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Improving walking ability in people with neurological conditions: A theoretical framework for biomechanics driven exercise prescription
Journal article   Peer reviewed

Improving walking ability in people with neurological conditions: A theoretical framework for biomechanics driven exercise prescription

Gavin Williams, Leanne Hassett, Ross Clark, Adam Bryant, John Olver, Meg E Morris and Louise Ada
Archives of Physical Medicine and Rehabilitation, Vol.100(6), pp.1184-1190
2019
DOI: https://doi.org/10.1016/j.apmr.2019.01.003
PMID: 30690011
url
https://doi.org/10.1016/j.apmr.2019.01.003View
Published Version

Abstract

Exercise gait physical and rehabilitation medicine paresis neurology
The purpose of this paper is to discuss how knowledge of the biomechanics of walking can be used to inform the prescription of resistance exercises for people with mobility limitations. Muscle weakness is a key physical impairment that limits walking in commonly occurring neurological conditions such as cerebral palsy, traumatic brain injury and stroke. Few randomised trials to date have shown conclusively that strength training improves walking in people living with these conditions. This appears to be because 1) the most important muscle groups for forward propulsion when walking have not been targeted for strengthening, and 2) strength training protocols have focused on slow and heavy resistance exercises, which do not improve the fast muscle contractions required for walking. We propose a theoretical framework to improve exercise prescription by integrating the biomechanics of walking with the principles of strength training outlined by the American College of Sports Medicine (ACSM), to prescribe exercises that are specific to improving the task of walking. The high angular velocities that occur in the lower limb joints during walking indicate that resistance exercises targeting power generation would be most appropriate. Therefore, we propose the prescription of plyometric and ballistic resistance exercise, applied using the ACSM guidelines for task-specificity, once people with neurological conditions are ambulating, to improve walking outcomes. This new theoretical framework for resistance training ensures that exercise prescription matches how the muscles work during walking.

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Rehabilitation
Sport Sciences

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