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Ferry B, Compagnat M, Yonneau J, Bensoussan L, Moucheboeuf G, Muller F, Laborde B, Jossart A, David R, Magne J, Marais L, Daviet JC. Awakening the control of the ankle dorsiflexors in the post-stroke hemiplegic subject to improve walking activity and social participation: the WAKE (Walking Ankle isoKinetic Exercise) randomised, controlled trial. Trials 2022; 23:661. [PMID: 35974379 PMCID: PMC9380386 DOI: 10.1186/s13063-022-06545-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Stroke is the leading cause of acquired disability in France. While 90% of patients recover the ability to walk, it is often limited with a steady speed of approximately 0.7 m/s. This limitation of walking activity is partly related to a decrease in strength associated with more or less significant spasticity. In particular, it seems that the strength of the dorsiflexor muscles is directly related to walking speed. We hypothesise that a protocol based on gestural repetition targeted at the ankle during the subacute phase potentiates the recovery of motor control, improving walking activity, and participates in recovering better social participation. Methods An estimated total of 60 patients with subacute stroke will be recruited to participate in this multicentre, interventional, prospective, randomised controlled trial. All participants will benefit from conventional rehabilitation. In addition, the experimental group will take part in an ankle isokinetic rehabilitation programme for 6 weeks (at least 25 sessions). The control group will receive the same duration of conventional rehabilitation. The primary outcome measure will be a 10-m walking speed at post-intervention. Secondary outcomes will include social participation, walking spatio-temporal parameters, and dorsiflexor strength. Outcome measurements will be taken at baseline, immediately after treatment (6 weeks), then at 6 months and 1 year of follow-up. Discussion This study aims to provide scientific evidence that a protocol based on an early over-solicitation of the ankle dorsiflexor muscles to promote their “awakening” can serve to achieve a more effective walking activity, which in turn encourages social participation following discharge from the hospital. This protocol should also help optimise physical medicine and rehabilitation practices: the more systematic use of the isokinetic dynamometer as a technique associated with, and integrated into the conventional rehabilitation protocol would allow an objective evaluation of the rehabilitation benefits and should increase the rehabilitation gain in central nervous system disorders. Trial registration Limoges University Hospital is the sponsor of this research (Unique Protocol ID: 87RI18_0010) This research is supported by the French Ministry of Health (PHRC 2020-A03328-31) and is conducted with the support of DGOS (PHRC interregional – GIRCI SOHO). The study protocol was approved by the French Human Subjects Protection Review Board (Comité de Protection des Personnes Nord-Ouest III) on February 23, 2021. The trial was registered in the ClinicalTrials.gov registry (NCT04800601) on March 16, 2021.
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Affiliation(s)
- Béatrice Ferry
- Laboratoire HAVAE (UR 20217), EA6310, Université de Limoges, Limoges, France
| | - Maxence Compagnat
- Laboratoire HAVAE (UR 20217), EA6310, Université de Limoges, Limoges, France.,Médecine Physique et de Réadaptation, CHU Limoges, Limoges, France
| | - Jules Yonneau
- Médecine Physique et de Réadaptation, CHU Limoges, Limoges, France
| | - Laurent Bensoussan
- Institut Universitaire de Réadaptation, Marseille, France.,Médecine Physique et Réadaptation, AP-HM, Marseille, France
| | | | - François Muller
- Médecine Physique et Réadaptation, Centre Rééducation Les Embruns, Bidart, France
| | - Bertrand Laborde
- Médecine Physique et Réadaptation, Centre Rééducation Les Embruns, Bidart, France
| | - Anne Jossart
- Médecine Physique et Réadaptation, CHU Poitiers, Poitiers, France
| | - Romain David
- Médecine Physique et Réadaptation, CHU Poitiers, Poitiers, France
| | - Julien Magne
- Centre d'Epidémiologie de Biostatistiques et Méthodologie de la Recherche, CHU Limoges, Limoges, France
| | - Loïc Marais
- Direction de la Recherche et de l'Innovation, CHU Limoges, Limoges, France
| | - Jean-Christophe Daviet
- Laboratoire HAVAE (UR 20217), EA6310, Université de Limoges, Limoges, France. .,Médecine Physique et de Réadaptation, CHU Limoges, Limoges, France.
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Büyükturan B, Şaş S, Kararti C, Özsoy İ, Habibzadeh A, Büyükturan Ö. Effects of Subtalar Joint Mobilization with Movement on Muscle Strength, Balance, Functional Performance, and Gait Parameters in Patients with Chronic Stroke: A Single-Blind Randomized Controlled Study. J Am Podiatr Med Assoc 2022; 112:20-275. [PMID: 36459070 DOI: 10.7547/20-275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Losses in muscle strength, balance, and gait are common in patients with chronic stroke (CS). Ankle joint movements play a key role in this population to maintain a sufficient level of functional activity. The aim of this study was to investigate the effects of the subtalar joint (STJ) mobilization with movement (MWM) technique on muscle strength, balance, functional performance, and gait speed (GS) in patients with CS. METHODS Twenty-eight patients with CS were randomly divided into the control group (n = 14) and the STJ MWM group (n = 14). A 30-min neurodevelopmental treatment program and talocrural joint MWM were applied to both groups. Also, STJ MWM was applied to the STJ MWM group. The patients were treated 3 days a week for 4 weeks. Ankle dorsiflexion and plantarflexion muscle strength, Berg Balance Scale, Timed Up and Go test, and GS were evaluated before and after treatment. RESULTS Berg Balance Scale and Timed Up and Go test scores, dorsiflexion and plantarflexion muscle strength, and GS improved in both groups after the treatment sessions (P < .05), but the improvements were greater in the STJ MWM group compared with the control group (P < .05). CONCLUSIONS According to these results, STJ MWM together with neurodevelopmental treatment and talocrural joint MWM can increase ankle muscle strength, balance, functional performance, and GS on the affected leg in patients with CS.
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Affiliation(s)
- Buket Büyükturan
- *School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Senem Şaş
- †Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Caner Kararti
- *School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İsmail Özsoy
- ‡Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selçuk University, Konya, Turkey
| | - Aida Habibzadeh
- §Department of Physical Therapy Science, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Öznur Büyükturan
- *School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
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Bae Y, Park D. Immediate Effect of Lower-Leg Kinesio Taping on Ankle Dorsiflexion and Gait Parameters in Chronic Stroke with Foot Drop. J Stroke Cerebrovasc Dis 2022; 31:106425. [PMID: 35255287 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Kinesio taping (KT) and proprioceptive neuromuscular facilitation (PNF) are interventions mainly used in clinical settings to improve gait after stroke. Lower-leg KT using the concept of PNF (PNF-KT) has been shown to enhance the recovery of gait speed in patients with stroke. But, the effect of PNF-KT on the ankle movement and gait parameters in stroke patients is unclear. We aimed to investigate the immediate effects of PNF-KT on ankle dorsiflexion range of motion (DF-ROM) and gait parameters in patients with stroke with foot drop. MATERIALS AND METHODS For the A-KT condition, tape was attached to the gastrocnemius and tibialis anterior muscles, and tape for eversion was attached. In the PNF-KT condition, tape was attached to the tibialis anterior, extensor hallucis and digitorum muscles. Ankle movement was measured as the ankle DF-ROM using an iSEN system. Gait ability was assessed using the GAITRite system. The measured gait variables were gait velocity, cadence, and step length (both sides). RESULTS A-KT and PNF-KT significantly improved the ankle DF-ROM, gait velocity, cadence, and the affected- and unaffected-side step length compared to that with no taping. Moreover, PNF-KT significantly increased the ankle DF-ROM, gait velocity, cadence, and the affected- and unaffected-side step length compared to that with A-KT. CONCLUSIONS PNF-KT applied to the affect side improved ankle DF-ROM and gait parameters in hemiplegic stroke patients than no taping, A-KT. Lower-leg PNF-KT may be a useful intervention in a rehabilitation program to improve ankle DF-ROM and gait parameters in chronic stroke patients with foot drop in clinical settings.
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Affiliation(s)
- Youngsook Bae
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea
| | - Donghwan Park
- Department of Physical Therapy, Graduate School, College of Health Sciences, Kyungnam University, Changwon, Republic of Korea.
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Proprioceptive Neuromuscular Facilitation Kinesio Taping Improves Range of Motion of Ankle Dorsiflexion and Balance Ability in Chronic Stroke Patients. Healthcare (Basel) 2021; 9:healthcare9111426. [PMID: 34828473 PMCID: PMC8619064 DOI: 10.3390/healthcare9111426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
This study aimed to determine the effect of a proprioceptive neuromuscular facilitation (PNF) pattern Kinesio taping (KT) application on the ankle dorsiflexion range of motion (DF-ROM) and balance ability in patients with chronic stroke. This crossover study included 18 patients with stroke. The subjects were randomly assigned to three interventions: barefoot, ankle KT (A-KT), and PNF-KT. The A-KT was applied to the gastrocnemius and tibialis anterior (TA) muscles, and subtalar eversion. The PNF-KT was applied on the extensor hallucis, extensor digitorum, and TA muscles. DR-ROM was measured using the iSen™, a wearable sensor. Balance ability was assessed based on static balance, measured by the Biodex Balance System (BBS), and dynamic balance, measured by the timed up and go (TUG) test and dynamic gait index (DGI). Compared with the barefoot and A-KT interventions, PNF-KT showed significant improvements in the ankle DF-ROM and BBS scores, TUG, and DGI. PNF-KT, for functional muscle synergy, improved the ankle DF-ROM and balance ability in patients with chronic stroke. Therefore, the application of PNF-KT may be a feasible therapeutic method for improving ankle movement and balance in patients with chronic stroke. Additional research is recommended to identify the long-term effects of the PNF-KT.
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Alamer A, Melese H, Getie K, Deme S, Tsega M, Ayhualem S, Birhanie G, Abich Y, Yitayeh Gelaw A. Effect of Ankle Joint Mobilization with Movement on Range of Motion, Balance and Gait Function in Chronic Stroke Survivors: Systematic Review of Randomized Controlled Trials. Degener Neurol Neuromuscul Dis 2021; 11:51-60. [PMID: 34512072 PMCID: PMC8420562 DOI: 10.2147/dnnd.s317865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Ankle joint mobilization with movement has been speculated to be an important intervention for enhancing range of motion, balance, and gait functions in chronic stroke survivors. Nonetheless, there is a scarcity of recent conclusive evidence that evaluates its efficacy in chronic stroke patients. The purpose of this review was to synthesize existing evidence on the efficacy of mobilization with movement therapy on range of motion, balance, and gait performance in subjects after stroke. Methods A comprehensive systematic search of literature was performed using the following databases: PubMed/Medline, CINAHL, AMED, PEDro, Cochrane Library, and Scopus. Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of included trials. The primary outcome measures of this review were dorsiflexion range of motion (DF-ROM), and Berg balance scale (BBS). This review was reported in accordance with PRISMA statement guidelines. Due to variations in relevant trials, meta-analysis was not carried out. Results and Conclusions Seven randomized controlled trials with a total of 224 subjects were analyzed. Evidence of overall quality was graded from moderate to high. This review found that mobilization with movement therapy could be an alternative rehabilitative intervention for subjects with chronic stroke to increase range of motion, balance, and gait ability. However, the evidence remains preliminary due to the small number of participants. Large-scale RCTs in the future are warranted to investigate the efficacy of mobilization with movement in subgroups of chronic stroke subjects.
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Affiliation(s)
- Abayneh Alamer
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Haimanot Melese
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Kefale Getie
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Sisay Deme
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Molla Tsega
- Department of Internal Medicine, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Sileshi Ayhualem
- Department of Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebremeskel Birhanie
- Department of Physiotherapy, School of Medicine, College of Health Sciences, TibebeGhion Comprehensive Specialized Hospital, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yohannes Abich
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmare Yitayeh Gelaw
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kinematic consistency in the knee manipulation learning: A comparison between expert and beginner therapists. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Varas-Diaz G, Cordo P, Dusane S, Bhatt T. Effect of robotic-assisted ankle training on gait in stroke participants: A case series study. Physiother Theory Pract 2021; 38:2973-2982. [PMID: 34424126 DOI: 10.1080/09593985.2021.1964658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Robotic rehabilitation therapy has grown rapidly during the last two decades allowing researchers and clinicians to deliver high-intensity training to persons with sensorimotor disorders caused by neurological injuries and diseases. METHODS This case series reports the effect of robot-assisted, impairment-oriented training for persons recovering from stroke on impairment of the paretic ankle as well as on the kinematic and spatiotemporal parameters of gait. Five persons with chronic stroke (>6 months post-stroke) participated in a 10-week training protocol, receiving three, 30-min sessions per week of a robot-assisted therapy. The robot-assisted intervention cyclically induced dorsiflexion and plantarflexion to the ankle at 5 degrees/s through ±15 degrees while the participants assisted with the imposed movement. Concurrently, participants received visual feedback of their active, assistive torque as well as targeted mechanical vibration of the ankle tendons when lengthened by the applied motion. Walking speed, cadence, step length of the non-paretic leg, percentage of paretic single limb support during the gait cycle, and ankle strength were assessed just before training began (baseline), after the last training session (post-training), and 3 months post-training (follow-up). DISCUSSION Robot-assisted training that provided assisted movement, biofeedback, and proprioceptive stimulation reduced ankle impairment and improved kinematic and spatiotemporal gait parameters, suggesting that impairment-oriented therapy applied to the paretic ankle may provide a valuable adjunct to locomotor therapies in persons with chronic gait disorders due to stroke.
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Affiliation(s)
- Gonzalo Varas-Diaz
- Department of Physical Therapy. University of Illinois at Chicago. Chicago, IL United States
| | - Paul Cordo
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, United States.,AMES Technology, Inc, Portland, OR, United States
| | - Shamali Dusane
- Department of Physical Therapy. University of Illinois at Chicago. Chicago, IL United States
| | - Tanvi Bhatt
- Department of Physical Therapy. University of Illinois at Chicago. Chicago, IL United States
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Cho JE, Lee WH, Shin JH, Kim H. Effects of bi-axial ankle strengthening on muscle co-contraction during gait in chronic stroke patients: A randomized controlled pilot study. Gait Posture 2021; 87:177-183. [PMID: 33945964 DOI: 10.1016/j.gaitpost.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ankle dysfunction in patients with stroke is a common but serious cause of balance and gait impairments. However, comprehensive paretic ankle training seldom exists. Thus, we investigated the effects of a bi-axial ankle muscle training program using visual feedback as a means to improve ankle strength and performance of functional activities in patients with stroke. METHODS This study was a randomized controlled pilot trial with concealed allocation and assessor blinding and intention-to-treat analysis. Twenty-five patients with stroke and difficulty in walking (e.g., foot drop) or ankle muscle weakness receiving inpatient rehabilitation were included. The experimental group underwent ankle muscle training consisting of passive stretching, control of ankle muscles, and active-resistive strengthening using visual feedback for 40 min per day, 5 times per week for 4 weeks. The control group underwent ankle-related physical therapy, including ankle range-of-motion exercises. The amount of time for training was equal between the two groups. The outcome measurements were isometric ankle contraction force to assess the strength of ankle muscles, ankle proprioception, Fugl-Meyer lower extremity score, Berg balance scale score, walking speed, and ankle co-contraction index to assess muscle efficiency during gait. RESULTS The analysis revealed significant between-group differences in the ankle muscle strength in each direction (P < 0.05), Fugl-Meyer score (P < 0.01), and stance-phase co-contraction index (P < 0.05). After training, the experimental group displayed significant within-group differences in the strength of the ankle muscles in each direction (P < 0.01), ankle proprioception (P < 0.05), and walking speed (P < 0.05). CONCLUSIONS Our findings demonstrate the significant short-term effects of ankle muscle training on strength, walking speed, and muscle efficiency in patients with chronic stroke.
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Affiliation(s)
- Ji-Eun Cho
- National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, South Korea
| | - Wan-Hee Lee
- Department of Physical Therapy, Sahmyook University College of Health Science, Seoul, South Korea
| | - Joon-Ho Shin
- National Rehabilitation Hospital, National Rehabilitation Center, Seoul, South Korea
| | - Hogene Kim
- National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, South Korea.
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Dice JL, Dendy D, Sizer PS, Cook CE, Feuling S, Brismée JM. Manual Therapy in Preadolescent Children: A Delphi Investigation of Physical Therapists in the United States. Phys Ther 2021; 101:6123359. [PMID: 33513233 DOI: 10.1093/ptj/pzab027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 10/24/2020] [Accepted: 11/29/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Limited research has investigated the use of manual therapy to treat the preadolescent (0-12 years of age) population with musculoskeletal and neurological impairments. The purpose of this study was to identify the following among physical therapists holding advanced credentials in pediatrics, neurodevelopmental treatment, or manual therapy: (1) consensus regarding effective techniques in the preadolescent population, (2) differences in opinion, and (3) perceived decision-making barriers and factors regarding use of manual therapy techniques. METHODS Credentialed physical therapists in the United States were recruited for a 3-round Delphi investigation. An electronic survey in Round 1 identified musculoskeletal and neurological impairments and the manual techniques considered effective to treat such conditions, in addition to factors and barriers. Responses were used to create the second round, during which a 4-point Likert scale was used to score each survey item. A third round of scoring established consensus. Descriptive statistics and composite scores were calculated for each manual technique by impairment. Between-group differences were calculated using the Mann-Whitney U test with Bonferroni correction. RESULTS Consensus was determined for several concepts. First, neuromuscular techniques were considered effective across all impairments, and joint mobilizations (grades I-IV) were believed to be effective to treat joint and muscle and myofascial impairments. Second, visceral manipulation and craniosacral therapy were considered ineffective in treating most impairments. There was lack of consensus and clear differences of opinion regarding the use of grade V mobilizations and dry needling. Significant barriers to use of manual therapy were: lack of knowledge, lack of evidence, and fear of litigation and harming patients. CONCLUSION This study is an initial step for developing manual therapy guidelines, research, and educational opportunities regarding manual therapy in pediatric physical therapy.
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Affiliation(s)
- Jenifer L Dice
- Texas Children's Hospital, Department of Physical Medicine and Rehabilitation, Houston, Texas, USA.,Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Doug Dendy
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Phillip S Sizer
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Chad E Cook
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Sara Feuling
- Texas Children's Hospital, Department of Physical Medicine and Rehabilitation, Houston, Texas, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Svane C, Nielsen JB, Lorentzen J. Nonsurgical Treatment Options for Muscle Contractures in Individuals With Neurologic Disorders: A Systematic Review With Meta-Analysis. Arch Rehabil Res Clin Transl 2021; 3:100104. [PMID: 33778477 PMCID: PMC7984980 DOI: 10.1016/j.arrct.2021.100104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate whether nonsurgical treatment can reduce muscle contractures in individuals with neurologic disorders. The primary outcome measure was muscle contractures measured as joint mobility or passive stiffness. DATA SOURCES Embase, MEDLINE, Cumulative Index to Nursing and Allied Health, and Physiotherapy Evidence Database in June-July 2019 and again in July 2020. STUDY SELECTION The search resulted in 8020 records, which were screened by 2 authors based on our patient, intervention, comparison, outcome criteria. We included controlled trials of nonsurgical interventions administered to treat muscle contractures in individuals with neurologic disorders. DATA EXTRACTION Authors, participant characteristics, intervention details, and joint mobility/passive stiffness before and after intervention were extracted. We assessed trials for risk of bias using the Downs and Black checklist. We conducted meta-analyses investigating the short-term effect on joint mobility using a random-effects model with the pooled effect from randomized controlled trials (RCTs) as the primary outcome. The minimal clinically important effect was set at 5°. DATA SYNTHESIS A total of 70 trials (57 RCTs) were eligible for inclusion. Stretch had a pooled effect of 3° (95% CI, 1-4°; prediction interval (PI)=-2 to 7°; I 2=66%; P<.001), and robot-assisted rehabilitation had an effect of 1 (95% CI, 0-2; PI=-8 to 9; I 2=73%; P=.03). We found no effect of shockwave therapy (P=.56), physical activity (P=.27), electrical stimulation (P=.11), or botulinum toxin (P=.13). Although trials were generally of moderate to high quality according to the Downs and Black checklist, only 18 of the 70 trials used objective measures of muscle contractures. In 23 trials, nonobjective measures were used without use of assessor-blinding. CONCLUSIONS We did not find convincing evidence supporting the use of any nonsurgical treatment option. We recommend that controlled trials using objective measures of muscle contractures and a sufficiently large number of participants be performed.
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Key Words
- BTX, botulinum toxin
- CCT, controlled clinical trial
- Contracture
- Nervous System Diseases
- PI, prediction interval
- PICO, patient, intervention, comparison, outcome
- PROM, passive range of motion
- RCT, randomized controlled trial
- Range of motion, articular
- Rehabilitation
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Affiliation(s)
- Christian Svane
- Department of Neuroscience, University of Copenhagen, Copenhagen
- Elsass Foundation, Charlottenlund, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen
- Elsass Foundation, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen
- Elsass Foundation, Charlottenlund, Denmark
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Sabbah A, El Mously S, Elgendy HHM, Farag MAAE, Elwishy AAB. Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00170-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Approximately half of stroke patients show impaired upper limb and hand function. Task-oriented training focuses on functional tasks, while joint mobilization technique aims to restore the accessory movements of the joints.
Objective
To investigate the effect of adding joint mobilization to task-oriented training to help the patients in reaching a satisfactory level of recovery for their hand function.
Patients and methods
Thirty chronic stroke patients with paretic hand participated in the study; they were divided equally into study and control groups. The study group received joint mobilization followed by task-oriented training for the affected hand. Meanwhile, the control group received task-oriented training only. Both groups received their treatment in the form of 3 sessions per week for 6 successive weeks. The primary outcome measures were hand function that was assessed by Jebsen-Taylor hand function test (JTT) and active and passive wrist extension range of motion (ROM) that was measured by a standard goniometer. The secondary outcome measure was the grip strength of the hand that was assessed by a JAMAR adjustable hand dynamometer.
Results
There was a significant improvement in all the outcome measurements in both groups that were more evident in the study group.
Conclusion
Combining joint mobilization with task-oriented training had a highly significant effect in improving the hand function in chronic stroke patients compared to task-oriented training alone.
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Immediate Effects of Ankle Joint Mobilization With Movement on Postural Control, Range of Motion, and Muscle Strength in Healthy Individuals: A Randomized, Sham-Controlled Trial. J Sport Rehabil 2020; 29:1060-1068. [PMID: 31754078 DOI: 10.1123/jsr.2019-0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/30/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Ankle proprioception is one of the crucial components contributing to postural control. Although the effects of Mulligan's mobilization with movement (MWM) on postural control, ankle dorsiflexion range of motion (DFROM), and muscle strength in people with ankle disorders have previously been investigated, it is still unclear whether ankle MWM had ability to change postural control, DFROM, and muscle strength. OBJECTIVES To reveal pure effects of MWM on postural control, ankle DFROM, and muscle strength in healthy individuals. DESIGN A prospective, randomized, double-blinded, sham-controlled study. SETTING Musculoskeletal laboratory, Dokuz Eylul University, Turkey. PARTICIPANTS Forty students in good health recruited from a local university. INTERVENTIONS Mulligan's MWM or sham application over ankle joint. MAIN OUTCOME MEASURES The primary outcome was postural control and measured using limits of stability (LOS) test. The secondary outcomes were tibialis anterior muscle strength and ankle DFROM, which were measured using handheld dynamometer and weight-bearing lunge test, respectively. All outcomes were assessed before and immediately after intervention. RESULTS Left and right ankle DFROM and LOS overall score showed a statistically significant improvement compared with first measurement in both groups (P < .05). However, LOS time was significantly improved only in the MWM group (P < .05). Statistical analyses of between-group mean differences showed that Mulligan's MWM provided significant improvement in the LOS in forward-right direction compared with sham application (P = .03). CONCLUSIONS The results of this study suggest that the application of Mulligan's MWM on ankle joint might be beneficial to improve postural control in forward right direction in individuals with healthy ankles. On the other hand, both MWM and sham application were able to increase overall postural control and DFROM, and MWM had no superiority over sham application for increasing these 2 variables.
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Youn PS, Cho KH, Park SJ. Changes in Ankle Range of Motion, Gait Function and Standing Balance in Children with Bilateral Spastic Cerebral Palsy after Ankle Mobilization by Manual Therapy. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E142. [PMID: 32961844 PMCID: PMC7552781 DOI: 10.3390/children7090142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the effect of ankle joint mobilization in children with cerebral palsy (CP) to ankle range of motion (ROM), gait, and standing balance. We recruited 32 children (spastic diplegia) diagnosed with CP and categorized them in two groups: the ankle joint mobilization (n = 16) group and sham joint mobilization (n = 16) group. Thus, following a six-week ankle joint mobilization, we examined measures such as passive ROM in ankle dorsiflexion in the sitting and supine position, center of pressure (COP) displacements (sway length, area) with eyes open (EO) and closed (EC), and a gait function test (timed up and go test (TUG) and 10-m walk test). The dorsiflexion ROM, TUG, and 10-m walk test significantly increased in the mobilization group compared to the control group. Ankle joint mobilization can be regarded as a promising method to increase dorsiflexion and improve gait in CP-suffering children.
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Affiliation(s)
- Pong Sub Youn
- Department of Physical Therapy, Kyungbok University, Namyangju-si 425, Korea;
| | - Kyun Hee Cho
- AVENS Hospital, Dongan-gu, Anyang-si 307, Korea;
| | - Shin Jun Park
- Department of Physical Therapy, Gangdong University, Daehak-gil 278, Korea
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Gomes MG, Primo AF, De Jesus LLJR, Dionisio VC. Short-term Effects of Mulligan's Mobilization With Movement on Pain, Function, and Emotional Aspects in Individuals With Knee Osteoarthritis: A Prospective Case Series. J Manipulative Physiol Ther 2020; 43:437-445. [PMID: 32839020 DOI: 10.1016/j.jmpt.2019.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the short-term effects of Mulligan's mobilization with movement (MWM) on pain, physical function, emotional aspects, and proprioceptive acuity after a 2-week treatment period and throughout a 3-week follow-up period. METHODS A single group of 30 participants (60.96 ± 5.16 years) with symptomatic knee osteoarthritis (KOA) was evaluated. The protocol involved 5 evaluations moments, before (baseline) and after 2 weeks of intervention (24 hours after the last session), and at 3-week follow-up. The intervention included 3 Mulligan's MWM techniques. The variables evaluated were pain (pressure pain threshold and Visual Numeric Scale), physical function (range of motion, proprioceptive acuity, and the Western Ontario and McMaster Universities Osteoarthritis Index) and emotional aspects (Beck Depression Inventory). Analysis of variance for repeated measures was used considering a significance level of 5%. RESULTS At the second evaluation (after intervention), the pressure pain threshold presented higher values for rectus femoris, tibialis anterior, and patellar tendon sites and reduced values for the Visual Numeric Scale, Beck Depression Inventory, and Western Ontario and McMaster Universities Osteoarthritis Index compared with baseline. Also, during the follow-up period, all variables returned close to baseline levels. Proprioceptive acuity and range of motion did not present significant changes. CONCLUSION Scores for pain relief, physical function, and emotional aspects improved after a course of MWM in this single group of individuals with KOA. Mobilization with movement had limited outcome during follow-up. It suggests that future clinical trials on the use of MWM for KOA should be considered.
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Affiliation(s)
- Matheus G Gomes
- Department of Physical Therapy, Federal University of Uberlândia, Brazil, Uberlândia, MG, Brazil.
| | - Anaysa F Primo
- Department of Physical Therapy, Federal University of Uberlândia, Brazil, Uberlândia, MG, Brazil
| | - Linda L J R De Jesus
- Department of Physical Therapy, Federal University of Uberlândia, Brazil, Uberlândia, MG, Brazil
| | - Valdeci C Dionisio
- Department of Physical Therapy, Federal University of Uberlândia, Brazil, Uberlândia, MG, Brazil
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Yoo D, Kim DH, Seo KH, Lee BC. The Effects of Technology-Assisted Ankle Rehabilitation on Balance Control in Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1817-1823. [DOI: 10.1109/tnsre.2019.2934930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Park D, Lee JH, Kang TW, Cynn HS. Four-week training involving ankle mobilization with movement versus static muscle stretching in patients with chronic stroke: a randomized controlled trial. Top Stroke Rehabil 2018; 26:81-86. [PMID: 30477417 DOI: 10.1080/10749357.2018.1550614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with stroke generally have diminished balance and gait. Mobilization with movement (MWM) can be used with manual force applied by a therapist to enhance talus gliding movement. Furthermore, the weight-bearing position during the lunge may enhance the stretch force. OBJECTIVES This study aimed to compare the effects of a 4-week program of MWM training with those of static muscle stretching (SMS). Ankle dorsiflexion passive range of motion (DF-PROM), static balance ability (SBA), the Berg balance scale (BBS), and gait parameters (gait speed and cadence) were measured in patients with chronic stroke. METHODS Twenty patients with chronic stroke participated in this study. Participants were randomized to either the MWM (n = 10) or the SMS (n = 10) group. Patients in both groups underwent standard rehabilitation therapy for 30 min per session. In addition, MWM and SMS techniques were performed three times per week for 4 weeks. Ankle DF-PROM, SBA, BBS score, and gait parameters were measured after 4 weeks of training. RESULTS After 4 weeks of training, the MWM group showed significant improvement in all outcome measures compared with baseline (p < 0.05). Furthermore, SBA, BBS, and cadence showed greater improvement in the MWM group compared to the SMS group (p < 0.05). CONCLUSIONS This study demonstrated that MWM training, combined with standard rehabilitation, improved ankle DF-PROM, SBA, BBS scores, and gait speed and cadence. Thus, MWM may be an effective treatment for patients with chronic stroke.
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Affiliation(s)
- Donghwan Park
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of Korea
| | - Ji-Hyun Lee
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of Korea
| | - Tae-Woo Kang
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of Korea
| | - Heon-Seock Cynn
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of Korea
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Yoo D, Son Y, Kim DH, Seo KH, Lee BC. Technology-Assisted Ankle Rehabilitation Improves Balance and Gait Performance in Stroke Survivors: A Randomized Controlled Study With 1-Month Follow-Up. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2315-2323. [PMID: 30418882 DOI: 10.1109/tnsre.2018.2879783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Many stroke survivors have limited ankle range of motion (ROM) caused by weak dorsiflexors and stiff plantarflexors. Passive ankle stretching exercises with physical therapists or a stretching board are usually recommended, but these treatments have some limitations (e.g., cost and availability of physical therapists). In this paper, we assessed the results of ankle stretching exercises delivered by a robotic ankle stretching system called motorized ankle stretcher (MAS) that we developed or by a stretching board on ankle ROM, balance control, and gait performance. The 16 stroke survivors were randomly assigned to an intervention group (IG) or a control group (CG) and participated in seven sessions of dorsiflexion stretching exercises for three-and-a-half consecutive weeks. Laboratory assessments included pre-assessment (baseline at the beginning of the first exercise session), post-assessment (at the end of the seventh exercise session), and retention assessment (one month after the seventh exercise session). All assessments included ankle ROM for the affected side, static/dynamic balance control with a sensory organization test (SOT), walking speed, walking cadence, and step length for the affected and unaffected sides. During seven sessions of ankle stretching exercises, the IG performed them using the MAS, and the CG used a stretching board. The IG significantly improved ankle ROM, SOT scores (i.e., static/dynamic balance control), walking speeds, walking cadences, and step lengths for the unaffected side after completing the seven exercise sessions of ankle stretching exercises and maintained the enhancements at the retention assessment. The CG did not significantly improve across the majority of outcome measures except for the SOT scores between the pre-assessment and retention assessment. Future work will investigate the ideal intensity, frequency, and duration of exercising with the MAS. Our research on technology-assisted ankle rehabilitation, which can ascertain the level of persistent improvement, long-term performance retention, and carry-over effects in stroke survivors, can be used to inform future designs.
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de Sousa DG, Harvey LA, Dorsch S, Glinsky JV. Interventions involving repetitive practice improve strength after stroke: a systematic review. J Physiother 2018; 64:210-221. [PMID: 30245180 DOI: 10.1016/j.jphys.2018.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022] Open
Abstract
QUESTIONS Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity? DESIGN Systematic review of randomised trials with meta-analysis. PARTICIPANTS Adults who have had a stroke. INTERVENTION Any intervention involving repetitive practice compared with no intervention or a sham intervention. OUTCOME MEASURES The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity. RESULTS Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2=44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2=50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2=36%) in favour of repetitive practice on lower limb activity. CONCLUSION Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. REVIEW REGISTRATION PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210-221].
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Affiliation(s)
- Davide G de Sousa
- Graythwaite Rehabilitation Centre, Ryde Hospital; John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
| | - Simone Dorsch
- Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
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Ganesh GS, Kumari R, Pattnaik M, Mohanty P, Mishra C, Kaur P, Dakshinamoorthy A. Effectiveness of Faradic and Russian currents on plantar flexor muscle spasticity, ankle motor recovery, and functional gait in stroke patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1705. [PMID: 29417699 DOI: 10.1002/pri.1705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/20/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE Spasticity is a major disabling symptom in patients post stroke. Though studies have demonstrated that electrical stimulation (ES) can reduce spasticity and improve passive ankle range of motion (ROM), not many studies have evaluated the effectiveness of ES on active ankle ROM. The purpose of this study was to determine the effectiveness of Faradic and Russian currents in the reduction of ankle plantar-flexor spasticity and improving motor recovery in patients post stroke. METHODS Eighty-three patients (29 females and 54 males; mean age of 57.12 years) were randomly assigned to Group 1 (task-oriented exercises), Group 2 (Faradic current for 10 min and task-oriented exercises), and Group 3 (Russian current for 10 min and task-oriented exercises) for a period of 5 sessions per week for 6 weeks. All patients were assessed for soleus and gastrocnemius muscles spasticity measured by modified modified Ashworth scale; active and passive range ROM measured by goniometer; and functional ambulation measured by modified Emory Functional Ambulation Profile at the time of recruitment to study and after 6 weeks. RESULTS Both the types of stimulation and exercises were not associated with improvements in modified Emory Functional Ambulation Profile (p > 0.05). The results showed that all the groups are effective in improving passive ankle ROM (p < 0.05) and reducing soleus and gastrocnemius muscles spasticity (p < 0.05). Though all the groups were effective in improving active ankle ROM, no group was found to be superior to another after treatment CONCLUSION: Adding ES to exercises are associated with low to medium effect sizes (<0.5) in reducing spasticity and improving ankle ROM.
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Affiliation(s)
- G Shankar Ganesh
- Composite Regional Centre for Persons with Disabilities, Lucknow, Uttar Pradesh, India
| | | | - Monalisa Pattnaik
- Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack Dt, Odisha, India
| | - Patitapaban Mohanty
- Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack Dt, Odisha, India
| | - Chittaranjan Mishra
- Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack Dt, Odisha, India
| | - Parminder Kaur
- Ohio State University School of Health and Rehabilitation Sciences, Columbus, OH, USA
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Vecchio M, Gracies JM, Panza F, Fortunato F, Vitaliti G, Malaguarnera G, Cinone N, Beatrice R, Ranieri M, Santamato A. Change in Coefficient of Fatigability Following Rapid, Repetitive Movement Training in Post-Stroke Spastic Paresis: A Prospective Open-Label Observational Study. J Stroke Cerebrovasc Dis 2017; 26:2536-2540. [PMID: 28666805 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND In post-stroke patients, the possibility of performing an active ankle dorsiflexion movement is favorable for the recovery of gait. Moreover, the fatigue due to repetitive active ankle dorsiflexion could reduce the speed gait. We assessed the change in coefficient of fatigability of active ankle dorsiflexion after a home-based self-rehabilitative procedure in post-stroke patients. METHODS In a prospective open-label observational study conducted in 2 university hospitals, a home-based self-rehabilitation treatment comprising two 12-minute sessions per day (3 times per week for 3 months) was performed by 10 outpatients with post-stroke lower limb impairment. Each session consisted of three 1-minute series of repeated active ankle dorsiflexion efforts at maximal speed on the paretic side, each one followed by 3-minute bouts of triceps surae stretch. Coefficients of fatigability of dorsiflexion and 10-meter barefoot ambulation speed were evaluated at baseline and at the end of the program. RESULTS At 3 months of follow-up, there was a decrease in the coefficients of fatigability of ankle dorsiflexion, both with knee flexed and extended (respectively from 8% to 2% and from 6% to 2%; P < .01), associated with an increase in comfortable ambulation speed (from .24 to .26 m/s; P < .05). CONCLUSIONS The reduction of coefficient of fatigability of ankle dorsiflexion, together with walking speed improvement, suggested the effectiveness of self-rehabilitation using alternated periods of self-stretch and rapid alternating efforts in the paretic lower limb after stroke.
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Affiliation(s)
- Michele Vecchio
- U.O. of Physical Medicine and Rehabilitation, Policlinico Vittorio Emanuele University Hospital, University of Catania, Catania, Italy
| | - Jean-Michel Gracies
- EA 7377 BIOTN, Université Paris-Est, Albert Chenevier-Henri Mondor Hospital, Service de Rééducation Neurolocomotrice, AP-HP, Créteil, France
| | - Francesco Panza
- U.O. of Physical Medicine and Rehabilitation, Policlinico Vittorio Emanuele University Hospital, University of Catania, Catania, Italy; Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico," Tricase, Lecce, Italy; Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.
| | - Francesca Fortunato
- Section of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giovanna Vitaliti
- Institute of Pediatrics, Policlinico Vittorio Emanuele University Hospital, University of Catania, Catania, Italy
| | - Giulia Malaguarnera
- Research Center "The Great Senescence," University of Catania, Catania, Italy
| | - Nicoletta Cinone
- "Physical Medicine and Rehabilitation" Unit, "OORR Hospital," University of Foggia, Foggia, Italy
| | - Raffaele Beatrice
- "Physical Medicine and Rehabilitation" Unit, "OORR Hospital," University of Foggia, Foggia, Italy
| | - Maurizio Ranieri
- "Physical Medicine and Rehabilitation" Unit, "OORR Hospital," University of Foggia, Foggia, Italy
| | - Andrea Santamato
- "Physical Medicine and Rehabilitation" Unit, "OORR Hospital," University of Foggia, Foggia, Italy; "Fondazione Turati" Rehabilitation Centre, Vieste, Foggia, Italy.
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