REHABILITION
TRAINING

Key considerations when designing a strength program for patients with disabilities.

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Engaging in some form of strength training can help patients develop the strength and coordination needed for a new activity, and it can help improve performance and prevent injuries in patients who are already engaged in some form of activity or sport.

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There are a few categories of patients for whom strength training may not be appropriate.

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People who have severe muscular dystrophy and those with active inflammatory myopathies, severe spasticity, or severe coordination or strength deficits may not be able to engage in typical strength training exercises,"

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For many other types of disabilities, however, the benefits associated with strength training are well documented. "Most individuals with neuromuscular disease, for instance, can benefit from engaging in some form of strength training,"

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A basic strength program typically begins with developing muscle endurance through low weight and higher repetitions.

 

Optimal form and technique are paramount to ensure maximum benefit and protection from injury. A single set of a strength exercise performed to muscle fatigue can provide almost all the same benefits as multiple sets.

 

These basic guidelines and suggestions to help keep patients with disabilities safe when engaging in strength training:

• Ensure that spasticity and primitive reflex patterns do not interfere with exercise performance. In patients with spasticity, the patient should work on strengthening antagonist muscle groups, the muscle groups that oppose the muscles responsible for spasticity.

• Strive for balance in muscle groups. Creating a program that helps patients work toward achieving muscle balance can also help address overuse and injuries to muscles that stem from a lack of balance. Individuals who use a wheelchair should strive for strength in the posterior shoulder and scapular stabilizer groups with the goal of producing a balanced shoulder force couple to protect the rotator cuff.

• Focus on proper positioning, using straps as needed. "Proper technique, as well as balanced, stable and secure positioning are critical, poor alignment can increase muscle tone and trigger primitive reflexes, particularly for patients with cerebral palsy or traumatic brain injury, or for those recovering from a stroke. Patients with cerebral palsy should attempt to maintain neutral head position and prevent neck flexion."

• Straps can also help patients, including those with spasticity, maintain stable posture and limit maladaptive response patterns. An elastic binder or chest strap can help patients maintain trunk stability and diminish the stimulus for extensor spasm response. Below-knee strapping can help with adductor spasticity. Patients who use straps during strength training should be monitored closely for skin breakdown.

• Use wrap-around weights and other adaptive equipment. Weights that can be wrapped around limbs and secured with fabric closures can be effective, particularly for amputees or patients with poor distal extremity (especially hand) function. Patients can also use manual resistance and tubing that allows them to exercise in multiple planes and diagonal spiral patterns.

• Incorporate stretching for spasticity reduction and injury prophylaxis. "Because suboptimal flexibility can hinder positioning and increase the risk of pressure sores, performing stretching exercises is important. It can help with spasticity reduction and injury prophylaxis.