Interventions For Weakness (2) Flashcards
What are impairments that come along with neuromuscular dysfunctions?
Alterations in muscle tone
Impaired sensation
Cognition/communication impaired
What is weakness more than?
Muscle atrophy
Does strengthening increase spasticity?
No
What is the structural component of strengthening?
Stiffness
What is the neural component of strengthening?
Recruitment and timing
Should people with neurological disorders participate in strength training?
Yes
What should be incorporated with strength training in neurological disorders?
Task specificity
What changes with strength training in neurological disorders?
Cortical excitability
Why are fewer motor neurons activated with increased strength training?
Due to enhanced efficacy of synapses
What does strength training do to motor unit recruitment?
Improves it
What does continued challenge to neuromuscular system cause?
Adapt and facilitate optimal recovery
What are the secondary strength impairments?
Atrophy
Loss of ROM
Contractures
Decreased endurance
What is the 5D practice pattern?
Non progressive disorders of CNS (TBI and stroke)
What is the 5E practice pattern?
Progressive disorders of CNS (MS, Parkinson’s, and ALS)
What is the 5G practice pattern?
Acute or chronic polyneuropathies (GBS)
What is the 5H practice pattern?
Non progressive disorders of spinal cord (SCI)
Where does weakness generally occur post stroke?
Distal with flexion and extension affected equally
What does stroke cause to happen to muscles?
Reduced force generation and slowness in force production (excessive sense of effort and rapid fatigue)
Where is the most struggle in muscle activation post stroke?
Shortened ROM of muscles especially with increased velocity (compensate by functioning in midrange - bend knees so quads are not fully shortened)
What type of contraction is most preserved post stroke?
Eccentric
What are the motor unit deficits post stroke?
Reduced number of motor units
Increased motor unit innervation ratios
Impaired firing rate regulation
What are the muscle fiber changes post stroke?
Disuse atrophy after 4-6 weeks
Type 2 fiber selective atrophy
Increased % of type 1 fibers
Why does weakness occur in TBIs?
Central neural activation deficits with impaired ability to activate motor units
Why does weakness occur in MS?
Disruption of spinal pathways to motor unit pool (muscle fatigue and reduced force production)
What is Parkinson’s more so about rather than weakness?
Initiation, timing, and sequencing
What is Parkinson’s impacted by?
Changes in muscle tone
What occurs in GBS?
LMN presentation (distal to proximal weakness symmetrically)
What occurs in ALS?
UMN and LMN presentation (effects hand/trunk first)
What occurs in myasthenia gravis?
LMN presentation (affects high use muscles first)
What occurs in post polio syndrome?
LMN presentation (prone to overuse)
What occurs in charcot Marie tooth?
Hereditary LMN presentation (progressive wasting)
What makes for most transfer of increased strength to increased function?
Specificity of training
What should be combined with strength training in MS?
Aerobic training to improve fitness, function, and QOL
How should strength training occur in those with mild to moderate MS?
2x a week at moderate intensity
How should strength training occur in those with moderate or severe MS?
Maintain strength and prevent decline
When should you not strength train in GBS?
While progressive it is contraindicated
How should you incorporate strength training in GBS once they are stable?
Progress from active assist to active to resistive
Why should you train affected muscles in ALS?
They are impacted by spasticity
How should you train muscles that are not yet affected in ALS?
Submaximal strengthening
What are the muscles that are key to prevent weakness in ALS?
Posture and respiration muscles
When should you not strengthen in myasthenia gravis?
During active crisis
How should you strengthen in myasthenia gravis?
Maintenance of non affected areas and strengthening affected areas post crisis
How do you train muscle that are 4+/5 in post polio syndrome?
Moderate to vigorous exercise
How do you train muscle that are 3+ to 4/5 in post polio syndrome?
Exercise cautiously
How do you train muscle that are 3 or below in post polio syndrome?
Stretching and protection (no resistance)
How should strengthening occur in those with charcot Marie tooth?
Strengthening above affected area and compensations
What is the key thing we need to look out for when training in most people with neuromuscular disorders?
Overuse and fatigue
What are the types of interventions done to help weakness in neurological disorders?
NMES
Electromyographic feedback
PNF
Progressive resistive exercise
Isokinetic exercise
Task specific strength training
What does electromyographic feedback best help do?
Train the timing of muscle contraction (very weak muscles)
What should intensity be at for strength training in neurological disorders?
60-80%
How should NMES be used for neurological disorders?
Very weak muscles (make functional if possible)
How should progressive resistive exercise be used for neurological disorders?
Focus on quality (3+/5 strength is best)
How should isokinetic be used for neurological disorders?
Teach how to safely use for progressing to independent
How should aquatics be used for neurological disorders?
Supported movement
Can offer resistance and input
Finish task on ground
