People with mild PD have impaired force production in all lower limb muscle groups: A cross‐sectional study

Abstract

Background Power is reduced in people with Parkinson's disease as a consequence of bradykinesia, but it is not clear whether reduced power is also due to a deficit in force production. The aim of this study was to quantify force production in all major lower limb muscle groups in people with PD during the “on” phase after medication, compared with aged‐matched neurologically normal control participants. Method Design: A cross‐sectional study was undertaken. Participants Thirty ambulatory people with PD and 24 neurologically normal controls. Outcome measures Isometric force production of the 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 using hand‐held dynamometry. Results There was a significant deficit in force production in participants with PD in all lower limb muscle groups tested, compared with control participants. On average, force production of participants with PD was 78% (range 67%–87%) of control participants, despite participants with PD regularly participating in exercise, being measured during their “on” phase after medication and having normal walking ability. The most severely affected muscle groups were the hip adductors (67%) and ankle plantarflexors (68%). Conclusion People with PD have a significant loss of force production in all lower limb muscle groups compared with age‐matched neurologically‐normal controls. Implications for Physiotherapy Practice Clinicians should regularly assess the strength of all lower limb muscle groups, regardless of participation in physical activity, responsiveness to levodopa medication and walking ability.

People with mild Parkinson's disease have impaired force production in upper limb muscles: A cross‐sectional study

“…The most severely affected muscle groups were the extensors at each joint, which all had deficits of over 25%. The average deficit in force production in the upper limb is the same as the average deficit we found in lower limb muscle groups (22%, SD 6%) (Salmon et al., 2021 ). This is unlike other neurological conditions, such as stroke, where the prevalence and extent of impairment in force production are greater for the upper limb than the lower limb (Tyson et al., 2006 ).…”

“…The common motor impairments associated with PD include bradykinesia, balance impairment, tremor and rigidity. However, it has become clear that a significant impairment in force production of muscle groups in the lower limb is also evident, even in people with mild PD (Salmon et al., 2021 ; Skinner et al., 2019 ). Force production is important because of its contribution to power, which is required to effectively complete many daily activities, for example, walking, house work and gardening (Lundgren‐Lindquist, 1983 ).…”

“…All the major muscle groups of the lower limb have been examined in relation to force production (Salmon et al., 2021 ; Skinner et al., 2019 ), with an average deficit of 22% evident across 12 major lower limb muscle groups in people with mild PD compared with healthy controls (Salmon et al., 2021 ). However, only three muscle groups in the upper limb have been tested (Jones et al., 2017 ; Pang & Mak, 2009 ; Robichaud et al., 2004 ; Roland et al., 2013 ).…”

Correlation Analysis of Lower-Limb Muscle Function With Clinical Status, Balance Tests, and Quality of Life in People With Parkinson Disease

“…[1][2][3] Impaired muscle function is also reported in people with PD compared with healthy individuals at the same age. [4][5][6][7][8][9][10] Interestingly, James Parkinson in his pioneer study, "An Essay on the Shaking Palsy" in 1817, already highlighted symptoms of muscle weakness in his patients. He reported early fatigue in the most affected lower limb and a similar loss of strength in the less-affected lower limb in later stages.…”

“…Parkinson disease (PD) is a progressive and degenerative neurological disease that is characterized by 4 well-established cardinal signs: tremor, bradykinesia, rigidity, and postural instability 1–3. Impaired muscle function is also reported in people with PD compared with healthy individuals at the same age 4–10. Interestingly, James Parkinson in his pioneer study, “An Essay on the Shaking Palsy” in 1817, already highlighted symptoms of muscle weakness in his patients.…”