Excerpted from "Resist This!," Stroke Connection Magazine, January/February 2004Tom Wisenbaker has been using strength training with stroke survivors for 15 years. A special needs fitness trainer, Tom works with survivors in Newbury Park, Calif. He is one of only a handful of people outside traditional therapy who work with stroke survivors. In 2002, he received the Ancillary Health Provider Award from the Camarillo Healthcare District in Ventura County, Calif.
“We see people all the time who come in believing that they can’t move their ankle or wrist, but with proper support, we get them moving, often within 20 minutes,” Tom says. “We get most people out of their braces, except for older women where we may be dealing with osteoporosis, but even then we work to get the ankle and calf stronger.”
Many healthcare professionals are concerned that resistance training can have a detrimental effect on spastic muscles. A recent review of the professional literature found no scientific evidence to back up that position. In fact, in a recent article in NeuroRehabilitation, investigators determined that targeted strength training in patients with muscle weakness due to strokes significantly increased muscle power without any negative effects on spasticity.
Tom has had similar experiences with the people he’s helped. “Contractions are a response to weakness. The contracting muscle is protecting the joint,” he says. “It’s the body trying to do what it can to protect itself, but this contraction is usable power. We work both the contracted and non-contracted muscles, but we concentrate on the affected side. As those muscles strengthen, the contractions lessen.
“When working a muscle, think full stretch to full contraction to work the muscle through its whole range. That is what strengthens things,” Tom says. “Walking doesn’t really strengthen the leg muscles because it doesn’t go through the full range; walking is good cardio, but it doesn’t build strength.”
“If you want to gain strength, find someone who will work you through a full range of motion with your hip, for instance. I watch survivors when we’re working, and they’re always up in their heads trying to feel the movement, but really it takes a long time to be able to feel. That’s why it’s important to have someone there to make sure the survivor goes through the full range."
“I never have people do a set routine. It’s not enough to do three sets of 10. You’ve got to do those at different speeds, weights, and reps so that the body has to adapt. When we fall into a routine, we stop making gains because we’re not pushing into new areas.”
“You really have to mix things up, which really stimulates the nervous system. It makes it more challenging and interesting. Of course, we don’t just go out and try stuff. It’s based on what the survivor has accomplished in the past. And they should always have someone there with them.”
“I get people after everyone else has given up on them, and they’ve been going downhill a long time. So many doctors and therapists who assess stroke survivors give only a few tests to decide if someone has plateaued. What we have found is that plateauing in one area doesn’t mean they’ve plateaued in every area. We have not seen someone who doesn’t continue to improve.”
“We had a lady from Denmark who was more than 20 years post-stroke, and she got her gait back after limping for all those years. People actually develop new muscle on their affected side. The experts didn’t think that was possible, but we clearly see it.”
“One of my clients was talking to his neurologist, who was impressed with how much improvement he had made. He asked the patient if we had planned that improvement because he didn’t believe that you could target areas and have them improve.”
“Brain injury is tough because all that you are suddenly betrays you. It takes a while for stroke survivors to regain trust in themselves: They have to see the knee support them, for example, they don’t just assume that it will. However, once they have that confidence, so much is possible. We don’t push anybody to fatigue because that’s an area of diminishing returns, and they leave frustrated. We always end with something they do well."
“The big thing I’ve learned is how amazingly adaptable and capable we are. The medical community is so external and passive and unwilling for us to look inside. When are they going to realize that the head is part of the body, that the brain cells are attached to the body, so our thoughts and desires are part of our body? It’s amazing what we can accomplish when we stop focusing on our limitations.”