Assessment of the strength of the trunk and upper limb muscles in
					stroke subjects with portable dynamometry: a literature review

Martins, Júlia Caetano; Teixeira-Salmela, Luci Fuscaldi; Aguiar, Larissa Tavares; Souza, Lucas Araújo Castro e; Lara, Eliza Maria; Faria, Christina Danielli Coelho de Morais

doi:10.1590/0103-5150.028.001.AR02

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Review articles • Fisioter. mov. 28 (1) • Mar 2015 • https://doi.org/10.1590/0103-5150.028.001.AR02 copy

Assessment of the strength of the trunk and upper limb muscles in stroke subjects with portable dynamometry: a literature review

Avaliação da força muscular pós-AVE pela dinamometria portátil: uma revisão da literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction

Clinical measurements of strength in stroke subjects are usually performed and portable dynamometers are one of the most employed instruments.

Objective

To verify the standardization procedures of the methods used to assess the strength of the trunk and upper limb muscles with portable dynamometers in stroke subjects, as well as to assess the psychometric properties which were already investigated.

Materials and methods

An extensive search was performed on the MEDLINE, SciELO, LILACS, and PEDro databases, by combining specific key words, followed by active manual searches by two independent researchers.

Results and discussion

Fifty-eight studies were included: three related to the trunk and 55 to the upper limb muscles, including handgrip and pinch strength assessments. The most investigated muscular groups were handgrip, elbow flexors/extensors, wrist extensors, and lateral pinch. Nine studies reported adequate reliability levels and the seated position was employed in the majority of the studies which assessed trunk, handgrip, and pinch strength, while the supine position was used for the other muscular groups. The number of trials most used was three, while the reported contractions and rest times were variable.

Final considerations

Most studies reported the positioning and/or the data collection protocols; however, there was no consensus on the standardization procedures. The only investigated psychometric property was reliability. Few studies evaluated the trunk muscles and other psychometric properties.

Dynamometer; Trunk; Upper limbs; Reliability; Validity

Study	Muscular group	Subject positioning	Protocol
Bohannon (23)	Lateral flexors	Sitting and trunk stabilization	NI
Bohannon (14)	Anterior and lateral flexors	Sitting, stabilization by the examiner in the proximal thigh	One trial, maximal isometric contractions over 5s
Bohannon et al. (42)	Anterior and lateral flexors	Sitting, stabilization by the examiner in the proximal thigh	One trial, maximal isometric contractions over 3 to 4s

Study	Subject position	Protocol
Sunderland et al. (12)	Sitting, hand on the thigh	Three alternate trials
Jones et al. (60)	Upper limb extended next to the body	Three trials
Van Deusen et al. (61)	NI	Three trials
Robinson et al. (62)	Sitting, elbow extended	Two trials, contraction of 6s
Bohannon (63)	Sitting, upper limb extended next to the body, elbow flexed to 90°	NI
Marque et al. (64)	Upper limb down and away from the body	Three trials, rest interval of 5min
Boissy et al. (9)	Sitting, shoulder abducted to 30° and flexed to 0º, elbow flexed to 90°	Three trials, rest interval of 2min
Bhakta et al. (65)	Sitting, elbow flexed to 90° and elbow extended	Three trials, contraction of 10s
Merians et al.(66)	NI	One trial
Pandyan et al. (67)	Elbow flexed to 90°, minimum elevation of the shoulder	Three trials, rest interval of 15s
Hammer et al. (28)	Sitting, feet resting, hand and forearm stabilized, elbow flexed to 90° shoulder flexed to 10º and abducted to 10º	Three trials, contraction of 10s, rest interval ≥ 30s
Dijkerman et al. (68)	Elbow flexed to 90°	Three alternate trials
Broeren et al. (69)	NI	Contraction of 10s
Bohannon (70)	Sitting, shoulder adducted, elbow flexed to 90°, wrist extended between 0° to 30°, ulnar deviation between 0° to 15°	One trial
Suputtitada et al. (71)	NI	Three trials
Kamper et al. (4)	NI	Two trials
Wolf et al. (72)	Sitting, elbow flexed to 90°	Three trials, contraction of 3s
Restemeyer et al. (73)	NI	Three trials
Ploughman et al. (31)	Sitting, elbow flexed to 90°, without trunk support	Three trials
Gosselin et al. (74)	NI	Two alternate trials
Kang et al. (75)	NI	Three trials
Beebe et al. (76)	Sitting, upper limb next to the body, elbow flexed to 90°, wrist slightly extended	Three trials
Bohannon (77)	Sitting, shoulder adduced, elbow flexed to 90°	One trial
Burdea et al. (78)	NI	Three trials

Study	Pinch type	Subjects’ position	Protocol
Van Deusen et al. (61)	Lateral and palmar	NI	Three trials
Conforto et al. (29)	Lateral	Sitting, shoulder adducted, elbow flexed to 90°, wrist extended between 0° to 30°, ulnar deviation between 0° to 15°	Five trials
Byl et al. (47)	Lateral and palmar	NI	NI
Suputtitada et al. (71)	Pinch strength	NI	Three trials
Hummel et al. (30)	Lateral	Sitting, shoulder adducted, elbow flexed to 90°, wrist extended between 0° to 30°, ulnar deviation between 0° to 15°	Nine trials, contraction between 1 and 3s
Lomarev et al. (79)	Pinch strength	NI	Five trials, rest interval of 10s
McDonnell et al. (80)	Pulp-to-Pulp	NI	Three trials, rest interval of 30s
Lang et al. (54)	Palmar	NI	NI
Ploughman et al. (31)	Lateral	Sitting, elbow flexed to 90°, without trunk support	Three trials
Beebe et al. (55)	Palmar	NI	NI
Klaiput et al. (81)	Lateral and pulp-to-pulp	NI	Three trials, rest interval of 15s
Beebe et al. (76)	Palmar	Sitting, upper limb next to the body, elbow flexed to 90°, wrist slightly extended	Three trials
Connelly et al. (57)	Lateral and palmar	NI	NI
Burdea et al. (78)	Pulp-to-pulp, lateral and palmar	NI	Three trials
Triandafilou et al. (58)	Lateral	NI	NI

Study	Muscular group	Subjects’ position	Protocol
Bohannon (24)	Wrist and elbow flexors/extensors; shoulder internal/external rotators, abductors/adductors	Supine, wrist and elbow flexion/extension, shoulder internal/external rotation: upper limb next to the body and elbow flexed at 90°; shoulder abduction/adduction: elbow extended and shoulder abducted at 45°. Manual stabilization next to the evaluated segment	Three trials, contractions of 4 to 5s, rest intervals between 10 and 30s
Bohannon et al. (82)	Wrist and elbow flexors/extensors; shoulder internal/external rotators, abductors/adductors, flexors/extensors	Supine, tested segment without the interference of gravity and in the middle of range of motion	Same as above
Bohannon et al. (25)	Wrist extensors; elbow flexors/extensors; shoulder internal/ external rotators, abductors, and flexors/extensors	Supine, tested segment without the interference of gravity and in the middle of range of motion	Same as above
Bohannon et al. (26)	Wrist extensors; elbow flexors, and shoulder external rotators	Supine, tested segment without the interference of gravity and the middle of range of motion, described by Bohannon (24)	One trial, contractions of 4 to 5s
Riddle et al. (83)	Wrist and elbow flexors/extensors; shoulder internal/external rotators	Supine (24)	Three trials, contractions of 4 to 6s, rest intervals of 10 to 30s
Bohannon et al. (84)	Elbow flexors	Supine, upper limb extended, 90° of elbow flexion, 30° of shoulder abduction, forearm at supine position	Four trials, contractions of 4 to 5s, rest intervals of 10s
Bohannon et al. (85)	Elbow flexors	Supine, elbow flexed at 90°, shoulder stabilization	Two trials, contractions of 4 to 5s
Bohannon (63)	Elbow flexors and shoulder abductors	Supine, elbow flexed at 90° and shoulder at 45°	NI
Bohannon et al. (86)	Wrist extensors, elbow flexors, and shoulder abductors	Supine, tested segment without the interference of gravity and in the middle of the range of motion, wrist extension: shoulder in neutral, elbow flexed at 90°, wrist in neutral and fingers relaxed. Stabilization: distal forearm; elbow flexion: shoulder in neutral, elbow flexed at 90°, forearm in supine. Stabilization: upper arm or shoulder; shoulder abduction: shoulder abducted at 45° and elbow extended. Stabilization: top of shoulder	NI
Andrews et al. (27)	Wrist extensors, elbow flexors, and shoulder abductors	Supine, tested segment without the interference of gravity, wrist extensors: shoulder in neutral, elbow flexed at 90°, and fingers relaxed. Stabilization: distal forearm, elbow flexors: elbow flexed at 90°, forearm in supine. Stabilization: upper arm or shoulder; elbow extensors: elbow flexed at 90°. Stabilization: anterior part of the shoulder or arm; shoulder abductors: shoulder abducted at 45° and elbow extended. Stabilization: shoulder	Two trials, contractions of 3 to 4s, rest intervals of 1 to 2min
Byl et al. (47)	Wrist extensors, elbow flexors, and shoulder flexors	Supine or sitting; wrist extensors: arm on the table, forearm in prone, and wrist in neutral. Stabilization: distal forearm; elbow flexors: elbow flexed at about 90°, forearm in supine. Stabilization: under the elbow, shoulder flexors: shoulder flexed and internally rotated, elbow flexed and forearm in supine. Stabilization at the trunk	NI
Bohannon (70)	Elbow flexors and shoulder abductors	Supine: elbow flexors: elbow flexed at 90° and forearm in supine; shoulder abuctors: shoulder abducted at 45° and elbow extended	One trial, contractions of 4 to 5s, rest intervals of 1min
Beebe et al. (55)	Index finger, wrist, elbow, and shoulder flexors and extensors	Supine, tested segment without the interference of gravity; forefinger flexors/extensors: NI; wrist flexors: NI; wrist extensors: shoulder in neutral, elbow flexed at 90°, and fingers relaxed. Stabilization: distal forearm; elbow flexors: elbow flexed at 90°, forearm in supine. Stabilization: anterior part of the shoulder or arm; shoulder flexors: shoulder flexed at 90° and elbow extended. Stabilization: axillary region, shoulder extensors: shoulder flexed at 90°, elbow flexed. Stabilization: shoulder	NI
Beebe et al. (76)	Index finger, wrist, elbow, and shoulder flexors and extensors	Same as above	NI

Study	Sample	Muscular group	Measurement property	Results
Bohannon (24)	n = 16, aged between 17 and 82 years	Wrist and elbow flexors/extensors, shoulder internal/external rotators and abductors/adductors	Test-retest reliability	0.95 ≤ r ≤ 0.99
Bohannon et al. (25)	n = 42, male and female, ages between 22 e 84 years, time since the onset of stroke between 9 and 233 days	Wrist extensors; elbow flexors/extensors; shoulder internal/external rotators, adductors, and flexors/extensors	Test-retest reliability	r² ≥ 0.88
Bohannon et al. (26)	n = 21, male and female	Wrist extensors, elbow flexors, and shoulder external rotators	Inter-rater reliability	0.88 ≤ r ≤ 0.94
Riddle et al. (83)	n = 31, mean age of 54.6 ± 18.1 years, time since the onset of stroke between 5 and 150 days	Wrist flexors and extensors, elbow flexors and extensors, and shoulder internal and external rotators	Test-retest and inter-rater reliabilities	Test-retest 0.91 ≤ r ≤ 0.99; ICC: 0.93-0.98 Inter-rater 0.92 ≤ r ≤ 0.98; ICC: 0.90-0.98
Bohannon et al. (85)	n = 23	Elbow flexors	Inter-rater reliability	ICC = 0.99
Bohannon (63)	n = 10, male and female, ages between 46 and 81 years, time since the onset of stroke between 2 and 10 days	Elbow flexors, shoulder abductors, and grip strength	Test-retest reliability	0.95 ≤ r_s ≤ 0.96
Bohannon et al. (42)	n = 11 male and female, mean age of 67.4 ± 10.2 years, time since the onset of stroke of 14.2 ± 11.5 days	Anterior and lateral trunk flexors	Inter-rater reliability	ICC = 0.80-0.82
Boissy et al. (9)	n = 15, male and female, ages between 29 and 65 years	Grip	Test-retest reliability	ICC = 0.91
Hammer et al. (28)	n = 18, male and female, ages between 38 and 63 years, time since the onset of stroke between 2 and 25 weeks	Grip	Test-retest reliability	C_R = 48.2 N

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[1] * JCM: MSc, e-mail: julia_caetano@yahoo.com.br LFTS: Ph.D, e-mail: lfts@ufmg.br LTA: Grad., e-mail: larissatavaresaguiar@gmail.com LACS: MSc, e-mail: lucas.araujo.ufmg@gmail.com EML: Grad., e-mail: izamlara@yahoo.com.br CDCMF: PhD, e-mail: cdcmf@ufmg.br