Effect of Strengthening Exercise in Addition to Task-Specific Gait Training after Stroke: a Randomised Trial Efficacy of Functional Strength Training on Restoration of Lower-Limb Motor Function Early After Stroke: Phase I Randomized Controlled Trial Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial Cost-effectiveness of a structured progressive task-oriented circuit class training programme to enhance walking competency after stroke: The protocol of the FIT-Stroke trial Walking and talking therapy: improving cognitive-motor dual-tasking in neurological illness. The effects of a strength and neuromuscular exercise programme for the lower extremity on knee load, pain and function in obese children and adolescents: study protocol for a randomised controlled trial Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial Effects of task-oriented training on mobility function in children with cerebral palsy. Feasibility of combining multi-channel functional neuromuscular stimulation with weight-supported treadmill training Efficacy of lower-limb muscle training modalities in severely dyspnoeic individuals with COPD and quadriceps muscle weakness: results from the DICES trial [Strength and coordination training for prevention of falls in the elderly]. A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial. A 9-Week Aerobic and Strength Training Program Improves Cognitive and Motor Function in Patients with Dementia: A Randomized, Controlled Trial. The effects of proprioceptive or strength training on the neuromuscular function of the ACL reconstructed knee: a randomized clinical trial. Walking Training with Foot Drop Stimulator Controlled by a Tilt Sensor to Improve Walking Outcomes: A Randomized Controlled Pilot Study in Patients with Stroke in Subacute Phase Neuromuscular Electrical Stimulation Versus Volitional Isometric Strength Training in Children With Spastic Diplegic Cerebral Palsy: A Preliminary Study
Rationale Gait deficits contribute considerably to functional disability after stroke , and the regaining of walking ability is a major goal in most stroke rehabilitation programmes . Evidence suggests that muscular strengthening exercises after stroke can improve strength and activity . Additionally , task-related practice performed at high intensities may enhance walking competency in people with stroke . However , there is insufficient evidence to conclude which approach is most effective . Aim This study will test the hypothesis that task-specific walking training plus targeted strength training is superior to task-specific walking training alone in improving strength , motor co-ordination , quality of independent walking , and participation in acute stroke patients . Design This trial is a prospect i ve , r and omised clinical trial . People after stroke who are living at home and attending outpatient clinics will be r and omly allocated into either an experimental or a control group . The experimental group will undertake task-specific walking training , plus targeted strength training three times per week over 10 weeks , while the control group will only undertake task-specific walking training . At baseline , after 10 weeks of intervention and 4 weeks after the cessation of the interventions , allocation-blinded research ers will collect outcome measures . Study outcomes Primary outcomes will be measured for levels of impairment ( strength and co-ordination ) , activity ( quality of walking ) , and participation ( quality of life ) . Secondary outcomes will be the minimal clinical ly important differences of lower limb strength , motor co-ordination , and gait speed After stroke , physiotherapy can promote brain reorganization and motor recovery . Combining muscle strength and functional training ( functional strength training , FST ) may be beneficial . The aim of the authors was to compare FST with conventional physiotherapy ( CPT ) while controlling for the potential confounder of therapy intensity in a multicenter , r and omized controlled observer-blind trial . The mean age of the participants was 68.3 ( st and ard deviation [ SD ] = 12.03 ) years at a mean of 34 ( SD = 20 ) days after stroke , with mean peak paretic knee extension torque ( torque ) of 22 ( SD = 25 ) Nm . The estimated sample size was 102 to detect a between-group difference of 0.2 m/s in walking speed . After baseline measures , participants were allocated r and omly to CPT or CPT + CPT or CPT + FST for 6 weeks . Additional experimental therapy was provided for up to 1 hour a day , 4 times each week . Outcomes were measured 6 weeks after baseline and at follow-up 12 weeks thereafter . Measures included walking speed , knee extensor torque , and functional mobility ( Rivermead ) . At outcome , both extraintensity groups showed greater increases in walking speed than the CPT group , but this reached significance only for the CPT + CPT group ( P = .031 ) . The CPT + CPT group also had a greater number of participants who walked at 0.8 m/s or above . No significant differences were observed for torque about the knee or for the Rivermead score . At follow-up , no significant differences were observed . These phase I results justify a subsequent trial of CPT + CPT versus CPT + FST Abstract Objective To compare two forms of device-specific training – body-weight-supported ( BWS ) ambulation on a fixed track ( TRK ) and BWS ambulation on a treadmill ( TM ) – to comprehensive physical therapy ( PT ) for improving walking speed in persons with chronic , motor-incomplete spinal cord injury ( SCI ) . Methods Thirty-five adult subjects with a history of chronic SCI ( > 1 year ; AIS ‘ C ’ or ‘ D ’ ) participated in a 13-week ( 1 hour/day ; 3 days per week ) training program . Subjects were r and omized into one of the three training groups . Subjects in the two BWS groups trained without the benefit of additional input from a physical therapist or gait expert . For each training session , performance values and heart rate were monitored . Pre- and post-training maximal 10-m walking speed , balance , muscle strength , fitness , and quality of life were assessed in each subject . Results All three training groups showed significant improvement in maximal walking speed , muscle strength , and psychological well-being . A significant improvement in balance was seen for PT and TRK groups but not for subjects in the TM group . In all groups , post-training measures of fitness , functional independence , and perceived health and vitality were unchanged . Conclusions Our results demonstrate that persons with chronic , motor-incomplete SCI can improve walking ability and psychological well-being following a concentrated period of ambulation therapy , regardless of training method . Improvement in walking speed was associated with improved balance and muscle strength . In spite of the fact that we withheld any formal input of a physical therapist or gait expert from subjects in the device-specific training groups , these subjects did just as well as subjects receiving comprehensive PT for improving walking speed and strength . It is likely that further modest benefits would accrue to those subjects receiving a combination of device-specific training with input from a physical therapist or gait expert to guide that training Background Most patients who suffer a stroke experience reduced walking competency and health-related quality of life ( HRQoL ) . A key factor in effective stroke rehabilitation is intensive , task-specific training . Recent studies suggest that intensive , patient-tailored training can be organized as a circuit with a series of task-oriented workstations . Primary aim of the FIT-Stroke trial is to evaluate the effects and cost-effectiveness of a structured , progressive task-oriented circuit class training ( CCT ) programme , compared to usual physiotherapeutic care during outpatient rehabilitation in a rehabilitation centre . The task-oriented CCT will be applied in groups of 4 to 6 patients . Outcome will be defined in terms of gait and gait-related ADLs after stroke . The trial will also investigate the generalizability of treatment effects of task-oriented CCT in terms of perceived fatigue , anxiety , depression and perceived HRQoL. Methods / design The multicentre single-blinded r and omized trial will include 220 stroke patients discharged to the community from inpatient rehabilitation , who are able to communicate and walk at least 10 m without physical , h and s-on assistance . After discharge from inpatient rehabilitation , patients in the experimental group will receive task-oriented CCT two times a week for 12 weeks at the physiotherapy department of the rehabilitation centre . Control group patients will receive usual individual , face-to-face , physiotherapy . Costs will be evaluated by having each patient keep a cost diary for the first 24 weeks after r and omisation . Primary outcomes are the mobility part of the Stroke Impact Scale ( SIS-3.0 ) and the EuroQol . Secondary outcomes are the other domains of SIS-3.0 , lower limb muscle strength , walking endurance , gait speed , balance , confidence not to fall , instrumental ADL , fatigue , anxiety , depression and HRQoL. Discussion Based on assumptions about the effect of intensity of practice and specificity of treatment effects , FIT-Stroke will address two key aims . The first aim is to investigate the effects of task-oriented CCT on walking competency and HRQoL compared to usual face-to-face physiotherapy . The second aim is to reveal the cost-effectiveness of task-oriented CCT in the first 6 months post stroke . Both aims were recently recommended as priorities by the American Hearth Association and Stroke Council . Trial registration This study is registered in the Dutch Trial Register as NTR1534 Using r and omized control trial methodology , we evaluated the effectiveness of a 5-week cognitive-motor dual-tasking training program developed to improve performance of a group of people with dual-tasking difficulties arising from acquired brain injury . Training involved twice-daily practice on exercises involving walking being combined with tasks which increased in cognitive dem and over the course of the intervention . A treatment group ( n = 10 ) was compared with a control group ( n = 9 ) . The primary outcome measure was a task requiring participants to walk and carry out a spoken sentence verification task simultaneously . Secondary outcome measures were measures of dual-tasking involving either two motor tasks or two cognitive tasks . A question naire measure relating to activities of daily living requiring dual-tasking was also completed . Compliance with the training program was good . We found evidence of improvement in performance on the primary outcome measure , but little evidence of generalization to other measures . There was some evidence that participants believed that their dual-tasking performance in everyday life was improved after the intervention . The study was limited in terms of sample size , was not blinded and did not control fully for therapist contact time , but has produced valuable data relating to effect sizes associated with this form of intervention . ( JINS , 2009 , 15 , 112 - 120 . ) Background Childhood obesity is one of the most critical and accelerating health challenges throughout the world . It is a major risk factor for developing varus/valgus misalignments of the knee joint . The combination of misalignment at the knee and excess body mass may result in increased joint stresses and damage to articular cartilage . A training programme , which aims at developing a more neutral alignment of the trunk and lower limbs during movement tasks may be able to reduce knee loading during locomotion . Despite the large number of guidelines for muscle strength training and neuromuscular exercises that exist , most are not specifically design ed to target the obese children and adolescent demographic . Therefore , the aim of this study is to evaluate a training programme which combines strength and neuromuscular exercises specifically design ed to the needs and limitations of obese children and adolescents and analyse the effects of the training programme from a biomechanical and clinical point of view . Methods / Design A single assessor-blinded , pre-test and post-test r and omised controlled trial , with one control and one intervention group will be conducted with 48 boys and girls aged between 10 and 18 years . Intervention group participants will receive a 12-week neuromuscular and quadriceps/hip strength training programme . Three-dimensional ( 3D ) gait analyses during level walking and stair climbing will be performed at baseline and follow-up sessions . The primary outcome parameters for this study will be the overall peak external frontal knee moment and impulse during walking . Secondary outcomes include the subscales of the Knee injury and Osteoarthritis Outcome Score ( KOOS ) , frontal and sagittal kinematics and kinetics for the lower extremities during walking and stair climbing , ratings of change in knee-related well-being , pain and function and adherence to the training programme . In addition , the training programme will be evaulated from a clinical and health status perspective by including the following analyses : cardiopulmonary testing to quantify aerobic fitness effects , anthropometric measures , nutritional status and psychological status to characterise the study sample . Discussion The findings will help to determine whether a neuromuscular and strength training exercise programme for the obese children population can reduce joint loading during locomotion , and thereby decrease the possible risk of developing degenerative joint diseases later in adulthood . Trial registration Clinical Trials NCT02545764 , Date of registration : 24 September 2015 Background and Purpose : A phase II , single-blinded , r and omized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity ( LE ) strength training to improve walking ability after stroke . Subjects : The participants were 80 adults who were ambulatory 4 months to 5 years after a unilateral stroke . Method : The exercise interventions consisted of body-weight – supported treadmill training ( BWSTT ) , limb-loaded resistive leg cycling ( CYCLE ) , LE muscle-specific progressive-resistive exercise ( LE-EX ) , and upper-extremity ergometry ( UE-EX ) . After baseline assessment s , participants were r and omly assigned to a combined exercise program that included an exercise pair . The exercise pairs were : BWSTT/UE-EX , CYCLE/UE-EX , BWSTT/CYCLE , and BWSTT/LE-EX . Exercise sessions were 4 times per week for 6 weeks ( total of 24 sessions ) , with exercise type completed on alternate days . Outcomes were self-selected walking speed , fast walking speed , and 6-minute walk distance measured before and after intervention and at a 6-month follow-up . Results : The BWSTT/UE-EX group had significantly greater walking speed increases compared with the CYCLE/UE-EX group ; both groups improved in distance walked . All BWSTT groups increased walking speed and distance whether BWSTT was combined with LE strength training or not . Discussion and Conclusion : After chronic stroke , task-specific training during treadmill walking with body-weight support is more effective in improving walking speed and maintaining these gains at 6 months than resisted leg cycling alone . Consistent with the overtraining literature , LE strength training alternated daily with BWSTT walking did not provide an added benefit to walking outcomes BACKGROUND / PURPOSE Improvement in mobility function has been the primary goal in the rehabilitation of children with cerebral palsy . Few studies have examined the effectiveness of task-oriented strength training for children with cerebral palsy . The purpose of this study was to examine the effects of task-oriented strength training on mobility function in children with cerebral palsy . STUDY DESIGN A single-blind , r and omized controlled trial with pre-training and post-training evaluations . MATERIAL S AND METHODS Ten children with cerebral palsy ( GMFCS levels I-III ) were r and omly assigned to an experimental group ( N = 5 ) or control group ( N = 5 ) . Mobility function was assessed using the Gross Motor Function Measure ( GMFM ) and the Timed " Up and Go " ( TUG ) test . Participants in the control group received conventional physical therapy focused on improving walking and balance through facilitation and normalization of movement patterns . Participants in the experiment group received task-oriented strength training focused on strengthening the lower extremities and practicing functional tasks similar to those the child performs during daily activities . RESULTS After the 5-week training period there were significant improvements in the experimental group for dimension D ( p = 0.009 ) , and dimension E ( p = 0.009 ) of the GMFM . The experimental group significantly reduced the time taken to complete the TUG ( p = 0.017 ) . CONCLUSION / SIGNIFICANCE This study supports the efficacy of task-oriented strength training for improving mobility function in children with cerebral palsy . The findings demonstrate that the application of a task-oriented strength training program is linked to positive functional outcomes . The results suggest that children with cerebral palsy may benefit from a task-oriented strength training program . Further studies with a larger r and omized sample and longer post-intervention follow-up are necessary to document the long-term effects of participation in task-oriented strength training programs in the cerebral palsy population More than 3 million stroke survivors live with residual disabilities and mobility deficits even after rehabilitation . Therefore , it is important to develop new , more effective , gait training methods . The purpose of this study was twofold : ( 1 ) testing the feasibility of combining multi-channel functional neuromuscular stimulation ( FNS ) using intramuscular ( IM ) electrodes and body weight supported treadmill training ( BWSTT ) for gait training ; and ( 2 ) documenting the potential gait practice advantages afforded by combining FNS-IM and BWSTT .  Eight subjects with gait deficits in the chronic phase ( > 12 months ) were enrolled . Intramuscular electrodes were placed in the paretic hip abductors , knee flexors and extensors , and ankle dorsiflexors , plantarflexors , and evertors . Subjects were treated with exercise and gait training using the combined technologies 1 1/2 h/week , four times/week , for 12 weeks . Feasibility was tested according to performance of the technologies , clinician skill factors , and subject satisfaction . Impairment , function , and quality of life were measured . Provision of practice for eight gait characteristics was catalogued . We found the following results for the combined technologies : ( 1 ) the combined technologies were safe and feasible ; ( 2 ) clinicians required five training sessions to reach proficiency ; ( 3 ) subjects were satisfied ; ( 4 ) there were significant gains in impairment and functional measures ; ( 5 ) a greater number of gait practice characteristics were provided with the combined technologies than with either alone Rationale Strength training and neuromuscular electrical stimulation ( NMES ) improve lower-limb muscle function in dyspnoeic individuals with chronic obstructive pulmonary disease ( COPD ) . However , high-frequency NMES ( HF-NMES ) and strength training have never been compared head-to-head ; and effects of low-frequency NMES ( LF-NMES ) have never been studied in COPD . Therefore , the optimal training modality to improve lower-limb muscle function , exercise performance and other patient-related outcomes in individuals with severe COPD remains unknown . Objectives To study prospect ively the efficacy of HF-NMES ( 75 Hz ) , LF-NMES ( 15 Hz ) or strength training in severely dyspnoeic individuals with COPD with quadriceps muscle weakness at baseline . Methods 120 individuals with COPD ( FEV1 : 33±1 % predicted , men : 52 % , age : 64.8±0.8 years ) were r and omised to HF-NMES , LF-NMES or strength training as part of a comprehensive inpatient pulmonary rehabilitation programme . No treadmill walking or stationary cycling was provided . Measurements and main results Groups were comparable at baseline . Quadriceps muscle strength increased after HF-NMES ( + 10.8 Newton-metre ( Nm ) ) or strength training ( + 6.1 Nm ; both p<0.01 ) , but not after LF-NMES ( + 1.4 Nm ; p=0.43 ) . Quadriceps muscle endurance , exercise performance , lower-limb fat-free mass , exercise-induced symptoms of dyspnoea and fatigue improved significantly compared with baseline after HF-NMES , LF-NMES or strength training . The increase in quadriceps muscle strength and muscle endurance was greater after HF-NMES than after LF-NMES . Conclusions HF-NMES is equally effective as strength training in severely dyspnoeic individuals with COPD and muscle weakness in strengthening the quadriceps muscles and thus may be a good alternative in this particular group of patients . HF-NMES , LF-NMES and strength training were effective in improving exercise performance in severely dyspnoeic individuals with COPD and quadriceps weakness . Trial registration Since muscle strength and coordination training in healthy elderly people has been effective in the primary prevention , a program for geriatric patients with falls is presented . Its aim is safer walking by an increase in muscular strength and improved coordination . The exclusion criteria and the size of the training program define a group of over 75 year old patients , who will be compared with a group with light physical exercise in a r and omized fashion . The first results show a remarkable increase in strength and a low complication rate . The functional relevance of our program remains to be proven Abstract Purpose To evaluate the effect of a multidisciplinary rehabilitation programme on disability , kinesiophobia , catastrophizing , pain , quality of life and gait disturbances in patients with chronic low back pain ( CLBP ) . Methods This was a parallel-group , r and omised , superiority-controlled pilot study in which 20 patients were r and omly assigned to a programme consisting of motor training ( spinal stabilising exercises plus usual-care ) and cognitive – behavioural therapy ( experimental group , 10 subjects ) or usual-care alone ( control group , 10 subjects ) . Before treatment , 8 weeks later ( post-treatment ) , and 3 months after the end of treatment , the Oswestry Disability Index , the Tampa Scale for Kinesiophobia , the Pain Catastrophizing Scale , a pain numerical rating scale , and the Short-Form Health Survey were assessed . Spatio-temporal gait parameters were also measured by means of an electronic walking mat . A linear mixed model for repeated measures was used for each outcome measure . Results The programme had significant group ( p = 0.027 ) , time ( p < 0.001 ) , and time-by-group interaction ( p < 0.001 ) effects on disability , with the experimental group showing an improvement after training of about 61 % ( 25 % in the control group ) . The analyses of kinesiophobia , catastrophizing , and the quality of life also revealed significant time , group , and time-by-group interaction effects in favour of the experimental group , and there was a significant effect of time on pain . Both groups showed a general improvement in gait parameters , with the experimental group increasing cadence significantly more . Conclusion The multidisciplinary rehabilitation programme including cognitive – behavioural therapy was superior to the exercise programme in reducing disability , kinesiophobia , catastrophizing , and enhancing the quality of life and gait cadence of patients with CLBP QUESTION Among people who are hospitalised for community-acquired pneumonia , does an inpatient exercise-based rehabilitation program improve functional outcomes , symptoms , quality of life and length of hospital stay more than a respiratory physiotherapy regimen ? DESIGN R and omised trial with concealed allocation , intention-to-treat analysis and blinding of some outcomes . PARTICIPANTS Forty-nine adults hospitalised for community-acquired pneumonia . INTERVENTION The experimental group ( n=32 ) underwent a physical training program that included warm-up , stretching , peripheral muscle strength training and walking at a controlled speed for 15 minutes . The control group ( n=17 ) underwent a respiratory physiotherapy regimen that included percussion , vibrocompression , respiratory exercises and free walking . The intervention regimens lasted 8 days . OUTCOME MEASURES The primary outcome was the Glittre Activities of Daily Living test , which assesses the time taken to complete a series of functional tasks ( eg , rising from a chair , walking , stairs , lifting and bending ) . Secondary outcomes were distance walked in the incremental shuttle walk test , peripheral muscle strength , quality of life , dyspnoea , lung function , C-reactive protein and length of hospital stay . Measures were taken 1 day before and 1 day after the intervention period . RESULTS There was greater improvement in the experimental group than in the control group on the Glittre Activities of Daily Living test ( mean between-group difference 39 seconds , 95 % CI 20 to 59 ) and the incremental shuttle walk test ( mean between-group difference 130 m , 95 % CI 77 to 182 ) . There were also significantly greater improvements in quality of life , dyspnoea and peripheral muscle strength in the experimental group than in the control group . There were no between-group differences in lung function , C-reactive protein or length of hospital stay . CONCLUSION The improvement in functional outcomes after an inpatient rehabilitation program was greater than the improvement after st and ard respiratory physiotherapy . The exercise training program led to greater benefits in functional capacity , peripheral muscle strength , dyspnoea and quality of life . REGISTRATION Clinical Trials.gov , NCT02103400 OBJECTIVE To compare training and follow-up effects of combined aerobic and strength training versus aerobic-only training on cognitive and motor function in institutionalized patients with dementia and to explore whether improved motor function mediates improved cognitive function . METHODS Using a 9-week , parallel , three-group , single-blind , r and omized , controlled trial with a follow-up assessment at week 18 , we assessed 109 patients with dementia ( age 85.5 ± 5.1 years ) in a psycho-geriatric nursing home . Each 9-week intervention consisted of 36 , 30-minute sessions . A combined group ( N = 37 ) received and completed two strength and two walking sessions per week , an aerobic group ( N = 36 ) completed four walking sessions , and a social group ( N = 36 ) completed four social visits per  week . Cognitive and motor functions were assessed at baseline , after the 9-week intervention , and after a consecutive 9 weeks of usual care . RESULTS Baseline corrected post-test scores in the combined versus the social group were higher for global cognition , visual memory , verbal memory , executive function , walking endurance , leg muscle strength , and balance . Aerobic versus social group scores were higher for executive function . Follow-up effects reversed toward baseline values . Motor improvement did not significantly mediate cognitive improvement . CONCLUSION Compared with a nonexercise control group , a combination of aerobic and strength training is more effective than aerobic-only training in slowing cognitive and motor decline in patients with dementia . No mediating effects between improvements in cognitive function via improved motor function were found . Future research into the underlying mechanistic associations is needed OBJECTIVES The purpose of this study was to determine the effects of a proprioceptive training program ( PT ) vs. a strength training ( ST ) program on neuromuscular function after anterior cruciate ligament ( ACL ) reconstruction . The second purpose was to establish the determinants of functional ability for the operated limb . METHODS Ten participants with unilateral ACL reconstructions were r and omly assigned to one of the following 12-week training protocol s : ( 1 ) isotonic ST , and ( 2 ) PT . The outcome measures were : ( 1 ) peak torque time of the hamstring muscles ( PeakTT ) , ( 2 ) average concentric and eccentric torques of the quadriceps and hamstring muscles , ( 3 ) one-legged single hop for distance ( SLHD ) , ( 4 ) one-legged time hop ( TH ) , and ( 5 ) subjective scores . RESULTS : There was a significant group by time interaction effect for PeakTT ( P = 0.017 ) . The PT group demonstrated greater percent change in isokinetic torques than the ST group at the end of the 12 weeks ( P < or = 0.05 ) . Participants in both groups demonstrated similar significant gains in functional ability and subjective scores ( P < or = 0.014 ) . Quadriceps strength is a determinant of functional ability for the operated limb ( R2 = 0.72 ) . CONCLUSIONS : Both training protocol s influenced PeakTT . The beneficial effects of ST on PeakTT appear to be load-dependent , while sufficient practice may be crucial in maintaining PeakTT improvements induced by PT . Proprioceptive training alone can induce isokinetic strength gains . Restoring and increasing quadriceps strength is essential to maximize functional ability of the operated knee joint Foot drop is a quite common problem in nervous system disorders . Neuromuscular electrical stimulation ( NMES ) has showed to be an alternative approach to correct foot drop improving walking ability in patients with stroke . In this study , twenty patients with stroke in subacute phase were enrolled and r and omly divided in two groups : one group performing the NMES ( i.e. Walkaide Group , WG ) and the Control Group ( CG ) performing conventional neuromotor rehabilitation . Both groups underwent the same amount of treatment time . Significant improvements of walking speed were recorded for WG ( 168 ± 39 % ) than for CG ( 129 ± 29 % , P = 0.032 ) as well as in terms of locomotion ( Functional Ambulation Classification score : P = 0.023 ) . In terms of mobility and force , ameliorations were recorded , even if not significant ( Rivermead Mobility Index : P = 0.057 ; Manual Muscle Test : P = 0.059 ) . Similar changes between groups were observed for independence in activities of daily living , neurological assessment s , and spasticity reduction . These results highlight the potential efficacy for patients affected by a droop foot of a walking training performed with a neurostimulator in subacute phase Background . To date , no reports have investigated neuromuscular electrical stimulation ( NMES ) to increase muscle force production of children with cerebral palsy ( CP ) using high-force contractions and low repetitions . Objective . The aims of this study were to determine if isometric NMES or volitional training in children with CP could increase muscle strength and walking speed and to examine the mechanisms that may contribute to increased force production . Methods . Eleven children with spastic diplegia were assigned to an NMES training group or to a volitional training group . Participants in the NMES group had electrodes implanted percutaneously to activate the quadriceps femoris and triceps surae muscles . The volitional group trained with maximal effort contractions . Both groups performed a 12-week isometric strength-training program .  Maximum voluntary isometric contraction ( MVIC ) force , voluntary muscle activation , quadriceps and triceps surae cross-sectional area ( CSA ) , and walking speed were measured pre- and post-strength training . Results . The NMEStrained group had greater increases in normalized force production for both the quadriceps femoris and triceps surae . Similarly , only the NMES group showed an increase in walking speed after training . Changes in voluntary muscle activation explained approximately 67 % and 37 % of the changes seen in the MVIC of the NMES and volitional groups , respectively . Quadriceps femoris maximum CSA increased significantly for the NMES group only . Conclusions . This study was the first to quantitatively show strength gains with the use of NMES in children with CP . These results support the need for future experimental studies that will examine the clinical effectiveness of NMES strength training
The results revealed that despite significant strength gains , many studies failed to show a significant improvement in walking capacity .
Strength testing and strengthening exercises were prioritized for the knee extensors and flexors , despite their relatively minor role in human walking .
Strengthening exercises performed in the neurologic population are not specific to the main muscle groups responsible for the power generation required for walking .
There is a predisposition for strength testing and strengthening exercises to focus on the knee flexors and extensors despite their relatively minor role during walking .
The aim of this systematic review was to investigate the task specificity of strength training programs for walking in neurologic rehabilitation .