John Branten, PT, Dip Geriatric PT
Chantal Leijgraaff, PT
Peter Huijbregts, PT, MSc, MHSc, DPT, OCS, FAAOMPT, FCAMT
* Mr. John Branten is a specialist geriatric physical therapist and team leader for allied health services in the extended care facility “Joachim en Anna” in Nijmegen, the Netherlands.
* Ms. Chantal Leijgraaff is a staff physical therapist in the extended care facility “Joachim en Anna” in Nijmegen, the Netherlands.
* Dr. Peter Huijbregts is an Assistant Professor at the University of St. Augustine for Health Sciences in St. Augustine, FL, and a consultant at Shelbourne Physiotherapy in Victoria, BC
Dr. Peter Huijbregts, PT, Shelbourne Physiotherapy, 100B-3200 Shelbourne Street
Victoria, BC V8P 5G8 Canada, (250) 598-9828 (phone) firstname.lastname@example.org,
Abstract: This article discusses the indications for the Theravital Bicycle Trainer as a therapeutic intervention for extended care residents with active instability of the hip or combined active instability of both the hip and the knee. Data were collected on leg extension strength and gait function. Nineteen patients referred to physical therapy with a diagnosis of gait dysfunction and strength deficits participated in the study; data from 18 patients were used for a retrospective statistical analysis. The Theravital intervention resulted in significant strength gains in both patient groups. Only the hip instability group showed significant improvements in gait function. The Theravital Bicycle Trainer seems to provide an effective therapeutic intervention for elderly patients with gait dysfunction due to hip abductor weakness. Patients with both hip and knee instability likely benefit more from a combination of Theravital training and open kinetic chain knee extensor strengthening. Patients with marked hip abductor weakness also seem to benefit more when open kinetic chain exercises for the hip abductor muscles are added to their therapeutic program. Further research is required to support these recommendations.
On average, a healthy 80 year-old has only half the strength of a person aged 401. An extended care resident has again only 60% of the strength of a healthy person of the same age2. In an extended care resident with a previous history of multiple falls, the strength of the main leg muscles will have further decreased to 30% of age-related normal levels2. Rantanen3 studied the effect of strength and balance on the quality of gait in 1,002 elderly women: the study showed a strong correlation between gait function and leg muscle strength.
An earlier quasi-experimental study within our facility (one-group pre-test post-test design) investigated the effects of open kinetic chain exercises for the quadriceps muscles as an intervention for improving gait in a population of extended care patients with thigh weakness4. This study lent support to the above-mentioned correlation between leg muscle strength and gait function: over a six-week period mean knee extension strength increased by 139% with concurrent improvement in gait function4. This substantial strength gain (with post-intervention values more than double the pre-intervention values) was explained by the often markedly diminished pre-intervention strength values in our study population.
In the discussion section of this earlier study4, the suggestion was made to strengthen not just the quadriceps muscles but also to include, e.g., the gluteal muscles by way of a therapeutic intervention program consisting of closed kinetic chain exercises. Another suggestion made was to study the effect of strength training on different types of gait dysfunction. The goal of this study is to address both suggestions mentioned above:
- What is the effect of closed kinetic chain strength training of the major leg extensor muscles, i.e., gluteal and quadriceps muscles?
- What is the effect of an increase in leg extension strength on different types of gait dysfunction?
In our study, the gait dysfunctions of interest were active instability of the hip and/or the knee. In this study, active instability of the hip was operationally defined as the presence of a Trendelenburg gait pattern; the operational definition for active knee instability was the presence of a ventral giving way of the knee during stance phase.
Leg extension strength was trained with a Theravital Bicycle Trainer (Figure 1). The Theravital is a movement trainer that has a passive as well as an active mode. The cycling motion on the Theravital is a closed kinetic chain exercise. In this study, a closed kinetic chain exercise was operationally defined as a multijoint movement with a movement structure similar to that of an ADL-function5, in this case the ADL functions of gait and sit-to-stand transfers.