Background: This study was designed to quantify torque production at different joint angles in the paretic and nonparetic knee joints of individuals with stroke. Methods: Extension and flexion torques were measured at 6 angles of the knee joint and normalized to peak torque in 19 subjects with stroke and 19 controls. Results: Paretic knee extension torque was lower than controls when the knee was positioned near extension. In contrast, nonparetic knee extension and flexion torques were higher than controls when the knee was positioned near full flexion. Conclusions: The paretic knee extensors demonstrated exaggerated weakness at short muscle lengths and the nonparetic knee extensors and flexors demonstrated selective strength gains. Clinicians should therefore consider paretic knee extensor strengthening near full extension and promote symmetrical use of the legs to prevent compensatory overuse of the nonparetic leg.

1.
Ada L, Canning C, Dwyer T: Effect of muscle length on strength and dexterity after stroke. Clin Rehabil 2000;14:55–61.
2.
Ada L, Canning CG, Low SL: Stroke patients have selective muscle weakness in shortened range. Brain 2003;126:724–731.
3.
Koo TK, Mak AF, Hung L, Dewald JP: Joint position dependence of weakness during maximum isometric voluntary contractions in subjects with hemiparesis. Arch Phys Med Rehabil 2003;84:1380–1386.
4.
Carr JH, Shepherd RB: Stroke Rehabilitation: Guidelines for Exercise and Training to Optimize Motor Skill. London, Butterworth Heinemann, 2004.
5.
Winstein CJ, Gardner ER, McNeal DR, Barto PS, Nicholson DE: Standing balance training: effect on balance and locomotion in hemiparetic adults. Arch Phys Med Rehabil 1989;70:755–762.
6.
Eng JJ, Chu KS: Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. Arch Phys Med Rehabil 2002;83:1138–1144.
7.
Lomaglio MJ, Eng JJ: Muscle strength and weight-bearing symmetry relate to sit-to-stand performance in individuals with stroke. Gait Posture 2005;22:126–131.
8.
Gowland C, Stratford P, Ward M, Moreland J, Torresin W, Van Hullenaar S, Sanford J, Barreca S, Vanspall B, Plews N: Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke 1993;24:58–63.
9.
Kelly-Hayes M, Robertson JT, Broderick JP, Duncan PW, Hershey LA, Roth EJ, Thies WH, Trombly CA: The American Heart Association Stroke Outcome Classification: executive summary. Circulation 1998;97:2474–2478.
10.
Bohannon RW, Smith MB: Interrater reliability of a Modified Ashworth Scale of muscle spasticity. Phys Ther 1987;67:206–207.
11.
Washburn RA, Zhu W, McAuley E, Frogley M, Figoni SF: The Physical Activity Scale for individuals with physical disabilities: development and evaluation. Arch Phys Med Rehabil 2002;83:193–200.
12.
Holder-Powell HM, Rutherford OM: Unilateral lower-limb musculoskeletal injury: its long-term effect on balance. Arch Phys Med Rehabil 2000;81:265–268.
13.
Skelton DA, Kennedy J, Rutherford OM: Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. Age Ageing 2002;31:119–125.
14.
Demura S, Yamaji S, Goshi F, Nagasawa Y: Lateral dominance of legs in maximal muscle power, muscular endurance, and grading ability. Percept Mot Skills 2001;93:11–23.
15.
Anderson DE, Madigan ML, Nussbaum MA: Maximum voluntary joint torque as a function of joint angle and angular velocity: model development and application to the lower limb. J Biomech 2007;40:3105–3113.
16.
Yoon TS, Park DS, Kang SW, Chun SI, Shin JS: Isometric and isokinetic torque curves at the knee joint. Yonsei Med J 1991;32:33–43.
17.
Gandevia SC, McKenzie DK: Activation of human muscles at short muscle lengths during maximal static efforts. J Physiol 1988;407:599–613.
18.
Christova P, Kossev A, Radicheva N: Discharge rate of selected motor units in human biceps brachii at different muscle lengths. J Electromyogr Kinesiol 1998;8:287–294.
19.
Vander Linden DW, Kukulka CG, Soderberg GL: The effect of muscle length on motor unit discharge characteristics in human tibialis anterior muscle. Exp Brain Res 1991;84:210–218.
20.
Gemperline JJ, Allen S, Walk D, Rymer WZ: Characteristics of motor unit discharge in subjects with hemiparesis. Muscle Nerve 1995;18:1101–1114.
21.
Rosenfalck A, Andreassen S: Impaired regulation of force and firing pattern of single motor units in patients with spasticity. J Neurol Neurosurg Psychiatry 1980;43:907–916.
22.
Patikas DA, Kotzamanidis C, Robertson CT, Koceja DM: The effect of the ankle joint angle in the level of soleus Ia afferent presynaptic inhibition. Electromyogr Clin Neurophysiol 2004;44:503–511.
23.
Toft E, Sinkjær T: H-reflex changes during contractions of the ankle extensors in spastic patients. Acta Neurol Scand 1993;88:327–333.
24.
Renner CI, Woldag H, Hummelsheim H: Central compensation at short muscle range is differentially affected in cortical versus subcortical strokes. Stroke 2006;37:2076–2080.
25.
Fridén J, Lieber RL: Spastic muscle cells are shorter and stiffer than normal cells. Muscle Nerve 2003;27:157–164.
26.
Svantesson U, Takahashi H, Carlsson U, Danielsson A, Sunnerhagen KS: Muscle and tendon stiffness in patients with upper motor neuron lesion following a stroke. Eur J Appl Physiol 2000;82:275–279.
27.
Wickiewicz TL, Roy RR, Powell PL, Edgerton VR: Muscle architecture of the human lower limb. Clin Orthop Relat Res 1983;179:275–283.
28.
Lieber RL, Fridén J: Functional and clinical significance of skeletal muscle architecture. Muscle Nerve 2000;23:1647–1666.
29.
Brouwer B, Ashby P: Corticospinal projections to lower limb motoneurons in man. Exp Brain Res 1992;89:649–654.
30.
Marchand-Pauvert V, Simonetta-Moreau M, Pierrot-Deseilligny E: Cortical control of spinal pathways mediating group II excitation to human thigh motoneurones. J Physiol 1999;517:301–313.
31.
Marque P, Nicolas G, Marchand-Pauvert V, Gautier J, Simonetta-Moreau M, Pierrot- Deseilligny E: Group I projections from intrinsic foot muscles to motoneurones of leg and thigh muscles in humans. J Physiol 2001;536:313–327.
32.
Lind AR, Taylor SH, Humphreys PW, Kennelly BM, Donald KW: The circulatory effects of sustained voluntary muscle contraction. Clin Sci 1964;27:229–244.
33.
Bezucha GR, Lenser MC, Hanson PG, Nagle FJ: Comparison of hemodynamic responses to static and dynamic exercise. J Appl Physiol 1982;53:1589–1593.
34.
Engardt M, Olsson E: Body weight-bearing while rising and sitting down in patients with stroke. Scand J Rehabil Med 1992;24:67–74.
35.
Alexander NB, Gu MJ, Branch M, Schultz AB, Ashton-Miller JA, Gross MM: Geriatrics: does leg torque influence rising from a chair in older adults. Rehabil R D Prog Rep 1995;32:101–102.
36.
Millington PJ, Myklebust BM, Shambes GM: Biomechanical analysis of the sit-to-stand motion in elderly persons. Phys Med Rehabil 1992;73:609–617.
37.
Knapik JJ, Wright JE, Mawdsley RH, Braun JM: Isokinetic, isometric and isotonic strength relationships. Arch Phys Med Rehabil 1983;64:77–80.
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