Strengthening Glut Med Post Stroke

[barrs1985]

I am currently working in Stroke Rehab and have come across alot of elderly patients that would benefit from glut med strengthening, Most of these patients are not able to stand independently. The strengthening exercise at the moment been used is side lying and ankles together while taking knees apart and holding.........

I have found that alot of these patients struggle to get into this position and execute the exercise correctly, any other clinicians choose to strengthen alternatively?

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[sdkashif]

If you wanted to have a good gait and walking pattern, you must strength and train the antigravity muscles of the lower limb and pelvic stabilizers. So if you find by your assessment that Gluteus medius is weak and needs strengthening, you get the benefit by correcting that deficiency of weakness of that muscle.

[barrs1985]

Yes i know that, the question im asking is what exercises do therapists use to strength these muscles with stroke patients. Thanks for your input. Is there any particular one beneficial for elderly stroke patients etc..

[sdkashif]

It is better to have a manual muscle testing in these patients and perform the graded active ROm exercises in these patients. Walking training of these patient on the sloped treadmill added both conditioning and strengthening of these patients. A patient with stroke have many other problems apart from the muscle weakness. During the early stages of stroke, flaccidity with no movement is common. Usually this is replaced by the development of spasticity, hyperreflexia, and mass patterns of movements, termed synergies. Muscle involved in synergies are so strongly linked together that that isolated movement outside the mass synergistic patterns are not possible. As recovery progresses, the spasticity and synergies begin to decline and advanced movement patterns become possible. Brunnstrom has described these patterns in detail.

Sequential Recovery Stages in Hemiplegia as described by Brunnstrom:

Stage 1

Recovery from hemiplegia occurs in stereo typed sequence of events that begin with a period of flaccidity immediately after the acute episode. No movements of limbs can be elicited.

Stage 2

As recovery begins the basic limb synergies or some of their components may appear as associated reactions, or minimal voluntary movement responses may be present. At this time spasticity begin to develop.

Stage 3

Thereafter patient begins voluntary control of movement synergies, although full range of all synergy componentsdoes not necessarily develop. Spasticity has further increased and may become severe.

Stage 4

Some movement combinations that do not follow the paths of either synergy are mastered, first with difficulty, then with more ease and spasticity begins to decline.

Stage 5

If progress continues, more difficult movement combinations are learned as the basic limb synergies lose their dominance over motor control.

Stage 6

With the disappearnace of spasticity, individual joint movements become possible and coordination approach normal. From here on, as the last recovery step, normal motor function is restored, but this last stage is not achieved by all, for the recovery process may plateau at any stage.

Synergy Patterns of Extremities

Upper Extremity

Flexion Synergy components

Scapular retraction/elevation or hyperextension
Shoulder abduction, external rotation
Elbow flexion
Forearn pronation
Wrist and fingers flexion

Extension Synergy Components

Scapular protraction
Shoulder adduction, internal rotation
Elbow extension
Forearm pronation
Wrist and fingers flexion]

Lower Extremity

Flexion Synergy Components

Hip flexion, abduction, external rotation
Knee Flexion
Ankle dorsiflexion, inversion
Toe dorsiflexion

Extension Synergy Components

Hip extension, adduction, internal rotation
Knee Extension
Ankle plantar flexion, inversion
Toe Plantar flexion

It may help you to understand the managment in Stroke

[barrs1985]

Thank you very much, this will prove most useful!
Greatly appreciated!!!!