Effects of individualized lower limb isokinetic strengthening in clinical rehabilitation of older post-stroke patients: A retrospective study
DOI:
https://doi.org/10.2340/jrm.v55.7803Keywords:
Stroke, Rehabilitation, Physical exercise, Strength, IsokineticAbstract
Objective: Muscle weakness in the lower limbs is a motor consequence of stroke that causes functional impairment. The aim of this study was to assess the effectiveness of an individualized isokinetic strengthening programme, using the moment-velocity profile, on functional recovery during post-stroke rehabilitation of older patients. A further objective was to describe the effects of the individualized isokinetic strengthening on muscular parameters.
Design: Retrospective study.
Patients: Older post-stroke patients.
Methods: Using the Barthel Index, functional abilities in basic daily tasks were assessed and retrospectively analysed for 88 patients in a post-stroke rehabilitation unit. Of these, 44 patients received conventional rehabilitation (conventional group) and 44 received individualized isokinetic strengthening in addition to conventional rehabilitation (isokinetic group). A 2-Group (isokinetic, conventional) × 2-Time (before, after intervention) repeated measures analysis of variance (ANOVA) was conducted. For muscular parameters, Student t-tests and Wilcoxon tests were performed.
Results: The Barthel Index score increased more in the isokinetic group (61.59 ± 26.34 to 88.18 ± 12.16) than in the conventional group (61.70 ± 26.5 to 76.93 ± 18.12). A significant Time × Group interaction was found (F(1,86) = 5.95, p = 0.02). In the isokinetic group all muscular parameters improved.
Conclusion: This retrospective clinical study suggests that lower limb isokinetic strengthening, individualized using the moment-velocity profile, is clinically efficient for functional recovery during post-stroke rehabilitation of older patients. Intragroup effects of isokinetic strengthening also suggest benefits for muscular parameters.
LAY ABSTRACT
Muscle weakness in the lower limbs is a motor consequence of stroke that limits abilities to accomplish activities of daily life, such as walking. Individualized isokinetic exercises, based on patient’s force deficit and using a specialized equipment that adapts resistance according to the amount of force applied in order to maintain a constant speed throughout the movement, were performed in a post-stroke rehabilitation unit for older adults with sub-acute stroke. Retrospective analysis showed that functional recovery, as assessed by the clinical Barthel Index, was better in the patient who received individualized isokinetic strengthening in addition to conventional rehabilitation, compared with those who received only conventional rehabilitation. In addition, the results suggest beneficial effects on muscular parameters, such as force.
Downloads
References
Khan F, Anjamparuthikal H, Chevidikunnan MF. The comparison between isokinetic knee muscles strength in the ipsilateral and contralateral limbs and correlating with function of patients with stroke. J Neurosci Rural Pract 2019; 10: 683–689. DOI: https://doi.org/10.1055/s-0039-1700612
Canning CG, Ada L, O’Dwyer N. Slowness to develop force contributes to weakness after stroke. Arch Phys Med Rehabil 1999; 80: 66–70. DOI: https://doi.org/10.1016/S0003-9993(99)90309-X
Hyngstrom AS, Onushko T, Heitz RP, Rutkowski A, Hunter SK, Schmit BD. Stroke-related changes in neuromuscular fatigue of the hip flexors and functional implications. Am J Phys Med Rehabil 2012; 91: 33–42. DOI: https://doi.org/10.1097/PHM.0b013e31823caac0
Kotwani S, Gadgil S, Ranade P. Comparison of neuromuscular fatigue in chronic stroke patients with healthy controls. Clin Investig 2018; 08: 1000140. DOI: https://doi.org/10.4172/Clinical-Investigation.1000140
Bohannon RW (editor). Isokinetic testing of muscle strength of older individuals post-stroke: an integrative review. Isokinet Exerc Sci 2020; 28: 303–316. DOI: https://doi.org/10.3233/IES-201146
Kim CM, Eng JJ. The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. Phys Ther 2003; 83: 49–57. DOI: https://doi.org/10.1093/ptj/83.1.49
Clark DJ, Condliffe EG, Patten C. Reliability of concentric and eccentric torque during isokinetic knee extension in post-stroke hemiparesis. Clin Biomech 2006; 21: 395–404. DOI: https://doi.org/10.1016/j.clinbiomech.2005.11.004
Hsu AL, Tang PF, Jan MH. Test-retest reliability of isokinetic muscle strength of the lower extremities in patients with stroke. Arch Phys Med Rehabil 2002; 83: 1130–1137. DOI: https://doi.org/10.1053/apmr.2002.33652
Rabelo M, Nunes GS, da Costa Amante NM, de Noronha M, Fachin-Martins E. Reliability of muscle strength assessment in chronic post-stroke hemiparesis: a systematic review and meta-analysis. Top Stroke Rehabil 2016; 23: 26–36. DOI: https://doi.org/10.1179/1945511915Y.0000000008
Hammami N, Coroian FO, Julia M, Amri M, Mottet D, Hérisson C, et al. Isokinetic muscle strengthening after acquired cerebral damage: a literature review. Ann Phys Rehabil Med 2012; 55: 279–291. DOI: https://doi.org/10.1016/j.rehab.2012.03.003
Pontes SS, de Carvalho ALR, Almeida KO, Neves MP, Ribeiro Schindler IFS, Alves IGN, et al. Effects of isokinetic muscle strengthening on muscle strength, mobility, and gait in post-stroke patients: a systematic review and meta-analysis. Clin Rehabil 2019; 33: 381–394. DOI: https://doi.org/10.1177/0269215518815220
Büyükvural Şen S, Özbudak Demir S, Ekiz T, Özgirgin N. Effects of the bilateral isokinetic strengthening training on functional parameters, gait, and the quality of life in patients with stroke. Int J Clin Exp Med 2015; 8: 16871–16879.
Singhal S, Pattnaik M, Mohanty P. Comparison of isokinetic strengthening with functional strengthening of lower limb and their effect on gait in hemiparesis due to stroke. neurology-neurorehabilitation 2017; 02: 10.35841/neurology-neurorehabilitation.2.1.25-33. DOI: https://doi.org/10.35841/neurology-neurorehabilitation.2.1.25-33
Hill KD, Hunter SW, Batchelor FA, Cavalheri V, Burton E. Individualized home-based exercise programs for older people to reduce falls and improve physical performance: a systematic review and meta-analysis. Maturitas 2015; 82: 72–84. DOI: https://doi.org/10.1016/j.maturitas.2015.04.005
Knight RL, Saunders DH, Mead G. Maximal muscle power after stroke: a systematic review. Clin Pract 2014; 11: 183–191. DOI: https://doi.org/10.2217/cpr.13.97
Alcazar J, Rodriguez-Lopez C, Ara I, Alfaro-Acha A, Rodríguez-Gómez I, Navarro-Cruz R, et al. Force-velocity profiling in older adults: an adequate tool for the management of functional trajectories with aging. Exp Gerontol 2018; 108: 1–6. DOI: https://doi.org/10.1016/j.exger.2018.03.015
Pickering C, Kiely J. Exercise response efficiency: a novel way to enhance population health? Lifestyle Genom 2018; 11: 129–135. DOI: https://doi.org/10.1159/000501206
Alcazar J, Rodriguez-Lopez C, Ara I, Alfaro-Acha A, Mañas-Bote A, Guadalupe-Grau A, et al. The force-velocity relationship in older people: reliability and validity of a systematic procedure. Int J Sports Med 2017; 38: 1097–1104. DOI: https://doi.org/10.1055/s-0043-119880
Jidovtseff B, Quièvre J, Hanon C, Crielaard JM. Les profils musculaires inertiels permettent une définition plus précise des charges d’entraînement. Sci Sports 2009; 24: 91–96. DOI: https://doi.org/10.1016/j.scispo.2008.09.002
Jiménez-Reyes P, Samozino P, Brughelli M, Morin JB. Effectiveness of an individualized training based on force-velocity profiling during jumping. Front Physiol 2017; 7: 677. DOI: https://doi.org/10.3389/fphys.2016.00677
Morin JB, Samozino P. Interpreting power-force-velocity profiles for individualized and specific training. Int J Sports Physiol Perform 2016; 11: 267–272. DOI: https://doi.org/10.1123/ijspp.2015-0638
Goldstein LB, Samsa GP. Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke 1997; 28: 307–310. DOI: https://doi.org/10.1161/01.STR.28.2.307
Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J 1965; 14: 61–65. DOI: https://doi.org/10.1037/t02366-000
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67: 206–207. DOI: https://doi.org/10.1093/ptj/67.2.206
Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377–381. DOI: https://doi.org/10.1249/00005768-198205000-00012
Cohen J. Statistical power Analysis. Current Directions in Psychological Science 2013; 1: 98–101. DOI: https://doi.org/10.1111/1467-8721.ep10768783
Hsieh YW, Wang CH, Wu SC, Chen PC, Sheu CF, Hsieh CL. Establishing the minimal clinically important difference of the Barthel Index in stroke patients. Neurorehabil Neural Repair 2007; 21: 233–238. DOI: https://doi.org/10.1177/1545968306294729
Sharp SA, Brouwer BJ. Isokinetic strength training of the hemiparetic knee: effects on function and spasticity. Arch Phys Med Rehabil 1997; 78: 1231–1236. DOI: https://doi.org/10.1016/S0003-9993(97)90337-3
Rouleaud S, Gaujard E, Petit H, Picard D, Dehail P, Joseph PA, et al. Isocinétisme et rééducation de la marche de l’hémiplégique. Ann Réadapt Méd Phys 2000; 43: 428–436. DOI: https://doi.org/10.1016/S0168-6054(00)00047-7
Kerimov K, Coskun Benlidayi I, Ozdemir C, Gunasti O. The Effects of Upper Extremity Isokinetic Strengthening in Post-Stroke Hemiplegia: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2021; 30: 105729. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105729
Reid KF, Fielding RA. Skeletal muscle power: a critical determinant of physical functioning in older adults. Exerc Sport Sci Rev 2012; 40: 4–12. DOI: https://doi.org/10.1097/JES.0b013e31823b5f13
Clémençon M, Hautier CA, Rahmani A, Cornu C, Bonnefoy M. Potential role of optimal velocity as a qualitative factor of physical functional performance in women aged 72 to 96 years. Arch Phys Med Rehabil 2008; 89: 1594–1599. DOI: https://doi.org/10.1016/j.apmr.2007.11.061
Bohannon RW. Contribution of neural and muscular factors to the short duration tension- developing capacity of skeletal muscle. J Orthop Sports Phys Ther 1983; 5: 139–147. DOI: https://doi.org/10.2519/jospt.1983.5.3.139
Watanabe M, Suzuki M, Sugimura Y, Kawaguchi T, Watanabe A, Shibata K, et al. The relationship between bilateral knee muscle strength and gait performance after stroke: the predictive value for gait performance. J Phys Ther Sci 2015; 27: 3227–3232. DOI: https://doi.org/10.1589/jpts.27.3227
Laroche DP, Cook SB, Mackala K. Strength asymmetry increases gait asymmetry and variability in older women. Med Sci Sports Exerc 2012; 44: 2172–2181. DOI: https://doi.org/10.1249/MSS.0b013e31825e1d31
Yen SC, Schmit BD, Wu M. Using swing resistance and assistance to improve gait symmetry in individuals post-stroke. Hum Mov Sci 2015; 42: 212–224. DOI: https://doi.org/10.1016/j.humov.2015.05.010
Hollands K, van Vliet P, Pelton T. Interventions for improving coordination of axial segments and lower limbs during walking following stroke: systematic review. JBI Libr Syst Rev 2011; 10: 1260–1362. DOI: https://doi.org/10.11124/01938924-201110220-00001
Published
How to Cite
License
Copyright (c) 2023 Lyne Daumas, Raphaël Zory, Axelle Garcia, Amyn Jaafar, Luisa Ientile, Emeline Michel, Guillaume Sacco, Frédéric Chorin
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.