The purpose of this research was to investigate the efficacy of a 12 week isokinetic conditioning progam for the lower limbs in 12 young adults with acquired brain injury. There is strong evidence that young adults following ABI (Acquired Brain Injury) have on-going issues with physical impairments and functional limitations many years after their brain injury, and that these limitations are substantial and restrictive. As most therapy resources are available for early rehabilitation only, and these resources are mainly located in large cities, there are many people who are not receiving rehabilitation to support their on-going progress. / There is a paucity of studies investigating conditioning programs in young adults with ABI, and the effect of focusing treatment on the negative rather than the positive features of the Upper Neurone Syndrome (UMNS). The dose prescription for strengthening programs is uncertain, the effect of resistive exercise on tone is controversial and the changes following exercise on muscle strength, muscle power, functional abilities, and quality of life are largely unknown. / The research was in the form of a series of single case studies, with an A-B-A design. For each subject, a series of isokinetic (strength, power, tone) and mobility (gait speed and time to rise from a chair) baseline assessments and 6 subsequent assessments at 2-weekly intervals were performed. The last assessment was performed 4 weeks after cessation of the program to determine any carryover effect. The Short Form-36 questionnaire (SF-36) and semi-structured interviews were administered pre- and post- exercise to reflect the life satisfaction of subjects, and their perspective of any changes in response to the conditioning program. / The multiple isokinetic and mobility measures provided data for analysis of individual cases which were managed statistically, and for clinically significant change. Data was also analysed for the group. Group isokinetic and mobility measures were compared at pre-exercise, post-exercise and 4 weeks following cessation of the conditioning program using repeated measures analysis of variance. / The isokinetic exercise program, on a Kin Com dynamometer, consisted of nine sets of maximal contractions at velocities of 60 and 90 deg/s for unilateral knee flexors and extensors, and ankle plantarflexors and dorsiflexors. These sets were divided into three cycles of six reciprocal contractions. Subjects attended twice weekly for 12 weeks. / The conditioning program resulted in significant improvements in peak torque and power of ankle plantarflexors and peak torque of knee extensors for the group. In addition, functional improvements resulted, in particular fast walking activity, repeated chair rises and participation in activities the subjects valued. There was a carryover effect after the program ceased for some measures. There was no deleterious effect on tone in response to the exercise program. Quality of life of all subjects assessed by using the SF36 questionnaire improved in the area of physical functioning. Occupational status, vitality, self-esteem and optimism were further common themes of improvement obtained from interview data at the completion of the exercise program. / This study demonstrated that a 12 week intensive, resistive, conditioning program produced significant improvement in muscle performance in ankle plantarflexors, knee extensors, function, and participation in valued activities, as well as in feelings of well-being, in a group of ABI subjects. There were no adverse symptoms in response to the high intensity, high repetition exercise protocol at the ankle, indicating that the exercise protocol is suitable for strengthening ankle muscles in individuals following ABI who have a broad range of abilities. / Three subjects experienced knee pain and stiffness in response to the exercise program. These three TBI subjects, who had the highest functional mobility of the group, were able to develop higher torques when exercising, and, the twice weekly, maximal, isokinetic conditioning program might have been excessive for these subjects. The other nine subjects with moderate to severe muscle weakness of knee muscles did not suffer any adverse knee symptoms in response to the conditioning program, and demonstrated improvements in muscle performance of knee muscles. Therefore, when exercising knee muscles, a similar intensive protocol should only be utilized when the individuals have marked or moderate weakness of knee muscles. / These results indicate that a change in therapeutic approach is needed and that the focus for treatment should shift from the positive to the negative features of the UMNS. Rehabilitation of individuals following ABI should incorporate muscle conditioning programs for the lower limbs. Also, many individuals who are currently not receiving therapy may benefit from muscle strengthening exercises. It is important that further research is conducted to establish the most useful conditioning protocol for individuals following ABI. / Thesis (PhDPhysiotherapy)--University of South Australia, 2005.
| Identifer | oai:union.ndltd.org:ADTP/267419 |
| Creators | Killington, Maggie. |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | copyright under review |
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