Abstract
Purpose
Sub-clinical muscle involvement, including myopathic changes and mitochondrial dysfunction of skeletal muscle, has been reported in people with Huntington’s disease (HD). Muscle strength was evaluated using a hand-held dynamometer. Reliability and validity in people with HD were determined.
Method
Isometric muscle strength of 6 lower limb muscle groups was measured in 20 people with HD and matched healthy controls. People with HD were evaluated with the Unified Huntington’s Disease Rating Scales (UHDRS). Within session reliability using intra-class correlation coefficients (ICC) was calculated. Discriminant and convergent validity was also evaluated.
Results
UHDRS motor scores of people with HD ranged from 28 to 80. Reliability of strength testing was excellent (ICC 0.86 to 0.98). People with HD had on average about half the strength of healthy matched controls. UHDRS motor scores and strength scores were significantly correlated (convergent) providing a further indication of validity of strength testing.
Conclusions
The hand-held dynamometer is a reliable and valid measurement tool to detect strength differences between people with HD and a matched control group. There is significant reduction in lower limb muscle strength in HD which does not appear to have been described previously.
Article PDF
Similar content being viewed by others
References
Andres PL, Hedlund W, Finison L, Conlon T, Felmus M, Munsat TL (1986) Quantitative motor assessment in amyotrophic lateral sclerosis. Neurology 36:937–941
Andrews AW, Bohannon RW (2000) Distribution of muscle strength impairments following stroke. Clin Rehabil 14:79–87
Arenas J, Campos Y, Ribacoba R, Martin MA, Rubio JC, Ablanedo P, Cabello A (1998) Complex I defect in muscle from patients with Huntington’s disease. Ann Neurol 43:397–400
Batterham A, George K (2003) Reliability in evidences based clinical practice: a primer for allied healthy professions. Physical Therapy in Sport 4:122–128
Bland JM (2000) An introduction to medical statistics. Oxford University Press, Oxford
Bohannon RW (1997) Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil 78:26–32
Bohannon RW (2006) Reference values for the timed up and go test: a descriptive meta-analysis. J Geriatr Phys Ther 29:64–68
Bohannon RW (1986) Test-retest reliability of hand-held dynamometry during a single session of strength assessment. Phys Ther 66:206–209
Busse ME, Pearson OR, Van Deursen R, Wiles CM (2004) Quantified measurement of activity provides insight into motor function and recovery in neurological disease. J Neurol Neurosurg Psychiatry 75:884–888
Cronbach LJ, Meehl PE (1955) Construct validity in psychological tests. Psychol Bull 52:281–302
Donner A, Eliasziw M (1987) Sample size requirements for reliability studies. Stat Med 6:441–448
Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191
Goonetilleke A, Modarres-Sadeghi H, Guiloff RJ (1994) Accuracy, reproducibility, and variability of hand-held dynamometry in motor neuron disease. J. Neurol. Neurosurg. Psychiatry 57:326–332
Gordon AM, Quinn L, Reilmann R, Marder K (2000) Coordination of prehensile forces during precision grip in Huntington’s disease. Exp Neurol 163:136–148
Hobart JC, Lamping DL, Thompson AJ (1996) Evaluating neurological outcome measures: the bare essentials. J Neurol Neurosurg Psychiatry 60:127–130
Kilmer DD, McCrory MA, Wright N, Rosko R, Kim H, Aitkens S (1997) Hand-held dynamometry reliability in persons with neuropathic weakness. Arch Phys Med Rehabil 78:1364–1368
Nollet F, Beelen A (1999) Strength assessment in postpolio syndrome: validity of a hand-held dynamometer in detecting change. Arch Phys Med Rehabil 80:1316–1323
Peacock IW (1987) A physical therapy program for Huntington’s disease patients. Clinical Management in Physical Therapy 7:22–23
Quinn L, Rao A (2002) Physical therapy for people with Huntington disease: current perspectives and case report. Neurology Report 26(3):145–153
Quinn N, Brown R, Craufurd D, Goldman S, Hodges J, Kieburtz K, Lindvall O, MacMillan J, Roos R (1996) Core Assessment Program for Intracerebral Transplantation in Huntington’s Disease (CAPIT-HD). Mov Disord 11:143–150
Reilmann R, Kirsten F, Quinn L, Henningsen H, Marder K, Gordon AM (2001) Objective assessment of progression in Huntington’s disease: a 3-year follow-up study. Neurology 57:920–924
Ribchester RR, Thomson D, Wood NI, Hinks T, Gillingwater TH, Wishart TM, Court FA, Morton AJ (2004) Progressive abnormalities in skeletal muscle and neuromuscular junctions of transgenic mice expressing the Huntington’s disease mutation. Eur J Neurosci 20:3092–3114
Riddle DL, Finucane SD, Rothstein JM, Walker ML (1989) Intrasession and intersession reliability of hand-held dynamometer measurements taken on brain-damaged patients. Phys Ther 69:182–194
Saft C, Zange J, Andrich J, Muller K, Lindenberg K, Landwehrmeyer B, Vorgerd M, Kraus PH, Przuntek H, Schols L (2005) Mitochondrial impairment in patients and asymptomatic mutation carriers of Huntington’s disease. Mov Disord 20:674–679
Shepherd RB (2001) Exercise and training to optimize functional motor performance in stroke: driving neural reorganization? Neural Plast 8:121–129
Shrout P, Fleiss J (1979) Intraclass correlation: Uses in assessing rater reliability. Psychol Bull 86:420–426
Sim J, Arnell P (1993) Measurement validity in physical therapy research. PhysTher 73:102–110
Simoneau G, Ulbrecht D, Derr J, Cavanagh P (1995) Role of somatosensory input in the control of human posture. Gait & Posture 3:115–122
Thompson LV (1994) Effects of age and training on skeletal muscle physiology and performance. Phys Ther 74:71–81
van Vugt JP, Siesling S, Piet KK, Zwinderman AH, Middelkoop HA, van Hilten JJ, Roos RA (2001) Quantitative assessment of daytime motor activity provides a responsive measure of functional decline in patients with Huntington’s disease. Mov Disord 16:481–488
Verbessem P, Lemiere J, Eijnde BO, Swinnen S, Vanhees L, Van Leemputte M, Hespel P, Dom R (2003) Creatine supplementation in Huntington’s disease: a placebo-controlled pilot trial. Neurology 61(7):925–930
Wadsworth CT, Krishnan R, Sear M, Harrold J, Nielsen DH (1987) Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing. Phys Ther 67:1342–1347
Wiles CM, Busse ME, Sampson CM, Rogers MT, Fenton-May J, van Deursen R (2006) Falls and stumbles in myotonic dystrophy. J Neurol Neurosurg Psychiatry 77:393–396
Wiles CM, Karni Y (1983) The measurement of muscle strength in patients with peripheral neuromuscular disorders. J Neurol Neurosurg Psychiatry 46:1006–1013
Wiles CM, Karni Y, Nicklin J (1990) Laboratory testing of muscle function in the management of neuromuscular disease. J Neurol Neurosurg Psychiatry 53:384–387
Willen C, Sunnerhagen KS, Ekman C, Grimby G (2004) How is walking speed related to muscle strength? A study of healthy persons and persons with late effects of polio. Arch Phys Med Rehabil 85:1923–1928
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Open Access This is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License ( https://creativecommons.org/licenses/by-nc/2.0 ), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
About this article
Cite this article
Busse, M.E., Hughes, G., Wiles, C.M. et al. Use of hand-held dynamometry in the evaluation of lower limb muscle strength in people with Huntington’s disease. J Neurol 255, 1534–1540 (2008). https://doi.org/10.1007/s00415-008-0964-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-008-0964-x