Every year over 15 million people world wide suffer a stroke and of these at least a third will be left with significant physical impairment. One of the common residual impairments is spasticity of one or more limbs. Spasticity is defined as a velocity dependent increase in the tonic stretch reflex, ie the faster the muscle is stretched the greater the resistance and more reflex activity, it is often associated with underlying muscle weakness and results in difficulty with day to day functional tasks such as walking, dressing and eating. A recent study on chronic stroke (over one year) showed that on average, the affected leg was only 46% as strong as the healthy population and that the ‘good’ leg was only 64% as strong.
It is widely recognized that in the healthy population strength training has many health benefits such as:
· Improved muscle strength and size
· Improved mobility and balance
· Enhanced performance of everyday tasks.
However, historically it was thought that resistance exercises in the neurologically impaired population would lead to an increase in muscle spasticity and therefore be detrimental to functional ability. Following a stroke, people were advised not to include strength training in their therapy programs for fear that it would further increase their spasticity.
In stark contrast, research over the past 20 years has shown that muscle weakness may be directly responsible for compromised muscle function and that effortful activity or strength training does not exacerbate spasticity, in fact, strength training can reduce spasticity in most cases. This would indicate that high intensity activity, including strength training is an important part of rehabilitation after stroke.
Strength training after stroke is best supervised following a thorough assessment by a neurological physiotherapist to ensure correct prescription of exercise. Consideration needs to be given to primary and associated impairments, position, function, dosage, equipment, progression and history of muscle as well as outcomes. Strength training is as much about skill training; learning how to create efficient pathways from the brain to the muscle and recruiting muscle effectively to provide force, as physiological changes leading to growth and size of muscle. Examples of strength training in the neurological population may include use of an electrical stimulation machine and manual guidance for very weak muscles through to progressive resistance training with weight vests and addition of multiple muscle groups for stronger muscles.
If you have had a stroke and feel that a strength training program could assist you in your daily life, please contact the neurological physiotherapy team at Advance Rehab Centre. 9906 7777, email@example.com