Is there evidence that strength training could help improve muscle function and other outcomes without reinforcing abnormal movement patterns or increasing reflex activity in a man who has had a stroke?

A 72-year-old man was admitted to the inpatient rehabilitation facility where I was completing the clinical education requirement for my Master's of Physical Therapy degree. The patient had had a left cerebral vascular accident 10 days prior to his admission. Magnetic resonance imaging confirmed an infarct consistent with a thrombosis in the area of the middle cerebral artery. The patient, a retired attorney, lived with his wife in a 2-story house that requires climbing 2 stairs to enter. His goals were to walk independently and to return to his hobbies of gardening and golfing. The patient's medical history included a 15-year history of hypertension, for which he has been treated with a cardioselective beta-blocker (metoprolol [Lopressor]).* Because his cardiac status was stable on admission to the rehabilitation facility, his physician cleared him to begin an exercise program. During my initial examination, I determined that the patient's right extremities were hemiparetic. He was able to hold his right shoulder in flexion, abduction, adduction, and extension and hold his right elbow in flexion and extension against gravity without using compensatory movements; however, he could not accept resistance without using compensatory movement at the scapulae and distal joints (3/5 muscle grade using manual muscle testing as described by Kendall et al1). He held his right wrist in flexion and extension against moderate resistance without recruiting compensatory movement patterns (4/5 muscle grade). He was able to hold his right hip in flexion, extension, abduction, and adduction and hold his right knee in flexion and extension against gravity without using compensatory movements; however, he could not accept resistance without using compensatory movement at the pelvis and distal joints (3/5 muscle grade). He demonstrated no active movement of his right ankle into dorsiflexion (0/5 muscle grade) and was able to move into plantar flexion only by using extension in his hip and knee.