Posts Tagged strength

[Abstract] Medical devices for self-help management: the case of stroke rehabilitation – Systematic Review

Abstract

Introduction: Self-help devices (SHD) have been used as an alternative to conventional treatment for post stroke rehabilitation. This review aims to look for evidence that a stroke survivor may have increased muscle strength with the use of SHD.

Methods: This article was conducted according to PRISMA, a statistical tool (state of the art by systematic review) and previously registered in PROSPERO (international prospective registry of systematic reviews) under number CRD42018091424. Studies addressing the use of SHD and its effect on muscle strength in stroke patients were included. The studies were read, selected and their metadata extracted. A Downs & Black scale was used to assess methodological quality.

Results: 41 publications were analyzed, of which only three met the proposed inclusion criteria. Two articles showed positive results in strength gain using SHD. One study presented a decrease in the mean reaching forces when compared to the intervention groups (subacute and chronic with assistance to grip) and controls but SHD assisted in performing the activity.

Conclusion: Studies using SHD suggest muscle strength improvement in stroke patients.

via Medical devices for self-help management: the case of stroke rehabilitation | International Journal of Advanced Engineering Research and Science

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[WEB PAGE] Physical Therapy at Home – Gorbel Rehab – Videos

Physical Therapy at Home

As rehab professionals around the world work to address patient needs during the COVID-19 pandemic, Gorbel is actively taking steps to improve efforts in delivering therapy during these difficult times. The Gorbel team of physical therapists have created a library of home exercise program videos for those patients who are now unable to receive therapy with the frequency or duration in which they normally would have. The current video categories are Strength, Range of Motion, Balance, and Caregiver Training. Each category has a ‘Playlist’ that includes multiple videos. We will continue to add categories and new videos in our commitment to assist your efforts to advance your patient’s recovery.

Stay safe, healthy and thank you for all you do.
Brian Reh, CEO Gorbel®

 

Physical Therapy Videos

Balance Videos Playlist  /  Caregiver Videos Playlist  /  Range of Motion Videos Playlist  /  Strength Videos Playlist

Balance Videos Playlist

Caregiver Videos Playlist

Range of Motion Videos Playlist

Strength Videos Playlist

 

Physical Therapist Bio

Matthew KlockMatthew Klock PT,DPT I am a licensed physical therapist in New York State and the Northeast Account Manager for Gorbel® Rehabilitation. Before joining Gorbel® I worked for Ochsner Health System in New Orleans, LA as the Supervisor of the Ochsner Sports Medicine Clinic. My passions include sports and orthopedics as well as new and emerging technologies. I believe that physical therapists should serve their patients by applying their wealth of knowledge in rehabilitation and pair it with the most cutting edge technologies to get the most out of every treatment.

 

Ramiro MaldonadoRamiro Maldonado PT, DPT I am a licensed Physical Therapist in New York State as well as the Clinical Business Development Specialist for Gorbel Rehabilitation. During my ten years as a clinician, my clinical interests lead me to specialize in vestibular and neuromuscular impairment, and I have completed the vestibular competency at Emory University. My passion now lies in helping patients and therapists by increasing awareness of rehabilitation technology and how it can improve patient outcomes. You can find out more about the products I represent, innovations in physical therapy, and me at TheBalancePT.com or follow me on Twitter or Instagram @RamiroDPT. Thank you!! 

Heidi ShenkHeidi Shenk, PT I am a licensed Physical Therapist in the states of Ohio and Indiana as well as the Account Manager for the Great Lakes Region of Gorbel Rehabilitation. I am a graduate of the Doisy College of Health Sciences at St Louis University. During my twenty-seven years as a clinician, my clinical interests led me to specialize in occupational medicine, outpatient orthopedics and in women’s health. My lifelong interest in technology and in improving therapist safety and patient outcomes has led to a passion in increasing awareness of rehabilitation technology and how it can improve patient care.

via Physical Therapy at Home | Gorbel Rehab

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[ARTICLE] Interventions involving repetitive practice improve strength after stroke: a systematic review – Full Text

Article Outline

  1. Introduction
  2. Method
    1. Identification and selection of studies
      1. Participants
      2. Intervention
      3. Comparison
      4. Outcome measures
    2. Assessment of risk of bias
    3. Data extraction and analysis
      1. Sensitivity analyses
      2. Subgroup analyses
  3. Results
    1. Flow of studies through the review
    2. Characteristics of included trials
      1. Risk of bias
      2. Participants
      3. Intervention
      4. Outcome measures
    3. Effects of repetitive practice
      1. Strength
      2. Upper limb activity
      3. Lower limb activity
      4. Subgroup analyses
      5. Post-hoc analysis
      6. Sensitivity analysis
  4. Discussion
  5. Appendix 1. Supplementary data
  6. References

Abstract

Questions

Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity?

Design

Systematic review of randomised trials with meta-analysis.

Participants

Adults who have had a stroke.

Intervention

Any intervention involving repetitive practice compared with no intervention or a sham intervention.

Outcome measures

The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity.

Results

Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2 = 44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2 = 50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2 = 36%) in favour of repetitive practice on lower limb activity.

Conclusion

Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity.

[…]

Continue —>  Interventions involving repetitive practice improve strength after stroke: a systematic review – Journal of Physiotherapy

 

Figure 1

Figure 1
Flow of studies through the review.

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[ARTICLE] Interventions involving repetitive practice improve strength after stroke: a systematic review – Full Text

Abstract

Questions

Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity?

Design

Systematic review of randomised trials with meta-analysis.

Participants

Adults who have had a stroke.

Intervention

Any intervention involving repetitive practice compared with no intervention or a sham intervention.

Outcome measures

The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity.

Results

Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2 = 44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2 = 50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2 = 36%) in favour of repetitive practice on lower limb activity.

Conclusion

Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity.

Introduction

The loss of strength after stroke is a common and important impairment. The average strength of the affected upper and lower limb in people who have had a significant stroke ranges from 30 to 50% of age-matched controls.1, 2, 3, 4 This loss of strength can result in profound activity limitations5, 6, 7 and participation restrictions.8Therefore, it is important to know which interventions are effective for improving strength after stroke. Progressive resistance training is commonly used to improve strength in people without disability9 and can be used to improve strength in people after stroke.10 Progressive resistance training is characterised by muscles working at high loads with low repetitions, that is, a load of 8 to 12 repetitions maximum (RM) for at least two sets with a progressive increase in the load.9 However, progressive resistance training is not commonly used after stroke, and often when strengthening programs claim to be using progressive resistance training they are not adhering to the guidelines.11 This may be because progressive resistance training is time-consuming to set up and difficult to implement in people with very weak muscles. In contrast, repetitive practice of tasks can be set up with minimal equipment and modified so that even people with very weak muscles can do some form of training.

Repetitive practice of tasks, such as walking, reaching and manipulation of objects, is a major component of rehabilitation after stroke. Some interventions used to promote repetitive practice include constraint-induced movement therapy, treadmill walking with body-weight support, or robotic devices. These interventions are typically performed with an emphasis on high repetitions and no added resistance to movement; hence, the principles of repetitive practice are very different to the principles of progressive resistance training. Repetitive practice is known to be effective for reducing activity limitations, with many systematic reviews confirming this.12,13, 14, 15 However, less is known about the effects of repetitive practice on strength after stroke, and no systematic reviews have specifically investigated this issue. Eight systematic reviews with meta-analyses have investigated the effects of strengthening interventions on strength after stroke. These reviews included studies that used progressive resistance training10, 16, 17, 18, 19, 20 or an artificial drive of muscle contraction21, 22 (ie, electrical stimulation without attempts to move a limb) as an intervention and did not focus specifically on repetitive practice. Since repetitive practice is widely used and recommended in rehabilitation after stroke,23 it is important to understand if interventions involving repetitive practice are effective for improving strength.

Therefore, the research questions for this systematic review were:

  • 1. Do interventions involving repetitive practice improve strength after stroke?
  • 2. Are any improvements in strength accompanied by improvements in activity?

Continue —> Interventions involving repetitive practice improve strength after stroke: a systematic review – Journal of Physiotherapy

Figure 1

Figure 1
Flow of studies through the review.
a Studies may have been excluded for failing to meet more than one inclusion criterion.

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[ARTICLE] Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review – Full Text

Article Outline

  1. Introduction
  2. Method
    1. Identification and selection of studies
    2. Assessment of characteristics of the studies
      1. Quality
      2. Participants
      3. Intervention
      4. Outcome measures
    3. Data analysis
  3. Results
    1. Flow of trials through the review
    2. Characteristics of included trials
      1. Quality
      2. Participants
      3. Intervention
      4. Outcome measures
    3. Effect of intervention
      1. Strength
      2. Activity
  4. Discussion
  5. Appendix 1. Supplementary data
  6. References

Abstract

Question

Does progressive resistance training improve strength and activity after stroke? Does any increase in strength carry over to activity?

Design

Systematic review of randomised trials with meta-analysis.

Participants

Adults who have had a stroke.

Intervention

Progressive resistance training compared with no intervention or placebo.

Outcome measures

The primary outcome was change in strength. This measurement had to be of maximum voluntary force production and performed in muscles congruent with the muscles trained in the intervention. The secondary outcome was change in activity. This measurement had to be a direct measure of performance that produced continuous or ordinal data, or with scales that produced ordinal data.

Results

Eleven studies involving 370 participants were included in this systematic review. The overall effect of progressive resistance training on strength was examined by pooling change scores from six studies with a mean PEDro score of 5.8, representing medium quality. The effect size of progressive resistance training on strength was 0.98 (95% CI 0.67 to 1.29, I2 = 0%). The overall effect of progressive resistance training on activity was examined by pooling change scores from the same six studies. The effect size of progressive resistance training on activity was 0.42 (95% CI –0.08 to 0.91, I2 = 54%).

Conclusion

After stroke, progressive resistance training has a large effect on strength compared with no intervention or placebo. There is uncertainty about whether these large increases in strength carry over to improvements in activity.

via Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review – Journal of Physiotherapy

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[BLOG POST] Strength training improves the nervous system’s ability to drive muscles

Imagine that the New Year has just begun. You’ve made a resolution to improve your physical fitness. In particular, you want to improve your muscle strength. You’ve heard that people with stronger muscles live longer and have less difficulty standing, walking, and using the toilet when they get older (Rantanen et al. 1999; Ruiz et al. 2008). So, you join a fitness centre and hire a personal trainer. The trainer assesses your maximal strength, and then guides you through a 4-week program that involves lifting weights which are about 80% of your maximum.

Sure enough, after the program, you become stronger (probably around 20% stronger) (Carroll et al. 2011). You think this is great – and it is! You are so excited, you decide to stand in front of your mirror, flex your biceps, and take a selfie (your plan is to post the picture to Facebook to show your friends how much bigger your muscles got). However, after examining the picture, you realise your muscles did not get bigger. Or perhaps they did get a little bigger, but not enough to explain your substantial improvement in strength. You are somewhat disappointed in this, but then you remember your goal was to get stronger, not necessarily bigger, so you post the picture, anyway.

Magnetic stimulation of the brain can be used to test how well a person can voluntarily drive their muscles.

Interestingly, the observations you made are completely consistent with the scientific literature. Within the first weeks of strength training, muscle strength can improve without a change in the size or architecture of the muscle (e.g., Blazevich et al. 2007). Consequently, researchers have speculated that initial improvements in muscle strength from strength training are due primarily to changes in the central nervous system. One hypothesis has been that strength training helps the nervous system learn how to better “drive” or communicate with muscles. This ability is termed voluntary activation, and it can be tested by stimulating the motor area of an individual’s brain while they perform a maximal contraction (Todd et al. 2003). If the stimulation produces extra muscle force, it means that the individual’s nervous system was not maximally activating their muscles. Currently, there is no consensus as to whether voluntary activation can actually be improved by strength training.

Therefore, we conducted a randomised, controlled trial in which one group of participants completed four weeks of strength training, while a control group did not complete the training (Nuzzo et al. in press). For the group who performed the training, each exercise session consisted of four sets of strong contractions of the elbow flexor muscles (i.e., the muscles that bend the elbow, such as the biceps). Before and after the four week intervention, both groups were tested for muscle strength, voluntary activation, and several other measures. The participants were healthy, university-aged, and they had limited or no experience with strength training.

WHAT DID WE FIND?

Prior to the intervention, the strength training and control groups had similar levels of muscle strength and activation of the elbow flexor muscles. After the intervention, the group who performed the strength training improved their strength by 13%. They also improved their voluntary activation from 88.7% to 93.4%. The control group did not improve muscle strength or voluntary activation.

SIGNIFICANCE AND IMPLICATIONS

The results from our study show that four weeks of strength training improves the brain’s ability to “drive” the elbow flexor muscles to produce their maximal force. This helps to explain how muscles can become stronger, without a change in muscle size or architecture. Moreover, the results suggest that clinicians should consider strength training as a treatment for patients with motor impairments (e.g., stroke), as these individuals are likely to have poor voluntary activation (Bowden et al. 2014).

PUBLICATION

Nuzzo JL, Barry BK, Jones MD, Gandevia SC, Taylor JL. Effects of four weeks of strength training on the corticomotoneuronal pathway. Med Sci Sports Exerc,  doi: 10.1249/MSS.0000000000001367.

KEY REFERENCES

Blazevich AJ, Gill ND, Deans N, Zhou S. Lack of human muscle architectural adaptation after short-term strength training. Muscle Nerve 35: 78-86.

Bowden JL, Taylor JL, McNulty PA. Voluntary activation is reduced in both the more- and less-affected upper limbs after unilateral stroke.Front Neurol 5: 239, 2014.

Carroll TJ, Selvanayagam VS, Riek S, Semmler RG. Neural adaptations to strength training: moving beyond transcranial magnetic stimulation and reflex studies. Acta Physiol 202: 119-140, 2011.

Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, White L. Midline hand grip strength as a predictor of old age disability.JAMA 281: 558-560, 1999.

Ruiz JR, Sui X, Lobelo F, Morrow Jr. JR, Jackson AW, Sjöström M, Blair SN. Association between muscular strength and mortality in men: prospective cohort study. BMJ 337: a439, 2008.

Todd G, Taylor JL, Gandevia SC. Measurement of voluntary activation of fresh and fatigued human muscles using transcranial magnetic stimulation. J Physiol 555: 661-671, 2003.

AUTHOR BIO

Jim Nuzzo is a Postdoctoral Fellow at Neuroscience Research Australia (NeuRA). His research investigates how strength training alters the neural connections between the brain and muscles. Click here to read Jim’s other blogs.

Source: Strength training improves the nervous system’s ability to drive muscles – Motor Impairment

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[Poster] A Toolkit for Objective Clinical Outcome Measures of Muscle Tone – Archives of Physical Medicine and Rehabilitation

To evaluate a wearable sensor-based toolkit for quantifying muscle tone in patients with upper motor neuron syndrome (UMNS).

Source: A Toolkit for Objective Clinical Outcome Measures of Muscle Tone – Archives of Physical Medicine and Rehabilitation

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[Abstract] Effects of ankle biofeedback training on strength, balance, and gait in patients with stroke – PEDro

Effects of ankle biofeedback training on strength, balance, and gait in patients with stroke
Kim S-J, Cho H-Y, Kim K-H, Lee S-M
Journal of Physical Therapy Science 2016 Sep;28(9):2596-2600
clinical trial
PURPOSE: This study aimed to investigate the effects of ankle biofeedback training on muscle strength of the ankle joint, balance, and gait in stroke patients. SUBJECTS AND METHODS: Twenty-seven subjects who had had a stroke were randomly allocated to either the ankle biofeedback training group (n = 14) or control group (n = 13). Conventional therapy, which adhered to the neurodevelopmental treatment approach, was administered to both groups for 30 minutes. Furthermore, ankle strengthening exercises were performed by the control group and ankle biofeedback training by the experimental group, each for 30 minutes, 5 days a week for 8 weeks. To test muscle strength, balance, and gait, the Biodex isokinetic dynamometer, functional reach test, and 10 m walk test, respectively, were used. RESULTS: After the intervention, both groups showed a significant increase in muscle strength on the affected side and improved balance and gait. Significantly greater improvements were observed in the balance and gait of the ankle biofeedback training group compared with the control group, but not in the strength of the dorsiflexor and plantar flexor muscles of the affected side. CONCLUSION: This study showed that ankle biofeedback training significantly improves muscle strength of the ankle joint, balance, and gait in patients with stroke.

Full text (sometimes free) may be available at these link(s):      help

Source: PEDro – Search Detailed Search Results

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[Abstract] A Meta-Analysis and Systematic Literature Review of Virtual Reality Rehabilitation Programs

Highlights

  • Virtual reality rehabilitation (VRR) programs are growing in popularity
  • VRR programs are more effective than traditional rehabilitation programs
  • Excitement, physical fidelity, and cognitive fidelity may cause VRR program success
  • More research is needed to better understand VRR programs

Abstract

A recent advancement in the study of physical rehabilitation is the application of virtual reality rehabilitation (VRR) programs, in which patients perform practice behaviors while interacting with the computer-simulation of an environment that imitates a physical presence in real or imagined worlds. Despite enthusiasm, much remains unknown about VRR programs. Particularly, two important research questions have been left unanswered: Are VRR programs effective? And, if so, why are VRR programs effective? A meta-analysis is performed in the current article to determine the efficacy of VRR programs, in general, as well as their ability to develop four specific rehabilitation outcomes: motor control, balance, gait, and strength. A systematic literature review is also performed to determine the mechanisms that may cause VRR program success or failure. The results demonstrate that VRR programs are more effective than traditional rehabilitation programs for physical outcome development. Further, three mechanisms have been proposed to cause these improved outcomes: excitement, physical fidelity, and cognitive fidelity; however, empirical research has yet to show that these mechanisms actually prompt better rehabilitation outcomes. The implications of these results and possible avenues for future research and practice are discussed.

Source: A Meta-Analysis and Systematic Literature Review of Virtual Reality Rehabilitation Programs

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[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

Chapter 9

Mobility and the Lower Extremity

Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995).In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.

For evidence tables, please click here.

Source: Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation

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