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- Title
Contralateral Strength Training as Preparation for Direct Strength Training in a Patient With Unilateral Foot-Drop Because of Multiple Sclerosis: A Case Report.
- Authors
Manca, Andrea; Ventura, Lucia; Martinez, Gianluca; Aiello, Elena; Deriu, Franca
- Abstract
Objective Direct strength training (DST) is effective in managing unilateral weakness in people with multiple sclerosis (MS). Its feasibility, however, is considerably reduced if one limb is too compromised to train. In this case, contralateral strength training (CST) of the unaffected side to induce a strength transfer to the untrained homologous muscles can help to establish a strength baseline in the weaker limb, eventually allowing direct training. Limited effects for CST, however, have been reported on patient functioning. We tested the effects on dynamometric, electromyographic, and functional outcomes of a sequential combination of CST and DST of the ankle dorsiflexors in a case of MS-related foot-drop. Methods A 56-year-old man diagnosed with relapsing-remitting MS exhibited severe weakness of the right dorsiflexors impairing functional dorsiflexion. The intervention consisted of a 6-week CST of the unaffected dorsiflexors followed by 2 consecutive 6-week DST cycles targeting the weaker dorsiflexors. Results At baseline, the participant could not dorsiflex his right ankle but could do so after CST. Maximal strength of the affected dorsiflexors increased by 80% following CST, by 31.1% following DST-1, and by a further 44.6% after DST-2. Neuromuscular recruitment was found progressively increased, with the largest changes occurring after DST-1. Improvements in mobility and walking speed were also detected, although plantar flexors' spasticity on the Modified Ashworth Scale increased from 1+ to 2. Conclusion In this case, the sequential combination of CST and DST proved a feasible approach to manage severe unilateral weakness in a patient who was not able, at least initially, to dorsiflex his weaker ankle. In this perspective, CST may prime a minimum gain in strength necessary to allow subsequent direct training.
- Subjects
ITALY; ACADEMIC medical centers; ANKLE; ANTHROPOMETRY; ELECTROMYOGRAPHY; EXERCISE; EXERCISE physiology; GAIT disorders; MULTIPLE sclerosis; MUSCLE strength; MUSCLE strength testing; NEUROLOGICAL disorders; RESEARCH funding; TREATMENT effectiveness; PRE-tests &; post-tests; FUNCTIONAL assessment; DESCRIPTIVE statistics; DORSIFLEXION; DISEASE complications
- Publication
Physical Therapy, 2020, Vol 100, Issue 10, p1816
- ISSN
0031-9023
- Publication type
Article
- DOI
10.1093/ptj/pzaa127