Can an Adult with Hemiplegia Since Childhood Benefit from Weight Training?

Ask the Hand Specialist - Hemiplegic Cerebral PalsyMy son’s hand, arm, leg, and foot are smaller on his affected side than on the other side of his body. What causes this? He had a stroke just before he was born and we’ve taken him to physical and occupational therapy for many years. I’ve wondered if some sort of weight training would have been helpful, but the therapists discouraged this at the time. I think they were concerned that the weight would increase the spastic tone. Are therapists still discouraging weight therapy? By weight therapy, I mean starting out lifting small weights with maybe a band around his forearm and then progressing to larger weights as he gets stronger. He’s an adult now. Is there a way to make his bones longer? Or, thicker? Or, is it too late? Will his bones continue to get smaller?

Great question. This orthopedic observation is well-know but under-studied. It is known that muscle cells are shorter in spastic muscles. These may actually be “epigenetic,” whereby reduced neural input to the affected side results in differential muscle growth. The good news is that even spastic muscles respond to training, and the old view that strength training increases spasticity has largely been disproven. Weight training, like all exercises, buts stress on the body, and the body’s response over time is to respond by increasing muscle mass and efficiency. I am not sure if it has been studied, but like strength training in other individuals (e.g., older adults), muscle tension on tendons/bones as a result of exercise can result in site-specific changes in the bone composition, size and structure. Probably thicker rather than longer. Whether this is noticeable to the naked eye, I am not sure. We have been adding functional weigh training (adding weights to bowls, pitchers, etc.) in children and adolescents with clear changes in strength and without changes in spasticity. A good physical therapist could help guide weight training, and it should only be done under appropriate medical supervision. But it is never too late to reap the rewards of exercise.

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