A push may help stroke victims with lingering weakness
I was fortunate enough to attend a professional weekend summit of the Medical Exercise Specialists Mastermind group in Katy, Texas, last December. We met at the Medical Exercise Training Institute for a weekend of hands-on learning and skill development and bonded over success stories, brainstormed about challenges and celebrated with good ol’ Texas BBQ!
The highlight of the weekend was observing an hour-long training session with a poststroke client. He had gone as far as he could go in his physiotherapy program and was left with “functional deficits.” He was no longer considered “acute,” but, was not ready for a regular gym routine. The deficits he was working on included left leg, arm and hand weakness along with an overall low level of function. This past month I was able to watch another session with a second client recovering from stroke via Facebook Live. Isn’t technology wonderful!
While much of what I saw could fit into a physiotherapy program, there are a few distinct features of Medical Exercise that made the session different. First of all, the client had gained as much strength as possible during six months of physiotherapy and … in his own words; it was “time to be pushed harder” and the focus of his program at the Medical Exercise Training Institute was to restore function. Unlike a standard gym program, his outcomes would not be measured in weight lifted or in sets and reps, but, in his ability to perform activities of daily living.
The Medical Exercise Specialist divided the client’s needs into three parts: core stability, improved shoulder function and greater muscle recruitment of his left leg to improve gait.
From my observations, I was able to identify three distinct techniques that were used during the training session.
1. When it comes to the movements we are trying to improve in stroke survivors, it is important to break them down into the smallest, most simple components possible. For example, raising the arm from the waist to reaching overhead can initially be trained by working from the waist to the sternum. This is done to be able to focus on individual muscles throughout the entire range of motion.
2. The client had flaccid rotator cuffs; meaning that they were not contracting and not supporting the shoulder as it moved. This resulted in limited range of motion and pain. Our MES used a series of techniques to isolate the rotator cuffs and force them to contract to the point of fatigue. Once he did this, there was decreased pain and increased range of motion in the client’s shoulder. Called muscle “activation,” it meant that once the muscles got to the point of fatigue, they continued to contract in a more appropriate way. We saw a demonstration of this in the leg as the thigh muscles were repeatedly flexed to the point of exhaustion. When this happened, there was more stability around the knee and the gait was smoother and more reliable.
3. In standard fitness training, we count sets and repetitions before resting and doing another set. In Medical Exercise, the focus is on exercise time, therefore, reps and sets are irrelevant. We saw a client perform complex movement patterns, while stabilizing with his weaker leg, in a limited range, for up to 10 minutes at a time. The activity ended when the client could no longer maintain a proper movement pattern due to fatigue.
An important take-home message from the session was that timing in recovery is critical. There is an absolute need for physiotherapy for someone recovering from a stroke, but there is also a time when something “more” is needed. With expertise, a plan and a bit of a push, there is a likelihood that improvement can continue and function can continue to be restored beyond what we may have accepted in the past.
Ernie Schramayr, CPT, is a Medical Exercise Specialist in Hamilton who helps his clients manage medical conditions with exercise. You can follow him at erniesfitnessworld.com. 905-741-7532 or firstname.lastname@example.org.