Exercise- a prescription for all or not?. Susan Edwards FCSP SRP. Historical perspective. no possibility of neuronal recovery orthopaedic approach clinical practice - change was possible review of neurophysiological rationale impaired reciprocal innervation skill acquisition and training
Abnormal muscular contraction
short muscle length
Balanced view of neural control of movement, biomechanical requirements for the task and limitations of CNS damage on both of these systems
What is it?
More likely to contribute to limb stiffness in children with CP but in adults with stroke, the primary problem seems to be in the inability to produce adequate force in the agonist (Davies et al 1996)
Over-emphasis on the neural control of movement has led to a neglect of the importance of muscle strength, force production and movement velocity
6 hours for CP child
(Tardieu et al 1988)
half hour for neurologically intact mouse!
biomechanical properties of muscle –
optimal force at mid range
is showing enhanced evidence over
(National Clinical Guidelines for Stroke 2002)
Variety of movement patterns
How often can a therapist carry out movements?
Need for regular exercise / stretching programme
(Liepert et al 2000)
- incomplete spinal cord injury (Deitz 2003)
- stroke (Hesse 1995, 1999)
- improved fitness and muscle strength
- improved mood and sense of well-being
- weight control
- improved bone density
- improved co-ordination
“Individuals with physical impairments will need a great deal of encouragement to engage in regular intensive exercise. This encouragement may not always be forthcoming from therapists who have been led to believe that effortful activity is harmful to their patients and must be avoided. However, recent evidence shows that this is not the case and that exercise should be an integral part of an overall rehabilitation programme.”
(Haas and Jones 2004)
“There is a consensus that muscle weakness is a feature in many neurological pathologies. The notion that increased co-activation of antagonistic muscles rather than muscular weakness is responsible for motor control problems has not been confirmed by scientific evidence.”
(Haas and Jones 2004)
Therapists need to encourage perseverance with tasks which are meaningful and at a level sufficient to induce changes in strength and fitness.
This should include on-going management / exercise outside of the ‘neurogym’ with more active collaboration with agencies providing leisure and social pursuits.