Strength Training in Neurological Rehabilitation

Strength Training in Evidence

Paresis (muscle weakness) is a key physical impairment in neurological disorders that limit mobility. [1] Adding resistance training to functional exercise has been found to improve muscle strength [2] and functional performance. [3]

A number of studies have explored strength training for various neurological conditions:

• Multiple Sclerosis (MS): A systematic review by Kjølhede et al. [4] reported strong evidence for progressive resistance training for muscle strength in MS patients. Patrocinio de Oliveira and colleagues [5] found improvement in knee extensor 1-rep max in patients with MS Timed 8-foot chairlift stand test after progressive resistance training and eccentric strength plyometric training. However, the authors noted that eccentric strength plyometric training appeared to improve the transfer of strength adaptations to functional testing. [5] Mañago et al. [6] Strength training parameters for patients with MS have been critically reviewed. They found that while strength was generally improved, only two studies to date have been able to demonstrate a meaningful link with gait changes. [6]
• Parkinson’s disease: A randomized controlled trial by Kanegusuku and colleagues [7] found that progressive resistance training specifically improved cardiovascular autonomic dysfunction in patients with Parkinson’s disease. Helgerud et al [8] found that high-intensity strength training is beneficial When treating people with Parkinson’s disease.
• Amyotrophic lateral sclerosis (ALS): Kalron et al. [9] found that a combined aerobic and strength training program lasting 12 weeks was superior to a flexibility program in improving respiratory functional mobility and fitness in ambulatory ALS patients. [9]
• Stroke: The Australian Stroke Foundation guidelines (2017) and AHA guidelines (2010) also strongly recommend progressive resistance exercises, but the optimal method of strengthening remains unknown. [1] Various systematic reviews [4][10][11][12][13] show increased strength After resistance training, but with limited effects on walking parameters. [14] In 2020, Veldema and Jansen[15] conducted a systematic review and concluded that while current data suggest that resistance training can have a positive Sufficient evidence for evidence-based rehabilitation. Williams et al. [14] investigated the task specificity of strength training for walking in neurological disorders and found quadriceps and hamstring training to be the most commonly used exercises in neurorehabilitation.

Biomechanics of Gait

A good understanding of gait parameters is required to develop appropriate walking exercises. Muscle recruitment and velocity affect walking mechanics at the hip, knee and ankle. [16] In older adults, lower walking speeds have been found to reduce gait quality. [17] Minimum level All muscles need strength to generate walking power, but not all muscles recruit strength equally.

Three key events are important for power generation in the walking cycle:

1. Hip extensor power generation at initial contact
2. Ankle plantar flexion power generation during push off (terminal stance)
3. Hip flexors generate power at toe-off to accelerate the leg through the swing phase

Forces that generate absorbing forces in the knee muscles:

• Knee extensors at terminal stance
• The knee flexors in the terminal swing decelerate the leg.

During the stance phase, the primary force is generated at the ankle as the plantar flexors generate force for pushing off at final stance. One study analyzed the forces generated by the ankle joint and found that the Achilles tendon generated the highest peak force. [18] The standing phase takes about 0.6 seconds gait cycle. Push off reps are about 0.15 seconds – this is when the Achilles tendon develops most of its power. Strength training can increase the strength of the muscles and tendons, but not the strength required to push up.

Is It Just About Strength?

Strength training trains the ability to overcome resistance, where you focus on moving as much weight as possible for a given number of repetitions. [19]

Progressive resistance training (PRE) is a form of strength training. Strength training focuses on overcoming resistance, but also on the ability to overcome resistance in the shortest amount of time [19]. PRE is considered the best way to improve force production and muscle Hypertrophy. Constantly varying resistance is the key to improving strength [1]. High-intensity resistance training improves strength, while ballistic (light load and high repetition) training increases energy production [1].

Speed is another factor that affects gait mechanics because muscle power generation during walking occurs at high angular velocities. Applying ballistic training principles at the ankle joint at a target speed may be the key to improving walking [1].

A 2017 study [20] evaluated the effect of functional high-speed resistance training (strength training) on improving muscle strength and walking ability in children with cerebral palsy. Muscle strength sprint test 1-minute walk test (1MWT) 10-meter shuttle run test reported significant improvement (SRT) Gross motor isometric strength of lower extremity muscles and dynamic ankle plantar flexor strength reflecting improved walking ability.

Recently, Gjesdal et al. [21] found that ballistic strength training is feasible and suitable for adults with cerebral palsy. In a test performed by Williams et al. with and without jumping, the seated leg press [22] reported a 70% increase in concentric velocity Ballistic conditions. Williams and Ada [23] recently conducted a study investigating the safety and accuracy of ballistic exercises performed at home in patients with neurological disorders. They found ballistic training to be safe (88% of the time) but less accurate (49%). [twenty three]

[24]

In a systematic review by Williams et al. [14] most studies did not include exercises related to all three major strength events that are important for walking. Instead, strength testing and strengthening exercises were prioritized despite the minimal role of knee extensors and flexors in the normal gait cycle.

Clinical Applications

Considerations for exercise prescription:

• Given gait biomechanics, strength training is recommended over traditional strength/resistance training.
• exercises should be done at speed
• Exercises must target the force-generating muscles (ankle plantar flexors). If the patient is unable to isolate the correct muscle, some modifications are made to achieve proper performance.

Based on the task-specific principles of the ACSM guidelines [25]:

• Role of the muscle
• Action of the muscle
• Type of contraction
• Active range and segmental alignment
• Load
• Speed of movement

Progression Principals:

• Progressive muscle overload
• Greater intensity
• Periodisation
• Increase total reps and volume
• Increasing the speed of movement
• Reduce rest
• Hypertrophy
• Muscle Endurance
• Sports application

In neurological disorders, greater proximal compensatory forces have been observed in the hip flexors and extensors. [26] Strength training can reverse these proximal compensations. [27] Although the quadriceps are important for getting up from chairs and stairs[28], strengthening the quadriceps is not It is better to walk.

Example exercises

To improve walking and gait, focus on ballistics or quick workouts, especially targeting the calves since it’s so important for walking. For example, if you don’t have resources or are in a home setting, it’s better to do a quick “calf drop” exercise instead of a controlled calf Elevate—that is, raise to the toes, then quickly lower and push up again. Or with a mini trampet, the exercise might consist of bouncing between alternating heel raises as demonstrated in the video below.