Wednesday, November 23rd, 2022
Great question. The answer is ABSOLUTELY!
For some clinicians, strengthening a hyperactive or spastic muscle is a very controversial topic. The thought of having stroke survivors squeeze their spastic finger flexors or flex their overactive biceps causes some clinicians to cringe.
In the past, many clinicians early in their career were frequently reminded to not evoke abnormal movement patterns while treating patients suffering from hemiparesis. According to their senior colleagues at the time, strengthening hyperactive muscles were considered harmful and detrimental even leading to increased spasticity, exaggerated abnormal movement patterns and possibly pain.
Of course, this was purely theoretical, based on “we’ve always done it this way”, carried on year-after-year, with no science to back it up. Nevertheless, most new-grads never questioned why and how this would happen, and as a novice clinician, were not ready to challenge conventional principles.
When you search for evidence-based treatment for clients suffering from spastic hemiparesis, you will be amazed. There are many studies indicating positive functional outcomes for strength training – without increasing spasticity or pain. In addition, none of the articles concluded that this form of treatment was ineffective or harmful.
In fact, according to ebrsr.com (Evidence-Based Review of Stroke Rehabilitation) 33 RCTs were found evaluating strength training for upper extremity motor rehabilitation. The findings showed that strength training was considered beneficial for clients suffering from hemiparesis.
Over the last 2 decades, the neurorehabilitation field has observed a clinical shift when it comes to recommended treatment interventions, as popular theoretical concepts from decades past have faded into the shadows of new scientific evidence.
From the days of avoiding contact on the palmer surface of spastic hands, or heavy emphasis on tone reduction techniques, to now appreciating the efficacy of hand and arm strength training (Patten et al., Butefisch et al., Teixeira-Salmela et al., Sharp et al., Fowler et al.).
From shunning abnormal movement patterns, or excessive exertion in fear of increasing spasticity, to now endorsing highly repetitive task-oriented training and Constraint Induced Movement Therapy (Wolf et. al, Winstein et al., Arya et al.)
From suggesting that the client’s inability to move one’s limb was the result of spasticity, to now recognizing that muscle weakness is the main contributing factor to lack of motion and impaired function (Harris et al., Patten et al., Ada et al.).
The evolution of neurorehabilitation treatment has been palpable to say the least. The Occupational Therapy profession (happy OT month by the way) is over 100 years old. AOTA’s Centennial Vision stated “We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs.”
As neurorehabilitation technology continues to flourish, and conventional treatment interventions are replaced or transformed based on current science, one cannot help but remain optimistic about the future.