safe and feasible in people who had MS and ankle plantarflexor spasticity. The observed reductions in resistance to passive motion from the spastic plantarflexors in the absence of sEMG changes might suggest a mechanical rather than a neural effect of the training.
IMPACT
Based on these preliminary findings, isokinetic resistance training does not exacerbate hypertonia in people with MS and ankle plantarflexor spasticity and could be safely used to manage muscle weakness in this population.
Topics: Humans; Middle Aged; Muscle Spasticity; Ankle; Multiple Sclerosis; Resistance Training; Ankle Joint; Muscle Weakness; Paresis; Muscle Hypertonia; Muscle, Skeletal
PubMed: 36222464
DOI: 10.1093/ptj/pzac146 -
Neuromuscular Disorders : NMD Jun 2022Myoglobinopathy is a rare autosomal dominant myopathy that manifests in adulthood with proximal and axial weakness and variable respiratory and cardiac failure. Muscle...
Myoglobinopathy is a rare autosomal dominant myopathy that manifests in adulthood with proximal and axial weakness and variable respiratory and cardiac failure. Muscle pathology features associated with myoglobinopathy include characteristic sarcoplasmic bodies in skeletal and cardiac muscles. Here we present the first case of myoglobinopathy in an Asian individual. Although myoglobinopathy patients were reported not to have facial muscle weakness, our patient had orbicularis oculi muscle weakness, tongue weakness and atrophy, poor movement of the soft palate, and dysarthria. This is also the first reported case of tube feeding in a patient with myoglobinopathy. The patient started NPPV 18 years after onset, indicating that an older age of onset may have resulted in slow disease progression. Muscle selectivity, characteristic muscle pathology, and progressive cardiopulmonary dysfunction and dysphagia are hallmarks of this disease.
Topics: Adult; Dysarthria; Facial Muscles; Humans; Muscle Weakness; Muscle, Skeletal; Muscular Diseases
PubMed: 35527200
DOI: 10.1016/j.nmd.2022.02.010 -
Journal of Neuroengineering and... Jul 2009Instead of hyper-reflexia as sole paradigm, post-stroke movement disorders are currently considered the result of a complex interplay between neuronal and muscular...
BACKGROUND
Instead of hyper-reflexia as sole paradigm, post-stroke movement disorders are currently considered the result of a complex interplay between neuronal and muscular properties, modified by level of activity. We used a closed loop system identification technique to quantify individual contributors to wrist joint stiffness during an active posture task.
METHODS
Continuous random torque perturbations applied to the wrist joint by a haptic manipulator had to be resisted maximally. Reflex provoking conditions were applied i.e. additional viscous loads and reduced perturbation signal bandwidth. Linear system identification and neuromuscular modeling were used to separate joint stiffness into the intrinsic resistance of the muscles including co-contraction and the reflex mediated contribution.
RESULTS
Compared to an age and sex matched control group, patients showed an overall 50% drop in intrinsic elasticity while their reflexive contribution did not respond to provoking conditions. Patients showed an increased mechanical stability compared to control subjects.
CONCLUSION
Post stroke, we found active posture tasking to be dominated by: 1) muscle weakness and 2) lack of reflex adaptation. This adds to existing doubts on reflex blocking therapy as the sole paradigm to improve active task performance and draws attention to muscle strength and power recovery and the role of the inability to modulate reflexes in post stroke movement disorders.
Topics: Adaptation, Physiological; Adult; Aged; Feedback, Physiological; Female; Follow-Up Studies; Humans; Male; Middle Aged; Models, Biological; Muscle Contraction; Muscle Spasticity; Muscle Weakness; Paresis; Posture; Psychomotor Performance; Reflex; Reflex, Abnormal; Stroke; Stroke Rehabilitation; Torque; Weight-Bearing; Wrist Joint
PubMed: 19627607
DOI: 10.1186/1743-0003-6-29 -
The European Respiratory Journal Apr 2012Intensive care unit-acquired weakness (ICUAW) is an increasingly recognised and important clinical consequence of critical illness. It is associated with significant... (Review)
Review
Intensive care unit-acquired weakness (ICUAW) is an increasingly recognised and important clinical consequence of critical illness. It is associated with significant morbidity and mortality. The aetiology of this disease is not well understood. The purpose of this article is to review our understanding of the molecular pathogenesis of ICUAW in the context of current knowledge of clinical risk factors and aetiology. Key features of the disease are loss of muscle mass resulting from a shift in the dynamic balance of muscle protein synthesis and breakdown and a reduction in force-generating capacity. These alternations are secondary to neuropathy, disruption of the myofilament structure and function, a disrupted sarcoplasmic reticulum, electrical inexcitability and bioenergenetic failure. As knowledge and understanding of ICUAW grows, potential therapeutic targets will be identified, hopefully leading to multiple strategies for prevention and treatment of this important condition.
Topics: Critical Illness; Energy Metabolism; Humans; Intensive Care Units; Muscle Proteins; Muscle Weakness; Risk Factors
PubMed: 21965224
DOI: 10.1183/09031936.00090011 -
Neurological Sciences : Official... Jul 2020Neuralgic amyotrophy (NA), even known as Personage-Turner's syndrome (PTS), is a neurologic condition, affecting the lower motor neurons of brachial plexus and/or... (Review)
Review
Neuralgic amyotrophy (NA), even known as Personage-Turner's syndrome (PTS), is a neurologic condition, affecting the lower motor neurons of brachial plexus and/or individual nerves or nerve branches, characterized by pain, muscle weakness/atrophy, and sensory symptoms. NA has an acute/subacute onset, after an infection or vaccination; it is more common in male and is rare in the pediatric population. The etiology remains uncertain, being considered heterogeneous and multifactorial. A severe acute neurologic pain around the shoulder girdle is the classic presenting symptom at onset. As the pain subsides, weakness and paresis develop. NA is usually unilateral, but sometimes, a subclinical contralateral limb involvement could be present and bilateral affection has been described. The diagnosis is clinical, through a comprehensive history and neurological examination. However, electrophysiological testing and imaging are critical, because there is no diagnostic test for PTS and it remains a diagnosis of exclusion. Upper brachial plexus peripheral involvement with weakness of periscapular and perihumeral muscles is the classic presentation, associated with electrophysiological evidence of denervation in the affected muscles. Imaging, laboratory, and genetic testing can be useful for the differential diagnosis. NA is in most cases a self-limiting condition, and it is characterized by good recovery. Treatment of NA usually involves a combination of corticosteroids, analgesics, immobilization, and physical therapy, even if limited data are available in children. Physiotherapy is required to maintain muscle strength.
Topics: Brachial Plexus; Brachial Plexus Neuritis; Child; Humans; Male; Muscle Weakness; Muscular Atrophy; Pain
PubMed: 32140911
DOI: 10.1007/s10072-020-04314-8 -
Current Opinion in Rheumatology May 1998Involvement of the quadriceps muscle group in knee osteoarthritis is receiving increasing research interest. The motor and sensory functions of muscle are intimately... (Review)
Review
Involvement of the quadriceps muscle group in knee osteoarthritis is receiving increasing research interest. The motor and sensory functions of muscle are intimately linked, and deficits in the sensorimotor functions of the quadriceps have been identified and proposed as possible factors in the pathogenesis of knee osteoarthritis or as consequences of the disease. Weakness of the quadriceps as a clinical feature of knee osteoarthritis has been well recognized for some time, but causes for this weakness and its significance as a determinant of the patient's disability is only now being investigated. Rehabilitation regimens that increase quadriceps weakness also effect improvements in the patient's disability, but the length and cost most of these research regimens would be impractical in the clinical setting. More clinically practicable rehabilitation regimens need to be devised that could be implemented in the community, if the management of this chronic, prevalent condition is to be managed effectively and cost-effectively.
Topics: Disability Evaluation; Humans; Knee Joint; Muscle Weakness; Osteoarthritis; Proprioception
PubMed: 9608328
DOI: 10.1097/00002281-199805000-00015