Joint position reproduction and joint position discrimination at the ankle are not related

Abstract

Purpose: Limited data in current literature can be found on the relation between the two commonly-used active proprioception assessment methods –active joint position reproduction (JPR) and active movement extent discrimination assessment (AMEDA). The current study compared the two active methods, JPR and AMEDA, to investigate their interrelationship over two studies that differed in task difficulty, using active ankle inversion movements made in weight-bearing to maximise ecological validity.

Methods: 50 participants volunteered in this research, 20 of whom on a harder protocol and the other 30 on an easier protocol, were tested by both methods, JPR and AMEDA. Proprioceptive acuity was represented by absolute error (AE) and variable error (VE) for JPR and by AE and the area under the curve (AUC) for AMEDA.

Results: Proprioceptive acuity scores are found to be significantly correlated within test methods but not between methods for either hard or easy tasks, where JPR AE and VE scores were not correlated with either AMEDA AE or AUC. Further, proprioceptive acuity scores were significantly higher on the easy task when tested with the AMEDA method, but not with JPR method.

Conclusion: Scores obtained from the two active movement proprioception tests, movement extent discrimination and joint position reproduction, were not significantly correlated. Taken together with previous findings, these results show that for proprioception, scores from the three classical psychophysical methods for measuring sensitivity (adjustment, limits and constant stimuli) are not correlated with each other. This suggests that each proprioception measurement system assesses a different aspect of proprioception.     

The effect of neck muscle fatigue on shoulder humeral rotation joint position sense

IntroductionCervical extensor muscle (CEM) fatigue causes decrements in upper limb proprioceptive accuracy during constrained single-joint tasks. This study used a novel humeral rotation joint position sense (JPS) measurement device to compare JPS accuracy in participants who received acute CEM fatigue vs. non-fatigued controls.MethodsParticipants had vision occluded and were passively guided into postures of internal humeral rotation from a baseline posture before and after a CEM fatigue or control protocol. Mixed model repeated measures ANOVAs were used to verify fatigue and compared absolute, constant, and variable JPS error between groups.ResultsCEM fatigue was verified via pre-post reduction in CEM strength, and myoelectric indicators of fatigue. However, between-group comparisons of absolute, constant, and variable JPS error were not statistically significant, despite having large effect sizes.DiscussionContrary to prevailing literature, unconstrained humeral rotation JPS did not appear to be affected by CEM fatigue in this study. However, between-group differences in JPS error were dwarfed by inter-trial variability, which likely arose due to the unconstrained nature of this task, conflating chances for a Type II error. Future research should perform a kinematic analysis of task constraints to highlight potential compensatory mechanisms obscuring significant findings in this otherwise robust effect.     

The effects of biofeedback training for efficient activation of infraspinatus on proprioception and EMG activity during shoulder external rotation

The purpose of this study investigated which biofeedback (BF) training enables efficient activation of the infraspinatus muscle that affect joint position sense (JPS) and force sense (FS) of the shoulder joint. Twenty healthy males participated and performed three external rotation (ER) exercises under three randomly assigned training conditions: 1) non-biofeedback (NBF), 2) BF and 3) force biofeedback (FBF). Each exercise was performed at intervals of one week between training conditions. After performed the ER exercise under each training condition, the relative error (RE) was calculated at shoulder ER 45° and 80°, and then shoulder ER force were measured to determine the JPS error and FS error, respectively. Muscle activity of infraspinatus and posterior deltoid were measured and compared between training conditions. The RE of shoulder ER 45° and 80° were significantly lower under the FBF conditions than other training conditions (P < 0.05). The RE of shoulder ER force were also significantly lower under the FBF conditions compared to those under the other training conditions (P < 0.05). The activity of the infraspinatus muscle was significantly higher under the FBF conditions during all three ER exercises than other training conditions (p < 0.05). We suggest that BF trainings can be useful to improve the proprioception of shoulder joint as well as activation of infraspinatus muscle while performing the ER exercises.     

Test-Retest reliability of the internal shoulder rotator muscles' stretch reflex in healthy men

Until now the reproducibility of the short latency stretch reflex of the internal rotator muscles of the glenohumeral joint has not been identified. Twenty-three healthy male participants performed three sets of external shoulder rotation stretches with various pre-activation levels on two different dates of measurement to assess test–retest reliability. All stretches were applied with a dynamometer acceleration of 10⁴°/s² and a velocity of 150°/s. Electromyographical response was measured via surface EMG. Reflex latencies showed a pre-activation effect (ƞ² = 0,355). ICC ranged from 0,735 to 0,909 indicating an overall “good” relative reliability. SRD 95% lay between ±7,0 to ±12,3 ms. The reflex gain showed overall poor test–retest reproducibility. The chosen methodological approach presented a suitable test protocol for shoulder muscles stretch reflex latency evaluation. A proof-of-concept study to validate the presented methodical approach in shoulder involvement including subjects with clinically relevant conditions is recommended.     

Center of Pressure Displacement of Standing Posture during Rapid Movements Is Reorganised Due to Experimental Lower Extremity Muscle Pain

Background

Postural control during rapid movements may be impaired due to musculoskeletal pain. The purpose of this study was to investigate the effect of experimental knee-related muscle pain on the center of pressure (CoP) displacement in a reaction time task condition.

Methods

Nine healthy males performed two reaction time tasks (dominant side shoulder flexion and bilateral heel lift) before, during, and after experimental pain induced in the dominant side vastus medialis or the tibialis anterior muscles by hypertonic saline injections. The CoP displacement was extracted from the ipsilateral and contralateral side by two force plates and the net CoP displacement was calculated.

Results

Compared with non-painful sessions, tibialis anterior muscle pain during the peak and peak-to-peak displacement for the CoP during anticipatory postural adjustments (APAs) of the shoulder task reduced the peak-to-peak displacement of the net CoP in the medial-lateral direction (P<0.05). Tibialis anterior and vastus medialis muscle pain during shoulder flexion task reduced the anterior-posterior peak-to-peak displacement in the ipsilateral side (P<0.05).

Conclusions

The central nervous system in healthy individuals was sufficiently robust in maintaining the APA characteristics during pain, although the displacement of net and ipsilateral CoP in the medial-lateral and anterior-posterior directions during unilateral fast shoulder movement was altered.     

Reliability of high-density surface electromyography for assessing characteristics of the thoracic erector spinae during static and dynamic tasks

PurposeTo establish intra- and inter-session reliability of high-density surface electromyography (HDEMG)-derived parameters from the thoracic erector spinae (ES) during static and dynamic goal-directed voluntary movements of the trunk, and during functional reaching tasks.MethodsTwenty participants performed: 1) static trunk extension, 2) dynamic trunk forward and lateral flexion, and 3) multidirectional functional reaching tasks on two occasions separated by 7.5 ± 1.2 days. Muscle activity was recorded bilaterally from the thoracic ES. Root mean square (RMS), coordinates of the barycentre, mean frequency (MNF), and entropy were derived from the HDEMG signals. Reliability was determined with intraclass correlation coefficient (ICC), coefficient of variation, and standard error of measurement.ResultsGood-to-excellent intra-session reliability was found for all parameters and tasks (ICC: 0.79-0.99), whereas inter-session reliability varied across tasks. Static tasks demonstrated higher reliability in most parameters compared to functional and dynamic tasks. Absolute RMS and MNF showed the highest overall reliability across tasks (ICC: 0.66-0.98), while reliability of the barycentre was influenced by the direction of the movements.ConclusionRMS and MNF derived from HDEMG show consistent inter-session reliability in goal-directed voluntary movements of the trunk and reaching tasks, whereas the measures of the barycentre and entropy demonstrate task-dependent reliability.     

Contrast of directional influence upon motor overflow between submaximal and maximal static exertions

This study investigated exertion-dependent motor overflow among healthy adults when they performed isometric tasks with contralateral joints in different task directions. Twenty healthy adults (10 males and 10 females, mean age = 26.2 yrs) were instructed to complete a set of isometric contractions of various force vectors with the shoulder, elbow, and wrist joints, in a total of ten motor tasks at submaximal and maximal intensities (50%, 100% maximal voluntary contractions). The electromyographical activities from eight muscles of the unexercised upper limb were recorded to characterize intensity of motor overflow during sustained isometric contraction. Both occurrence frequency and magnitude of motor overflow in terms of standardized net excitation (SNE) increased with exertion level for all joint movements (P < 0.001). Additionally, the motor overflow magnitude depended strongly on the task direction of maximal isometric contraction (P < 0.05). Motor overflow was particularly augmented by the contralateral isometric contractions where task directions were opposed to gravity. However, such a directional effect upon SNE was not evident during submaximal contraction (P > 0.05). The difference of the net excitation between maximal and submaximal contraction (DNE(100%-50%MVC) data) indicated that the pectoralis major and triceps brachii consistently exhibited a marked recruitment in reaction to change in task direction of isometric contraction. Patterned motor overflow may be physiologically relevant to topological mapping of the ipsilateral pathways and altered effectiveness of use-dependent interhemispherical connectivity. The current observations provide better insight into gain in muscle strength due to contralateral exercise.     

Functional activity characteristics of individuals with shoulder dysfunctions

Shoulder-related dysfunction affects individuals’ ability to function independently and thus decreases quality of life. Functional task assessment is a key concern for a clinician in diagnostic assessment, outcome measurement, and planning of treatment programs. The purpose of this study was to test the reliability of the FASTRAK 3-dimensional (3-D) motion analysis and surface electromyography (sEMG) systems to analyze 3-D shoulder complex movements during functional tasks and compare motion patterns between subjects with and without shoulder dysfunctions (SDs).For the test, sEMG and 3-D motion analysis systems were used to characterize the functional tasks. Twenty-five asymptomatic male subjects and 21 male subjects with right shoulder disorders performed four functional tasks which involved arm reaching and raising activities with their dominant arms. Reliability was estimated by the intraclass correlation coefficient (ICC). Motion pattern was compared between two groups using mixed analysis of variances (ANOVAs). Shoulder complex kinematics and associated muscular activities during functional tasks were reliably quantified (ICC = 0.83–0.99) from the means of three trials. Relative to the group without SDs, the group with SDs showed significant alteration in shoulder complex kinematics (3°–40°) and associated muscular activities (3–10% maximum). Scapular tipping, scapular elevation, upper trapezius muscle function, and serratus anterior muscle function may have implications in the rehabilitation of patients with SDs.     

Technical report: Reliability and validity of the iSAM 9000 isokinetic dynamometer

This study assessed the mechanical reliability and validity of the INRTEK iSAM 9000 isokinetic dynamometer, and compared the obtained torque values of the prototype device with those from a traditional device. Sixty volunteers (40 men and 20 women) were tested at 60 degrees per second for shoulder, knee, and trunk flexion, and extension on both the Cybex 6000 and a new isokinetic dynamometer (iSAM 9000). Intraclass correlation coefficients (ICC) and standard errors of measurement (SEM) revealed a high level of reproducibility and precision in the device's torque measurements (ICC range = 0.94-0.98; SEM range = 5.2-29.7). Pearson r values revealed very high relationships between the two instruments (set 1: r = 0.84-0.93; set 2: r = 0.87-0.93; P < 0.05). Significantly higher peak torque for both sets of left and right knee flexion and extension, right shoulder extension and trunk extension was found for the iSAM 9000 compared to the Cybex 6000 (P < 0.05). The strong ICCs and small SEMs support the device's mechanical reliability and validity. The high correlation coefficients between the prototype dynamometer and the Cybex 6000 support the new device's validity in the measurement of isokinetic torque. The findings of this study will be used to refine the next generation of the INRTEK isokinetic device with respect to test protocols and the reliability of measuring human muscle performance.     

Reliability of assessing trunk motor control using position and force tracking and stabilization tasks

System-based methods have been applied to assess trunk motor control in people with and without back pain, although the reliability of these methods has yet to be established. Therefore, the goal of this study was to quantify within- and between-day reliability using systems-based methods involving position and force tracking and stabilization tasks. Ten healthy subjects performed six tasks, involving tracking and stabilizing of trunk angular position in the sagittal plane, and trunk flexion and extension force. Tracking tasks involved following a one-dimensional, time-varying input signal displayed on a screen by changing trunk position (position tracking) or trunk force (force tracking). Stabilization tasks involved maintaining a constant trunk position (position stabilization) or constant trunk force (force stabilization) while a sagittal plane disturbance input was applied to the pelvis using a robotic platform. Time and frequency domain assessments of error (root mean square and H₂ norm, respectively) were computed for each task on two separate days. Intra-class correlation coefficients (ICC) for error and coefficients of multiple correlations (CMC) for frequency response curves were used to quantify reliability of each task. Reliability for all tasks was excellent (between-day ICC≥0.8 and CMC>0.75, within-day CMC>0.85). Therefore, position and force control tasks used to assess trunk motor control can be deemed reliable.     

Reproducibility of a new signal processing technique to assess joint sway during standing

Postural control strategies can be investigated by kinematic analysis of joint movements. However, current research is focussing mainly on the analysis of centre of pressure excursion and lacks consensus on how to assess joint movement during postural control tasks. This study introduces a new signal processing technique to comprehensively quantify joint sway during standing and evaluates its reproducibility. Fifteen patients with non-specific low back pain and ten asymptomatic participants performed three repetitions of a 60-second standing task on foam surface. This procedure was repeated on a second day. Lumbar spine movement was recorded using an inertial measurement system. The signal was temporally divided into six sections. Two outcome variables (mean absolute sway and sways per second) were calculated for each section. The reproducibility of single and averaged measurements was quantified with linear mixed-effects models and the generalizability theory. A single measurement of ten seconds duration revealed reliability coefficients of .75 for mean absolute sway and .76 for sways per second. Averaging a measurement of 40 seconds duration on two different days revealed reliability coefficients higher than .90 for both outcome variables. The outcome variables’ reliability compares favourably to previously published results using different signal processing techniques or centre of pressure excursion. The introduced signal processing technique with two outcome variables to quantify joint sway during standing proved to be a highly reliable method. Since different populations, tasks or measurement tools could influence reproducibility, further investigation in other settings is still necessary. Nevertheless, the presented method has been shown to be highly promising.     

Inter- and intra-rater reliability of 3D kinematics during maximum mouth opening of asymptomatic subjects

Previous studies evaluated 3D human jaw movements using kinematic analysis systems during mouth opening, but information on the reliability of such measurements is still scarce. The purpose of this study was to analyze within- and between-session reliabilities, inter-rater reliability, standard error of measurement (SEM), minimum detectable change (MDC) and consistency of agreement across raters and sessions of 3D kinematic variables during maximum mouth opening (MMO). Thirty-six asymptomatic subjects from both genders were evaluated on two different days, five to seven days apart. Subjects performed three MMO movements while kinematic data were collected. Intraclass correlation coefficient (ICC), SEM and MDC were calculated for all variables, and Bland-Altman plots were constructed. Jaw radius and width were the most reproducible variables (ICC > 0.81) and demonstrated minor error. Incisor displacement during MMO and angular movements in the sagittal plane presented good reliability (ICC from 0.61 to 0.8) and small errors and, consequently, could be used in future studies with the same methodology and population. The variables with smaller amplitudes (condylar translations during mouth opening and closing and mandibular movements on the frontal and transversal planes) were less reliable (ICC < 0.61) and presented larger SEM and MDC. Although ICC, SEM and MDC showed less between-session reproducibility than within-session and inter-rater, the limits of agreement were larger in inter-rater comparisons. In future studies care must be taken with variables collected on different days and with mandibular movements in the frontal and transversal planes.     

Plasma variation and reproducibility of oxidized LDL-cholesterol and low-grade inflammation biomarkers among participants of the Malmö Diet and Cancer cohort

Context: Large epidemiological studies often collect non-fasting samples, although the reliability of biomarkers may be uncertain.

Objective: To explore the reliability and reproducibility of a single measurement of selected biomarkers in a sub-sample of the Malmö Diet and Cancer cohort.

Methods: We estimated single- and average-measures intraclass correlation coefficients (ICC) for oxidized (ox)-LDL, interleukin (IL)-1β, IL-6, IL-8 and TNF-α.

Results: Single-measures ICC in non-fasting samples of ox-LDL, IL-1β, IL-6, IL-8 and TNF-α were the following: 0.85, 0.71, 0.61, 0.78 and 0.66 for men, and 0.67, 0.81, 0.87, 0.69 and 0.81 for women. Biomarkers at non-fasting and fasting samples were highly correlated (all r?>?0.80).

Conclusions: The observed ICC suggest that most of the examined biomarkers (non-fasting blood) would allow meaningful analysis in epidemiological studies.     

Neurotransmitter system markers in adult barrel field

Abstract

Purpose: Skin contributes to joint position sense (JPS) at multiple joints. Altered cutaneous input at the foot can modulate gait and balance and kinesiology tape can enhance proprioception at the knee, but its effect may be dependent on existing capacity. The effect of texture at the knee, particularly in those with poor proprioception, is unknown. The aim of this study was to determine the effect of textured panels on JPS about the knee.

Materials and methods: Eighteen healthy females were seated in an adjustable chair. Their left leg (target limb) moved passively from 65° to a target of flexion (115° or 90°) or extension (40°). Their right leg (matching limb) was passively moved towards this target angle and participants indicated when their limbs felt aligned. We tested three textured panels over the knee of the matching limb and two control conditions. The target limb maintained a control panel. Directional error, absolute error and variable error in matching between limbs were calculated.

Results: On average textured panels over the knee increased JPS error compared to control pants for participants with poor JPS. These participants undershot the target at 90° of flexion significantly more with textured panels (?11°?±?3°) versus control (?7°?±?3°, p?=?0.04).

Conclusions: For participants with poor JPS accuracy, increased JPS error at 90° with a textured panel suggests these individuals utilised altered cutaneous information to adjust joint position. We propose increased error results from enhanced skin input at the knee leading to the perception of increased flexion.     

Intersession reliability of a posturo-stabilometric test,using a force platform

Aim of the studyTo evaluate the intersession reliability of a posturo-stabilometric examination.MethodsSingle blind clinical trial conducted in two sessions over two weeks.44 healthy volunteers free from postural and temporomandibular disorders. All the subjects complied with the criteria for completing the study.All the subjects underwent two sessions of posturo-stabilometric examinations in different visual and mandibular conditions.Sway area, sway length and the coordinates of the center of pressure were evaluated and statistically analyzed using the Intraclass correlation coefficient (ICC).ResultsAll the posturo-stabilometric parameters seemed to have an excellent reproducibility with overall ICCs higher than 70% and good confidence intervals except for the sway area (ICC 0.422 with CI 0.283–0.560 with open eyes and ICC 0.554 with CI 0.424–0.683 with closed eyes).ConclusionsThe posturo-stabilometric examination carried out using a force platform has a good intrasession and intersession reliability, especially considering sway velocity, COP X and COP Y parameters. The force platform usefulness in analyzing static posture is confirmed in any medical field.     

Real-time intersession and interrater reliability of the functional movement screen

The purpose of this study was to examine the real-time intersession and interrater reliability of the functional movement screen (FMS). The overall study consisted of 19 volunteer civilians (12 male, 7 female). The intersession reliability consisted of 12 men and 7 women, whereas 10 men and 6 women participated in the interrater reliability test session. Two raters (A and B) were involved in the interrater reliability aspect of this study. The FMS includes 7 tests: deep squat (DS), hurdle step (HS), in-line lunge (IL), shoulder mobility (SM), active straight leg raise (ASLR), trunk stability push-up (TSPU), and rotary stability (RS). Researchers analyzed the data via intraclass correlation (ICC). To determine the reliability of the intersession scoring of the FMS and the intrasession interrater scoring of the FMS a 2-way mixed effects model intraclass correlation coefficient (ICC(3,1)) was used for the continuous data, whereas a weighted Cohen's kappa (κ) was used for the categorical data. The dependent variables were FMS total score (0-21 scale) and associated tests were DS, HS, IL, SM, ASLR, TSPU, and RS. Intersession reliability (ICC, SEM) and κ were as follows: FMS total score (0.92, 0.51), DS (κ = 0.69), HS (κ = 0.16), IL (κ = 0.69), SM (κ = 0.84), ASLR (κ = 0.69), TSPU (κ = 0.77), and RS (no covariance). Interrater reliability (ICC, SEM) and κ were as follows: FMS total score (0.98, 0.25), DS (κ = 1.0), HS (κ = 0.33), IL (κ = 0.88), SM (κ = 0.90), ASLR (κ = 0.88), TSPU (κ = 0.75), and RS (no covariance). The FMS total scores displayed high intersession and interrater reliabilities. Finally, with the exception of HS, all tasks displayed moderate to high intersession reliability and good to high interrater reliability.     

Reproducibility of MUAP properties in array surface EMG recordings of the upper trapezius and sternocleidomastoid muscle

The use of array surface EMG recordings for detailed assessment of motor control and muscle properties is increasing. Motor unit action potentials (MUAPs) and their properties can be extracted from these recordings. The objective of this study was to determine the reproducibility of variables obtained from array surface EMG recordings of the shoulder and neck muscles during different functional tasks.Eight-channel linear arrays were placed on the upper trapezius (UT) and sternocleidomastoid (SCM) muscles of 12 healthy subjects. Subjects performed 3 tasks: shoulder abduction (90°), ironing (repetitively touching two ends of a horizontal bar in front of the subject), and 90° head turning. The protocol was performed twice while electrodes remained on and repeated a third time a week later.Three global and six MUAP-related variables were calculated. Intra-class correlation coefficients (ICC) were calculated to assess reliability and smallest detectable changes (SDC) were calculated to assess agreement.In general, the EMG variables showed high levels of reliability which suggests they may be effective for differentiating between-subjects. SDC was found to be considerably lower for the frequency-related (5–23%) than for the amplitude-related variables (15–78%), indicating that the frequency-related variables may be more suitable for investigating interventions which aim to modify motor control. There was no difference in reproducibility between global and MUAP-related variables, which justifies their complementary use.     

Reduced scapular muscle control and impaired shoulder joint position sense in subjects with chronic shoulder stiffness

The purpose of the present study was to determine (1) if joint position sense (JPS) in subjects with shoulder stiffness (SS) differs from that in controls; (2) if, when JPS is reduced in SS, it is related to scapular muscular activities in the mid/end ranges of motion; and (3) if a person’s function is associated with his or her level of JPS. Eighteen subjects with unilateral SS and 18 controls were included. Each subject performed abduction by self-selecting an end/mid range position. The electromagnetic motion-capturing system collected kinematic data while surface electromyography collected muscle activities (upper trapezius, lower trapezius, and serratus anterior muscles). Subjects were asked to move the upper limb to the target position (end/mid range) accurately without visual guidance. Reduced JPS was observed in subjects with SS (2.7 degrees in mid range, p < 0.05). The JPS was enhanced by an increased scapula muscular activation level in the end range of motion (R = ?0.61 for SS and ?0.41 for controls) and by coordination among muscles’ activation in the mid-range of motion (R = ?0.87 for SS and R = ?0.53 for controls). Impaired JPS was also related to self-reported functional status (R = ?0.56) in subjects with SS. Shoulder JPS in subjects with chronic SS is impaired in comparison with controls. In the mid-range motion, the coordination of scapula muscular activation is related to shoulder JPS. Impaired JPS is also function-related in subjects with SS. These findings suggest that the coordination among scapula muscles’ activation were important to consider in the rehabilitation of patients with chronic SS.     

Reproducibility of kinematic motion coupling parameters during manual upper cervical axial rotation mobilization: A 3-dimensional in vitro study of the atlanto-axial joint

IntroductionThe reproducibility of the 3-dimensional (3D) kinematic aspects of motion coupling patterns of segmental manual mobilizing techniques is not yet known. This study analyzes the segmental 3D aspects of manual mobilization of the atlanto-axial joint in vitro.Methods and materialsTwenty fresh human cervical specimens were studied in a test–retest situation with two examiners. The specimens were manually mobilized using three different techniques: a regional mobilization technique, a segmental mobilization technique on the atlas with manual fixation of the axis and a segmental mobilization applying a locking technique. Segmental kinematics were registered with a Zebris CMS20 ultrasound-based tracking system. The 3D aspects of motion coupling between main axial rotation and coupled lateral bending were analyzed by six parameters: the range of motion the three motion components, the cross-correlation, the ratio and the shift.ResultsThe results indicate stronger intra- than inter-examiner reproducibility. The range of motion of the axial rotation component shows a substantial level of intra- and inter-examiner reproducibility (ICC’s 0.67–0.76). The parameters describing the coupling patterns show only moderate to substantial intra-examiner reproducibility for the more experienced of the two examiners (ICC’s 0.55–0.68). All other correlations were not significant and no differences could be observed between regional versus segmental techniques.ConclusionReproducibility of segmental 3D-aspects of manual mobilization of the atlanto-axial joint in an in vitro situation can differ between examiners. The results of the present study may indicate a possible tendency to higher reproducibility if mobilizations are performed by an examiner with high expertise and experience in applying the specific techniques. Continued investigation including more examiners with different levels of experience and different techniques is necessary to confirm these observations.     

Novel Use of the Nintendo Wii Board for Measuring Isometric Lower Limb Strength: A Reproducible and Valid Method in Older Adults

BackgroundPortable, low-cost, objective and reproducible assessment of muscle strength in the lower limbs is important as it allows clinicians to precisly track progression of patients undergoing rehabilitation. The Nintendo Wii Balance Board (WBB) is portable, inexpensive, durable, available worldwide, and may serve the above function.ObjectiveThe purpose of the study was to evaluate (1) reproducibility and (2) concurrent validity of the WBB for measuring isometric muscle strength in the lower limb.MethodsA custom hardware and software was developed to utilize the WBB for assessment of isometric muscle strength. Thirty older adults (69.0±4.2 years of age) were studied on two separate occasions on both the WBB and a stationary isometric dynamometer (SID). On each occasion, three recordings were obtained from each device. For the first recording, means and maximum values were used for further analysis. The test-retest reproducibility was examined using intraclass correlation coefficients (ICC), Standard Error of Measurement (SEM), and limits of agreement (LOA). Bland-Altman plots (BAP) and ICC’s were used to explore concurrent validity.ResultsNo systematic difference between test-retest was detected for the WBB. ICC within-device were between 0.90 and 0.96 and between-devices were from 0.80 to 0.84. SEM ranged for the WBB from 9.7 to 13.9%, and for the SID from 11.9 to 13.1%. LOA ranged for the WBB from 20.3 to 28.7% and for the SID from 24.2 to 26.6%. The BAP showed no relationship between the difference and the mean.ConclusionsA high relative and an acceptable absolute reproducibility combined with a good validity was found for the novel method using the WBB for measuring isometric lower limb strength in older adults. Further research using the WBB for assessing lower limb strength should be conducted in different study-populations.