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Todd G. Goldbeck and George J. Davies

Context:

Functional testing of patients is essential to clinicians because it provides objective data for documentation that can be used for serial reassessment and progression through a rehabilitation program. Furthermore, new tests should require minimal time, space, and money to implement.

Purpose:

To determine the test-retest reliability of the Closed Kinetic Chain (CKC) Upper Extremity Stability Test.

Participants:

Twenty-four male college students.

Methods:

Each subject was tested initially and again 7 days later. Each subject performed 1 submaximal test followed by 3 maximal efforts. A 45-second rest was given after each 15-second test. The 2 maximal-test scores were averaged and compared with those from the retest.

Results:

The intraclass correlation coefficient was .922 for test-retest reliability. A paired-samples t test (.927) was conducted, and the coefficient of stability was .859. The results indicate that the CKC Upper Extremity Stability Test is a reliable evaluation tool.

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Susan B. Andersen, Donna M. Terwilliger and Craig R. Denegar

The purpose of this study was to determine if a difference exists in the reproducibility of knee joint flexion angles in an open versus a closed kinetic chain. Thirty generally healthy subjects (12 males, 18 females; mean age 23.8 years) participated. Subjects actively reproduced small, medium, and large knee flexion angles (with target angles of 15°, 45°, and 75°, respectively) in an open and a closed kinetic chain while being videotaped. Goniometric measurements were taken from the videotape of initial and reproduced joint angles. Data were analyzed using ANOVA with repeated measures on kinetic chain test position and joint angle. Subjects more accurately reproduced knee flexion angles in a closed kinetic chain position. The main effect for angle and the interaction of angle and test position were nonsignificant. The results indicate that knee joint position is more accurately reproduced in closed kinetic chain. Closed kinetic chain testing is also a more functional assessment of joint position sense, and thus closed kinetic chain assessment of lower extremity joint position sense is recommended.

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Lílian Ramiro Felicio, Marcelo Camargo Saad, Rogério Ferreira Liporaci, Augusto do Prado Baffa, Antônio Carlos dos Santos and Débora Bevilaqua-Grossi

Purpose:

To evaluate patellar kinematics of volunteers without knee pain at rest and during isometric contraction in open- and closed-kinetic-chain exercises.

Methods:

Twenty individuals took part in this study. All were submitted to magnetic resonance imaging (MRI) during rest and voluntary isometric contraction (VIC) in the open and closed kinetic chain at 15°, 30°, and 45° of knee flexion. Through MRI and using medical e-film software, the following measurements were evaluated: sulcus angle, patellar-tilt angle, and bisect offset. The mixed-effects linear model was used for comparison between knee positions, between rest and isometric contractions, and between the exercises.

Results:

Data analysis revealed that the sulcus angle decreased as knee flexion increased and revealed increases with isometric contractions in both the open and closed kinetic chain for all knee-flexion angles. The patellar-tilt angle decreased with isometric contractions in both the open and closed kinetic chain for every knee position. However, in the closed kinetic chain, patellar tilt increased significantly with the knee flexed at 15°. The bisect offset increased with the knee flexed at 15° during isometric contractions and decreased as knee flexion increased during both exercises.

Conclusion:

VIC in the last degrees of knee extension may compromise patellar dynamics. On the other hand, it is possible to favor patellar stability by performing muscle contractions with the knee flexed at 30° and 45° in either the open or closed kinetic chain.

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Jose E. Rivera

Closed kinetic chain and functional rehabilitation have lately received increased attention in the rehabilitation community. The purpose of this paper is to review biomechanical considerations applicable to the lower extremity, in a way that clearly justifies the use of functionally sound rehabilitation exercises. The origin of the kinetic chain concept is reviewed, and the differences in biomechanical events in the foot, ankle, and knee under open versus closed chain conditions are described. An analysis of these biomechanical events supports the notion that function results from the integration of muscles and joints to achieve desired outcomes. This leads to the conclusion that rehabilitation exercises, in order to be functional, must demand integration of muscular activity, must be of a closed kinetic chain nature, and must challenge the utilization of normal proprioceptive mechanisms. Guidelines for the practical application of these principles are clearly outlined, and examples of functional activities are described. Readers are encouraged to explore creative and challenging approaches to help clients achieve their highest level of function.

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Lynn Snyder-Mackler

Closed kinetic chain exercise is a common component of lower extremity rehabilitation. It has virtually replaced open kinetic chain exercise in the treatment of some conditions. In this paper, anatomy and physiology as they relate to closed chain exercise are examined to elucidate its unique contributions to rehabilitation. Claims made about the specificity, functionality, and safety of closed kinetic chain exercise are discussed. Muscle action, the stretch–shortening cycle, joint position sense, and clinical cases are used to illustrate the distinct role of closed kinetic chain exercise in rehabilitation.

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Scott M. Lephart and Timothy J. Henry

The confusion between the terms open kinetic chain and closed kinetic chain becomes even greater with application to the upper extremity. Upper extremity function is very difficult to define, due to the numerous shoulder positions and the great velocities with which the shoulder can move. Classifying exercises for rehabilitation of the upper extremity is very difficult due to the complexity of the joint. Many definitions and classification systems have been proposed; however, none of these entirely encompass rehabilitation of the upper extremity. Using previous classifications we have developed a Functional Classification System that is designed to serve as a template for upper extremity rehabilitation. This system has been designed to restore functional shoulder stability, which is dependent upon proper scapulothoracic and glenohumeral stability, and humeral control; all of these are in part mediated by neuromuscular mechanisms. The objective of our new Functional Classification System is to restore functional stability of the shoulder by reestablishing neuromuscular control for overhead activities.

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Robert C. Manske, Barbara Smith and Frank Wyatt

Context:

Athletes are often examined for return to sports using a functional-testing algorithm. No research has determined whether a closed kinetic chain (CKC) isokinetic testing bout influences the reliability of functional tests.

Objective:

To determine whether a concentric CKC isokinetic test bout alters test–retest reliability of lower extremity functional testing.

Design:

Subjects participated in velocity-spectrum CKC isokinetic bouts on 2 days 1 week apart.

Setting:

Hospital-based clinic.

Participants:

28 normal subjects (mean age 26.7 years, height 27.2 cm, weight 75.8 kg).

Analysis and Results:

Means and SDs were determined. Intraclass correlation coefficients were used to calculate test–retest reliability and between days 1 and 2 ranged from .91 to .98.

Conclusions:

Even after a CKC isokinetic test bout, test–retest reliability of functional tests is very high. Future research should determine test–retest reliability of functional tests for patients with lower extremity pathology.

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Mary E. Ubinger, William E. Prentice and Kevin M. Guskiewicz

When the upper extremity is injured, open kinetic chain (OKC) exercises are primarily used to increase strength and restore functional ability—the goals of rehabilitation. It is also imperative, however, that the receptors responsible for static and dynamic stabilization of the joint be trained. This can be done with closed kinetic chain (CKC) exercises. The purposes of this study were to investigate the effect of a 4-week CKC training program on the neuromuscular control of the upper extremity and to determine whether there was a significant difference between skill-dominant limb and nondominant limb stability indices. Thirty-two physically active participants (14 men, 18 women) were tested on the FASTEX 4 weeks apart. The training group's scores significantly improved, whereas the control group's scores remained the same. It was concluded that the CKC training significantly improved the training group's ability to remain stable. The results suggest that CKC training can increase the accuracy of joint position sense because of increased stimulation of the mechanoreceptors.

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Michael D. Rosenthal, Lawrence L. Baer, Penny P. Griffith, Fredrik D. Schmitz, William S. Quillen and Kenn Finstuen

The purpose of this study was to determine if a relationship existed between work output as measured by the Lateral Step-Up Test (LSUT) and work output as measured by a Kin-Com isokinetic dynamometer test (KCT). Forty subjects were randomly assigned to one of two different testing orders. Subjects performed each test with their dominant leg only. Group 1 performed the LSUT followed by the KCT. The second group performed the same two exercises in reverse order. A multiple linear regression analysis was performed (Kin-Com work = Constant + Age + Gender + Lateral step-up work) and was found to provide a good fit to the data. Gender, age, and lateral step-up work were each subsequently analyzed, with the other independent variables held constant. A significant relationship existed (r = .74, p < .01) between the calculated work performed on the LSUT and Kin-Com work. This preliminary finding suggests that clinicians may consider employing standardized closed kinetic chain exercise tests as an objective measure of musculoskeletal performance.

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Lee Herrington

Context:

Authors have investigated knee joint-position sense (JPS) in non-weight-bearing open kinetic chain (OKC) manner, but few have investigated JPS during closed kinetic chain (CKC) weight-bearing activities or the relationship between these two.

Objective:

To investigate the relationship between knee JPS during OKC and CKC maneuvers.

Design:

2-group (men and women) repeated-measures.

Setting:

Biomechanics laboratory.

Participants:

80 asymptomatic subjects.

Interventions:

None.

Main Outcome Measure:

Absolute error score of knee JPS during 2 conditions, a CKC squat or OKC knee-flexion maneuver.

Results:

Statistical analysis by 2-way ANOVA showed sex not to have a significant effect on error score (P = .475), but statistically significant differences between error scores occurred during the 2 tests (P = .0001), the CKC test producing lower error scores (group mean absolute error score OKC [5.6° ± 4.3°] and CKC [2.8° ± 2.4°]), with the absence of a correlation between scores of each test (r = .1).

Conclusion:

Testing JPS in a CKC scenario would seem appropriate—the ability is greatest (least errors), and conversely any deficits might be most obvious.