The purposes of this study were to compare the value of isokinetic testing and manual muscle testing (MMT) in longitudinal measurements of muscle strength in patients with neuromuscular disease and to identify any consistent pattern demonstrated by the isokinetic testing of patients with specific diagnoses. We measured knee extensor muscle strength at periodic intervals in patients, using MMT and isokinetic testing at angular limb velocities of 30 and 180 degrees/sec. An isokinetic fatigability test also was conducted. The results indicated that in patients who were graded 9 to 10 (ie, within normal limits) by MMT methods, sequential isokinetic strength tests revealed improvement not indicated by MMT. In patients, however, having weakness detectable by MMT and whose course was deteriorating, isokinetic testing did not seem to add clinically significant information for long-term management. Some patients with myotonia demonstrated an increase in peak torque during the fatigability test; this response was unique among the diagnoses we tested. Isokinetic testing may provide, in some patients with neuromuscular disease, valuable information when used in conjunction with MMT for sequential monitoring of strength. Continued research is needed to investigate the value of isokinetic testing in the diagnosis and management of patients with neuromuscular disease.
he effects on the lower kinetic chain of structural abnormalities of the feet include diffuse o r specific lower extremity pain, low back pain, and/ o r other structural abnormalities of the foot (9,10,12,15,19,33,34). However, the frequency of structural deformities of the foot in healthy individuals is not extensively documented. McPoil et al measured the forefoot-to-rearfoot relationship of 58 asymptomatic female subjects. A forefoot valgus was present in 44.8% and a forefoot varus was present in 8.6% of the 116 feet surveyed (2 1). This study addressed the following question: What is the frequency of forefoot varus, valgus, o r neutral in healthy individuals?T w o structural abnormalities of the forefoot-rearfoot relationship are forefoot varus and valgus ( 1 0.33). In forefoot varus, with the subtalar joint in a neutral position, the forefoot is in the fixed position of inversion on the rearfoot in the frontal plane. This static deformity causes the subtalar and midtarsal joints to pronate from midstance to the pushoff phase of the gait cycle. Instead of being a rigid lever for propulsion, the fbrefoot now becomes a mobile structure, causing an increase in the stress and shear forces transmitted to
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