Benefits of Resistance training

After suffering from a neurological event most people’s first reaction is, “how soon will I regain function back into my extremities that were affected?”  Stroke recovery is very personalized and unique to each and every person. The sooner someone can start therapy after a neurological event the better outcomes they are more than likely to have. Patients require high repetitions to start regeneration of neural pathways to rewire our brain so that signals can reach the rest of our bodies. Once a person has started to demonstrate increased range of motion it is key to focus on strengthening to build up muscle mass to prevent atrophy or subluxations specifically in the shoulders. Clinicians have a variety of ways to provide strength training to a person who has suffered a neurological event.  

One of the ways strength training is initiated is by doing activities that force a patient to go against gravity using the natural resistance that gravity puts on your body when moving. As patient’s perform high repetitive tasks it will begin to assist in building up endurance and strength to complete simple task such as putting on a shirt. Clinicians can use weights, resistive bands, manual techniques, but the newest technique is using robotic training or other versions of advanced technology.  

The robotic technology that is now on the market is applying each neuroplastic principle but emphasizes high repetitions and strengthening. For instances, an upper extremity robot like the BURT, will allow a patient to complete shoulder flexion to the best of their ability then the robot will continue to move the arm through full ROM to complete task. This allows for the patient to do the work while still receiving a functional stretch to decrease tone that could form in the joints from none use. Another way robotic technology is functional is you can grade the down or up the resistances that the robot provides. You can instruct patients to resist the robot’s movement to address an isometric contraction to increase strength within smaller muscle groups. Strength training really starts taking place once a patient begins to show functional movement. Feys et al, “demonstrated that highly repetitive, stereotyped movements can be effective in stroke subjects if the movements are facilitated by external forces applied to the limb. Robotic devices can also provide force feedback for sensorimotor-type rehabilitative training, measure speed, direction, and strength of residual voluntary activity, and interactively evaluate patients’ movements and assist them in moving the limb through a predetermined trajectory during a given motor task,” (Feys et al, 1998).

Advance technology opens doors and new opportunities for us to maximize the most out of our therapy sessions to help get our patients better faster. In a study by P. Lum, C. Burgar, P. Shor, M. Majmundar, and M. Van der Loos, they examined the benefits of robot-assisted movement training compared with conventional therapy techniques for rehabilitation of the upper limb motor function after a stroke. One of their outcomes were, “Greater strength gains in the robot group could have been due to the active-constrained mode, which is a form of maximal-effort resistance exercise. These strength gains could have been the basis for the robot group's greater improvements in reach extent and Fugl-Meyer scores after 2 months of treatment,” (Lum, P. S., Burgar, C. G., Shor, P. C., Majmundar, M., & Van der Loos, M. 2002). Robotic training is allowing patient to achieve higher outcomes throughout therapy sessions increase shorter stays within the post-acute hospital stays. The use of robotics allows for a lower impact training that utilizes a high repetitive component that allows for patients to increase strength and ROM throughout their exercises as opposed to higher impact exercises such as dumbbells or theraband in the beginning stage of rehab.

Ashley Gatewood, MOT, OTR/L, CSRS

References

Lum, P. S., Burgar, C. G., Shor, P. C., Majmundar, M., & Van der Loos, M. (2002). Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Archives of physical medicine and rehabilitation, 83(7), 952–959. https://doi.org/10.1053/apmr.2001.33101

Stein, Joel MD; Krebs, Hermano Igo PhD; Frontera, Walter R. MD, PhD; Fasoli, Susan E. ScD; Hughes, Richard PT, NCS; Hogan, Neville PhD Comparison of Two Techniques of Robot-Aided Upper Limb Exercise Training After Stroke, American Journal of Physical Medicine & Rehabilitation: September 2004 - Volume 83 - Issue 9 - p 720-728

doi: 10.1097/01.PHM.0000137313.14480.CE

Feys H.M.; De Weerdt W.J.; Selz B.E.; et al. Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. Stroke. 1998; 29: 785-792