Strength Training in Neurological Rehabilitation: Difference between revisions
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Another systematic review by Kjølhede in 2012 reported strong evidence regarding progressive resistance training on muscle strength for people with MS but the mechanism of how strength training affecting strength needs more studies in the future<ref name=":0">Kjølhede T, Vissing K, Dalgas U. Multiple sclerosis and progressive resistance training: a systematic review. Multiple Sclerosis Journal. 2012 Sep;18(9):1215-28.</ref>. | Another systematic review by Kjølhede in 2012 reported strong evidence regarding progressive resistance training on muscle strength for people with MS but the mechanism of how strength training affecting strength needs more studies in the future<ref name=":0">Kjølhede T, Vissing K, Dalgas U. Multiple sclerosis and progressive resistance training: a systematic review. Multiple Sclerosis Journal. 2012 Sep;18(9):1215-28.</ref>. | ||
Progressuve resistance exercises were strongly recommended by the Australian Stroke Foundation guidelines (2017) and the AHA guidelines (2010), however, the optimal strengthening approach is still unknown<ref>Williams G, Strength Training in Neurological Rehabilitation Course, Physioplus 2019 </ref>. | Progressuve resistance exercises were strongly recommended by the Australian Stroke Foundation guidelines (2017) and the AHA guidelines (2010), however, the optimal strengthening approach is still unknown<ref name=":2">Williams G, Strength Training in Neurological Rehabilitation Course, Physioplus 2019 </ref>. | ||
Despite being effective in musle strengthening but most of the applied studies failed to show improvement in walking capacity<ref name=":1">Williams G, Kahn M, Randall A. Strength training for walking in neurologic rehabilitation is not task specific: a focused review. American journal of physical medicine & rehabilitation. 2014 Jun 1;93(6):511-22.</ref>. | Despite being effective in musle strengthening but most of the applied studies failed to show improvement in walking capacity<ref name=":1">Williams G, Kahn M, Randall A. Strength training for walking in neurologic rehabilitation is not task specific: a focused review. American journal of physical medicine & rehabilitation. 2014 Jun 1;93(6):511-22.</ref>. | ||
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* Load | * Load | ||
* Speed of movement | * Speed of movement | ||
The systematic review mainly found that quadriceps and hamstrings exercises were the most common used exercises in strength prevention in the selected studies so mainly targeting the kee joint. leg extension | |||
Biomechanics of Gait | |||
A good understanding of task specific gait parameters is needed to prescribe specfic exercises to improve walking. | |||
Not only walking mechanics and transition through different phases of gait but also speed has a great effect on walking mechanics across hip, knee and ankle joints<ref>Schwartz MH, Rozumalski A, Trost JP. The effect of walking speed on the gait of typically developing children. Journal of biomechanics. 2008 Jan 1;41(8):1639-50.</ref>. | |||
A thourough analysis of diffferent mechanics is important to undernstand normal gait and deviations from the normal pattern | |||
Muscle power generation for walking | |||
A imnimal level of strength is required in all muscles to generate the power for wlaking, however, not all muscles are created equally. Some muscles are more recruited throuout the walking cycle while other mscle contribute less. Knowing the important muscles is important to priotorize for Rx. | |||
Three key events are important for power generation during walking cycle: | |||
* 2-Ankle PF power generation at push-off at terminal stance | |||
* 1-Hip extensor power generation at Initial Contact | |||
* 3-Hip flexor power generation at toe-off to accelerate the leg through swing phase pre-swing | |||
Key events at the knee for power absorption rather than power generation: | |||
* Knee extensors at terminal stance | |||
* Knee flexors at terminal swing to decelrate the leg. | |||
At the stance phase, main power is genrated at the ankle at terminal stance key peak, liesser at the hip and a negative -[pwer absorption. | |||
At terminal stance, small contribution from the calf muscle and the main is generated from the tendon-Achillies tendon. Breaking it down: most power is coming from the tendon-related to power storage and release<ref>Sawicki GS, Lewis CL, Ferris DP. It pays to have a spring in your step. Exercise and sport sciences reviews. 2009 Jul;37(3):130.</ref> | |||
Power vs strength: | |||
Strength: reflects the maximum amount of force a muscle can produce | |||
power: rate of force production | |||
PRE: is the best method for improving the force production and muscle hypertrophy | |||
changing resistance constantly is the key to improve strength | |||
Ballistic /plyometric training dor power generation- power generation; stretch s cycle uses lighter loads and more repetitions | |||
Heavy resistance training improves strength wheras ballistic training doesn't increase strength but it improves power genrations<ref name=":2" />. | |||
Task Specificity for Ankle PF/DF | |||
Stance phase make up about 0.6 sec of the gait cycle, push off 0.15 seconds- that's where the achillies tendon is producing the power. Applied strength trainign/resistance trianing can increase the calf-tendon/muscle strength but not the power needed for the push off. improving the tendon fucntion is a key to improve walking mechanics at terminal stance utilizing the Achillies tendon power generation capacity. | |||
Muscle Function for walking occurs at high angular velocities which means that we need to work on power generation at a targeted speed, consider ballistic strengthening training mostly at the ankle<ref name=":2" />. | |||
== References == | == References == | ||
Revision as of 23:04, 27 December 2019
Original Editor - Mariam Hashem
Top Contributors - Mariam Hashem, Jess Bell, Kim Jackson, Tony Lowe, Lucinda hampton, Admin and Tarina van der Stockt
Evidence for Muscle Weakness
reduced Motor control, dextrity deficits, paresis(muscle weakness) and slowness of movment are well known charectristics of upper motor neurone syndorme. is a feature for upper motor neurone syndrome.
Muscle weakness is a key physical impairement in neurological conditions limiting mobility.
Feasibility studies started 15 years ago to improve mobility by introducing strength training to neurological rehabilitation.
A study by Cooke et al in 2010[1] compared the effect of functional strength training and conventional physiotherapy improve walking speed, distance and mechanics.
Resistance training was found to improve muscle strength[2] and was found to improve functional performance if resistance training was added to functional exercises[3].
Another systematic review by Kjølhede in 2012 reported strong evidence regarding progressive resistance training on muscle strength for people with MS but the mechanism of how strength training affecting strength needs more studies in the future[4].
Progressuve resistance exercises were strongly recommended by the Australian Stroke Foundation guidelines (2017) and the AHA guidelines (2010), however, the optimal strengthening approach is still unknown[5].
Despite being effective in musle strengthening but most of the applied studies failed to show improvement in walking capacity[6].
Current Evidence in Strength training
systematc review demoenstrated improvement in strength following resistance training but limited impact on walking[4][7][8][9][10].
A study by William et al [6] aimed to investigate task specifity of strength training for walking in neurological conditions.
Task Specific Criteria for Muscle Strengthning
Based on ACSM guidelines[11]:
- Role of the muscle
- Action of the muscle
- Type of contraction
- Active range and segmental alignement
- Load
- Speed of movement
The systematic review mainly found that quadriceps and hamstrings exercises were the most common used exercises in strength prevention in the selected studies so mainly targeting the kee joint. leg extension
Biomechanics of Gait
A good understanding of task specific gait parameters is needed to prescribe specfic exercises to improve walking.
Not only walking mechanics and transition through different phases of gait but also speed has a great effect on walking mechanics across hip, knee and ankle joints[12].
A thourough analysis of diffferent mechanics is important to undernstand normal gait and deviations from the normal pattern
Muscle power generation for walking
A imnimal level of strength is required in all muscles to generate the power for wlaking, however, not all muscles are created equally. Some muscles are more recruited throuout the walking cycle while other mscle contribute less. Knowing the important muscles is important to priotorize for Rx.
Three key events are important for power generation during walking cycle:
- 2-Ankle PF power generation at push-off at terminal stance
- 1-Hip extensor power generation at Initial Contact
- 3-Hip flexor power generation at toe-off to accelerate the leg through swing phase pre-swing
Key events at the knee for power absorption rather than power generation:
- Knee extensors at terminal stance
- Knee flexors at terminal swing to decelrate the leg.
At the stance phase, main power is genrated at the ankle at terminal stance key peak, liesser at the hip and a negative -[pwer absorption.
At terminal stance, small contribution from the calf muscle and the main is generated from the tendon-Achillies tendon. Breaking it down: most power is coming from the tendon-related to power storage and release[13]
Power vs strength:
Strength: reflects the maximum amount of force a muscle can produce
power: rate of force production
PRE: is the best method for improving the force production and muscle hypertrophy
changing resistance constantly is the key to improve strength
Ballistic /plyometric training dor power generation- power generation; stretch s cycle uses lighter loads and more repetitions
Heavy resistance training improves strength wheras ballistic training doesn't increase strength but it improves power genrations[5].
Task Specificity for Ankle PF/DF
Stance phase make up about 0.6 sec of the gait cycle, push off 0.15 seconds- that's where the achillies tendon is producing the power. Applied strength trainign/resistance trianing can increase the calf-tendon/muscle strength but not the power needed for the push off. improving the tendon fucntion is a key to improve walking mechanics at terminal stance utilizing the Achillies tendon power generation capacity.
Muscle Function for walking occurs at high angular velocities which means that we need to work on power generation at a targeted speed, consider ballistic strengthening training mostly at the ankle[5].
References[edit | edit source]
- ↑ Cooke EV, Tallis RC, Clark A, Pomeroy VM. Efficacy of functional strength training on restoration of lower-limb motor function early after stroke: phase I randomized controlled trial. Neurorehabilitation and Neural Repair. 2010 Jan;24(1):88-96.
- ↑ Royal College of Physicians Intercollegiate Stroke Working Party. National Clinical Guidelines for Stroke. 3rd ed. London,UK: Royal College of Physicians; 2008.
- ↑ Olivetti L, Schurr K, Sherrington C, et al. A novel weightbearing strengthening program during rehabilitation of older people is feasible and improves standing up more than a nonweight-bearing strengthening program: a randomised trial.Aust J Physiother. 2007:53:147-153.
- ↑ 4.0 4.1 Kjølhede T, Vissing K, Dalgas U. Multiple sclerosis and progressive resistance training: a systematic review. Multiple Sclerosis Journal. 2012 Sep;18(9):1215-28.
- ↑ 5.0 5.1 5.2 Williams G, Strength Training in Neurological Rehabilitation Course, Physioplus 2019
- ↑ 6.0 6.1 Williams G, Kahn M, Randall A. Strength training for walking in neurologic rehabilitation is not task specific: a focused review. American journal of physical medicine & rehabilitation. 2014 Jun 1;93(6):511-22.
- ↑ Ada L, Dorsch S, Canning CG. Strengthening interventions increase strength and improve activity after stroke: a systematic review. Australian Journal of Physiotherapy. 2006 Jan 1;52(4):241-8.
- ↑ Morris SL, Dodd KJ, Morris ME. Outcomes of progressive resistance strength training following stroke: a systematic review. Clinical rehabilitation. 2004 Feb;18(1):27-39.
- ↑ Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Archives of physical medicine and rehabilitation. 2002 Aug 1;83(8):1157-64.
- ↑ Van De Port IG, Wood-Dauphinee S, Lindeman E, Kwakkel G. Effects of exercise training programs on walking competency after stroke: a systematic review. American Journal of Physical Medicine & Rehabilitation. 2007 Nov 1;86(11):935-51.
- ↑ American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine and science in sports and exercise. 2009 Mar;41(3):687.
- ↑ Schwartz MH, Rozumalski A, Trost JP. The effect of walking speed on the gait of typically developing children. Journal of biomechanics. 2008 Jan 1;41(8):1639-50.
- ↑ Sawicki GS, Lewis CL, Ferris DP. It pays to have a spring in your step. Exercise and sport sciences reviews. 2009 Jul;37(3):130.
