Evidence Based Practice - Strengthening

Question 1

What three factors affect muscle strength?

Answer 1

Structural - decreased cross-sectional area and reduced density of fibres
Biomechanical - inefficient leverage across the joints
Functional - inefficient recruitment of number, type and frequency of motor units

Question 2

What are the secondary complications of weakness?

Answer 2

secondary atrophy, reduced muscle volume, decreased cross-sectional area

Question 3

What are the primary benefits of strength training?

Answer 3

increase strength and functional performance

Question 4

What are the secondary benefits of strength training?

Answer 4

Decreased muscle stiffness, decreased co-contraction, decreased hyperreflexia

Question 5

How can task specific exercise decrease stiffness?

Answer 5

improve neural control and maintian muscle extensibility, reduce co-contraction

Question 6

How can task specific exercises improve strength?

Answer 6

improves firing and synchronisation of the motor units increase muscle length, increase muscle mechanics

Question 7

What types of exercises should be included in a strengthening programme?

Answer 7

weight-bearing and non-weight-bearing exercises

Concentric and eccentric exercises

Question 8

What are the principles of exercises for grades 0 and 1?

Answer 8

initally eccentric with outer and middle ranges

progress to concentric and eccentric

Question 9

What are the principles of strengthening grades 2 and 3?

Answer 9

Specific training - functionally to increase force generation and intersegmental control of the muscles

Start impairment based then practice in function

Question 10

What are the principles of exercises for grades 4 and 5?

Answer 10

Start progressive resistance training and high intesity for 70-80% of 1RM

Question 11

How to achieve full movements?

Answer 11

Modification of exercises to achieve graded practice and stop the patient getting too used to one exercise

Question 12

How many reps should be applied?

Answer 12

continuous repetitions to mild fatigue - then short rest and repeat same number of repetitions up into the 100s

Question 13

What should the speed of movement be?

Answer 13

Start quickly as easier, then slow down to increase force through muscle (newton’s 2nd law), then speed up again for explosive force

Question 14

What are the specific EBP points for MS?

Answer 14

• Improve CV fitness - 75mins of vigerous exercise, or 150mins of moderate exercise per week
• Complete strength training 3 times per week with no negative effects on fatigue
• Improve poor recall with handouts and photos
• Combine supervised and HEP = in conjunction with family
• only work to mild fatigue - accounting for fatigue caused by MS