Advertisement

Lower Limb Strength Is Significantly Impaired in All Muscle Groups in Ambulatory People With Chronic Stroke: A Cross-Sectional Study

Published:November 23, 2015DOI:https://doi.org/10.1016/j.apmr.2015.10.106

      Abstract

      Objective

      To measure the strength of the major muscle groups of the affected and intact lower limbs in people with stroke compared with age-matched controls.

      Design

      Cross-sectional study.

      Setting

      University laboratory.

      Participants

      Ambulatory stroke survivors (n=60; mean age, 69±11y), who had had a stroke between 1 and 6 years previously, and age-matched controls (n=35; mean age, 65±9y) (N=95).

      Interventions

      Not applicable.

      Main Outcome Measures

      The maximum isometric strength of 12 muscle groups (hip flexors and extensors, hip adductors and abductors, hip internal rotators and external rotators, knee flexors and extensors, ankle dorsiflexors and plantarflexors, ankle invertors and evertors) of both lower limbs was measured using handheld dynamometry. All strength measurements were taken in standardized positions by 1 rater.

      Results

      The affected lower limb of the participants with stroke was significantly weaker than that of the control participants for all muscle groups (P<.01). Strength (adjusted for age, sex, and body weight) was 48% (range, 34%–62%) of that of the control participants. The most severely affected muscle groups were hip extensors (34% of controls), ankle dorsiflexors (35%), and hip adductors (38%), and the least severely affected muscle groups were ankle invertors (62%), ankle plantarflexors (57%), and hip flexors (55%). The intact lower limb of the participants with stroke was significantly weaker than that of the control participants for all muscle groups (P<.05) except for ankle invertors (P=.25). Strength (adjusted for age, sex, and body weight) was 66% (range, 44%–91%) of that of the control participants. The most severely affected muscle groups were hip extensors (44% of controls), ankle dorsiflexors (52%), and knee flexors (54%).

      Conclusions

      Ambulatory people with chronic stroke have a marked loss of strength in most of the major muscle groups of both lower limbs compared with age-matched controls.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wagner J.M.
        • Dromerick A.W.
        • Sahrmann S.A.
        • Lang C.E.
        Upper extremity muscle activation during recovery of reaching in subjects with post-stroke hemiparesis.
        Clin Neurophysiol. 2007; 118: 164-176
        • Kamper D.G.
        • Fischer H.C.
        • Cruz E.G.
        • Rymer W.Z.
        Weakness is the primary contributor to finger impairment in chronic stroke.
        Arch Phys Med Rehabil. 2006; 87: 1262-1269
        • Lin S.
        Motor function and joint position sense in relation to gait performance in chronic stroke patients.
        Arch Phys Med Rehabil. 2005; 86: 197-203
        • Bohannon R.W.
        Muscle strength and muscle training after stroke.
        J Rehabil Med. 2007; 39: 14-20
        • Harris J.E.
        • Eng J.J.
        Paretic upper-limb strength best explains arm activity in people with stroke.
        Phys Ther. 2007; 87: 88-97
        • Canning C.G.
        • Ada L.
        • Adams R.
        • O'Dwyer N.
        Loss of strength contributes more to physical disability after stroke than loss of dexterity.
        Clin Rehabil. 2004; 18: 300-308
        • Cameron D.M.
        • Bohannon R.W.
        • Garrett G.E.
        • Owen S.V.
        • Cameron D.A.
        Physical impairments related to kinetic energy during sit-to-stand and curb-climbing following stroke.
        Clin Biomech. 2003; 18: 332-340
        • Bohannon R.W.
        Correlation of lower limb strengths and other variables with standing performance in stroke patients.
        Physiother Can. 1989; 41: 198-202
        • Marigold D.S.
        • Eng J.J.
        • Tokuno C.D.
        • Donnelly C.A.
        Contribution of muscle strength and integration of afferent input to postural instability in persons with stroke.
        Am Soc Neurorehabil. 2004; 18: 222-229
        • Suzuki K.
        • Imada G.
        • Iwaya T.
        • Handa T.
        • Kurogo H.
        Determinants and predictors of the maximum walking speed during computer-assisted gait training in hemiparetic stroke patients.
        Arch Phys Med Rehabil. 1999; 80: 179-182
        • Nakamura R.
        • Watanabe S.
        • Handa T.
        • Morohashi I.
        The relationship between walking speed and muscle strength for knee extension in hemiparetic stroke patients: a follow-up study.
        Tohoku J Exp Med. 1988; 154: 111-113
        • Kim C.M.
        • Eng J.J.
        The relationship of lower-extremity muscle torque to locomotor performance in people with stroke.
        Phys Ther. 2003; 83: 49-57
        • Bohannon R.W.
        Correlation of knee extension force and torque with gait speed in patients with stroke.
        Physiother Theory Pract. 1991; 7: 185-190
        • Nadeau S.
        • Arsenault A.B.
        • Gravel D.
        • Bourbonnais D.
        Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke.
        Am J Phys Med Rehabil. 1999; 78: 123-130
        • Suzuki K.
        • Nakamura R.
        • Yamada Y.
        • Handa T.
        Determinants of maximum walking speed in hemiparetic stroke patients.
        Tohoku J Exp Med. 1990; 162: 337-344
        • Bohannon R.W.
        • Walsh S.
        Association of paretic lower extremity muscle strength and standing balance with stair-climbing ability in patients with stroke.
        J Stroke Cerebrovasc Dis. 1991; 1: 129-133
        • Mercier C.
        • Bourbonnais D.
        Relative shoulder flexor and handgrip strength is related to upper limb function after stroke.
        Clin Rehabil. 2004; 18: 215-221
        • Boissy P.
        • Bourbonnais D.
        • Carlotti M.M.
        • et al.
        Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function.
        Clin Rehabil. 1999; 13: 354-362
        • Andrews A.W.
        • Bohannon R.W.
        Short-term recovery of limb muscle strength after acute stroke.
        Arch Phys Med Rehabil. 2003; 84: 125-130
        • Andrews A.W.
        • Bohannon R.W.
        Distribution of muscle strength impairments following stroke.
        Clin Rehabil. 2000; 14: 79-87
        • Adams R.W.
        • Gandevia S.C.
        • Skuse N.F.
        The distribution of muscle weakness in upper motoneuron lesions affecting the lower limb.
        Brain. 1990; 113: 1459-1476
        • Neckel N.
        • Pelliccio M.
        • Nichols D.
        • Hidler J.
        Quantification of functional weakness and abnormal synergy patterns in the lower limb of individuals with chronic stroke.
        J NeuroEng Rehabil. 2006; 3: 1-11
        • Horstman A.M.
        • Beltman M.J.
        • Gerrits K.H.
        • et al.
        Intrinsic muscle strength and voluntary activation of both lower limbs and functional performance after stroke.
        Clin Physiol Funct Imaging. 2008; 28: 251-261
        • Wadsworth C.T.
        • Krishnan R.
        • Sear M.
        • Harrold J.
        • Nielsen D.H.
        Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing.
        Phys Ther. 1987; 67: 1342-1347
        • Bohannon R.W.
        Knee extension force measurements are reliable and indicative of walking speed in stroke patients.
        Int J Rehabil Res. 1989; 12: 193-194
        • Bohannon R.W.
        Test-retest reliability of hand-held dynamometry during a single session of strength assessment.
        Phys Ther. 1986; 66: 206-209
        • Bohannon R.W.
        Muscle strength in patients with brain lesions: measurement and implications.
        in: Harms-Ringdal K. Muscle strength. Churchill Livingstone, Edinburgh1993: 187-225
        • Harris J.E.
        • Eng J.J.
        Strength training improves upper-limb function in individuals with stroke: a meta-analysis.
        Stroke. 2010; 41: 136-140
        • Bale M.
        • Strand L.I.
        Does functional strength training of the leg in subacute stroke improve physical performance? A pilot randomized controlled trial.
        Clin Rehabil. 2008; 22: 911-921
        • Flansbjer U.-B.
        • Miller M.
        • Downham D.
        • Lexell J.
        Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation.
        J Rehabil Med. 2008; 40: 42-48
        • Lee M.-J.
        • Kilbreath S.L.
        • Singh M.F.
        • et al.
        Comparison of effect of aerobic cycle training and progressive resistance training on walking ability after stroke: a randomized sham exercise-controlled study.
        J Am Geriatr Soc. 2008; 56: 976-985
        • Bohannon R.W.
        Knee extension strength and body weight determine sit-to-stand independence after stroke.
        Physiother Theory Pract. 2007; 23: 291-297
        • Hislop H.J.
        • Montgomery J.
        • Connelly B.
        • Daniels L.
        Daniels and Worthingham’s muscle testing: techniques of manual examination.
        6th ed. W.B. Saunders, Philadelphia1995