Functional Training and Resistive training beneficial for Stroke

We know, based on neuroplastic principles, that “time matters” and “intensity is key” after having a stroke. Research has suggested that patients see the most recovery in the first 3-6 months after onset of a stroke. If a patient receives intense inpatient rehabilitation right after having a stroke, they will be able to address deficits quickly, but what happens after rehab? Can patients still expect to see recovery? What are the best exercises? Can they continue to recover at home? These are some of the questions that patients and family members continually ask. 

As clinicians, we also treat individuals who have had multiple strokes, so they are dealing with chronic symptoms. Based on research, 40% of patients never regain functional use of the upper limb which keeps them from participating in daily activities (Harris & Eng, 2010). Patients require sufficient upper extremity strength, 4/5 strength on the manual muscle testing score (MMT), to complete daily tasks such as putting on a shirt. So, how do we help our patients continue to recover with chronic symptoms or after rehab is done?

Before leaving an inpatient facility or even in an outpatient setting, patients are receiving a home exercise program to increase recovery on days they don’t have therapy. Home exercise programs need to be attainable and beneficial for patients to continue at home when/if they have limited assistance. Researchers have been examining two forms of upper-extremity rehabilitation for persons post-stroke: 1) functional task practice (FTP) and 2) functional task practice combined with upper-extremity power training (i.e., dynamic high-intensity resistance training) which they are referring to as HYBRID (Patten et al., 2013). By implementing a hybrid home exercise program, it allows for a patient to feel like they are benefitting from their exercises because they are implementing daily tasks with strengthening aspects. Patten et al., stated in their study that a HYBRID produced significant improvements not only in isometric strength, neuromotor activation and power production, but clinical parameters of impairment and functional activities. These benefits are key for a patient who is recovery and striving to live an independent life again.

It’s our responsibility as occupational therapists to design a program that will allow patients to achieve maximal independence. A Hybrid Program can assist patient throughout their healing process to help decrease risk of spasticity, tone, and edema. Patients will be able to adapt to their exercises and increase the resistance or weight throughout the daily program.   

Ashley Gatewood, MOT, OTR/L, CSRS.

References:

Harris, J. E., & Eng, J. J. (2010). Strength training improves upper-limb function in individuals with stroke. Stroke, 41(1), 136–140.

Patten, C., Condliffe, E. G., Dairaghi, C. A., & Lum, P. S. (2013). Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke. Journal of NeuroEngineering and Rehabilitation, 10(1), 1.