Steve Hopkins works with a patient on both upper- and lower-extremity exercises.

Resistance training and the specialty equipment available on the market today is proving appropriate for not only patients with neuromuscular disorders, but for both preconditioned and inactive clients, athletes, and the over-50 crowd. Recumbent bicycles seem to be the product of choice among PTs and rehabilitation specialists as some of the models offer bidirectional resistance—strengthening muscles as limbs extend and as they return. Other features include closed-chain technology (no rotary movements); upper-body odometers; and controls for ratio, step length, pace, and exercise duration, to name a few. In this article, we will explore a few of the options out there, including resistance training systems, how they are used in the clinical setting, and the benefits realized by practitioners and clients alike.

RECUMBENT RECOVERY

Steve Hopkins, a certified personal trainer with a focus in older adult wellness and postrehabilitative exercise at Evangelical Homes of Michigan (www.evangelicalhomes.org) in Ann Arbor, Mich, uses both the T4 and T5XR models of recumbent cross trainers by NuStep Inc ((www.nustep.com), Ann Arbor, Mich. "We use the leg stabilizer, the WellGrips™, foot straps, and hip belt," he says. "In our environment, exercise is an extremely important component of our diverse wellness program. The NuStep is a helpful piece of equipment because 95 percent of our residents are able to use it and enjoy it." In a therapeutic environment, they can have their PTs use the NuStep equipment in their subacute rehabilitation units or meet the client right in the wellness center. "The wonderful part of this process," he says, "is that our physical therapists can introduce a piece of equipment during therapy that the resident can continue to use and progress with even after therapy has been discontinued," he explains.

The progressive capability of the NuStep allows Hopkins' team to coach cardio enhancement as well as strength improvements. "A great example is our protocol to our fall-reduction program, FallProof®. Upon initial assessment, if we have residents who are not capable of participating in the program due to lack of strength, NuStep is the specific piece of equipment we introduce to build strength," he adds. Besides the great advantage of usability, its residents enjoy many of the neat graphics, the comfort of the seat, engaging in some of their fun competitions and the ease of getting started in their workout or session.

MULTIFACETED SYSTEMS

Kenji Carp, PT, OCS, ATC, and competency certified vestibular therapist with Physiotherapy Associates (www.physiocorp.com) in Eugene, Ore, uses the Shuttle 2000, Shuttle Recovery, and Shuttle Mini with his clients. "It's the closest equivalent to the gym machine like the traditional weight cable machine with a leg press," he says. "The person lies down and puts his/her leg against the platform and does a leg press against it. The beauty of the Shuttle, because it has the elastic resistance and it is very durable, is that you can do plyometric maneuvers and progress all the way from resistance training (classic strength training), to actually jumping against it," he explains.

Hopkins guides the patient through a focused upperextremity resistance set.

Carp says the machine is accessible to just about everyone because the exercises are done lying down. He notes that people who are quite debilitated and have balance issues, such as its elderly patients, can grab a hold of the handles for an easy transfer on and off the machine. "The Shuttle Recovery in particular has a very wide platform, and the actual cliff that lays on the table is well-cushioned for patients who don't quite feel as stable or desire more comfort.

In industry terms, Carp says it has a "really low basement and a really high ceiling." This means that because a patient is horizontal, the equipment can be adjusted so there's zero resistance and it's rolling and free-wheeling. It can be used for range of motion or simple positioning, or for patients who can't work very hard because they are so deconditioned."

In addition, one of the features on the Shuttle Recovery is an insert that doubles as a low sturdy bench-like table. It doesn't have to be used for exercise, but rather, it can be used as a quick manual therapy treatment, to rest a patient, or to practice sit-to-stand transfers. "We use it a lot with neurological patients," Carp says.

Carp adds that with the adjustability and control capabilities of the Shuttle System (www.shuttlesystems.com), it's really safe, so as soon as it's indicated in a patient's postoperative, they can use it fairly quickly. "We have the ability to ramp up the resistance when the athlete is ready," he says. "We can see him through all phases, from controlled and very conservative, all the way up to that final sport-specific phase where he's trying to jump and move plyometrically as hard and fast as he can." Putting the patient in a sitting position in order to do upper-body work is another plus.

Jennifer Magee, a certified strength conditioning specialist at Washington-based Athletic Engineering (www.athleticengineering.com), uses the Shuttle Recovery as well. "It's a very well-rounded piece of equipment," she says. "It caters to all different types of clients, not just those who want to get in shape." Magee likes the fact that it can be turned into a table. "You can do Pilates, stretches, and plyometrics with it," she adds, along with the strength aspect. "With the wider bench you can elevate it and make it parallel to the ground and lower it in order to do the exercises, if need be." Those who are on the table doing physical therapy can be automatically put into whatever position you need them to be in on a flat table.

Magee has trained young athletes all the way from age 8 on up. "My specialty is strength conditioning," she says. "I also do a lot of post-physical therapy." She has trained an MS patient on and off for some time. "It's nice because it's a higher piece of equipment than a lot of the standard leg presses. It's such an easy accessible machine, he can transfer from his wheelchair to the shuttle easier than if it was one of the bulky machines that you have to maneuver your hips around. You pull your chair up, you take the arm off the chair, and transfer over," she explains.

There's a rope that Magee has attached to the back of the equipment to help clients lift and pull themselves up. "Since it is up higher than a normal piece of equipment, once they pull themselves into an upright position, they turn and rotate their hips so their feet are on the ground. It's like they're sitting in a regular chair, depending on their height. They have the ability to grab hold of the footrest and help themselves up as well," she says. In addition, Magee says there isn't anything that will smash their fingers. The tubings are how they adjust the weight and are done very easily in the back where you don't have to bend down underneath the footboard to pull it.

VERSATILITY MATTERS

Andy Baxter, a medical exercise specialist with Baxter Fitness Solutions (www.bfitsolutions.com) in Ashland and Medford, Ore, works with the over-50 market and sees a lot of neuromuscular disorders and issues of balance as they relate to general loss of function and strength. "With the SCIFIT System and the bidirectional capability, it takes them out of their dominant neuromuscular patterning while promoting new patterns that are ultimately going to improve their motor skills and perceptive ability. They are going to be much better at it if they're more in tune with where they are in space and time."

Baxter observes this with neuromuscular and deconditioned clients frequently. "Our big three are Parkinsonism, stroke, and MS. All the compensatory patterns that allow them to function when they are limited leads them down the wrong path because they're less stable; the compensatory mechanisms are inefficient," Baxter says.

SCIFIT (www.scifit.com), Tulsa, Okla, offers products that were engineered initially for the medical environment. From recumbent bikes and treadmills, to steppers and ellipticals, biomechanics ensure that patients achieve desired results in a secure, efficient manner.

"In our systems, everything we do is closed-chain and compound," Baxter explains. "We don't do any rotary movements where there's a single axis rotation. We don't want to put undue stress on the joint. We want to put the load in the muscle where it belongs."

"The upper-body ergometer is fantastic," for shoulder work, according to Baxter. The bidirectional capabilities are also great if you have a compromised shoulder. The crank arm length is adjustable on the UBE, allowing one arm to be fully extended for full range of motion and the other to be in close if the shoulder is compromised."

"The other thing we do quite a bit is change the ratio from forward to backward. Typically in the shoulder client we are going to be spending most of our time in a posterior motion," he says. "We are going to stay away from the forward motion more than we might otherwise." So, for example, instead of changing direction every 30 seconds or every minute, they might do a 2:1 or 3:1 ratio of backward to forward. The machine allows you to do that and "at will."

FUNCTIONAL RESISTANCE

"Our therapy is separate from the health club, but we do have access to it," says Mike Duffy, PT, of Akron General Sports and Physical Therapy (www.agmc.org) in Ohio. "We have access to Life Fitness (www.lifefitness.com) treadmills, ellipticals, and all the various strength equipment." Duffy notes that his clientele consists of the orthopedic outpatient. There are a lot of knee surgeries and tendinitis, some fractures, elderly patients with arthritic change as well as the 30- to 40-year-old age bracket.

"We also use the resistance machine," according to Duffy. "It may be 7 years old now, but it's an update from the previous line, he says. "The torque angles are more comfortable to the natural body motion of the knee, shoulder, or hip. Less stress on your joints."

"If someone has a knee replacement or even a hip replacement and he is farther along [in therapy], the Life Fitness machine is easy for the patient to get in and out of and to use. Even the same with the upper-extremity equipment; it's just easier to maneuver to get to the height you want," he adds.

Jeff Stone, PT, MSPT, at AthletiCo-Deerfield, (www.athletico.com) in Michigan, utilizes Life Fitness' Dual Adjustable Pulley (DAP) machine for incorporating functional resistance training into his patients' physical therapy treatment plans. "AthletiCo-Deerfield has chosen to utilize the DAP machine because of its adaptability and versatility. The DAP allows our physical therapists the freedom to customize functional exercises for a wide variety of diagnoses and treatment techniques," he says.

The PTs and athletic trainers at AthletiCo-Deerfield primarily use the DAP for nonoperative and postoperative outpatient orthopedic patients. This can include pediatrics, adults, and geriatric patients with injuries to the upper extremities, lower extremities, and spine. "More specifically, many patients with rotator cuff dysfunction, patellofemoral pain, and low back pain use the DAP for functional resistance training exercises," Stone says. The DAP allows the PT to create a customized, progressive, and functional treatment protocol for that patient's particular diagnosis. "We use resistance training from the DAP to assist with restoring range of motion; normalizing movement patterns such as walking; increasing the muscular strength and endurance needed for activities of daily living; and progressing higher-level functions such as jumping, running, and agility drills."

Nina Silberstein is a contributing writer for Physical Therapy Products. For more information, contact .