Thesis (Ph.D.)--University of Delaware, 2009. / Principal faculty advisor: Slobodan Jaric, Dept. of Health, Nutrition, & Exercise Sciences. Includes bibliographical references.

Hand grip strength (HGS) is a new nutritional assessment parameter proposed by American Society for Parenteral and Enteral Nutrition (ASPEN) and the Academy of Nutrition and Dietetics (the Academy) for diagnosis of adult malnutrition related to acute illnesses, chronic diseases or starvation. Identification of ≥2 of the following conditions is considered to be malnourishment – weight loss, loss of muscle mass, loss of subcutaneous fat, fluid accumulation, diminished HGS and inadequate energy intake. HGS is also a marker of sarcopenia, a condition defined by low muscle mass and low muscle strength or performance, as identified by the European Working Group on Sarcopenia in Older People. It has also been shown that lower HGS is associated with deficits in activities of daily living (ADL) and mobility. HGS is emerging as an important screening tool especially in the malnourished and aging population. This research evaluates the applicability of HGS as a nutrition screening tool in long-term care older adults. Data from a total of 129 participants age ≥60 years involved in an ongoing walking program in long-term care facilities in Saskatoon available for analysis at the time this work was undertaken. Participants were randomly assigned for an intervention period of 16 weeks to one of three study groups: 1) Usual Care Group, 2) Interpersonal Interaction Group, and 3) Walking Program Group. Activity of daily living, cognition and depression scores and hand grip strength were recorded at baseline and every eight weeks. Information on vitamin D intake status prior to study commencement was also collected. This study provides values of low grip strength similar to those defined for the risk of sarcopenia in frail older adults. Stronger baseline HGS was correlated with greater ADL independence in females (B=0.079, P=0.044). Greater ability to eat at baseline was also associated with stronger grip in females when cognition status was taken into consideration. Baseline ADL (B=-0.024) and HGS (B=1.004) were significant predictors of subsequent ADL and HGS, respectively, in males (P<0.01). Baseline HGS was associated with subsequent ADL and HGS in females, but such association was modified by other covariates. In summary, if grip strength is to be used as a nutritional screening tool in long-term care facilities, dietitians shall be cautious of other factors such as the residents’ cognitive status and age and use in conjunction with other nutrition assessment methods.

Thesis (Ph. D.)--Rutgers University, 2010. / "Graduate Program in Biomedical Engineering." Includes bibliographical references (p. 132-138).

Heart failure is a progressive condition that affects over 5.7 million Americans and costs associated with heart failure account for 2-3 % of the national health care budget. The high rates of morbidity and mortality along with increased costs from readmissions associated with advanced heart failure have led to the exploration of advanced treatments such as left ventricular assist devices (LVADs). LVADS have demonstrated morbidity and mortality benefit but cost remains extensive with costs per quality-adjusted years > $400,000. With this in mind, it is important to identify those who are most likely to benefit from an LVAD to avoid unfavorable outcomes and cost. Although general guidelines and criteria for patient eligibility have been established, choosing patients for LVAD implantation remains challenging. A new focus on patient selection involves the presence of frailty. While frailty has been studied in the elderly population and in patients undergoing cardiac surgery, frailty in patients undergoing left ventricular assist device (LVAD) remains controversial. The purpose of this dissertation was to examine measures of frailty in patients undergoing LVAD implantation. The specific aims of this dissertation were to: (1) identify a feasible frailty measure in adults with end-stage heart failure who underwent LVAD implantation by testing the hypothesis that frailty would predict 30 day rehospitalization rates using Fried’s criteria, Short Physical Performance Battery test, handgrip strength, serum albumin and six minute walk test (2) Determine whether frailty measures improve 3 months post LVAD implantation (3) compare sensitivity of these three measures to change in frailty. Surgical approaches, including heart transplantation and LVAD implantation, for patients with end-stage heart failure was discussed in this dissertation. Data from two subsets of participants who underwent LVADS at the University of Kentucky between 2014 and 2017 were included in the analysis for this dissertation. In the first study, we found that none of the measures are good predictors of frailty in patients with advanced heart failure who undergo LVAD implantation. Handgrip was the only marker of frailty that predicted 30 day readmission but the relationship was a negative association. In the second study, six-minute walk and low serum albumin levels reflect short-term improvement in frailty. These simple measures may be used to determine those patients who are responsive to LVAD implantation. The findings of these studies filled some gaps in our understanding of markers of frailty in patients undergoing LVADs. We gained a better understanding of which markers of frailty are likely to improve in most people after LVAD implantation and thus frailty should not preclude candidate selection for an LVAD. Subsequently, more research is needed to investigate these markers and outcomes.

Bakgrund: Sportfysioterapeuter hjälper atleter att förbättra sport-specifika förmågor. Inom ishockey är slagskottet den skotteknik som producerar den snabbaste puckhastigheten. Handgreppsstyrka har visat sig vara viktig för en hockeyspelares sport-specifika förmågor och klubbrörelser. Skridskohastighet är en viktig variabel sett till hockeyspelares övergripande prestationsnivå. Syfte: Att undersöka den genomsnittliga maximala skotthastigheten, den genomsnittliga maximala handgreppsstyrkan och den genomsnittliga maximala skridskohastigheten hos en grupp manliga svenska elithockeyspelare och undersöka sambandet mellan den maximala skotthastigheten och den maximala handgreppsstyrkan samt skridskohastigheten. Metod: Ett lag på tjugotre manliga elithockeyspelare tillfrågades varav tjugo deltog i studien. Endast utespelare tillfrågades. Tvärsnittstudie med kvantitativ ansats bestående av enstaka mätningar på en grupp. Skotthastighet, handgreppsstyrka och skridskohastighet mättes en gång per testperson vid tre separata tillfällen. Resultat: Sjutton hockeyspelare slutförde studien. Den genomsnittliga maximala skotthastigheten var 128,167 km/h. Den genomsnittliga maximala handgreppsstyrkan var 60,2 kg. Den genomsnittliga skridskohastigheten var 1,405s mätt på en sträcka av 15 meter. Sambandet mellan skotthastighet och handgreppsstyrka var svagt negativt och ej statistiskt signifikant (r=-0,042; p=0,876). Sambandet mellan skotthastighet och skridskohastighet var svagt negativt och ej statistiskt signifikant (r=-0177; p=0,508).     Konklusion: De genomsnittliga maximala värdena på skotthastighet, handgreppsstyrka och skridskohastighet är jämförbara med andra studiers värden. Sambandet mellan skotthastighet och handgreppstyrka samt skridskohastighet var svagt vilket pekar på att dessa faktorer inte är en indikator på skotthastigheten vid ett slagskott. Fler studier behövs för att stödja studiens resultat. / Background: Sportsfysiotherapists help athletes improve their sport-specific abilities. In ice-hockey, the slap shot is the shot-technique that produces the greatest puck velocity. Hand grip strength have shown to be important to hockey players sport-specific abilities and stick movements. Skating speed is an important variable for the hockey players overall performance.    Aim: To investigate the mean hand grip strength, skating speed and shooting speed on a group swedish male elite ice-hockey players and investigate the correlation between these factors.     Methods: A team of twentythree male elite hockey players were asked to participate in the study. Twenty players participated. A cross-sectional study with a quantitative approach consisting of single measures on one group. Puck velocity, handgrip strength and skating speed were measured one time per player on three separate sessions.    Results: Seventeen hockey players completed the studie. The mean puck velocity was 128,167 km/h. The mean hand grip strength were 60,2 kg. The mean shooting speed were 1,405s measured on a distance of 15 meters. The correlation between puck velocity and hand grip strength were not statistically significant weak negative (r=-0,042; p=0,876). The correlation between mean puck velocity and shooting speed were not statistically significant weak negative(r=-0,177; p=0,508).    Conclusion: The mean maximal values of puck velocity, hand grip strength and shooting speed are comparable with similar values from other studies. The correlation between puck velocity and hand grip strength and shooting speed were weak which indicate that these factors do not affect the puck velocity from a slap shot. Further studies are needed to strengthen this study's result.

Abstract  Background: Body composition is an important health parameter in several disease conditions, e.g., the inflammatory back disease spondylarthritis (SpA). Body mass index (BMI) is the most common anthropometric body composition assessment but has several limitations. As a result, several studies have been carried out to improve its validity by combining different body parameters. Nickerson equation (NE) is one of the equations developed to address the limitation of BMI. However, the knowledge is lacking on the preference of the NE which includes BMI (body weight and height), hand grip strength, and sex to estimate body fat percent over BMI alone among individuals with spondylarthritis. Aim: This study aims to assess the association between BMI and the Nickerson equation (NE) -estimate body fat percentage- with body composition measured with bioelectrical impedance assessment (BIA) and in individuals with spondylarthritis. Methods: Thirty-two individuals with SpA 17 women and 15 men with a median (range) age of 47 (30-66) years were included. The weight (kg), length (cm), hand grip strength (kg), and sex were registered to estimate values of body composition by the NE. BIA was equally used to assess total body fat %, visceral fat (cm2), and skeletal muscle mass (kg). Associations between the NE, or body mass index (BMI), and BIA were analyzed by Spearman’s correlations (rs). Results: The result shows that the NE has a rs of 0.6 to BIA total body fat higher than the BMI correlation coefficient of 0.3 but NE has a lower coefficient of 0.3 to visceral fat than the BMI which is 0.6, NE also has a negative correlation coefficient of 0.6 to skeletal muscles.  Conclusion: This study suggested that the Nickerson Equation which combines BMI, hand grip strength, and sex is a better assessment of body composition in individuals with spondylarthritis and encourages clinicians to consider using the Nickerson equation in clinical setting instead of BMI where access to precise assessment tools is unavailable.

Background  Maximum voluntary bite force (BF) and hand grip strength (HS) serve as muscle strength markers from the jaw motor system and hand motor system.   Aim  To investigate i) differences in maximum BF and HS between dominant and non-dominant sides, ii) differences between repeated tests in the same session and iii) correlation between BF and HS.     Methods Fifteen resistance trained adults (n=6 women, mean age 24 (SD 1.04) years and n=9 men, mean age 27 (SD 4.06) years) were tested with electronic BF and HS devices, with three repeated tests per side. Paired sample T-test was used to detect differences in BF and HS between sides and whether there was a difference between repeated tests. Pearson test was used to determine correlation between BF and HS. P-value &lt;0.05 was considered statistically significant.    Results HS showed differences between dominant and non-dominant sides in three tests (T1 P=&lt;0.0001, T2 P=0.0002 and T3 P=0.0011). BF showed differences between repeated tests in the same session for T1-T2 (P=0.007), T1-T3 (P&lt;0.0001) and T2-T3 (P=0.028) on dominant side and between T1-T2 (P=0.014), T1-T3 (P=0.010) on non-dominant side. Correlation between BF and HS showed r=0.41 for merged data (dominant + non-dominant side) (P=0.02).   Conclusions  In the context of resistance trained adults, the findings showed that BF did not alter between sides while HS did, with higher force production for the dominant hand. Repeated tests showed differences between tests for BF, but not for HS. A weak to moderate correlation could be observed when comparing BF to HS.

No description available.

Elektroneurografi är en undersökningsmetod som används för att undersöka nervledingskapaciteten i perifera nerver. Det är en metod som ofta används på sjukhuskliniker vid diagnostisering av perifera nervsjukdomar. Syftet med studien är att undersöka om det finns en signifikant skillnad i motorisk och sensorisk nervledningshastighet, amplitud och F-respons mellan dominant och icke-dominant hand. I studien undersöktes det även om en korrelation finns mellan handgreppsstyrka och svarsamplitud från motorisk elektroneurografi.  I studien deltog 26 testpersoner från biomedicinska analytikerprogrammet i termin 6. Testpersonernas genomsnittsålder är 24 år (range 21-32 år), och testpersonernas kroppslängd är i genomsnitt 169 cm (range 155- 185). Elektroneurografi utfördes motoriskt och sensoriskt på nervus medianus bilateralt. Handgreppsstyrka undersöktes bilateralt med Jamar Hydraulic Hand dynamometer. För samtliga mätvariabler bestämdes signifikantnivån till α=0,05.  Resultatet visar att det finns en signifikant skillnad i sensorisk nervledningshastighet, motorisk amplitud och sensorisk amplitud mellan dominant och icke-dominant hand. Sensorisk nervledningshastighet är högre i icke-dominant hand, medan motorisk och sensorisk amplitud är högre i dominant hand. Däremot kan inte en signifikant skillnad påvisas i motorisk nervledningshastighet, FM-latens samt antalet F-svar mellan dominant och icke-dominant hand. Resultatet visar att det inte finns någon korrelation mellan handgreppsstyrka och amplitud i motorisk elektroneurografi. I dag används samma referensvärden för dominant och icke-dominant hand. Den här studien visar att det kan finnas ett värde i att utforma referensintervall som baseras på handdominans. / Electroneurography is an examination method used for examining the nerve conduction capacity of the peripheral nerve. The method is often used in hospitals in the diagnosis of peripheral nerve injuries. The aim of this study is to examine if there is a significant difference in motor and sensory nerve conduction velocity, amplitude, and F-response between dominant and non-dominant hands. The correlation between hand grip strength and the amplitude in motor electroneurography was also examined in this study.  The study involved 26 students from Biomedical Scientist Programme term 6. The average age of the participants is 24 years (range 21-32 years), and the participants body length is on average 169 cm (range 155-185 cm). Electroneurography was performed on the median nerve bilaterally. Hand grip strength was examined bilaterally with Jamar Hydraulic Hand dynamometer. For all measurement variables, the significant level was determined to α=0,05.  The result shows that there is a significant difference in sensory nerve conduction velocity, motor amplitude, and sensory amplitude between dominant and non-dominant hands. Sensory nerve conduction velocity is higher in non-dominant hand, while motor and sensory amplitude is higher in dominant hand. However, a significant difference cannot be detected in motor nerve conduction velocity, FM-latency, and the number of F-responses between dominant and non-dominant hands. The result shows no correlation between hand grip strength and the amplitude in motor electroneurography.  Today, the same reference values are used for dominant and non-dominant hands. This study shows that there may be a value in creating reference intervals based on hand dominance.

Contexte :Le conditionnement précédant la greffe de cellules souches hématopoïétiques (CSH) a été associé avec des taux élevés de malnutrition meme à 100 jours après la greffe. Objectif: Cette étude évalua l'impact du conseil nutritionel fournie à la sortie de l'hôpital sur l'état nutritionnel,100 jours après la greffe de CSH (dit T4).Conception: Il s'agissait d'un essai contrôlé randomisé monocentrique. Les patients adultes étaient randomisés à un groupe témoin (GT) recevant des soins habituels et un groupe d'intervention (GI) recevant des conseils nutritionnels mensuels après la sortie de l’hôpital. Le résultat principal était le score de l'évaluation globale subjective générée par le patient (PGSGA) à T4. La malnutrition était évalué aussi par le score de la société américaine de nutrition parentérale et entérale/Académie de nutrition et diététique (AND-ASPEN).Résultats: 52 participants ont été randomisés (août 2016 jusqu'en août 2017) et 46 ont été analysés [65% d'hommes, 63% de greffes autologues, GI (n = 22), GT (n = 24)]. Les deux groupes etaient comparable au moment de randomization.A T4, le pourcentage de patients bien nourris n'était pas significativement différent entre les groupes selon le PGSGA (72% GI vs 43% GT, p = 0,063). Le pourcentage de patients bien nourris selon AND-ASPEN s'est améliorré à T4 dans le GI (50% vs 14%, p = 0,02) et non pas dans le GT par rapport aux valeurs d'admission. A T4, le GI avait un apport de protéines et de calories plus élevé que le GT(p<0.05).Conclusion:Le conseil nutritionnel après la greffe de CSH a amélioré l’apport en protéines et calories ainsi que le score AND-ASPEN mais non pas le score PGSGA. / Background: Conditioning preceding Hematopoietic Stem Cell Transplantation (HSCT) has been associated with elevated rates of malnutrition until 100 days post HSCT.Objective: This study aimed to assess the impact of nutritional counseling provided at hospital discharge on nutritional status 100 days post HSCT (defined as T4). Design: This was a single center randomized controlled trial among adult HSCT patients. Around discharge from the hospital, recruited patients were randomized to a Control Group (CG) receiving usual care and to an Intervention Group (IG) receiving nutritional counseling on a monthly basis post discharge.The primary outcome was the Patient Generated Subjective Global Assessment (PGSGA) scores at T4. Malnutrition was also assessed though the American Society for Parenteral and Enteral Nutrition/ Academy of Nutrition and Dietetics malnutrition score.Results: 52 participants were randomized (August 2016 until August 2017) and 46 were analyzed [65% males, 63% autologous HSCT, IG (n=22), CG (n=24)]. Groups were comparable at randomization. At T4, the percent of well-nourished patients was not significantly different between groups when assessed via PGSGA (72% IG vs. 43% CG, p=0.063).The percent of wellnourished patients as per AND-ASPEN criteria improved in IG at T4 (14% vs. 50%, p=0.02) and remained the same in CG (48% vs. 50%, p=1) compared to admission values. IG had higher protein and caloric intake (p<0.05). Conclusion:Nutritional counseling post HSCT improved patients’ protein and caloric intake and AND-ASPEN score but did not significantly improve PGSGA score.