Clinical StudyLower extremity isokinetic muscle strength in patients with Parkinson’s disease
Introduction
Parkinson’s disease (PD) is a common neurodegenerative condition characterized by slowness of movement (bradykinesia), stiffness of the muscles (rigidity), tremor, balance disturbances, and a progressive decrease in motor function.[1], [2], [3] When combined with additional factors, decreased muscle strength can lead to falls among elderly patients, causing fractures, joint dislocations, severe soft tissue lesions, and head trauma.[4], [5] Available statistics indicate the fall rate is higher among people with PD compared to healthy elderly individuals.[4], [6]
Muscle weakness is one of the main symptoms of PD.7 In recent clinical trials, decreased muscle strength has been observed in patients with PD.[8], [9], [10], [11], [12] Kakinuma et al. measured the isokinetic muscle strength of knee extension and flexion and observed isokinetic strength reduction on the side more affected by PD.12 Nallegowda et al. tested the strength of the trunk, hip, and ankle flexor and extensor muscles using isokinetic measurements, and reported a decrease in strength in all the flexor and extensor muscle groups.9 Pedersen et al. obtained lower isokinetic concentric torque results on quantitative assessment of dorsiflexors for patients with PD compared to control subjects.10 Inkster et al. observed that reduced strength of the hip muscles contributes to the difficulty experienced by patients with PD in rising from a chair.11 Finally, Nogaki et al. hypothesised that muscle weakness in PD is likely to depend on movement velocity.[8], [13]
In contrast to the isokinetic evaluations described, some studies have evaluated quantitative isotonic and isometric muscle strength.[7], [14], [15]
To date, no reported study has evaluated the isokinetic strength of the hip, knee, and ankle joints together. Some limited studies, however, have evaluated muscle groups at different isokinetic velocities in the lower extremities,13 as well as the correlation between muscle strength and clinical status, and muscle strength and falls,9 among patients with PD.
We evaluated the lower extremity flexor and extensor isokinetic muscle strength at the hip, knee, and ankle joints in patients with PD. We aimed to determine which muscle groups and movement velocities of the lower extremity are more greatly affected by the disease, and to discover the relationship between muscle weakness, clinical status, and falls.
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Patients
This investigation was designed as a cross-sectional, controlled study. Patients were recruited from the outpatient clinics of the Physical Medicine and Rehabilitation and Neurology Departments, and were diagnosed with PD according to the United Kingdom Parkinson’s Disease Society Brain Bank criteria.9 The study was approved by the ethical committee at the Inonu University School of Medicine. Written consent was obtained from all participants.
Twenty-five patients (17 male, 8 female) were
Results
The characteristics of the patient and control groups are outlined in Table 1. There was no statistically significant difference between the two groups in age, weight, or height. The mean disease duration was 5.6 ± 3.9 years (with a range of 1 to 15 years). Fifteen patients (60%) were at Hoehn and Yahr stage II, and 10 (40%) were at stage III. In the patient group, the UPDRS-ME and -ADL scores were 26.3 ± 12 and 8.9 ± 5, respectively.
During the past 6 months, 12 patients with PD had fallen (48%),
Discussion
Lower extremity muscle strength has a major effect on mobility. No previous studies have evaluated the overall flexor and extensor muscle strength in the hip, knee, and ankle joints in patients with PD, although several studies have evaluated the muscle strength in one or two joints separately.[10], [12], [13] We assessed muscle strength with an isokinetic dynamometer to determine which muscle groups were most affected, and at which of the predetermined movement velocities, to evaluate their
Conclusion
Although muscle strength decreased in the lower extremity, especially in the hip and knee, muscle weakness was not associated with the velocities at which it was evaluated in this study. The evaluation of muscle weakness may be a useful tool for the assessment of clinical severity and fall risk in patients with PD. It should be noted, however, that conflicting previous results and the lack of specific standards necessitate further studies.
References (27)
- et al.
Understanding the dopaminergic deficits in Parkinson’s disease: insights into disease heterogeneity
J Clin Neurosci
(2009) - et al.
Muscle weakness in Parkinson’s disease: a follow-up study
Parkinsonism Relat Disord
(2001) - et al.
Falls in the elderly
Emerg Med Clin North Am
(1990) - et al.
Relationship between freezing of gait (FOG) and other features of Parkinson’s: FOG is not correlated with bradykinesia
J Clin Neurosci
(2003) - et al.
Functional decline in Parkinson disease
Arch Neurol
(2001) - et al.
Predicting falls in individuals with Parkinson disease: a reconsideration of clinical balance measures
J Neurol Phys Ther
(2006) - et al.
Falling risk factors in Parkinson’s disease
NeuroRehabilitation
(2005) Clinical practice. Preventing falls in elderly persons
N Engl J Med
(2003)- et al.
The validity of the GaitRite and the functional ambulation performance scoring system in the analysis of Parkinson gait
NeuroRehabilitation
(2002) - et al.
Muscle strength testing in Parkinson’s disease
Eur Neurol
(1986)
Role of sensory input and muscle strength in maintenance of balance, gait, and posture in Parkinson’s disease: a pilot study
Am J Phys Med Rehabil
Gait analysis, isokinetic muscle strength measurement in patients with Parkinson’s disease
Scand J Rehabil Med
Leg muscle strength is reduced in Parkinson’s disease and relates to the ability to rise from a chair
Mov Disord
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