Overwork Weakness: Hand Study by Putnam Siskind, Shy et al

[Guest guest]

As mentioned in one of my previous posts, Dr Shy and team have recreated

the study done by Paolo Vinci on overwork weakness in the hands of people

impacted by CMT1A.

Rather than a conclusive finding that " yes, overwork weakness does result " there

is an inconclusive finding, although some questions with regard to progression

and the use of the nine-hold peg test.

For my own approach to physical management of CMT, this again points that

nothing contraindicates exercise for me. But, as I have said on numerous

occassions, I do nothing without the full knowledge and consultation of the

medical / physiotherapy / coaching team I use to ensure that I am not doing

anything to damage or injure myself.

I realise I am very lucky in the way that I have managed to build a support

network to whom I can ask so many questions, but I am happy to try to share my

experiences as best as I can (knowing we are all different) and to help anyone

who is interested in learning more about exercise and my approaches. I have a

relatively mild expression of CMT1A but that does not mean that I do not

struggle with it - rather I always am learning something new about myself and

how CMT impacts me, and through creativity and determination I find ways to

adapt.

Best wishes,

Donna from London

www.myfitnessyear.com

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Here is the extract of the paper presented at the CMT conference in July 2009 in

Antwerp.

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Dominant vs. non-dominant hand strength in CMTIA.

A. Putnam, C. Siskind, S.M.E. Feely, S. Sottile, M.E. Shy and L..T.

Department of Neurology, Wayne State University, Detroit MI, USA

BACKGROUND: There is controversy regarding the presence of overwork weakness in

Charcot-Marie-Tooth disease (CMT), If overwork weakenss exists, recommendations

for management and therapy will be impacted " Here, we assess the presence of

overwork weakness in CMTIA by comparing strength and dexterity in the dominant

and non-dominant

hand.

MATERIALS/METHODS: Hand strength and dexterity were measured in 220 individuals

with CMTlA. Hand strength was measured with handgrip and pinch-force

dynamometry, and manual muscle testing using a modified MRC scale. Dexterity was

assessed using the nine-hole peg test Paired T-tests were performed comparing

the dominant and non-dominant

hand performance " Hand performance was also analyzed after stratifying by

disease severity (mild, moderate, or severe), determined by the CMT Neuropathy

Score

RESULTS:

Overall, there was no statistically significant difference in strength between

the dominant and non-dominant hand in any of the measures that were assessed.

For dexterity, the dominant hand was on average lA5 seconds faster than the

non-dominant hand (p=O ,002). After stratifying by severity, mildly affected

individuals had greater dexterity in their dominant hand, which was on average

1,89 seconds faster (p<O,OOI); however, the

moderately and severely affected groups showed no statistically significant

difference between the dominant and non-dominant hand.

CONCLUSION:

Overall these finding do not clearly demonstrate the presence of overwork

weakness in CMTIA.

Neither dynamometry nor manual muscle testing were able to detect

any statistically significance difference in strength between the dominant and

non dominant hand. A relative decrease in dexterity of the dominant hand was

observed in the moderately affected group when compared to the mildly affected

group. It is not clear if this is a function of disease progression or whether

the nine-hole peg test is more sensitive at detecting the presence of overwork

weakness in individuals with CMT.

Results from this study do not support new physical therapy recommendations.