Isocinétisme et rééducation de la marche de l’hémiplégique

Effects of individualized lower limb isokinetic strengthening in clinical rehabilitation of older post-stroke patients: A retrospective study

OBJECTIVE

Muscle weakness in the lower limbs is a motor consequence of stroke that causes functional impairment. The aim of this study was to assess the effectiveness of an individualized isokinetic strengthening programme, using the moment-velocity profile, on functional recovery during post-stroke rehabilitation of older patients. A further objective was to describe the effects of the individualized isokinetic strengthening on muscular parameters.

DESIGN

Retrospective study.

PATIENTS

Older post-stroke patients.

METHODS

Using the Barthel Index, functional abilities in basic daily tasks were assessed and retrospectively analysed for 88 patients in a post-stroke rehabilitation unit. Of these, 44 patients received conventional rehabilitation (conventional group) and 44 received individualized isokinetic strengthening in addition to conventional rehabilitation (isokinetic group). A 2-Group (isokinetic, conventional) × 2-Time (before, after intervention) repeated measures analysis of variance (ANOVA) was conducted. For muscular parameters, Student t-tests and Wilcoxon tests were performed.

RESULTS

The Barthel Index score increased more in the isokinetic group (61.59 ± 26.34 to 88.18 ± 12.16) than in the conventional group (61.70 ± 26.5 to 76.93 ± 18.12). A significant Time × Group interaction was found (F(1,86) = 5.95, p = 0.02). In the isokinetic group all muscular parameters improved.

CONCLUSION

This retrospective clinical study suggests that lower limb isokinetic strengthening, individualized using the moment-velocity profile, is clinically efficient for functional recovery during post-stroke rehabilitation of older patients. Intragroup effects of isokinetic strengthening also suggest benefits for muscular parameters.

The Effects of Upper Extremity Isokinetic Strengthening in Post-Stroke Hemiplegia: A Randomized Controlled Trial

OBJECTIVE

The aim of this study was to evaluate the efficacy of isokinetic strengthening in paretic upper extremity among patients with post-stroke hemiplegia.

METHODS

Hemiplegic patients with at least 6 months post-stroke and those with arm and hand Brunnstrom motor recovery stage ≥ 3 were included to the study. Patients were randomized into two groups. Isokinetic training group received 4 weeks (3 days/week) of isokinetic strengthening, while the control group was tailored strengthening exercises with exercise bands. Outcome measures were the isokinetic peak torque of wrist flexor and extensors, Fugl-Meyer Assessment of upper extremity, Stroke Impact Scale (SIS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, hand grip strength, peak isometric strength of wrist flexor and extensors. Outcome measures were evaluated before treatment, after treatment (at the end of week 4) and 4 weeks after the end of treatment (at the end of week 8). The trial was registered at ClinicalTtrials.gov (ID: NCT03834311).

RESULTS

After 4 weeks, changes in extensor peak torque at 60°/sn (p=0.007) and extensor peak isometric muscle strength (p=0.007) were higher in the isokinetic group (n=12) than those in the control group (n=12). At the end of week 8, only DASH score revealed a significantly higher improvement in the isokinetic group than that in the control group (p=0.014).

CONCLUSIONS

Isokinetic strengthening may provide motor and functional improvement in paretic upper extremity among patients with post-stroke hemiplegia.

Isokinetic muscle strengthening after acquired cerebral damage: a literature review

OBJECTIVE

Isokinetic strengthening is a rehabilitation technique rarely used in stroke patients. However, the potential benefits of force and endurance training in this population are strongly suspected.

METHOD

This literature review synthesizes the results of clinical trials on this topic. The research was conducted on PubMed, using "Stroke", "rehabilitation", "isokinetic", "upper limb" and "training" as keywords.

RESULTS

Seventeen studies focusing on the use of isokinetics in assessment or rehabilitation (six studies) following stroke were reviewed. For the lower limb, muscle strength and walking ability improved after isokinetic rehabilitation programs. For the upper limb, the only two studies found in the literature suggest improvement in the strength of the trained muscles, of grip force, of the Fugl-Meyer motor score and of global functional capacities. This review does not reveal any consensus on the protocols to be implemented: type of muscle contraction, velocities….

CONCLUSION

While isokinetic strengthening has not proven its efficiency in rehabilitation of the upper limb following stroke, its interest with regard to rehabilitation of the lower limbs has been recognized. Randomized controlled trials in this field are necessary to confirm its efficiency, especially concerning upper arm rehabilitation.

Évaluation préliminaire des effets de la rééducation sur les paramètres de force, d'équilibre et de marche dans la sclérose en plaques

OBJECTIVE

To evaluate the impact of rehabilitation on balance, gait and strength in inpatients with multiple sclerosis (MS).

METHODS

Twenty-one in patients with MS benefited from a program of rehabilitation with evaluation before and after rehabilitation. Balance was assessed by stabilometry, walking speed with use of a locometer device and maximal peak torque of knee extensor and flexor with use of an isokinetic dynamometer at 60 degrees /s speed. The functional independence measure (FIM) was also applied before and after rehabilitation.

RESULTS

After rehabilitation, patients showed significant improvement in balance with opened and closed eyes, velocity gait, strength of the lower quadriceps and the higher hamstrings and FIM values. Absolute values of gait speed and strength parameters were related as were improvement in velocity speed and the higher hamstrings.

CONCLUSION

The results are encouraging and confirm the interest and tolerance of a program of rehabilitation among patients with MS.