Effective strength training for walking in neurological rehabilitation
Prof Gavin Williams
In recent years, muscle weakness has been identified as the main cause of walking limitations for many neurological conditions such as stroke, brain injury and cerebral palsy. Many randomised controlled trials have targeted muscle strengthening programs to improve walking capacity. Despite significant increases in muscle strength, these trials have had little impact on walking. There appears to be two major gaps limiting the translation of current evidence into improved capacity to walk. The first relates to the biomechanics of walking and the second relates to the implementation of strengthening exercises. Firstly, three main muscle groups provide the majority of power for forward progression during walking. They are the ankle plantar-flexors, hip extensors and hip flexors. The role of these muscle groups during walking is well established. However, our research findings suggest that clinicians are strengthening the wrong muscle groups during rehabilitation, and the role of the three most important muscle groups is not well understood.
Secondly, for strength training to be effective, the type of strengthening exercise needs to be very specific if improved function (walking) is to occur. The American College of Sports Medicine (ACSM) has published guidelines related to factors such as the frequency, intensity, specificity and progress. Although these guidelines are a well-established gold-standard, there appears to be little attention paid to the importance of the best models for implementing strength training in neurological rehabilitation. Strength training is highly topical in neurological rehabilitation phase, yet despite the prioritisation of strength training there has been limited translation to improved walking outcomes. The focus of this TRIP application is the implementation of strength training guidelines in neurological rehabilitation to improve walking outcomes.
NHMRC TRIP Fellowship; $175,303
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