Stroke and strength training?

[MarinaPT]

Should strength training (05,1,2 kg weights) be included in a rehab programme for chronic hemiplegic patients, with moderate spasticity?

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[gcoe]

Strength training is established as a valid and effective therapy in stroke. Weakness is a key impairment that develops after hemispheric stroke. Furthermore in chronic stroke residual weakness is complicated by accelerated ageing of the neuro-musculoskeletal system so that patients tend to become weaker over time.

Strength training is also an important component of falls prevention. key muscles in the legs are important for maintaining good balance.

There is little evidence that Strength training causes harm. Such training does not increase spasticity.There may be the usual precautions with any programme using progressive resistance training where there is an increased risk of injury to muscle or over-training if carried out over zealously. Gradual increase in intensity. well controlled exercises and having sufficient recovery periods between strengthening training periods will reduce these risks.

When thinking of strengthening it is important to consider building up muscle endurance and also speed of contraction (Power) and not just pure strengthening. And there may be special value in training muscles for activities that the person wants to improve in (task specificity) rather than doing strengthening exercises in isolation

For a review of strengthening programmes for stroke see:
Ada, L., Dorsch, S., & Canning, C. G. (2006). Strengthening interventions increase strength and improve activity after stroke: a systematic review. Aust J Physiother, 52(4), 241-248.

[Laila Ib]

HELP HELP ...I need professional opinion, my Mother had a stroke about 2 months ago , left side hemiplegic .. She is 76 years old, over Wight, She had been discharged from the hospital about a month ago, receiving daily physiotherapy at home for about 1 and a half to 2 hours per day... every session she suffers a lot of pain (at least that is what she claim) screaming from the pain calling for someone to help her.. is this pain during the session is normal, or are we doing something wrong.
I have to add that she was not an active person before the stroke, she use to move very little and her both knees are totally damaged .. pleeeeeease I WANT SOMEONE TO HELP ME

[gcoe]

Hi Laila Ib

It sounds a very distressing situation for you and your mother.

After a stroke so many functions can be affected so I don't know what exactly is going on with your mother.

Here are some common scenarios:

1. The stroke damaged the perception of pain or the regulation of that perception of pain so that now your mother experiences pain that where there is no real reason why she should be ie no tissue damage
2. As above but she is actually having problems - the trouble is that the perception of pain is now exaggerated. This is quite common in stroke. Your mom probably has advanced osteoparthritis of her knees and the are sore when she weight bears or moves them. the experience of pain may now be way out of proportion to the state of her knees. With the loss of the increased inactivity after the stroke this can make the osteoarthritis worse so gets to be a vicious cycle.
3. Your mother may not have a changes perception of pain. It might be that her arthritis has been aggravated by the induced inactivty. With the weakness (I take it your mother has severe weakness down one side of her body?) this can make affect the function of the knees and there is less protection of the arthritic joints. In which case she needs some help with the knees. Sometimes a combination non sterodal anti-inflammatory drugs and active physiotherapy to improve the function of the joints and strength of the muscles that protect the knees
4. Your mother may have either of the above but into addition to this she may have undergone some cognitive or personality change since the stroke. For example is she more prone to emotional outbursts or finds it harder to reason through things? In which case the screaming maybe because of the discomfort or she hates the effort required to do anything or she feels out of control or whatever. However it gets expressed this way - sort of a behaviour problem really. In which case the screaming may be get "reinforced" when the therapist gives in to the screaming and gives her a break.. At this point you really need an assessment by a clinical psychologist who can give some practical help with how to manage this.

There are a number of options here. First off you need to have the problem properly diagnosed. If the problem is due to 1) or 2) then there are a number of medications that may help your mother. These medications work on central nervous system. It may be that your mother needs to be seen by a pain team - a group of health professionals that take a whole approach when pain becomes a problem in itself.

Rather a long answer but you get the point - there can be lots of reasons and everyone presents somewhat differently. whatever I would advise you to get some specific help. Your mother is probably dreading physiotherapy which only makes matters worse.

[Laila Ib]

Thank you very much for your useful and valuable answer, we are going to consult her neurologist to advice us for the right pain relieving medication that may help her without affecting the rehabilitation progress( i heard about a medication call lyrica for the pain – what do u think of this one ).
My other questions is: in these cases the daily physiotherapy treatment for about 2 hours is the way it should be? Is it too much or too little? Now after about a month she can move her legs sits in the bed side without support for about half an hour 3 to 4 times a day and she stand with the help of the physiotherapist for 2 min. during the session, are we doing o.k.

[gcoe]

lyrica for the pain

If your mother has neuropathic pain then Lyrica is one of many options. A rehab doctor or pain specialist or neurologist can help identify something that should help.

in these cases the daily physiotherapy treatment for about 2 hours is the way it should be? Is it too much or too little?

Generally more is better - as long as your mother is tolerating it and not getting too fatigued. By most standards your mother is quite fortunate to get 2 hours of individual physio.

Now after about a month she can move her legs sits in the bed side without support for about half an hour 3 to 4 times a day and she stand with the help of the physiotherapist for 2 min. during the session, are we doing o.k

I presume your mother has had a severe stroke. In which case it sounds like she is doing well :-) This gives her a bit of independence now doesn't it and means she doesn't have to be reclining all day.

[Fyzzio]

Hi Laila,
I have also commented on your other post.
My main thought was:
Has anyone ever asked your mother what it is that she would like to achieve?

I mean, yes, she is very fortunate to get that much intervention and yes, the pain should not be occuring and if, then adequate pain control has to be in place.
But so far, I have not read anywhere, whether the interventions are been administered with your mother's goals in mind and therefore, whether she is motivated to participate in the programme.

Just another thought.

Regards,
Fyzzio