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Richard Bohannon is a well respected author who has published extensively in the field of stroke rehabilitation. This comprehensive review paper provides the reader with an overview of key issues including; the nature and relevance of muscle strength, how it is quantified and a review of the evidence for strength training of the lower limbs after stroke. The relevance of muscle strength is described in terms of the ability of muscles to generate the acceleration and deceleration forces necessary for the completion of functional tasks. An interesting description of the theoretical relationship between strength and functional performance is provided and studies that correlate lower limb strength with functions such as stair climbing, sit to stand and gait performance are described. The limitations of measures of motor and the advantages of dynamometry over manual testing are considered. The author draws the reader’s attention to two important and often overlooked areas of weakness, the trunk and the muscles on the non-hemiparetic side, with proximal muscles being affected more than distal.
The article includes a review of the pertinent literature relating to the evidence for strength training of the lower limbs post stroke. Three systematic reviews and twelve research articles including five randomised controlled trials were appraised and summarised in table format. The type of resisted exercise studied included weights, pneumatic machines, elastic bands, isokinetic machines and the use of body weight. The results showed that muscle strengthening strategies result in increased muscle strength. Evidence to support the effectiveness of strength training on improvements on variables other than strength e.g. stair climbing, sit to stand, gait speed was less conclusive. Bohannon concurs with others in his view that overall the current evidence for the effectiveness of strength training on function after stroke is poor except for specific activities of sit to stand and step-ups.
This paper provides the reader with a comprehensive overview of the nature and extent of muscle weakness after stroke and the current evidence to support strength training programmes.