<p>The aims of this study were to investigate the mechanisms underlying (1) the ageing-related motor handicap at the whole muscle, cellular, contractile protein and myonuclear levels; and (2) ageing-related differences in muscle adaptability.</p><p>In vivo muscles function was studied in the knee extensors. Decreases were observed in isokinetic and isometric torque outputs in old age in the sedentary men and women and elite master sprinters. A 20-week long specific sprint and resistance training successfully improved the maximal isometric force and rate of force development in a subgroup of master sprinters.</p><p>In vitro measurements were performed in muscle biopsies from the vastus lateralis muscle. Immunocytochemical and contractile measurements in single membrane permeabilized muscle fibres demonstrated ageing- and gender-related changes at the myofibrillar level. In sedentary subjects, data showed a preferential decrease in the size of muscle fibres expressing type IIa MyHC in men, lower force generating capacity in muscle fibres expressing the type I MyHC isoform in both men and women and lower maximum velocity of unloaded shortening (V₀) in fibres expressing types I and IIa MyHC isoforms in both men and women. The master sprinters also experienced the typical ageing-related reduction in the size of fast-twitch fibres, a shift toward a slower MyHC isoform profile and a lower V₀ of type I MyHC fibres, which played a role in the decline in explosive force production capacity. The fast-twitch fibre area increased after the resistance training period. A model combining single muscle fibre confocal microscopy with a novel algorithm for 3D imaging of myonuclei in single muscle fibre segments was introduced to study the spatial organisation of myonuclei and the size of individual myonuclear domains (MNDs). Significant changes in the MND size variability and myonuclear organization were observed in old age, irrespective gender and fibre type. Those changes may influence the local quantity of specific proteins per muscle fibre volume by decreased and/or local cooperativity of myonuclei in a gender and muscle fibre specific manner.</p><p>In conclusion, the ageing-related impairments in in vivo muscle function were related to significant changes in morphology, contractile protein expression and regulation at the muscle fibre level. It is suggested that the altered myonuclear organisation observed in old age impacts on muscle fibre protein synthesis and degradation with consequences for the ageing-related changes in skeletal muscle structure and function. However, the improved muscle function in response to a 20-week intense physical training regime in highly motivated physically active old subjects demonstrates that all ageing-related in muscle function are not immutable.</p>

The aims of this study were to investigate the mechanisms underlying (1) the ageing-related motor handicap at the whole muscle, cellular, contractile protein and myonuclear levels; and (2) ageing-related differences in muscle adaptability. In vivo muscles function was studied in the knee extensors. Decreases were observed in isokinetic and isometric torque outputs in old age in the sedentary men and women and elite master sprinters. A 20-week long specific sprint and resistance training successfully improved the maximal isometric force and rate of force development in a subgroup of master sprinters. In vitro measurements were performed in muscle biopsies from the vastus lateralis muscle. Immunocytochemical and contractile measurements in single membrane permeabilized muscle fibres demonstrated ageing- and gender-related changes at the myofibrillar level. In sedentary subjects, data showed a preferential decrease in the size of muscle fibres expressing type IIa MyHC in men, lower force generating capacity in muscle fibres expressing the type I MyHC isoform in both men and women and lower maximum velocity of unloaded shortening (V0) in fibres expressing types I and IIa MyHC isoforms in both men and women. The master sprinters also experienced the typical ageing-related reduction in the size of fast-twitch fibres, a shift toward a slower MyHC isoform profile and a lower V0 of type I MyHC fibres, which played a role in the decline in explosive force production capacity. The fast-twitch fibre area increased after the resistance training period. A model combining single muscle fibre confocal microscopy with a novel algorithm for 3D imaging of myonuclei in single muscle fibre segments was introduced to study the spatial organisation of myonuclei and the size of individual myonuclear domains (MNDs). Significant changes in the MND size variability and myonuclear organization were observed in old age, irrespective gender and fibre type. Those changes may influence the local quantity of specific proteins per muscle fibre volume by decreased and/or local cooperativity of myonuclei in a gender and muscle fibre specific manner. In conclusion, the ageing-related impairments in in vivo muscle function were related to significant changes in morphology, contractile protein expression and regulation at the muscle fibre level. It is suggested that the altered myonuclear organisation observed in old age impacts on muscle fibre protein synthesis and degradation with consequences for the ageing-related changes in skeletal muscle structure and function. However, the improved muscle function in response to a 20-week intense physical training regime in highly motivated physically active old subjects demonstrates that all ageing-related in muscle function are not immutable.

Made available in DSpace on 2016-06-02T20:19:27Z (GMT). No. of bitstreams: 1 6773.pdf: 1423884 bytes, checksum: 7e9d34dd271eeaddbef853357ac2a926 (MD5) Previous issue date: 2015-02-27 / Financiadora de Estudos e Projetos / This study aimed to compare neuromuscular aspects, such as antagonist co-activation during knee extension (Coext) and flexion (Coflex), functional ratio of the maximum concentric hamstring strength to the maximum eccentric quadriceps strenght for knee flexion (Icon:Qexc), knee extensor torque in concentric (PTcon_ext) and eccentric (PTexc_ext) ways, the concentric knee flexor torque (PTcon_flex) and physical function, in different knee OA degrees. It was also objective of this dissertation investigate the center of pressure (COP) behavior (amplitude and velocity of the anterior-posterior and medial-lateral displacement) during a task involving eccentric quadriceps contraction, and the correlation between center of pressure and variables related to muscle performance and physical function. These objectives comprise two studies, with different methodologies. Study I: 20 subjects with knee OA (GOA) and 20 healthy subjects (GC) performed a postural stability evaluation, standing on two force platforms (Bertec Mod) with 45 degrees of knee flexion. PTcon_flex and PTexc_ext were evaluated in a speed of 90°/s. Subjects answered Physical Function and Stiffness subscales of the questionnaire Western Ontario MacMaster Universities Osteoarthritis Index (WOMAC). Intergroup statistical analysis shown that subjects of the GOA, compared to GC, had no difference in postural control parameters, had lower Icon: Qexc (p = 0.004) and poorer selfreported physical function (p = 0.00) and stiffness (p = 0.001). Antero-posterior COP displacement was moderately and negatively correlated with the physical function subscale (&#961; = -0.480, p = 0.02). Antero-posterior COP speed was moderately and negatively correlated with the physical function WOMAC subscale (&#961; =-0.52, p = 0,01) and stiffness WOMAC subscale (&#961; = -0.44, p = 0.03). Study II: 20 subjects with knee OA grade II (GOAII), 15 with knee OA grade III (GOAIII) and 19 healthy subjects (GC) performed isokinetic knee extension and flexion at 60 °/s, simultaneously to the electromyographic assessment of muscles quadriceps (vastus lateralis, rectus femoris, vastus) and hamstrings (biceps femoris and semitendinosus). Subjects answered Physical Function WOMAC subscale and performed functional tests 30-s chair-stand test (STS30s), 40mfast-paced walk test (Caminhada40m) and a stair-climb test (Escada). After intergroup analysis, GOAII showed higher Coflex (p = 0.001), higher Icon:Qexc (p = 0.000), &#931;emgflex_flex (p = 0.000), lower PTcon_ext (p = 0:02) and PTexc_ext (p = 0.008) and worse self reported physical function (p= 0.000). In GOAIII were identified greater Icon:Qexc (p = 0.000), lower PTcon_ext (p = 0.000), PTexc_ext (p = 0.000) and PTcon_flex (p = 0.04), worse self-reported Physical Function (p = 0.000) and worse performance in the functional tests: STS30s Caminhada40m e Escada (p = 0.017 p = 0.000 and p = 0.001, respectively). There was no difference between the GOAII and GOAIII for all variables (p &#8805; 0.05). Together, these results suggest a neuromuscular adaptation present in individuals with knee OA, justifies the need for intervention from the early degrees of the disease and highlight the importance of taking into account different forms of assessment of physical function. / Foi objetivo desta dissertação comparar aspectos neuromusculares, como coativação do antagonista durante a extensão (Coext) e flexão (Coflex) do joelho, relação funcional de força concêntrica de isquiotibiais e excêntrica de quadríceps para flexão de joelho (Icon:Qexc), torque extensor do joelho nos modos concêntrico (PTcon_ext) e excêntrico (PTexc_ext), o torque flexor do joelho no modo concêntrico (PTcon_flex) e a função física nos diferentes graus da OA do joelho. Também foi objetivo dessa dissertação investigar o comportamento do centro de pressão (amplitude e velocidade do deslocamento ântero-posterior e médio-lateral) durante uma tarefa envolvendo contração excêntrica do quadríceps e correlaciona-lo às variáveis relacionadas ao desempenho muscular e função física. Estes objetivos compõem dois estudos, com metodologias distintas. Estudo I: 20 indivíduos com OA de joelhos (GOA) e 20 sujeitos saudáveis (GC) realizaram avaliação da estabilidade postural, em pé sobre duas plataformas de força (Bertec Mod) e flexão de joelhos de 45 graus. Também foram avaliados PTcon_flex e PTexc_ext na velocidade de 90°/s e os sujeitos responderam às seções função física e rigidez do questionário Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Após análise estatística intergrupo, não foi observada diferença estatística para as variáveis do controle postural entre os sujeitos com OA e o GC. No entanto, foram identificados menor PTexc_ext (p=0.01), menor Icon:Qexc (p=0.004), pior auto-relato de função física (p=0,00) e rigidez (p=0,001). A análise de correlação indicou correlação entre o controle postural e função física e rigidez. Estudo II: Vinte indivíduos com OA do joelho grau II (GOAII), 15 com OA do joelho grau III (GOAIII) e 19 saudáveis (GC) realizaram teste isocinético de extensão do joelho a 60°/s, simultaneamente à avaliação eletromiográfica dos músculos do quadríceps (vasto lateral, reto femural e vasto medial) e isquiotibiais (bíceps femural e semitendíneo). Os sujeitos responderam à seção Função Física do qustionário WOMAC e realizaram testes funcionais de sentar e levantar de uma cadeira por 30 segundos (STS30s), caminhada de 40 metros (Caminhada40m) e subida e descida de escada (Escada). Após análise intergrupo, o GOAII apresentou maior Coflex (p = 0.001), maior Icon:Qexc (p = 0.000), &#425;emgflex_flex (p = 0.000), menores PTcon_ext (p = 0.02) e PTexc_ext (p = 0.008) e pior auto-relato de função física (p = 0.000 ). No GOAIII foram identificados maior Icon:Qexc (p = 0.000), menores PTcon_ext (p = 0.000), PTexc_ext (p = 0.000) e PTcon_flex (p = 0.04), pior auto-relato de função física (p = 0.000) e pior desempenho nos testes STS30s, Caminhada40m e Escada (p = 0.017 p = 0.000 e p = 0.001, respectivamente). Não houve diferença entre o GOAII e GOAIII para nenhuma das variáveis (p &#8805; 0.05). Em conjunto, os resultados sugerem uma adaptação neuromuscular presente nos indivíduos com OA do joelho, necessidade de intervenção desde os graus iniciais da doença e destacam a importância de levar em conta diferentes formas de avaliação da função física.

Made available in DSpace on 2014-12-17T15:16:06Z (GMT). No. of bitstreams: 1 RobsonAS.pdf: 4092657 bytes, checksum: bfcb1dfee12e404a9e060942b5799125 (MD5) Previous issue date: 2009-07-31 / The Patellofemoral pain syndrome is defined as a fore or retro patellar pain and it has multifactorial etiology, where the bad patellar alignment is the most acceptable hypothesis. However proximal factors to the knee, as the debility of the muscles of the hip, have been demonstrated as a contributing factor to the appearing of that syndrome. Purpose: To evaluate if exists a relation between the hip muscles performance and the development of the SDPF. Methods: Thirty women took part in this study. They were divided in two groups; a control group (fifteen asymptomatic subjects) and an experimental group (fifteen subjects with the diagnosis of SDPF). The muscle performance was evaluated in an isokinetic dynamometer, where it was verified the peak torque (PT), PT to body weight, PT time and the agonist/antagonist relation. It was also analyzed the electromyographic activity of the middle gluteus. The data was analyzed by the not paired t test at a significance level of 5%. Results:. Didn t have significant difference to the PT of the abductor muscles (p = 0,46) and lateral rotators of the hip (p = 0,17) between groups. Also didn t have significant difference to the PT values by the body weight, to these muscle groups either (p = 0,10 e p = 0,11, respectively). Didn t have significant difference between the amplitude of the signal (p = 0,05) and the onset of medium gluteus (p = 0,25) between the groups. Conclusion: In the experimental conditions realized, the study didn t demonstrate a relation between performance the hip muscles behavior and the development of the SDPF / A S?ndrome da Dor Patelofemural (SDPF) ? definida como uma dor anterior ou retropatelar e possui etiologia multifatorial, onde o mau-alinhamento patelar ? a hip?tese mais comumente aceita. Entretanto fatores proximais ao joelho, como a debilidade dos m?sculos do quadril, t?m sido sugerido como um fator contribuinte ao surgimento desta s?ndrome. Objetivo: Avaliar se existe rela??o entre a performance dos m?sculos do quadril e o desenvolvimento da SDPF. M?todos: Participaram do estudo 30 mulheres alocadas em um grupo controle (15 sujeitos assintom?ticos) e um grupo experimental (15 sujeitos com diagn?stico de SDPF). A performance muscular foi avaliada em um dinam?metro isocin?tico, onde verificou-se o Pico de Torque (PT), PT pelo peso corporal, tempo do PT e a rela??o agonista/antagonista. Tamb?m foi analisada a atividade eletromiogr?fica do gl?teo m?dio. Os dados foram analisados atrav?s do teste t n?o pareado com um n?vel de signific?ncia de 5%. Resultados: N?o houve diferen?a significativa entre o PT dos m?sculos abdutores (p = 0,46) e rotadores laterais do quadril (p = 0,17) entre os grupos. Tamb?m n?o foi encontrada diferen?a significativa no PT pelo peso corporal, para esses grupos musculares (p = 0,10 e p = 0,11, respectivamente). N?o houve diferen?a entre a amplitude do sinal eletromiogr?fico (p = 0,05) e o onset do gl?teo m?dio (p = 0,25) entre os grupos. Conclus?o: Nas condi??es experimentais realizadas, o estudo n?o demonstrou rela??o entre a performance dos m?sculos do quadril e o desenvolvimento da SDPF

Made available in DSpace on 2016-06-02T20:18:12Z (GMT). No. of bitstreams: 1 2959.pdf: 1881236 bytes, checksum: 0562673d7f2deff6e61218a2842d970d (MD5) Previous issue date: 2010-05-03 / Universidade Federal de Minas Gerais / This work consists of two studies. The aim of the first study was to investigate quadriceps and hamstring muscle volumes and strength deficits of the knee extensors and flexors in people with chronic hemiparesis compared to a healthy group. Fifteen individuals with chronic stroke and fifteen healthy individuals took part in this study. Motor function, quadriceps and hamstring muscle volume (MV), and maximal concentric and eccentric contractions of the knee extensors and flexors were obtained. The quadriceps muscle showed a reduction in MV. The peak torque of the paretic and non paretic limbs knee extensors and flexors was reduced in both contraction modes and velocities. There were significant correlations between motor function and strength deficits. With regard to muscle mass, there was a difference between quadriceps and hamstring response. There was no disuse atrophy; however this did not prevent extensor torque reduction. The aim of the second study was to investigate the effects of ground level gait training combining body weight support (BWS) and functional electrical stimulation (FES). Twelve people following chronic stroke. An A1-B-A2 system was applied; A1 and A2 corresponded to ground level gait training using BWS, and B corresponded to the same training associated to FES. The analyzed variables were: mean walking speed of locomotion; step length; stride length, speed and duration; initial and final double support duration; single-limb support duration; swing period; range of motion (ROM), maximum and minimum angles of foot, leg, thigh, and trunk segments. Mean walking speed, stride length and speed increased. Regarding the ROMs, there was a significant increase for leg and thigh. There was not improvement in the variables measured during the FES phase. Ground level gait training using BWS was effective to improve some gait, and the association to FES did not provide any additional improvement in the measured parameters. / Esse trabalho é composto por dois estudos. O objetivo do primeiro estudo foi investigar os volumes dos músculos quadríceps e isquiotibiais e os déficits de força dos músculos extensores e flexores do joelho em hemiparéticos crônicos comparados a um grupo controle saudável. Quinze indivíduos com hemiparesia crônica e 15 indivíduos saudáveis fizeram parte do estudo. Foram obtidos: pontuação da função motora geral, volume muscular (VM) dos músculos quadríceps e isquiotibiais e contrações concêntricas e excêntricas dos músculos extensores e flexores do joelho. O músculo quadríceps do membro parético apresentou redução no VM comparado ao membro contralateral. Os picos de torque extensor e flexor dos membros parético e contralateral apresentaram-se reduzidos para ambos os modos de contração e ambas as velocidades e correlações entre a função motora e os déficits de força muscular foram encontradas. Observou-se que há diferentes respostas entre os músculos quadríceps e isquiotibiais com relação à massa muscular. Não foi observada atrofia muscular por desuso. Entretanto, esse fato não preveniu a redução do torque articular. O objetivo do segundo estudo foi investigar os efeitos de um treinamento de marcha, em piso fixo, associado ao suporte parcial de peso corporal (SPPC) e à estimulação elétrica funcional (EEF) do nervo fibular comum, em hemiparéticos crônicos. Participaram do estudo 12 hemiparéticos crônicos. O sistema adotado foi o A1-B-A2, no qual A correspondeu ao treinamento de marcha em piso fixo com SPPC e B ao mesmo treinamento associado à EEF. Foram analisadas: velocidade média de locomoção, comprimento do passo, comprimento, velocidade e duração da passada; duração dos períodos de apoio duplo inicial e final, apoio simples e balanço; ângulos máximos e mínimos e amplitude de movimento (ADM) dos segmentos pé, perna, coxa e tronco dos membros parético e não-parético. Houve um aumento na velocidade média e no comprimento e velocidade do ciclo. Com relação às ADMs, houve aumento significativo entre as avaliações para o segmentos: perna e coxa após. Não houve melhora nas variáveis mensuradas na fase de EEF. Concluímos que o treinamento com SPPC, em piso fixo, foi efetivo na melhora de alguns aspectos da marcha e a associação à EEF não promoveu melhora adicional dos parâmetros mensurados.

Measuring lower limb strength and symmetry is a common practice in elite sports to determine the return to sports point in time during rehabilitation, and this information could be useful for amateur athletes too. However, the devices used for this are highly sophisticated and hardly accessible. The aim of this project is to devise an affordable system for lower limb strength measurement which can be integrated with a common training system, to make this type of information widely available. The system is built up on a flywheel-based leg extension machine (LegExx by Exxentric AB) that allows quadriceps training at maximal force in concentric and eccentric contraction. Inexpensive standard components and software were used for prototyping. The parameters of interest were angular velocity of extension/flexion in the knee and force applied by the athlete. In the first step, evaluation was limited to the concentric phase of movement. Angular velocity and leg position was measured with a gyroscope sensor (Movesense by Suunto). For force measurement, two approaches were tested: In prototype A, the tension of the drive belt, which ultimately puts the flywheel into rotation, was measured with a sensor for tensile forces (Tindeq Progressor 300). In prototype B, a more direct measurement was used, with force sensors mounted under the contact point of the athlete’s shank with the swing beam of the LegExx. Sensor data were transmitted via Bluetooth to a mobile device or a laptop and displayed graphically after synchronization of the data streams. Force values were converted to torque using inverse kinematics to make the two prototypes comparable. The first prototypes were shown to be workable and yielded similar readings for concentric peak torque, with realistic wave forms in the graphical display. Comparison with results of a gold standard isokinetic dynamometer revealed, however, major discrepancies mainly regarding the absolute torque values. Oscillation in the belt system were identified as an issue in prototype A, while cross talk between sensors and vulnerability to leg placement occurred in prototype B. However, these issues are not insurmountable, and it is suggested to proceed with the development of prototype B, as it has the advantage of simultaneous measurement and direct comparison of both legs. / Att mäta styrka och symmetri i nedre extremiteterna är vanligt inom elitidrott för att avgöra när man kan återgå till idrottsutövning under rehabiliteringen, och denna information kan vara användbar även för amatöridrottare. De apparater som används för detta är dock mycket sofistikerade och svårtillgängliga. Syftet med detta projekt är att utforma ett prisvärt system för mätning av styrkan i nedre extremiteterna som kan integreras med ett vanligt träningssystem, för att göra denna typ av information allmänt tillgänglig. Systemet är uppbyggt på en svänghjulsbaserad benspark maskin (LegExx från Exxentric AB) som möjliggör quadriceps träning vid maximal kraft i koncentrisk och excentrisk kontraktion. Kostnadseffektiva standardkomponenter och mjukvara användes för prototypframställning. De parametrar som var av intresse var vinkelhastighet för utsträckning- /böjning i knäet och den kraft som utövades av idrottaren. I det första steget begränsades utvärderingen till rörelsens koncentriska fas. Vinkelhastighet och benposition mättes med en gyroskopisk sensor (Movesense från Suunto). För kraftmätning testades två tillvägagångssätt: I prototyp A mättes dragkraften i drivremmen, som i slutändan sätter svänghjulet i rotation, med en sensor för dragkrafter (Tindeq Progressor 300). I prototyp B användes en mer direkt mätning med kraftsensorer som monterades under kontaktpunkten mellan idrottsutövarens smalben och LegExx:s svängbalk. Sensordata överfördes via Bluetooth till en mobil enhet eller en bärbar dator och visades grafiskt efter synkronisering av dataströmmarna. Kraftvärden omvandlades till vridmoment med hjälp av invers kinematik för att göra de två prototyperna jämförbara. De första prototyperna visade sig fungera och gav liknande mätningar för koncentriskt toppmoment, med realistiska vågformer i den grafiska displayen. En jämförelse med resultaten från en isokinetisk dynamometer med guldstandard visade dock på stora skillnader, främst när det gäller de absoluta vridmomentvärdena. Oscillation i bältesystemet identifierades som ett problem i prototyp A, medan överkoppling mellan sensorer och känslighet för benplacering förekom i prototyp B. Dessa problem är dock inte oöverstigliga, och det föreslås att man fortsätter att utveckla prototyp B, eftersom den har fördelen av samtidig mätning och direkt jämförelse av båda benen.

The evaluation of shoulder abduction and flexion strength is important in the rehabilitation after rotator cuff tear. The purpose of this work is to assess the intra and inter-rater reliability of measurement data from an isokinetic dynamometer used to evaluate shoulder abduction and flexion strength, with the aim to identify sources of measurement errors and suggest improvements. The measurement data was collected by a research group at Karolinska Institute and contained load and torque data from thirteen healthy subjects in the ages of 25 to 87 years. The measurements were carried out on two occasions, one week apart. Systematic differences between occasions are analyzed using the Shapiro Wilk test, the paired t-test, and Wilcoxon signed rank test. The agreement of the measurements is analyzed quantitatively using the coefficient of variation and the Bland Altman plot, and quantitively, using the intraclass correlation coefficient. A significant systematic difference in shoulder abduction and flexion load measurements was found, and the recommendation to prevent this is that components should be calibrated in a standardized way. The measurements showed varying reliability within and between measurement occasions and that after familiarization with the isokinetic dynamometer, repeatability improved. The findings indicate a need of a standardized protocol for patient education and placement. Measurements from the position sensor contributed to more random torque values. To improve the repeatability in measurements from the position sensor, axis of rotation should be kept aligned. An increasing variability in measurements with increasing load and torque was found. The recommendation is to use a preload for patients using more force in the movement, to make sure a preset speed is not exceeded, which contributes to more reliable measurements. / Utvärderingen av axelabduktion och flexionsstyrka är viktig i rehabiliteringen efter skada i axelleden. Syftet med det här arbetet är att bedöma intra- och interbedömartillförlitligheten hos mätdata från en isokinetisk dynamometer som används för att utvärdera axelabduktion och flexionsstyrka, med syftet att identifiera källor till mätfel och föreslå förbättringar. Mätdatat samlades in av en forskargrupp vid Karolinska Institutet och innehöll belastnings- och vridmomentdata från tretton friska försökspersoner i åldrarna 25 till 87 år. Mätningarna utfördes vid två tillfällen med en veckas mellanrum. Systematiska skillnader mellan tillfällena analyseras med Shapiro Wilk-testet, det parade t-testet och Wilcoxon signed rank test. Mätningarnas överensstämmelse analyseras kvantitativt med hjälp av variationskoefficienten och Bland Altman-diagrammet, samt kvalitativt med hjälp av intraklasskorrelationskoefficienten. En signifikant systematisk skillnad i axelabduktion och flexionsbelastningsmätningar hittades, och rekommendationen för att förhindra detta är att komponenter bör kalibreras på ett standardiserat sätt. Mätningarna visade på en varierande tillförlitlighet inom och mellan mättillfällen och att efter bekantskap med den isokinetiska dynamometern, förbättrades repeterbarheten. Slutsatserna indikerar ett behov av ett standardiserat protokoll för patientutbildning och placering. Mätningar från positionssensorn bidrog till mer slumpmässiga vridmomentvärden. För att förbättra repeterbarheten i mätningar från positionssensorn bör rotationsaxeln hållas i linje. En ökande variation mellan mättillfällen med ökande belastning och vridmoment hittades. Rekommendationen är att använda en förspänning för patienter som använder mer kraft i rörelsen, för att säkerställa att en förinställd hastighet inte överskrids, vilket bidrar till mer tillförlitliga mätningar.