Posts Tagged Muscle weakness

[BLOG POST] Resistance training after stroke improves strength but not necessarily function

Muscle weakness is the largest cause of disability after stroke (Canning et al 2004). Stroke survivors have levels of muscle strength that are about half of that of people who have not had a stroke (Dorsch et al 2016Horstman et al 2008). Thus, it is important to identify interventions that can improve muscle strength in stroke survivors.

The most proven method for improving muscle strength is progressive resistance training. Progressive resistance training involves lifting a load 8 to 15 times to the point of muscle fatigue and then progressively increasing the intensity of the exercise over the course of an intervention. Progressive resistance training has been shown to be effective at increasing muscle strength in people without stroke, but it is unclear how effective it is at improving muscle strength and physical function in stroke patients.

In our recent paper (Dorsch et al. 2018), we reviewed data from 11 clinical trials that used progressive resistance training to try to improve strength and function in people with stroke. Our review included trials in which study participants were stroke survivors at any time after stroke, and the trials also needed to include an intervention group that performed progressive resistance training and a control or placebo group that did not perform the training. We looked at the changes in muscle strength and function in these studies. In general, studies that involved training of leg muscles, function was measured with walking speed, and studies that involved training of arm muscles involved functional tests of the arms.

WHAT DID WE FIND?

We found that progressive resistance training is effective at increasing muscle strength in people with stroke. The average increase in strength is 50% in muscles that are specifically targeted by training. However, this large increase in strength does not consistently reduce disability. That is, the improvement in strength does not always carryover directly to better walking or better use of the affected arm in functional tasks.

 

SIGNIFICANCE AND IMPLICATIONS

In stroke survivors, progressive resistance training increases muscle strength. However, this does not necessarily improve arm function or the ability to walk. This finding suggests that if stroke survivors are strong enough to participate in resistance training then muscle weakness is not their main impairment, and training should target other impairments, such as loss of coordination. However, if a patient has very weak muscles – too weak to move against small resistances or against gravity – then increasing strength should still be a priority.

 

PUBLICATION REFERENCE

Dorsch S, Ada L, Alloggia D. Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review. J Physiother 64:84-90, 2018.

KEY REFERENCES

Canning CG, Ada L, Adams R, O’Dwyer NJ. Loss of strength contributes more to physical disability after stroke than loss of dexterity. Clin Rehabil 18:300-308, 2004.

Dorsch S, Ada L, Canning CG. Lower limb strength is significantly impaired in all muscle groups in ambulatory people with chronic stroke: a cross-sectional study. Arch Phys Med Rehabil 97:522-527, 2016.

Horstman AM, Beltman MJ, Gerrits KH, Koppe P, Janssen TW, Elich P, deHaan A. Intrinsic muscle strength and voluntary activation of both lower limbs and functional performance after stroke. Clin Physiol Funct Imaging 28:251-261, 2008.

AUTHOR BIO

Dr Simone Dorsch is a lecturer in Neurological Physiotherapy at the Australian Catholic University and a member of the StrokeEd collaboration which teaches workshops on the clinical implementation of evidence based practice in stroke and aged care rehabilitation (www.StrokeEd.com). Her current research focuses on strengthening interventions after stroke and strategies to increase practice intensity in rehabilitation.

via Resistance training after stroke improves strength but not necessarily function – Motor Impairment

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[WEB SITE] Bioness Announces Commercial Availability of the L300 Go™ System to Healthcare Professionals

Source: Bioness Announces Commercial Availability of the L300 Go™ System to Healthcare Professionals

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[ARTICLE] New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments – Full Text

Abstract:

The work presented here suggests new ways to tackle exergames for physical rehabilitation and to improve the players’ immersion and involvement. The primary (but not exclusive) purpose is to increase the motivation of children and adolescents with severe physical impairments, for doing their required exercises while playing. The proposed gaming environment is based on the Kinect sensor and the Blender Game Engine. A middleware has been implemented that efficiently transmits the data from the sensor to the game. Inside the game, different newly proposed mechanisms have been developed to distinguish pure exercise-gestures from other movements used to control the game (e.g., opening a menu). The main contribution is the amplification of weak movements, which allows the physically impaired to have similar gaming experiences as the average population. To test the feasibility of the proposed methods, four mini-games were implemented and tested by a group of 11 volunteers with different disabilities, most of them bound to a wheelchair. Their performance has also been compared to that of a healthy control group. Results are generally positive and motivating, although there is much to do to improve the functionalities. There is a major demand for applications that help to include disabled people in society and to improve their life conditions. This work will contribute towards providing them with more fun during exercise.

1. Introduction

For a number of years, the possibility of applying serious games for rehabilitation purposes has been thoroughly investigated [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]. It is often claimed that serious games reduce health system costs and efforts as they enable in-home rehabilitation without loss of medical monitoring, and in so doing provide an additional fun factor for patients [22,23,24]. Multiple reviews have summarized the very powerful contributions and reveal that the systems are generally evaluated as feasible, but no state of general applicability has yet been reached [2,3,5,7,11,13].
Most studies are quite specialised and tend to cover the same groups of largely elderly patients (e.g., stroke and Parkinson’s), which do not constitute a credible target group per se for gaming among the population. In addition, the impression is that the same functionalities are being tested repeatedly, without any evolution. Above all, other groups like children and adolescents with chronic diseases are rarely addressed, even though they are an excellent target group and would probably benefit greatly from using exergames as they need to move like any other child but are mostly limited to performing their exercises with a physiotherapist. This is generally boring, time-consuming and prevents them from playing with friends during this time. If instead they could play games involving physical exercises, without it feeling like rehabilitation, due to proper immersion and motivation, they would possibly need fewer sessions with the therapist, which may in turn improve their social life. Commercially available games would be good enough for many children with physical disabilities, if only they were configurable and adaptive to their potential and needs. Remote controls (RC) are typically not sufficiently configurable (button functions cannot be changed or the RC cannot be used with one hand) and are only made for hands (why not for feet or the mouth?) Some RCs are not sufficiently precise in detection, and so the user ends up tired and loses motivation. Motion capture devices like the Kinect sensor seem to provide better prerequisites for exergaming purposes but feature important limitations too, (e.g., detection of fine movements and rotations) such that the needs of many people are still not be covered by commercial solutions.
However, this is not due to the sensors, but rather the software, which lacks configurability for special needs, such as simple adjustments of level difficulties or the option of playing while seated. For the latter, some Kinect games are available [29], but those are hardly the most liked ones, as has been stated by affected users [30]. Therefore, more complex solutions are required to adapt a game to problems like muscle weaknesses (most games require wide or fast movements), spasticity (“strange” movements are not recognized) or the available limbs (for instance configuring a game to be controlled with the feet for players without full hand use).
To fill these gaps, the authors of the work presented here are pursuing the overall aim (as part of a long-term project) of creating an entertaining exergaming environment for adventure games that immerses the players into a virtual world and makes them forget their physical impairments. Knowledge of the gaming industry is applied to create motivating challenges that the users have to solve, which are sufficiently addictive to make the exercises pass to an unconscious plane. The gaming environment is configurable to the user’s potential and requirements. Challenges will be programmable by a therapist and will also adapt themselves to the players automatically real-time, by observing their fatigue or emotional state (lowering the difficulty or switching to more relaxing exercises when needed)…

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Figure 8. Different scenes while the volunteers were playing. (a) “The Paper-Bird”, (b) “The Ladder”, (c) “The Boat” and (d) “Whack-a-Mole”.

Continue —> Sensors | Free Full-Text | New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments | HTML

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[Abstract] Ankle plantarflexor spasticity is not differentially disabling for those who are weak following traumatic brain injury

ABSTRACT

Primary objectives: The main aim of this study was to determine whether the presence of distal lower-limb spasticity had a greater impact on mobility for those who had greater levels of muscle paresis following traumatic brain injury (TBI).

Research design: This was a cross-sectional cohort study of convenience. Seventy-five people attending physiotherapy for mobility limitations following TBI participated in this study. All participants had sustained a moderate–severe TBI and were grouped according to the presence or absence of ankle plantarflexor spasticity for comparison.

Main outcomes and results: The primary outcome measure for mobility was self-selected walking speed and the primary outcome measure for muscle strength was hand-held dynamometry. Secondary outcome measures for mobility and muscle strength were the High-level Mobility Assessment Tool (HiMAT) and ankle power generation (APG) at push-off. Spasticity was quantified with the Modified Tardieu scale. Participants with ankle plantarflexor spasticity (Group 2) had slower self-selected walking speeds. There was no statistically significant effect for Group and plantarflexor strength (p = 0.81).

Conclusion: Although participants with ankle plantarflexor spasticity walked significantly slower than those without, the presence of ankle plantarflexor spasticity did not lead to greater mobility limitations for those who were weak.

Source: Ankle plantarflexor spasticity is not differentially disabling for those who are weak following traumatic brain injury: Brain Injury: Vol 0, No 0

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[Review] Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery – Full Text PDF

Abstract

Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients’ mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients.

This multiple systematic review focuses both on standard treatment methods and on innovating  rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed.

At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some  interventions may be under debate, motor skill learning and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.

Introduction

The World Health Organisation (WHO) estimates that stroke events in EU countries are likely to increase by 30% between 2000 and 2025 (Truelsen et al., 2006). The most common deficit after stroke is hemiparesis of the contralateral upper limb, with more than 80% of stroke patients experiencing this condition acutely and more than 40% chronically (Cramer et al., 1997).

Common manifestations of upper extremity motor impairment include muscle weakness or contracture, changes in muscle tone, joint laxity and impaired motor control. These impairments induce disabilities in common activities such as reaching, picking up objects, and holding onto objects (for a review on precision grip deficits, see Bleyenheuft and Gordon, 2014).

Motor paresis of the upper extremity may be associated with other neurological manifestations that affect the recovery of motor function and thus require focused therapeutic intervention. Deficits in somatic sensations (body senses such as touch, temperature, pain and proprioception)  after stroke are common with prevalence rates variously reported to be 11%-85% (Carey et al., 1993; Hunter, 2002; Yekutiel, 2000). Functionally, the motor problems resulting from sensory deficits after stroke can be summarized as (1) impaired detection of sensory information, (2) disturbed motor tasks performance requiring somatosensory information, and (3) diminished upper extremity rehabilitation outcomes (Hunter, 2002). Sensation is essential for safety even  if there is adequate motor recovery (Yekutiel, 2000). Also, up to 50% of patients experience  pain of the upper extremity during the first year after stroke, especially shoulder pain and complex regional pain syndrome-type I (CRPS-type I), which may impede adequate early rehabilitation (Jönsson et al., 2006; Kocabas et al., 2007; Lundström et al., 2009; Sackley et al.,2008). Furthermore, joint subluxation and muscle contractures can lead to nociceptive musculoskeletal pain (de Oliveira et al., 2012). Among other complications of stroke the neglect syndrome (Ringman et al., 2004) and spasticity (Sommerfeld et al., 2004; Welmer et al., 2010) affect motor and functional outcomes.

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[ARTICLE] Grip strength is a representative measure of muscle weakness in the upper extremity after stroke – Full Text

Abstract

Background: Muscle weakness is the most common impairment in the upper extremity after stroke, leading to a reduced ability to use the arm and the hand in daily activities. Grip strength is easier to measure than precise, but more time-consuming, isokinetic and isometric arm muscle strength measurements. It would therefore be advantageous in a clinical setting if grip strength could be used as a proxy for muscle strength in the entire upper extremity.
Objective: To investigate the association between grip strength and isometric and isokinetic arm muscle strength in persons with chronic stroke.
Methods: Forty-five persons with mild-to-moderate paresis in the upper extremity, at least 6 months post-stroke participated. Isometric grip strength was measured with a computerized grip dynamometer and arm strength (isometric shoulder abduction and elbow flexion as well as isokinetic elbow extension and flexion) with an isokinetic dynamometer. Pearson’s correlation coefficient was used to determine the association between the muscle strength measurements.
Results: There were significant correlations (p < .0001) between grip strength and all arm strength measurements in both the more affected (r = 0.77–0.82) and the less affected upper extremity (r = 0.65–0.82).
Conclusion: This cross-sectional study showed that grip strength is strongly associated with muscle strength in the arm in persons in the chronic phase after stroke. As grip strength is easy to measure and less time-consuming than arm muscle strength measurements, this implies that grip strength can be a representative measure of muscle weakness of the entire upper extremity in the chronic phase after stroke.

Continue —>  Grip strength is a representative measure of muscle weakness in the upper extremity after stroke – Topics in Stroke Rehabilitation –

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[ARTICLE] Reliability of muscle strength assessment in chronic post-stroke hemiparesis: a systematic review and meta-analysis

Abstract

Background:Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque.

Objective:To systematically investigate and organize the evidence of the reliability of muscle strength evaluation measures in post-stroke survivors with chronic hemiparesis.

Data Sources:Two assessors independently searched four electronic databases in January 2014 (Medline, Scielo, CINAHL, Embase).

Study Selection:Inclusion criteria comprised studies on reliability on muscle strength assessment in adult post-stroke patients with chronic hemiparesis.

Data Extraction:We extracted outcomes from included studies about reliability data, measured by intraclass correlation coefficient (ICC) and/or similar. The meta-analyses were conducted only with isokinetic data.

Results:Of 450 articles, eight articles were included for this review. After quality analysis, two studies were considered of high quality. Five different joints were analyzed within the included studies (knee, hip, ankle, shoulder, and elbow). Their reliability results varying from low to very high reliability (ICCs from 0.48 to 0.99). Results of meta-analysis for knee extension varying from high to very high reliability (pooled ICCs from 0.89 to 0.97), for knee flexion varying from high to very high reliability (pooled ICCs from 0.84 to 0.91) and for ankle plantar flexion showed high reliability (pooled ICC = 0.85).

Conclusion:Objective muscle strength assessment can be reliably used in lower and upper extremities in post-stroke patients with chronic hemiparesis.

Source: Maney Online – Maney Publishing

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