Isokinetic measurements of muscle strength in hysterical paresis

doi:10.1016/0013-4694(85)91027-2

Electroencephalography and Clinical Neurophysiology

Volume 61, Issue 5, November 1985, Pages 370-374

https://doi.org/10.1016/0013-4694(85)91027-2 Get rights and content

Abstract

The torque during isokinetic knee extensions and flexions was determined in repeated tests at 3 speeds of angular rotation in 25 patients with pareses considered to be hysterical after relevant examinations and follow-up. The torque records were combined with surface EMG from the quadriceps and the hamstring muscles in some patients.

Besides the weakness, 3 signs were observed that are not usually seen in patients with pareses due to verified peripheral or central lesions. These signs were:

1.
(1) Enlarged variability of torque in repeated tests of the same movement (larger than 20% of maximum torque in 22 patients).
2.
(2) Higher torque in fast movements than in slow movements (8 patients).
3.
(3) Force production in knee flexion less than that expected from the weight of leg and lever arm due to restraining activation of the quadriceps muscle (12 patients). The restraint was present although there was no spasticity.

The signs reflect inconsistent and contradictory motor performance that is not compatible with a genuine paresis. Thus, they aid the identification of weakness of functional origin.

Résumé

On a déterminé le couple de torsion en extension et flexion isocinétique du genou dans des tests à 3 vitesses de rotation angulaire chez 25 patients atteints d'une parésie considérée comme hystérique à la suite d'examens adéquats répétés. Les enregistrements du couple de torsion étaient associés à celui de l'EMG de surface du quadriceps et du biceps femoris chez certains patients. Outre la faiblesse 3 signes furent relevés, qui n'existent pas habituellement chez les patients atteints de parésies liées à des lésions périphériques ou centrales confirmées. Ces signes étaient:

1.
(1) une grande variabilité du couple lors de la répétition du même mouvement (supérieure à 20% du maximum chez 22 patients),
2.
(2) un couple plus important dans les mouvements rapides que dans les mouvements lents chez 9 patients,
3.
(3) une force dans la flexion du genou inférieure à celle que laissait prévoir le poids de la jambe en raison d'une activation du quadriceps. Cette limitation était présente malgré l'absence de spasticité.

Ces symptômes révèlent une performance motrice imprévisible et contradictoire, incompatible avec une parésie essentielle. Ils permettent l'identification d'une faiblesse qui serait d'origine fonctionnelle.

References (5)

A.B. Carter
A physician's view of hysteria
Lancet
(1972)
L. Gransberg et al.
Determination of dynamic muscle strength in man with acceleration controlled isokinetic movements
Acta physiol. scand.
(1983)

There are more references available in the full text version of this article.

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^☆: This study was supported by grants from Vivian L. Smith Foundation for Restorative Neurology and Foundations of Karolinska Institute.

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Isokinetic measurements of muscle strength in hysterical paresisMesures isocinétiques de la force musculaire dans les parésies hystériques☆

Abstract

Résumé

A physician's view of hysteria

Lancet

Determination of dynamic muscle strength in man with acceleration controlled isokinetic movements

Acta physiol. scand.