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Strength training in stroke

 Muscle strength is defined as the ability to generate force against a

load and is assessed as the maximum load that can be moved or the
maximum torque that can be generated during a movement.
 Deficits in muscle strength are common in both the affected and
unaffected side following stroke.
 Two other aspects of muscle strength which are affected after
stroke are; 1) muscle endurance, the ability to generate torque
against a load for an extended period of time and 2) muscle power,
the ability to generate torque against a load at speed
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Strength training in stroke

 Paresis is found in 80% to 90% of all patients after stroke and is a

major factor in impaired motor function, activity limitation, and
disability.
 Patients are unable to generate the force necessary for initiating and
controlling movement.
 The degree of primary weakness is related to the location and size
of the brain injury and varies from a complete inability to achieve
any contraction (hemiplegia) to hemiparesis with measurable
impairments in force production.
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Strength training in stroke

 Post-stroke weakness is associated with a number of changes in

both the muscle and the motor unit. Changes occur in muscle
composition, including atrophy of muscle fibers. There is a
selective loss of type II fast-twitch fibers with subsequent increase
in the percentage of type I fibers (a finding also reported in the
elderly). This selective loss of type II fibers results in slowed force
production, difficulty with initiation and production of rapid, high-
force movements, and rapid onset of fatigue.
 The number of functioning motor units and discharge firing rates
also decrease.
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Strength training in stroke

 Patients demonstrate inefficient patterns of muscle activation and

higher levels of co-contraction.
 Progressive resistive strength training has been shown to improve
muscle strength in individuals with stroke.
 Exercise modalities for strengthening include free weights, elastic
bands or tubing, and machines .
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Strength training in stroke

 For patients who are very weak (less than 3/5), gravity-minimized
exercises using powder boards, sling suspension, or aquatic
exercise is indicated.
 Gravity-resisted active movements are indicated for patients who
demonstrate 3/5 strength (e.g., arm lifts, leg lifts).
 Patients who demonstrate adequate strength in independent gravity-
resisted movement (e.g., 8 to 12 repetitions) can be progressed to
exercise using added resistance (e.g., free weights, bands, or
machines).
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Strength training in stroke

 Gravity-resisted active movements are indicated for patients who

demonstrate 3/5 strength (e.g., arm lifts, leg lifts). Patients who
demonstrate adequate strength in independent gravity-resisted
movement (e.g., 8 to 12 repetitions) can be progressed to exercise
using added resistance (e.g., free weights, bands, or machines).
 Ideally resistance training should occur 2 to 3 times a week; three
sets of 8 to 12 repetitions per exercise should be used.
 Combining resistance training with task-oriented functional
activities enhances carryover in terms of improving function (e.g.,
sit-to-stand transfers, partial wall squats, step-ups, stair climbing
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Strength training in stroke

 Circuit training workstations can be used to maximize muscle

training. Lifting free weights or using elastic bands places added
demands for postural stability in sitting and standing and is an
important element of training to improve postural control.
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References

1. O'Sullivan SB, Schmitz TJ, Fulk G. Physical rehabilitation. FA

Davis; 2019 Jan 25.
2. DeLisa JA, Gans BM, Walsh NE, editors. Physical medicine and
rehabilitation: principles and practice. Lippincott Williams &
Wilkins; 2005.
3. Lazaro RT, Reina-Guerra SG, Quiben M, editors. Umphred's
Neurological Rehabilitation: Umphred's Neurological
Rehabilitation-E-Book. Elsevier Health Sciences; 2019 Dec 5.