Muscle Weakness and Cocontraction in Upper Limb Hemiparesis: Relationship to Motor Impairment and Physical Disability Time and magnitude of torque generation is impaired in both arms following stroke. Muscle strength of trunk flexion-extension in post-stroke hemiplegic patients. Trunk Muscle Strength in Relation to Balance and Functional Disability in Unihemispheric Stroke Patients Mechanisms of Chronic Muscle Wasting and Dysfunction after an Intensive Care Unit Stay. A Pilot Study. Anticipatory postural adjustment in selected trunk muscles in post stroke hemiparetic patients. Alterations in Respiratory and Limb Muscle Strength and Size in Patients With Sepsis Who Are Mechanically Ventilated Recovery of standing balance and functional mobility after stroke. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke [Computer-based rehabilitation of cognitive impairments and motor arm function of patients with hemiparesis after stroke]. The interobserver agreement of handheld dynamometry for muscle strength assessment in critically ill patients Upper motor neuron lesions: their effect on muscle performance and appearance in stroke patients with minor motor impairment. Directional control of reaching is preserved following mild/moderate stroke and stochastically constrained following severe stroke Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF). Cortico-spinal excitability and hand motor recovery in stroke: a longitudinal study Limb muscle dysfunction in COPD: effects of muscle wasting and exercise training.
The purpose of this article is to describe the relationship between poststroke upper limb muscle weakness and cocontraction , and clinical measures of upper limb motor impairment and physical disability .  Electromyographic ( EMG ) activity of the  paretic and nonparetic wrist flexors and extensors of 26 chronic stroke survivors were recorded during isometric wrist flexion and extension . The root mean square ( RMS ) of the EMG signal was used as a measure of strength of contraction . A ratio of RMS of antagonist and agonist muscles was used as a measure of cocontraction . Upper limb motor impairment and physical disability were assessed with the Fugl-Meyer motor assessment ( FMA ) and the  arm motor ability test ( AMAT ) , respectively . The strength of muscle contraction was significantly stronger in the nonparetic limb ( P < 0.001 ) . The degree of cocontraction was significantly greater in the paretic limb ( P < 0.001 ) . The strength of muscle contraction in the paretic limb correlated significantly with FMA ( r = 0.62 to 0.87,P ≤ 0.001 ) and AMAT ( r = 0.66 to 0.80 , P ≤ 0.001 ) scores . Similarly , the degree of cocontraction correlated significantly with FMA ( r = -0.70 to -0.64 , P ≤ 0.001 ) and AMAT ( r = -0.72 to -0.62 , P ≤ 0.001 ) scores . Muscle weakness and degree of cocontraction correlate significantly with motor impairment and physical disability in upper limb hemiplegia . This relationship may provide insights toward development of specific interventions . However , additional studies are needed to demonstrate a cause and effect relationship Muscle strength , usually measured as the peak torque during maximal contraction , is impaired in persons with stroke . Time-dependent properties of muscle contraction may also be altered but have not been quantified . We quantified both magnitude ( peak torque ) and time-dependent parameters ( times to develop and reduce torque ) in eight different isometric joint actions . Parameters were compared among the more and less affected arms of 20 persons with chronic stroke and the nondominant arms of 10 similarly aged healthy persons .  Torque-generation parameters were independent from one another ( i.e. , low correlations ) and highly reliable between trials and days . All parameters were impaired in the more affected arm , whereas peak torque and time to develop torque were impaired in the less affected arm . Following stroke , torque-generation impairments include both magnitude and time-dependent properties and exist not only in the more affected but also in the less affected arm . Clinicians attempting to improve upper-extremity function should employ therapeutic exercises that challenge patients to improve both their strength and speed of muscle contraction This study was undertaken to determine muscle strength of trunk flexion-extension in hemiplegic patients after stroke compared with that of normal controls . The design consisted of a nonr and omized control trial in a secondary care setting ( a rehabilitation unit at a hospital facility ) . The subjects included 25 post-stroke male hemiplegic patients and 25 male healthy controls . The maximal peak torques of trunk flexion-extension  at angular velocities of 0 degrees ( isometric contraction ) , 60 degrees , 120 degrees , and 150 degrees/s were measured by using an isokinetic dynamometer ( Cybex Trunk Extension-Flexion Unit , Cybex , Ronkonkoma , NY ) . Peak torque of trunk flexion and extension in hemiplegic patients was significantly smaller than that of healthy controls ( P < 0.05 ) , except isometric trunk flexion ( P > 0.05 ) . The weakness of trunk flexion-extension muscles in hemiplegic patients might be accounted for by the bilateral innervation from the motor cortex , the insufficient use of high threshold motor units , and disuse atrophy Karatas M , Çetin N , Bayramoglu M , Dilek A : Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients . Am J Phys Med Rehabil 2004;83:81–87 . Objective To evaluate trunk muscle strength in unihemispheric stroke patients and to assess how it relates to body balance and functional disability in this patient group . Design This prospect i ve case-comparison study investigated isometric and isokinetic reciprocal trunk flexion and extension strength at angular velocities in 38 unihemispheric stroke patients and 40 healthy volunteers .  The Berg balance scale was used to assess balance and stability , and the  FIM ™ instrument was used to evaluate functional disability in the patient group . Patients were evaluated as soon as they were able to st and long enough for testing . Results Peak torque values for trunk flexion and extension were lower in the stroke patients than in the controls . The differences were significant for trunk flexion and for trunk extension . In both groups , peak torque values for trunk flexors were greater than peak torque values for trunk extensors . There was a significant positive correlation between trunk muscle strength and Berg balance scale score at discharge . Trunk muscle strength was not correlated with FIM total score or FIM motor score , but the locomotion-transfers FIM subscore at discharge was positively correlated with trunk muscle torque values , except for isometric extension . Conclusion The findings indicate trunk flexion and extension muscle weakness in unihemispheric stroke patients , which can interfere with balance , stability , and functional disability RATIONALE Critical illness survivors often experience permanent functional disability due to intensive care unit (ICU)-acquired weakness . The mechanisms responsible for long-term weakness persistence versus resolution are unknown . OBJECTIVES To delineate cellular mechanisms underlying long-term weakness persistence in ICU survivors . METHODS We conducted a nested , prospect i ve study of critically ill patients mechanically ventilated for 7 days or longer . The patients were recruited from the RECOVER program  and serially assessed over 6 months after ICU discharge . Twenty-seven of 82 patients consented to participate ; 15 and 11 patients were assessed at 7 days and 6 months after ICU discharge , respectively . MEASUREMENTS AND MAIN RESULTS We assessed motor functional capacity , quadriceps size , strength , and voluntary contractile capacity and performed electromyography , nerve conduction studies , and vastus lateralis biopsies  for histologic , cellular , and molecular analyses . Strength and quadriceps cross-sectional areas were decreased 7 days after ICU discharge . Weakness persisted to 6 months and correlated with decreased function . Quadriceps atrophy resolved in 27 % patients at 6 months . Muscle mass reconstitution did not correlate with resolution of weakness , owing to persistent impaired voluntary contractile capacity . Compared with Day 7 , increased ubiquitin-proteasome system-mediated muscle proteolysis , inflammation , and decreased mitochondrial content all normalized at 6 months . Autophagy markers were normal at 6 months . Patients with sustained atrophy had decreased muscle progenitor ( satellite ) cell content . CONCLUSIONS Long-term weakness in ICU survivors results from heterogeneous muscle pathophysiology with variable combinations of muscle atrophy and impaired contractile capacity . These findings are not explained by ongoing muscle proteolysis , inflammation , or diminished mitochondrial content . Sustained muscle atrophy is associated with decreased satellite cell content and compromised muscle regrowth , suggesting impaired regenerative capacity OBJECTIVES To study electromyographic characteristics of anticipatory postural adjustment in axial and lateral , posterior and anterior trunk muscles during the performance of upper- and lower-limb flexion tasks , in subjects with hemiparesis after stroke and to determine the relationship between anticipatory activity and subjects ' motor and functional status . DESIGN A nonr and omized control study . SETTING Geriatric rehabilitation center in Israel . PARTICIPANTS Fifty poststroke hemiparetic patients and 30 healthy control subjects . INTERVENTION  Electromyographic activity of the lumbar erector spinae and of the latissimus dorsi muscles was recorded bilaterally during flexion of either arm and from the 2 rectus abdominis and obliquus externus muscles during flexion of either hip . MAIN OUTCOME MEASURES Muscles ' onset latency , cross-correlation values between the temporal activation profile of corresponding pairs and between ipsilateral muscular pairs , symmetry in activation magnitude of corresponding muscles , and relation between electromyographic activity and motor and functional performance RESULTS Onset latencies of trunk muscles were partially delayed in the patients with longest hindrance displayed by the erector spinae ipsilateral to the flexing arm ( P<.04 ) . Temporal synchronization between pertinent muscular pairs was lower in the patients than in the healthy subjects , with significant group differences ( P<.05 or lower ) in the correlations between ipsilateral pairs of trunk muscles . Activation of the corresponding lateral trunk muscles in the patients was significantly less symmetrical than in the controls ( P<.03 or lower ) because of reduced activity on the paretic body side , especially on flexing of the paretic limbs . Conversely , in the controls as well as on the nonparetic side of the patients , limb flexion was associated with increased activity in the ipsilateral lateral trunk muscle . The erector spinae muscle in both groups and on both sides was more active on the contralateral side than on the ipsilateral side to the flexing arm . The reduced activity level in trunk muscles on the paretic body side was associated with deficiencies in motor and functional abilities . CONCLUSIONS Major impairments in the activity of trunk muscles in hemiparetic subjects were manifested in the reduced activity level of the lateral trunk muscles , in delayed onset , and in reduced synchronization between activation of pertinent muscular pairs . These problems were associated with motor and functional deficits and warrant specific consideration during physical rehabilitation of post stroke hemiparetic patients Background Skeletal muscle wasting and weakness are common in patients with sepsis in the intensive care unit , although less is known about deficits in diaphragm and limb muscles when mechanical ventilation also is required . Objective The objective of this study was to concurrently investigate relative differences in both thickness and strength of respiratory and peripheral muscles during routine care . Design A prospect i ve , cross-sectional study of 16 alert patients with sepsis and 16 people who were healthy ( control group ) was used . Methods Assessment was made of the diaphragm , upper arm , forearm , and thigh muscle thicknesses with the use of ultrasound ; respiratory muscle strength by means of maximal inspiratory pressure ; and isometric h and grip , elbow flexion , and knee extension forces with the use of portable dynamometry . To describe relative changes , data also were normalized to fat-free body mass ( FFM ) measured by bioelectrical impedance spectroscopy . Results Patients ( 9 men , 7 women ; mean age=62 years , SD=17 ) were assessed after a median of 16 days ( interquartile range=11–29 ) of intensive care unit admission . Patients ' diaphragm thickness did not differ from that of the control group , even for a given FFM . When normalized to FFM , only the difference in patients ' mid-thigh muscle size significantly deviated from that of the control group . Within the patient sample , all peripheral muscle groups were thinner compared with the diaphragm . Patients were significantly weaker than were the control group participants in all muscle groups , including for a given FFM . Within the critically ill group , limb weakness was greater than the already-significant respiratory muscle weakness . Limitations Volitional strength tests were applied such that successive measurements from earlier in the course of illness could not be reliably obtained . Conclusions When measured at bedside , survivors of sepsis and a period of mechanical ventilation may have respiratory muscle weakness without remarkable diaphragm wasting . Furthermore , deficits in peripheral muscle strength and size may exceed those in the diaphragm OBJECTIVE To examine the extent to which recovery of functional balance and mobility is accompanied by change in a few specific physiologic measures of postural control . DESIGN Longitudinal prospect i ve study . SETTING Laboratory setting in Ontario . PARTICIPANTS Twenty-seven volunteers ( age , 64.2+/-13.7y ) undergoing 4 weeks of rehabilitation after stroke participated . At initial testing , patients were 32.7+/-18.4 days poststroke and exhibited a moderate level of motor recovery ( lower-extremity and postural control , stages 3 - 4 on the Chedoke-McMaster Stroke Assessment Impairment Inventory ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Three functional measures ( Berg Balance Scale , Clinical Outcome Variables Scale , gait speed ) were assessed . Three physiologic measures ( electromyographic data of hamstrings and soleus muscles bilaterally , postural sway , arm acceleration )  were taken while subjects stood quietly on a force platform and while they performed a rapid shoulder flexion movement of the nonparetic upper extremity . RESULTS After 1 month of rehabilitation , there was an overall significant improvement in all outcome measures ( functional , physiologic ) . However , 10 patients failed to show any improvement in the electromyographic activation of hamstrings muscle on the paretic side in response to the rapid arm movement . These patients compensated by increasing the anticipatory activation of the nonparetic hamstrings . CONCLUSION After stroke , patients showed improvement in both physiologic and functional measures of balance and mobility over a 1-month period . We have identified some patients who may be using compensatory strategies to increase function . The factors that may predict those patients who are likely to use compensatory strategies awaits further study OBJECTIVE To evaluate the impact of a program of muscle strengthening and physical conditioning on  impairment and disability in chronic stroke subjects . DESIGN A r and omized pretest and posttest control group , followed by a single-group pretest and posttest design . SUBJECTS Thirteen community-dwelling stroke survivors of at least 9 months . INTERVENTION A 10-week ( 3 days/week ) program consisting of a warm-up , aerobic exercises , lower extremity muscle strengthening , and a cool-down . MAIN OUTCOME MEASURES Peak isokinetic torque of the major muscle groups of the affected lower limb , quadriceps and ankle plantarflexor spasticity , gait speed , rate of stair climbing , the Human Activity Profile ( HAP ) , and the Nottingham Health Profile ( NHP ) were recorded twice for the treatment group and three times for the control group . RESULTS Significant improvements were found for all the selected outcome measures ( HAP , NHP , and gait speed ) for the treatment group ( p < .001 ) . In terms of overall training effects , the 13 subjects demonstrated increases in strength of the affected major muscle groups , in HAP and NHP profiles , and in gait speed and rate of stair climbing without concomitant increases in either quadriceps or ankle plantarflexor spasticity . CONCLUSIONS The 10-week combined program of muscle strengthening and physical conditioning result ed in gains in all measures of impairment and disability . These gains were not associated with measurable changes of spasticity in either quadriceps or ankle plantarflexors Background Repetitive task practice is argued to drive neural plasticity following stroke . However , current evidence reveals that hemiparetic weakness impairs the capacity to perform , and practice , movements appropriately . Here we investigated how power training ( i.e. , high-intensity , dynamic resistance training ) affects recovery of upper-extremity motor function post-stroke . We hypothesized that power training , as a component of upper-extremity rehabilitation , would promote greater functional gains than functional task practice without deleterious consequences . Method Nineteen chronic hemiparetic individuals were studied using a crossover design . All participants received both functional task practice ( FTP ) and HYBRID ( combined FTP and power training ) in r and om order . Blinded evaluations performed at baseline , following each intervention block and 6-months post-intervention included : Wolf Motor Function Test ( WMFT-FAS , Primary Outcome ) , upper-extremity Fugl-Meyer Motor Assessment , Ashworth Scale , and Functional Independence Measure . Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG . Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining : EMG onset position threshold , burst duration , burst intensity and passive torque at each speed . Results Primary outcome : Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP ( p = .049 ) , regardless of treatment order . These functional improvements were retained 6-months post-intervention ( p = .03 ) . Secondary outcomes : A greater proportion of participants achieved minimally important differences ( MID )  following HYBRID vs. FTP ( p = .03 ) . MIDs were retained 6-months post-intervention . Ashworth scores were unchanged ( p > .05).Increased maximal isometric joint torque , agonist EMG and peak power were significantly greater following HYBRID vs. FTP ( p < .05 ) and effects were retained 6-months post-intervention ( p ’s < .05 ) . EMG position threshold and burst duration were significantly reduced at fast speeds ( ≥120º/s ) ( p ’s < 0.05 ) and passive torque was reduced post-washout ( p < .05 ) following HYBRID . Conclusions Functional and neuromechanical gains were greater following HYBRID vs. FPT . Improved stretch reflex modulation and increased neuromuscular activation indicate potent neural adaptations . Importantly , no deleterious consequences , including exacerbation of spasticity or musculoskeletal complaints , were associated with HYBRID . These results contribute to an evolving body of contemporary evidence regarding the efficacy of high-intensity training in neurorehabilitation and the physiological mechanisms that mediate neural recovery OBJECTIVE To evaluate the usefulness of the computer program made for the patients after stroke to treat their cognitive impairments and hemiparesis . RESEARCH DESIGN AND METHODS The experimental group involved 10 patients after stroke who were obliged to train on a computer every day during their three-week stay on the rehabilitation ward . The control group involved 10 patients after stroke who did not participate in any computer training during their rehabilitation process . The first part of the computer tasks trains the attention impairments and visual-motor co-ordination problems . We modified the joystick by adding special buttons to train movements of the wrist , thumb and forefinger of the impaired h and . Computer tasks are made in the way to stimulate both the cognitive functions and h and dexterity at the same time . RESULTS This initial research shows a statistically significant improvement of the cognitive functions and h and dexterity among patients from the experimental group . According to these results we did not observe any significant improvement in the cognitive functions among patients who did not train on a computer ( control group ) . CONCLUSIONS The results of this research suggest the usefulness of this computer program in training cognitive impairments and visual-motor co-ordination as well as h and dexterity among the patients after stroke Objective : Muscle weakness often complicates critical illness and is associated with increased risk of morbidity , mortality , and limiting functional outcome even years later . To assess the presence of muscle weakness and to examine the effects of interventions , objective and reliable muscle strength measurements are required . The first objective of this study is to determine interobserver reliability of h and held dynamometry . Secondary objectives are to quantify muscle weakness , to evaluate distribution of muscle weakness , and to evaluate gender-related differences in muscle strength . Design : Cross-sectional observational study . Setting : The surgical and medical intensive care units of a large , tertiary referral , university hospital . Patients : A cross-sectional , r and omly selected sample of awake and cooperative critically ill patients . Interventions : None . Measurements and Main Results : H and held dynamometry was performed in critically ill patients who had at least a score of 3 ( movement against gravity ) on the Medical Research Council scale . Three upper limb and three lower limb muscle groups were tested at the right-h and side . Patients were tested twice daily by two independent raters . Fifty-one test – retests were performed in 39 critically ill patients .  H and held dynamometry demonstrated good interobserver agreement with intraclass correlation coefficients > 0.90 in four of the muscle groups tested ( range , 0.91–0.96 ) and somewhat less for hip flexion ( intraclass correlation coefficient , 0.80 ) and ankle dorsiflexion ( intraclass correlation coefficient , 0.76 ) . Limb muscle strength was considerably reduced in all muscle groups as shown by the median z-score ( range , −1.08 to −3.48 sd units ) . Elbow flexors , knee extensors , and ankle dorsiflexors were the most affected muscle groups . Loss of muscle strength was comparable between men and women . Conclusions : H and held dynamometry is a tool with a very good interobserver reliability to assess limb muscle strength in awake and cooperative critically ill patients . Future studies should focus on the sensitivity of h and held dynamometry in longitudinal studies to evaluate predictive values toward patients ' functional outcome OBJECTIVE To evaluate muscular performance and appearance in patients with prior stroke who were ambulatory . DESIGN Nonr and omized study . SETTING University hospital laboratory . SUBJECTS Sixteen persons ( 11 men , 5 women ) with minor motor impairments , 6 to 24 months after stroke , were included . As reference , data were used from a population -based sample of 144 men and women . MAIN OUTCOME MEASUREMENTS Muscle performance was evaluated using a  Kin-Com dynamometer  in both the affected and the nonaffected leg . Peak isometric strength was measured at a 60 degree angle in both extension and flexion . Maximal isokinetic strength was measured at 60 degrees/sec and at 180 degrees/sec . Endurance was evaluated during isometric and dynamic knee extensions . Muscle biopsies were taken on nine patients and muscle tissue areas were determined with computed tomography . RESULTS The affected leg was weaker but not different in relative endurance compared with the nonaffected side . The performance of the nonaffected side was somewhat lower than that of a matched reference population . No major difference in fiber composition between the affected and nonaffected legs was noted , except for a lower degree of capillarization in the affected leg . CONCLUSION In well-functioning stroke patients with good motor performance , further muscle training that includes resistance exercise might be indicated Recent evidence suggests that brain injury can impair the ability to independently activate shoulder and elbow muscles . We hypothesized that if muscle activation patterns are constrained , then brain-injured subjects should not be able to accurately grade initial h and movement direction during reaching toward a broad range of target directions . To test this hypothesis , we measured h and trajectories during reaching in three-space by 16 hemiparetic stroke subjects  to an array of 75 targets distributed throughout the workspace . Contrary to our hypothesis , we found that the ability to grade movement direction was largely preserved following mild and moderate stroke . However , the most severely impaired subjects exhibited a degradation of directional control consistent with a loss of independent muscle control . Initial and final h and movement directions for these subjects were grouped roughly in two opposing directions , in a plane parallel with the coronal plane of the body , rather than distributed across the normal range . Selection between the two movement directions appeared partially r and om , in that subjects initiated over 50 % of movements in the direction generally opposite the intended target , for targets to one side of the body . These results suggest that individuals with severe stroke are constrained to use only two gross , stereotypical muscle coactivation patterns for reaching control , and that selection between these patterns is stochastically influenced as the actual direction of motion is not strictly predictable given the desired direction AIMS To assess the prevalence and clinical impact of reductions in the skeletal muscle mass of patients with chronic heart failure ( HF ) . Chronic HF is accompanied by co-morbidities that influence the quality of life and outcomes . METHODS AND RESULTS We prospect ively enrolled 200 patients with chronic HF . The appendicular skeletal muscle mass of the arms and the legs combined , was assessed by dual energy X-ray absorptiometry . We analysed the muscle strength in arms and legs , and all patients underwent a 6-min walk test , a 4-m walk test , and spiroergometry testing . Muscle wasting was defined as the appendicular muscle mass 2 SD below the mean of a healthy reference group of adults aged 18 - 40 years , as suggested for the diagnosis of muscle wasting in healthy ageing ( sarcopenia ) . Muscle wasting was detected in 39 ( 19.5 % ) subjects . Patients with muscle wasting had significantly lower values for h and grip and quadriceps strength as well as lower total peak oxygen consumption ( peakVO2 , 1173 ± 433 vs. 1622 ± 456 mL/min ) , lower exercise time ( 7.7 ± 3.8 vs. 10.22 ± 3.0 min , both P < 0.001 ) , and lower left ventricular ejection fraction ( LVEF , P = 0.05 ) than patients without . The distance walked during 6 min and the gait speed during the 4-m walk were lower in patients with muscle wasting ( both P < 0.05 ) . Serum levels of interleukin-6 were significantly elevated in patients with muscle wasting ( P = 0.001 ) . Logistic regression showed muscle wasting to be independently associated with reduced peak VO2 adjusted for age , sex , New York Heart Association class , haemoglobin , LVEF , distance walked in 6 minutes , and the number of co-morbidities ( odds ratio 6.53 , p = 0.01 ) . CONCLUSION Muscle wasting is a frequent co-morbidity among patients with chronic HF . Patients with muscle wasting present with reduced exercise capacity and muscle strength , and advanced disease Objective To describe the relationship between changes of cortico-spinal excitability and motor recovery of the affected h and after stroke . Methods Eighteen hemiparetic stroke patients with a severe-to-mild upper limb motor impairment were r and omized .  Cortico-spinal excitability measures ( resting motor thresholds and motor evoked potentials )  obtained from a distal ( abductor pollicis brevis ) and proximal ( biceps brachii ) upper limb muscle were assessed for both hemispheres . Motor function of the affected h and was tested by the Wolf Motor Function and Action Research Arm tests . The evaluations were performed at baseline and weekly over 7 weeks of in-patient neurological rehabilitation . Results Severe h and dysfunction was associated with a strong suppression of ipsilesional cortico-spinal excitability and a shift of excitability towards the contralesional hemisphere . Mild h and impairment was associated with a shift of cortico-spinal excitability towards the ipsilesional hemisphere . Favorable motor recovery correlated with an increase of ipsilesional cortico-spinal excitability PURPOSE Lower-limb muscle weakness has often been reported in COPD , and contributes to exercise intolerance . Controversial information is available regarding upper-limb muscle adaptations and the influence of muscle wasting on muscle weakness . We investigated leg and arm muscle function in 59 stable COPD patients ( GOLD stage III ) with preserved fat-free mass ( FFM ) and in 28 patients with reduced FFM relative to age- and sex-matched healthy control subjects and studied the effects of 8 wk of whole-body exercise training . METHODS FFM was measured with bioelectrical impedance analysis .  Isokinetic quadriceps ( F-leg ) and biceps strength ( F-arm ) , as well as quadriceps ( E-leg ) and biceps endurance ( E-arm ) were determined with a Biodex dynamometer . Exercise training consisted of cycle ergometry , treadmill walking , weight training , and gymnastics during 5 d.wk . RESULTS F-leg ( 76.2 + /- 3.6 vs 118.2 + /- 6.3 N.m , P < 0.001 ) and F-arm ( 25.6 + /- 1.3 vs 38.1 + /- 2.1 N.m , P < 0.001 ) were significantly and similarly reduced in the COPD patient group compared with controls . Also , E-leg ( -2.13 + /- 0.12 vs -1.61 + /- 0.11 , P < 0.01 ) , but not E-arm ( -2.72 + /- 0.11 and -2.47 + /- 0.13 NS ) , was decreased in patients . F-leg ( 62.4 + /- 4.3 vs 82.8 + /- 4.7 N.m , P < 0.01 ) , but not F-arm or muscle endurance , was reduced in FFM-depleted compared with non-FFM-depleted patients . Whereas after training F-leg and E-leg significantly increased by 20 % in the whole COPD group , biceps muscle function remained unchanged . CONCLUSION Lower- and upper-limb muscle dysfunction was observed in COPD patients , irrespective of the presence of FFM depletion . Generalized muscle weakness suggests systemic muscular involvement , although the preserved arm endurance and the poor response of arm performance to exercise training is indicative for intrinsic differences in muscular adaptations between leg and arm muscles
Conclusion :  Objective muscle strength assessment  can be reliably used in lower and upper extremities in post-stroke patients with chronic hemiparesis
Background : Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque .
Objective : To systematic ally investigate and organize the evidence of the reliability of muscle strength evaluation measures in post-stroke survivors with chronic hemiparesis .