Strength training in spastic hemiparesis: should it be avoided?

Controversy exists between accepted principles of strength training and one of our popular neurological therapeutic exercise approaches. Graded resistive exercise is a common method of strength training in the general population. Bobath avoided resistive exercise with post-stroke individuals with spasticity suggesting that the use of effort would only increase cocontraction and reduce coordination. Bobath's theories remain unsupported. The purpose of this study was to test the clinical assumption that graded resistive exercise leads to loss of force production and force modulation in spastic subjects in such a way that spasticity and cocontraction increases and force control is reduced. Nine subjects with a diagnosis of stroke with left hemiplegia and evidence of spasticity in the left biceps performed graded resistive exercise with simultaneous measurements of cocontraction, spasticity levels, and fractionated reaction time. The results of this study indicated that there was little difference between the effects of graded exercise on the performance of paretic and non-paretic muscle. When differences were found, resistive exercise appeared to have a beneficial effect on the performance of paretic muscle. The results of this study suggest that graded resistive exercise is not detrimental to post-stroke spastic muscle, and should be considered as a possible remediation for the deficits of muscle weakness and reduced function in post-stroke individuals.