Posts Tagged Muscle weakness
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 2016; Horstman 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.
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.
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.
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.
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[ARTICLE] New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments – Full Text
Figure 8. Different scenes while the volunteers were playing. (a) “The Paper-Bird”, (b) “The Ladder”, (c) “The Boat” and (d) “Whack-a-Mole”.
[Abstract] Ankle plantarflexor spasticity is not differentially disabling for those who are weak following traumatic brain injury
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.
[Review] Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery – Full Text PDF
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.
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.
[ARTICLE] Grip strength is a representative measure of muscle weakness in the upper extremity after stroke – Full Text
[ARTICLE] Reliability of muscle strength assessment in chronic post-stroke hemiparesis: a systematic review and meta-analysis
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