This document provides information on gait training, exercise, muscle contractions, and screening processes for exercise. It discusses the contractile and non-contractile components of muscle, including the fascial system. Several exercises are described that can help improve mobility and function for individuals who have experienced a mild stroke. Screening tools like health history forms and PAR-Q are recommended to establish trust and safety. Assessments of various physical measures are also outlined.

1. GAIT -
TRAINING

2. •Function of movement where coordinated
movement is a skill that can be taught.
The more we learn about the fascial
system the more we realize that all
muscles are interconnected yet many
exercises are designed to work on only
one muscle group or body part at a time.
Exercise

3. There are two distinct parts of
human skeletal muscle
•The contractile element
•visco-‐elastic non-‐contractile
component

4. The Non-‐contractile Component Includes The Fascia Or Connective
Tissue, Which Surrounds. Each Layer Of The Contractile Element:
• The endomysium the connective tissue around
an individual myofibril (muscle fiber)
•The perimysium the layer of connective tissue
around a fascicle
• The epimysium the outermost layer of
connective tissue around an entire muscle or
collection of fascicles

5. THE CONTRACTILE ELEMENT OF MUSCLE IS
ORGANIZED INTO DIFFERENT LAYERS:
• The myofibril, or individual muscle fiber, comprised of
sections of sarcomeres containing the actin and
myosin protein filaments responsible for muscle
contractions.
•
• The fascicle formed by a bundle of individual muscle
fibers.
• An entire section of muscle containing of a number of
fascicles.

6. MUSCLE CONTRACTIONS BY THE CONTRACTILE ELEMENT
ARE GENERALLY IDENTIFIED AS:
• Wholly eccentric a lengthening action where the
resistive force is overcoming the muscular force
• Wholly concentric a shortening action where the
muscular force is overcoming the resistive force
• Completely isometric an action where the muscle
fibers are contracting but no joint motion occurs

7. The non-‐contractile component is comprised
primarily of fascia, which is broadly defined as all
of the soft, fibrous connective tissue interwoven
between all of the cells and organs within the
human body (and should be considered an organ in
its own right) (Schleip et al., 2012).

8. Recent research suggests that non-
‐contractile connective tissue is the
richest sensory organ in the human
body, containing up to 10 times as
many free nerve endings than the
contractile element (Schleip et al.,
2012)

9. •If the system is not properly balanced, then forces
such as compression, tension, torsion or shear can
change the architecture of cellular structures and the
overall function of the body.
•Continued stresses from repetitive movement patterns,
movements performed with poor technique, or a lack of
multiplanar movement in general affects the body on
many different levels and can have a significant impact
on the results a client experiences from an exercise
program

10. ● If you were mildly affected by stroke, you may still
have some degree of weakness in the affected arm and
leg, but generally have some ability to control your
movements.
● You may also have some obvious stiffness or muscle
spasms, particularly with fatigue or stress.
● You may be able to walk without someone’s
assistance, but may use a walker, cane or brace.
For many gauging longer distances or uneven terrain, you
may require some minimal assistance from another person, a
more supportive walking aid or a wheelchair

11. Abnormalities may be present when you walk, but may be
corrected by exercise and by fitting shoes with lifts or
wedges.
A prescription for these shoe modifications can be obtained
from a doctor following evaluation by a physical therapist.
You can usually use the stairs with or without handrails,
with a helper close by or with very minimal assistance.

12. To identify individuals who may be at a higher risk of an
adverse event during physical activity.
1. Has your doctor ever told you that you have a heart
condition or have
2. Do you ever experience unexplained pains in your chest
at rest or during physical activity/exercise?
3. Do you ever feel faint or have spells of dizziness during
physical activity/exercise that causes you to lose balance?

13. • 4. Have you had an asthma attack requiring immediate medical attention
at any time over the last 12 months?
• 5. If you have diabetes (type I or type II) have you had trouble
controlling your blood glucose in the last 3 months?
• 6. Do you have any diagnosed muscle, bone or joint problems that you
have been told could be made worse by participating in physical
activity/exercise?
• 7. Do you have any other medical condition(s) that may make it
dangerous for you to participate in physical activity/exercise?

14. •IF THEY ANSWERED ‘YES’ to any
of the 7 questions, please seek
guidance

15. “Screening and Risk Stratification Process.”
An initial interview with a potential client in which basic
demographic information is obtained, along with the
client’s health history.Two types of forms are
used at a minimum:
The health history form and the PAR-Q form.

16. When health screening forms are used
appropriately, these tools help establish a
foundation of trust that facilitates the
development of the trainer–client relationship.
Combined with effective communication skills,
these tools further improve the possibility of
achieving the client’s goals.

17. Assessments are tests and measurements used with their clients to
evaluate their current physical and functional status. Assessments may
include:
➤ resting and exercise heart rate;
➤ resting and exercise blood pressure;
➤ body weight and height;
➤ body composition estimates using skinfold calipers, etc.;
➤ circumference measurements of limbs, hips, and waist;
➤ calculation of body mass index;
➤ calculation of waist-to-hip ratio;
➤ measurements of flexibility using a sit and reach, etc.;
➤ tests for muscular strength/muscular endurance; and
➤ tests for cardiorespiratory fitness via walking, biking, stepping, etc.

18. The following exercises can help you:
•Require less assistance for stair climbing
•Move more steadily when you walk
•Improve balance and endurance
•Strengthen and refine movement patterns
•Improve the coordination and speed of movement
necessary for fine motor skills, such as fastening buttons
or tying shoelaces.

19. To correct poor movement patterns,
one has to become aware of the pattern
they’ve adopted, and retrain their brain
and central nervous system (CNS).
Small, precise movements are the most
effective way to retrain the CNS, and
restore the correct muscle movement
pattern.

20. Foam rollers are one tool that can be
used to accomplish this task. They are
hard, cylindrical and unstable, and their
use requires complete concentration.
Therefore, they are not only used for
muscle exercises or treatments, but are
brain exercises as well.

21. To enhance hip and knee control
Start with your knees bent, feet resting on the floor.
b. Slowly slide the heel of your affected leg down so that the leg
straightens.
c. Slowly bring the heel of your affected leg along the floor,
returning to the starting position. Keep your heel in contact with the
floor throughout the exercise.
Note:
Your foot will slide more smoothly if you do this exercise without
shoes.

22. To improve hip control in preparation for walking
activities.
Start with your unaffected leg flat on the floor and your
affected leg bent
b. Lift your affected foot and cross your affected leg
over the other leg.
c. Lift your affected foot and un-cross, resuming the
position of step b.
d. Repeat the crossing and uncrossing motion several
times.

23. To strengthen the muscles that stabilize the shoulder
a. Lie on your back with your arms resting at your sides.
b. Keep your elbow straight, lift your affected arm to shoulder level with your
hand pointing to the ceiling.
c. Raise your hand toward the ceiling, lifting your shoulder blade from the
floor.
d . Hold for three to five seconds, and then relax,allowing your shoulder blade
to return to the floor.
e. Slowly repeat the reaching motion several times.
f. Lower your arm to rest by your side.

24. To strengthen the shoulder muscles as well as those which
straighten the elbow
a. Lying on your back, grasp one end of an elasticized band
* in each hand with enough tension to provide slight resistance to
the exercise, but without causing undue strain.
b. To start, place both hands alongside the unaffected hip,
keeping your elbows as straight as possible.
c. Move your affected arm upward in a diagonal direction,
reaching out to the side, above your head, keeping your elbow
straight

25. To improve control of knee motions for walking
a. Lie on your unaffected side with the bottom knee bent for
stability and your affected arm placed in front for
support.
b. Starting with your affected leg straight, bend your
affected knee, bringing the heel toward your buttocks, then
return to the straightened position.
c. Concentrate on bending and straightening your knee while
keeping your hip straight.

26. To improve weight shift and control for proper walking techniques.
Start with your knees bent, feet flat on the floor and knees close
together.
b. Lift your hips from the floor and keep them raised in the air.c.
Slowly twist your hips side to side. Return to center and lower
your hips to the floor.
d. Rest. Repeat motion.
Note: This exercise may be difficult for some stroke survivors and
it may worsen back problems. Do not do it if you experience pain.

27. To improve balance, weight shift and control to prepare for walking activities.
The starting position is on your hands and knees. Weight should be evenly distributed on both arms
and both legs.
b . Rock in a diagonal direction back toward your right heel as far as possible, then as far forward
toward your left hand as possible.
c. Repeat motion several times, slowly rocking as far as possible in each direction.
d.Return to center
e. Rock in a diagonal direction toward your right hand. Move as far back as possible in each direction
slowly.
Note: For safety, an assistant may be nearby to prevent loss of balance. This position may not be
appropriate or safe for elderly stroke survivors.
Consult your doctor and/or physical therapist before attempting this
exercise.

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