Physical therapy improves lower limb muscle strength but not function in individuals with amyotrophic lateral sclerosis: A case series study

Kato, Naoki; Hashida, Goichi; Kobayashi, Mizuki; Konaka, Kuni

doi:10.1016/j.rehab.2017.09.007

Cited by 12 publications

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“…[ 1 ] Exercise for ambulatory patients with motor neuron disease (ALS, and spinal and bulbar muscular atrophy) is more effective when muscle strength or function are lower; this suggests an improvement in disuse muscle weakness. [ 13 – 15 ] However, as muscle weakness progresses, it also becomes an overload in activities of daily living, and improvement cannot be expected. [ 1 ] Case 2 was ambulatory during the initial hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Effect of muscle strengthening exercise and time since onset in patients with amyotrophic lateral sclerosis

2018

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Exercise for patients with amyotrophic lateral sclerosis (ALS) can be expected to improve function at the early stage of disease, but improvement cannot be expected at the late stage. However, no report has investigated the correlation between the effect of exercise and time since onset. This study examined the relevance between the effect of muscle strengthening exercise and time since onset in patients with ALS.This study is a retrospective nonconsecutive case series study at a single university hospital. We included 2 patients with ALS who were admitted twice. Case 1 was a 60-year-old man with the bulbar type. He was hospitalized 10 months (ALS functional rating scale-revised, 42 points) and 1 year and 8 months (33 points) after onset. Case 2 was a 52-year-old man with the lower limb type. He was hospitalized 1 year and 3 months (44 points) and 1 year and 8 months (33 points) after onset. Physical therapy was implemented daily on weekdays for approximately 30 minutes. The intervention period was 2 weeks. Lower limb muscle strengthening exercises were mainly performed and exercise intensity was adjusted to a modified Borg Scale score of 5 (lower limbs). The study investigated knee extension muscle strength (KEMS) by using a hand-held dynamometer and Functional Ambulation Categories (FAC) at the start and end of physical therapy during each hospitalization.KEMS improved during the initial hospitalization in both patients, and FAC improved in Case 2; neither KEMS nor FAC improved during rehospitalization in either patient. In Case 1, KEMS was maintained for 10 months.The current results suggest that the positive effect of muscle strengthening exercise is greater at the early stage and may be maintained in patients with bulbar type ALS. In addition, improvement can be achieved approximately 1 year after onset and in patients with an ALSFRS-R score of 40 points or more. Therefore, it is necessary to initiate and continue exercise earlier after onset.

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Section: Discussionmentioning

confidence: 99%

Effect of muscle strengthening exercise and time since onset in patients with amyotrophic lateral sclerosis

2018

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“…Muscle strength was measured by using a hand-held dynamometer (µ-Tas F-1, ANIMA, Japan). The KEMS was measured as previously reported 8 ) . KEMS and improvement rate were calculated as follows…”

Section: Participants and Methodsmentioning

confidence: 99%

“…We previously reported that 2 to 3 weeks of physical therapy for ambulatory ALS patients significantly improved lower limb muscle strength, and that those with muscle strength below the normal range showed greater improvement 8 ) . In this previous study, we examined ambulatory ALS patients; however, the severity of motor weakness varied.…”

Section: Introductionmentioning

confidence: 94%

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Lower limb muscle strengthening exercises in patients with early-stage amyotrophic lateral sclerosis: a case series study

et al. 2020

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[Purpose] We investigated whether patients with early-stage amyotrophic lateral sclerosis can improve their voluntary strength with a physical therapy program. [Participants and Methods] This retrospective case series study at a single university hospital included 13 patients with amyotrophic lateral sclerosis (amyotrophic lateral sclerosis functional rating scale-revised ≥35, modified functional ambulation categories score ≥4). Physical therapy was performed for 3 weeks. We investigated knee extension muscle strength and modified functional ambulation categories scores at the start and end of the therapy and calculated the improvement rate of knee extension muscle strength. We performed a regression analysis of the relationship between knee extension muscle strength at the start of the study and the improvement rate. [Results] The knee extension muscle strength improved significantly; however, the effect size was small (0.13). The modified functional ambulation categories scores did not improve significantly. The knee extension muscle strength at the start of the therapy was negatively correlated with the improvement rate (logarithmic transformed linear regression: adjusted R 2 =0.27). [Conclusion] A short-duration exercise program improved lower limb muscle strength in patients with early-stage amyotrophic lateral sclerosis. Additionally, we found that patients with weaker lower limb muscle strength at the start of the therapy demonstrated greater improvement at the end of the therapy.

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“…, Krafttrai ning in Kombination mit Atem, Gang und Treppentraining[21], isometrisches Training, Ausdauertraining und Stretching/Ran geofmovementTherapie[22] sowie das Training mittels Arm robotik[23] und das häusliche Training unter TelemonitoringBe dingungen[24]. Drei neuere Studien haben eindeutig einen Nut zen für mehrere Methoden belegen können: In einer Studie konnte gezeigt werden, dass sowohl das Hand und Fahrradergometer in Kombination mit aktiver Übungsbehandlung gegen die Schwer kraft, die aktive Übungsbehandlung gegen die Schwerkraft allein sowie das passive Bewegen der Extremitäten die motorische Ver schlechterung verlangsamen[25].…”

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Rehabilitation bei Amyotropher Lateralsklerose

Groß¹,

Summ²

2019

Nervenheilkunde

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ZUSAMMENFASSUNGIn der stationären neurologischen Rehabilitation in Deutschland werden vorwiegend akute neurologische Erkrankungen, aber nur selten schwere, fortschreitende neuromuskuläre Erkrankungen wie die Amyotrophe Lateralsklerose behandelt. Mittlerweile liegt jedoch in Bezug auf die Amyotrophe Lateralsklerose eine umfangreiche Evidenz für den positiven Nutzen in der Rehabilitation angewandter Methoden und den Einsatz von in der Rehabilitation tätigen Fachbereichen vor: Physiotherapie, Übungsbehandlung, Atmungstherapie, Logopädie, Ernährungstherapie, Ergotherapie, der Einsatz von Hilfsmitteln, assistive Technologien, Elektrorollstühlen und Unterstützter Kommunikation sowie multidisziplinäre Zusammenarbeit und Palliative Care können das Leben der Patienten verlängern, Teilhabe und Lebensqualität verbessern und ein würdevolles Sterben ermöglichen. Essenziell sind die Integration der Angehörigen und beatmungsmedizinischer Expertise in die Behandlung. Ambulante und stationäre neurologische sollten daher fester Bestandteil der Behandlung der Amyotrophen Lateralsklerose sein.

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Physical therapy improves lower limb muscle strength but not function in individuals with amyotrophic lateral sclerosis: A case series study

Cited by 12 publications

References 12 publications

Effect of muscle strengthening exercise and time since onset in patients with amyotrophic lateral sclerosis

Effect of muscle strengthening exercise and time since onset in patients with amyotrophic lateral sclerosis

Lower limb muscle strengthening exercises in patients with early-stage amyotrophic lateral sclerosis: a case series study

Rehabilitation bei Amyotropher Lateralsklerose

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