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Effect of Contralateral Strength Training on Muscle Weakness in People With Multiple Sclerosis: Proof-of-Concept Case Series

Andrea Manca, Maria Paola Cabboi, Enzo Ortu, Francesca Ginatempo, Daniele Dragone, Ignazio Roberto Zarbo, Edoardo Rosario de Natale, Giovanni Mureddu, Guido Bua, Franca Deriu
DOI: 10.2522/ptj.20150299 Published 1 June 2016
Andrea Manca
A. Manca, BSc, MSc, Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
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Maria Paola Cabboi
M.P. Cabboi, MD, Department of Biomedical Sciences, University of Sassari.
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Enzo Ortu
E. Ortu, MD, PhD, Neurology Unit, A. Segni Hospital–ASL n. 1, Sassari, Italy.
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Francesca Ginatempo
F. Ginatempo, BSc, MSc, Department of Biomedical Sciences, University of Sassari.
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Daniele Dragone
D. Dragone, BSc, Department of Biomedical Sciences, University of Sassari.
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Ignazio Roberto Zarbo
I.R. Zarbo, MD, Department of Experimental and Clinical Medicine, University of Sassari.
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Edoardo Rosario de Natale
E.R. de Natale, MD, PhD, Department of Biomedical Sciences, University of Sassari.
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Giovanni Mureddu
G. Mureddu, BSc, Neurorehabilitation Unit, Policlinico Sassarese, Sassari, Italy.
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Guido Bua
G. Bua, MD, Neurorehabilitation Unit, Policlinico Sassarese.
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Franca Deriu
F. Deriu, MD, PhD, Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 43/b, 07100 Sassari, Italy.
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Abstract

Background The contralateral strength training (CST) effect is a transfer of muscle performance to the untrained limb following training of the contralateral side.

Objective The aim of this study was to explore, in individuals with multiple sclerosis (MS) presenting marked lower limb strength asymmetry, the effectiveness of CST on management of muscle weakness of the more-affected limb following training of the less-affected limb.

Design A single-subject research design was used.

Methods Eight individuals with MS underwent 16 to 18 high-intensity training sessions of the less-affected ankle dorsiflexor muscles. The primary outcome measure of this single-system case series was maximal strength expressed as peak moment and maximal work. Secondary outcome measures were: Six-Minute-Walk Test, Timed “Up & Go” Test, 10-Meter Timed Walk Test, and Multiple Sclerosis Quality of Life–54 questionnaire.

Results After the 6-week intervention, the contralateral more affected (untrained) limb showed a 22% to 24% increase in maximal strength. From pretest-posttest measurements, participants also performed significantly better on the clinical and functional secondary outcome measures. At the 12-week follow-up, the strength levels of the weaker untrained limb remained significantly superior to baseline levels in the majority (5 out of 8) of the outcome parameters.

Limitations Considering the design used, the absence of a control group, and the sample size, these findings should be cautiously generalized and will need confirmation in a properly planned randomized controlled trial.

Conclusions The present proof-of-concept study shows, for the first time, the occurrence of the CST effect on muscle performance of ankle dorsiflexor muscles in people with MS. These preliminary findings reveal new potential implications for CST as a promising rehabilitation approach to those conditions where unilateral muscle weakness does not allow or makes difficult performing conventional strength training of the weaker limb.

Footnotes

  • Dr Manca, Dr Deriu, and Dr Dragone conceptualized and designed the study. Dr Cabboi, Dr Ortu, Dr Ginatempo, Dr Zarbo, Dr de Natale, and Dr Mureddu collected the data. Dr Manca, Dr Deriu, Dr Bua, and Dr Dragone interpreted the data. Dr Manca, Dr Deriu, and Dr Dragone drafted the manuscript. All authors provided critical review of the manuscript.

  • The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Bioethics Committee of the Local Health Authority (ASL n.1-Sassari, Italy; Prot. number 1160/L/2013).

  • This work was supported by Fondazione Italiana Sclerosi Multipla (grant FISM 2013/R/11) and by Fondazione Banco di Sardegna (grant FBS 2014/0190). Upon request, the authors can provide any underlying research materials related to the article.

  • ClinicalTrials.gov identifier: NCT02010398.

  • Received May 20, 2015.
  • Accepted November 22, 2015.
  • © 2016 American Physical Therapy Association
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Vol 96 Issue 6 Table of Contents
Physical Therapy: 96 (6)

Issue highlights

  • Language Matters
  • Multidisciplinary Biopsychosocial Rehabilitation for Nonspecific Chronic Low Back Pain
  • Improvement of Physical Therapist Assessment of Risk of Falls in the Hospital and Discharge Handover Through an Intervention to Modify Clinical Behavior
  • Cost-Effectiveness of Physical Therapy Only and of Usual Care for Various Health Conditions: Systematic Review
  • Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial
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  • Long-Term Effect of Exercise Therapy and Patient Education on Impairments and Activity Limitations in People With Hip Osteoarthritis: Secondary Outcome Analysis of a Randomized Clinical Trial
  • Effect of Contralateral Strength Training on Muscle Weakness in People With Multiple Sclerosis: Proof-of-Concept Case Series
  • Vestibular Rehabilitation After Traumatic Brain Injury: Case Series
  • Physical Therapy as Treatment for Childhood Obesity in Primary Health Care: Clinical Recommendation From AXXON (Belgian Physical Therapy Association)
  • Physical Therapists' Ways of Talking About Overweight and Obesity: Clinical Implications
  • Evidence of Impaired Proprioception in Chronic, Idiopathic Neck Pain: Systematic Review and Meta-Analysis
  • Reliability and Structural and Construct Validity of the Functional Strength Measurement in Children Aged 4 to 10 Years
  • Reliability of Physical Activity Measures During Free-Living Activities in People After Total Knee Arthroplasty
  • Structural Validity of the Dutch Version of the Patient-Rated Wrist Evaluation (PRWE-NL) in Patients With Hand and Wrist Injuries
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Effect of Contralateral Strength Training on Muscle Weakness in People With Multiple Sclerosis: Proof-of-Concept Case Series
Andrea Manca, Maria Paola Cabboi, Enzo Ortu, Francesca Ginatempo, Daniele Dragone, Ignazio Roberto Zarbo, Edoardo Rosario de Natale, Giovanni Mureddu, Guido Bua, Franca Deriu
Physical Therapy Jun 2016, 96 (6) 828-838; DOI: 10.2522/ptj.20150299

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Effect of Contralateral Strength Training on Muscle Weakness in People With Multiple Sclerosis: Proof-of-Concept Case Series
Andrea Manca, Maria Paola Cabboi, Enzo Ortu, Francesca Ginatempo, Daniele Dragone, Ignazio Roberto Zarbo, Edoardo Rosario de Natale, Giovanni Mureddu, Guido Bua, Franca Deriu
Physical Therapy Jun 2016, 96 (6) 828-838; DOI: 10.2522/ptj.20150299
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Subjects

  • Neurology/Neuromuscular System
    • Multiple Sclerosis
  • Intervention
    • Therapeutic Exercise
  • Musculoskeletal System/Orthopedic
    • Injuries and Conditions: Lower Extremity

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