Muscle strengthening of knee extensors in hemiparetics: prospective and longitudinal study
Wildja de Lima Gomes, Thais Botossi Scalha, Ana Carolina Nunes Bovi, Wagner de Mello e Castro, Amanda Pennacchi, Gabriela Aparecida Gomes, Mariana Taranto, Enio Walker de Azevedo Cacho, Núbia Maria Freire Vieira Lima
Background: Several attempts to reduce spasticity have been directed to stroke sufferers based on the historical view that spasticity is the major determinant of motor dysfunction and that its reduction results in improved function of the affected limb. Paresis is also recognized as a limiting factor in hemiparetic rehabilitation and has a negative impact on self-care, mobility, or up and down stairs due to slow activation of motor units and difficulty in producing adequate amount of muscle strength. In the treatment of spasticity, many therapeutic procedures have been used. Resisted exercises occur when there is load on the body segment distal to the muscle that develops muscle tension, occurs muscle shortening and an external force is overcome. Objective: The aim of this study was to analyze the results of isometric and isotonic strengthen program in the quadriceps muscles of the affected limb of patients with chronic hemiparesis secondary to stroke and to evaluate its effects on spasticity, motor function of the lower limb, balance and mobility. Methods: The participants were divided into three groups: isotonic strengthening, isometric strengthening and control group. It was applied the Ashworth scale, Fugl-Meyer Protocol, Time Up and Go test and Berg Balance Scale. Results: The isometric and isotonic strengthening program presented post-treatment variations, whereby only the isometry group showed improvement in balance. The control group did not show a significant improvement. There was no increase in the muscular tonus of the quadriceps or hamstrings immediately after the treatment. Conclusion: The selective muscle strengthening of the quadriceps resulted in an increase of the motor function, balance and mobility followed by a decrease or maintenance of the muscular tonus of the patients.
1. O’Dwyer N, Ada L, Neilson P. Spasticity and muscle contracture following stroke. Brain. 1996;119(5):1737-1749
2. Sharp S, Brouwer B. Isokinetic strength training of the hemiparetic knee: Effects on function and spasticity. Archives of Physical Medicine and Rehabilitation. 1997;78(11):1231-1236
3. Teixeira-Salmela L, Oliveira E, Santana E, Resende G. Muscle strengthening and physical conditioning in chronic stroke subjects. 2017.
4. Teixeira-Salmela L, Silva P, Lima R, Augusto A, Souza A, Goulart F. Exercise Machines and aerobic conditioning on functional performance of chronic stroke survivors. Acta Fisiátrica. 2003;10(2).
5. Maynard V, Bakheit A, Shaw S. Comparison of the impact of a single session of isokinetic or isotonic muscle stretch on gait in patients with spastic hemiparesis. Clinical Rehabilitation. 2005;19(2):146-154.
6. Lindmark B, Hamrin E. Relation between Gait Speed, Knee Muscle Torque and Motor Scores in Post-Stroke Patients. Scandinavian Journal of Caring Sciences. 1995;9(4):195-202.
7. Corrêa F, Soares F, Andrade D, Gondo R, Peres J, Fernandes A et al. Atividade muscular durante a marcha após acidente vascular encefálico. Arquivos de Neuro-Psiquiatria. 2005;63(3b):847-851.
8. Teixeira-Salmela L, Olney S, Nadeau S, Brouwer B. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Archives of Physical Medicine and Rehabilitation. 1999;80(10):1211-1218.
9. Morris S, Dodd K, Morris M. Outcomes of progressive resistance strength training following stroke: a systematic review. Clinical Rehabilitation. 2004;18(1):27-39.
10. Ouellette M, LeBrasseur N, Bean J, Phillips E, Stein J, Frontera W et al. High-Intensity Resistance Training Improves Muscle Strength, SelfReported Function, and Disability in Long-Term Stroke Survivors. Stroke. 2004;35(6):1404-1409
11. Kisner C, Colby L. Exercicios terapeuticos. Barueri (SP): Manole; 2009.
12. Holden M, Gill K, Magliozzi M. Gait Assessment for Neurologically Impaired Patients. Physical Therapy. 1986;66(10):1530-1539.
13. Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Phys Ther. 1966 Apr;46(4):357-75.
14. Jonsson M, Tollbäck A, Gonzales H, Borg J. Inter-rater reliability of the 1992 international standards for neurological and functional classification of incomplete spinal cord injury. Spinal Cord. 2000;38(11):675-679
15. Miyamoto S, Lombardi Junior I, Berg K, Ramos L, Natour J. Brazilian version of the Berg balance scale. Brazilian Journal of Medical and Biological Research. 2004;37(9):1411-1421.
16. Maki T, Quagliato E, Cacho E, Paz L, Nascimento N, Inoue M et al. Estudo de confiabilidade da aplicação da escala de Fugl-Meyer no Brasil. Revista Brasileira de Fisioterapia. 2006;10(2):177-183
17. Ng S, Hui-Chan C. The Timed Up & Go Test: Its Reliability and Association With Lower-Limb Impairments and Locomotor Capacities in People With Chronic Stroke. Archives of Physical Medicine and Rehabilitation. 2005;86(8):1641-1647.
18. Aveiro M, Granito R, Navega M, Driusso P, Oishi J. Influence of a physical training program on muscle strength, balance and gait velocity among women with osteoporosis. Revista Brasileira de Fisioterapia. 2006;10(4).
19. Lee M, Kilbreath S, Singh M, Zeman B, Lord S, Raymond J et al. Comparison of Effect of Aerobic Cycle Training and Progressive Resistance Training on Walking Ability After Stroke: A Randomized Sham Exerciseâ€“Controlled Study. Journal of the American Geriatrics Society. 2008;56(6):976-985.
20. Moraes, GFS; Nascimento, LR; Glória, AE; Teixeira-Salmel, LF; Paiva, CMP; Lopes, TAT et al. The influence of muscle strengthening on upper limb motor performance in stroke subjects. Acta Fisiátr.2008;15(4):245-248.
21. Junqueira, RT, Ribeiro, AM and Sciann, AA. “Efeitos do fortalecimento muscular e sua relação com a atividade funcional e a espasticidade em indivíduos hemiparéticos.” Braz. j. phys. ther.(Impr.) 2004: (8.3) 247-252.
22. Lee M, Kilbreath S, Singh M, Zeman B, Lord S, Raymond J et al. Comparison of Effect of Aerobic Cycle Training and Progressive Resistance Training on Walking Ability After Stroke: A Randomized Sham Exerciseâ€“Controlled Study. Journal of the American Geriatrics Society. 2008;56(6):976-985.
23. Lee M, Kilbreath S, Singh M, Zeman B, Davis G. Effect of Progressive Resistance Training on Muscle Performance after Chronic Stroke. Medicine & Science in Sports & Exercise. 2010;42(1):23-34.
24. Flansbjer U, Miller M, Downham D, Lexell J. Progressive resistance training after stroke: Effects on muscle strength, muscle tone, gait performance and perceived participation. Journal of Rehabilitation Medicine. 2008;40(1):42-48.
25. Lee S, Kang K. The Effects of Isokinetic Eccentric Resistance Exercise for the Hip Joint on Functional Gait of Stroke Patients. Journal of Physical Therapy Science. 2013;25(9):1177-1179.
26. Badics, E., Wittmann, A., Rupp, M., Stabauer, B., & Zifko, U. A. Systematic muscle building exercises in the rehabilitation of stroke patients.” NeuroRehabilitation 17.3 (2002): 211-214
27. Ryan A, Ivey F, Prior S, Li G, Hafer-Macko C. Skeletal Muscle Hypertrophy and Muscle Myostatin Reduction After Resistive Training in Stroke Survivors. Stroke. 2010;42(2):416-420.
28. Bale M, Inger Strand L. Does functional strength training of the leg in subacute stroke improve physical performance? A pilot randomized controlled trial. Clinical Rehabilitation. 2008;22(10-11):911-921.
29. Cooke E, Tallis R, Clark A, Pomeroy V. Efficacy of Functional Strength Training on Restoration of Lower-Limb Motor Function Early After Stroke: Phase I Randomized Controlled Trial. Neurorehabilitation and Neural Repair. 2009;24(1):88-96.
30. Jorgensen J, Bech-Pedersen D, Zeeman P, Sorensen J, Andersen L, Schonberger M. Effect of Intensive Outpatient Physical Training on Gait Performance and Cardiovascular Health in People With Hemiparesis After Stroke. Physical Therapy. 2010;90(4):527-537.