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NI1 > Strength, Weakness & Loss of Dexterity > Flashcards

Strength, Weakness & Loss of Dexterity Flashcards

1
Q

What are the 2 factors that contribute to strength?

A
  • Neural: Activation of motor units

- Muscular: Cross-sectional area of muscle fibres

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2
Q

What are the implications of a loss of strength?

A
  • Contributes significantly to activity limitation
  • Leg strength highly correlated with walking speed in the aged
  • Strongly correlated with function
  • Makes an independent contribution to function after stroke
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3
Q

What evidence is there for the contribution of strength & dexterity to function after stroke?

A
  • Examined relative contribution of strength & dexterity to function for 6 months after stroke
  • Strength & dexterity combined predict 75-80% of the variance of function in the first 6/12 after stroke
  • Strength makes a significant contribution to function after stroke
  • Loss of strength is a more significant contributor than loss of dexterity to physical disability after stroke
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4
Q

What is the evidence regarding leg strength in stroke patients?

A
  • Leg strength measured in people >1 year post stroke
  • Compared with age-matched controls
  • Strength of people with stroke 1/3-2/3 of normal
  • No difference between flexors/extensors or distal/proximal muscles
  • Unaffected side also weaker than control
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5
Q

What is the evidence regarding weakness and contracture in stroke patients?

A
  • Measured contracture & strength every 20 deg through full elbow range
  • Stroke subjects had more weakness in shortened range
  • Contracture did not contribute to inner range weakness
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6
Q

What is the evidence regarding peak force in stroke patients?

A
  • Examined time required to reach peak force after onset of muscle contraction in patients post stroke
  • Stroke patients were slow to reach peak force & were unable to generate max force
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7
Q

What is the evidence regarding torque production in stroke patients?

A
  • Compared torque produced during rapid contraction between healthy subjects, MS patients & patients with other UMNLs
  • Greater reduction in torque production associated with an increase in contraction speed
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8
Q

What is the evidence regarding force in MS patients?

A
  • Examined force produced over a 30s contraction in MS patients
  • Rapid initial reduction in force in MS patients
  • MS patients less able to maintain max force over time
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9
Q

What is the evidence regarding the functioning of motor units in stroke patients?

A
  • Functional denervation of motor units occurs from 3/12 post stroke
  • By 6/12 post stroke there is only 50% of motor units functioning
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10
Q

What are the characteristics of loss of strength in neurological populations?

A
  • Selective weakness in the shortened range
  • Increased time to peak force production
  • Greater reduction in force production with increased contraction speed
  • Decreased ability to sustain contractions
  • Substantial reduction in the number of functional motor units over time
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11
Q

What are the implications of the loss of strength characteristics?

A
  • Routinely assess/train strength
  • Assess/train all muscle groups for strength loss
  • Assess/train the intact side for strength loss
  • Start training early
  • Include inner range
  • Included sustained & rapid contractions
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12
Q

What is the evidence for strength training in stroke patients?

A
  • Systematic review of strength training in acute & chronic stroke
  • Strengthening interventions increase strength, improve function & don’t exacerbate spasticity in stroke patients
  • Strength training should routinely include FES, EMG & PRE
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13
Q

What needs to be considered to clinically implement strength training?

A
  • Mode
  • Intensity
  • Frequency
  • Progression
  • Monitoring
  • Precautions
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14
Q

What does the mode of strength training depend on?

A
  • Level of weakness
  • Other impairments
  • Neural vs muscular components of strength
  • Relationship of weakness to function
  • Distribution of weakness
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15
Q

What are the mode options for below grade 2 (Oxford)?

A
  • Mental practice
  • Eliminate gravity & friction
  • Reduce lever arm
  • EMG
  • Functional electrical stimulation
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16
Q

What are the mode options for grade 3 & above (Oxford)?

A
  • Add resistance (theraband)
  • Perform single & multiple muscle group strengthening
  • Consider weight bearing & NWB
17
Q

What does the intensity of strength training depend on?

A

Is weakness due to

  • Loss of activation of motor units
  • Loss of cross sectional area of a muscle fibre
18
Q

What intensity is recommended when weakness is due to a loss of activation of motor units?

A

Grade 3 or above:

  • 8-12 reps 60-80% 1RM
  • Progress when patient can do 12 reps with good form
  • Patient must be able to do 8 reps with good form at new intensity

Below grade 3:

  • High reps, daily, 5x20 reps
  • High mental effort
19
Q

What intensity is recommended when weakness is due to a loss of cross sectional area of a muscle fibre?

A
  • High physical effort
  • High load, low reps
  • 60-80% 1RM, 1-3 sets 8-12 reps
20
Q

What is the recommended frequency of strength training?

A
  • Inversely related to intensity
  • Minimum of 1 set
  • At least 1 min rest between sets
  • 3 times/week
21
Q

How should strength training be progressed?

A
  • Must include progression to ensure it remains fatiguing
  • Either reps, sets, load, number of sessions/week or type (inner/outer, isometric holds etc)
  • Only one component should be progressed at a time
22
Q

What does the monitoring of strength training include?

A
  • Subjective & objective monitoring strategies
  • E.g. Borg RPE, fatigue, muscle soreness, dynamometry, MMT, 10RM
  • Always monitor function
23
Q

What are the precautions for strength training?

A
  • Warm-up
  • Controlled speed
  • Avoid breath holds
  • Use good technique
  • Monitor
  • Progress gradually
24
Q

What does evidence show regarding spasticity?

A
  • Spasticity is not the main impairment post stroke

- Strength training doesn’t exacerbate spasticity

25
Q

What does evidence show regarding overwork weakness?

A

More likely to be fatigue than irreversible loss of strength

26
Q

What is dexterity?

A
  • Ability to solve any motor task precisely, quickly, rationally & deftly with flexibility in regard to the changing environment
  • Loss of dexterity is the loss of coordination of voluntary muscles to meet environmental demands
27
Q

What are the signs of loss of dexterity?

A
  • Dysmetria: Overshooting (hypermetria) or under shooting (hypometria)
  • Dyssynergia: Decomposition of movement
  • Dysdiadochokinesia: Inability to perform rapid alternating movements
  • Postural instability: Poor balance
28
Q

What are some of the common adaptive motor behaviours?

A
  • Restriction of amplitude of movement
  • Restriction of degrees of freedom
  • Excessive pre-shapoing & use of support surface during upper limb tasks
  • Excessive BOS, stepping & use of arms during standing & walking
  • Increased speed & difficulty slowing down in walking
  • Increased variability of performance
29
Q

What did Kautz & Brown 1998 find regarding loss of dexterity?

A
  • Examined difference in timing of muscle activation between stroke patients & health controls performing ergometer pedalling
  • Patients had disordered timing of hamstrings & quads
  • Associated with reduced mechanical output
30
Q

How is dexterity assessed?

A
  • Finger-nose/finger-finger
  • Heel-shin
  • Toe tapping/heel tapping/supination-pronation
  • Heel over shin
  • Task performance (adaptive strategies, changing speed/direction, stop on command, add dual task)
31
Q

What should interventions for improving dexterity include?

A
  • Activity training incorporating all relevant joints

- Not related to assessment tests

32
Q

What are the types of dexterity activity training?

A
  • Modified (e.g. treadmill)
  • Whole task
  • Whole task under varying conditions
33
Q

What are the principles for training dexterity?

A
  • Increase accuracy
  • Vary distance
  • Vary speed
  • Change BOS
  • Vary direction
  • Vary characteristics of the task
  • Vary characteristics of the environment
  • Promote flexibility
34
Q

What are the clinical implications of research regarding dexterity training?

A
  • Loss of dexterity can impair work output & can be present in absence of weakness
  • Training must involve whole task practice, multiple joints & postural adjustments
  • Function is not possible without strength, but dexterity is also important
  • Functional training must be task specific
35
Q

What evidence is there for upper limb strength training in stroke survivors with mild-mod motor impairment?

A
  • Systematic review of strength training for upper limb in stroke population
  • Strength training significantly improves strength & function in the upper limb
  • Strength training doesn’t increase spasticity or pain
36
Q

What evidence is there for reaching ability in stroke survivors with normal strength?

A
  • Assessed stroke patients with normal strength in reaching for a target
  • Patients had indirect trajectories & poor inter-joint coordination compared with unaffected side (dyssynergia)
37
Q

What evidence is there for using reaching training to improve sitting balance in stroke survivors?

A
  • Sitting balance trained in stroke patients using reaching beyond arms length
  • Increased reaching distance & speed, increased loading of affected leg
  • No improvement in walking/standing balance
38
Q

What evidence is there for training STS & step-ups in TBI patients?

A
  • TBI patients trained in STS & step-ups

- Significant improvement in STS

NI1 (10 decks)

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