Weight Training and Exercises for Stroke Patients

Chris Kaiser, Cardiology Editor of ”MedPage Today” reports on ”Working with Weights” for stroke rehab patients. The article is reviewed by Zalman S. Agus, MD; Professor Emeritus , Perelman School of Medicine at the University of Pennsylvania etal. This is a preliminary study of a 6 month study program for combined aerobic and resistance training which resulted in improvements in cognitive function for post stroke patients. The idea was to incorporate resistance training — often overlooked in stroke rehab — that may help improve cognitive skills in stroke survivors. In addition to that aerobic exercise also contributed to improvements in cognition at 6 months, according to Susan Marzolini, BPHE, MSc, of the Toronto Rehabilitation Institute, and her colleagues. Resistance training is not usually a standard component of stroke rehab, according to Marzolini. She stated that “To measure the muscle mass, we used dual-energy x-ray absorptiometry, which is a very precise method. We found that the greater the improvement in muscle mass, the greater the improvement in cognition.” The muscles that were affected most by stroke in this study were those for walking — especially, the hip flexors, which raise the knees up, and the pretibial muscles, which lift the toes up. Many rehab centers have stroke patients only moving their legs, but under the revised program weights are added. The intensity of the amount of weight is the key to their improvement,” according to Marzolini. Marzolini determines the heaviest weight a patient can lift, divides that by half, and then proceeds with 10 repetitions. The reps are then increased gradually. When the patient shows he is ready for more weight, he drops back down to 10 reps. In addition patients also use resistance bands in order to strengthen weak muscles. Resistance training has also added an overall 30% improvement in bilateral strength. Marzolini and her colleagues found an association between positive changes in concentration and attention and aerobic exercise, as it was measured by maximal oxygen consumption. This was independent of time from stroke, sex and change in fat mass and depression score . Forty one patients were studied who suffered a mild or moderate stroke. The mean age was 63, and 70% of the patients used some type of walking assistance. The time from stroke to the start of rehabilitation varied from several months to 5 years. By using the Montreal Cognitive Assessment test, the researchers found that this training program resulted in a significant overall improvement in cognition and specifically in attention and concentration at 6 months following rehabilitation. Marzolini and her team is preparing for stage two of this research, which is a study that randomizes stroke patients to aerobic and resistance training or exclusively resistance training. “I suspect aerobic and resistance training are working synergistically,” Marzolini said. Marzolini feels that exercise is very important for everyone, and especially for stroke patients. Rehab programs should include both strength and aerobic training. In line with the thinking of Marzolini when it comes to exercising limbs that have been affected by strokes the most effective physical therapy products should be used. One of the most efficient such devices currently in use in leading rehabilitation centers worldwide is the TUTOR system. The HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR and 3DTUTOR) has become a key system in neuromuscular rehabilitation for stroke victims as well as for those recovering from brain and spinal injuries, Parkinson’s, MS, CP and other limb movement limitations. These innovative devices implement an impairment based program with augmented motion feedback that encourages motor learning through intensive active exercises and movement practice. The TUTOR products consist of a wearable glove or braces that detect limb movement showing the patient how much active or assisted active movement they are actually doing. The rehabilitation software uses special rehabilitation games to set a new target for this movement in terms of the patient’s ability to move their limb. The devices then measure the limb movement and give feedback to the patient. In this way the TUTOR system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice. The TUTORs are fully certified by the FDA and CE and can be used in the patient’s home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.