Stand Up and Climb Out of Ankle Spasticity
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Peter J. Lee
Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, et al. The effect of functional stretching exercises on functional outcomes in spastic stroke patients: a randomized controlled clinical trial [published online ahead of print]. J Bodyw Mov Ther. 2017. doi:10.1016/j.jbmt.2017.09.021
Ankle spasticity is a common impairment after stroke that affects ambulation and decreases the ability to carry out activities of daily living (ADL).1 An interdisciplinary team of researchers in Iran performed a randomized blinded clinical trial assessing the effect of functional exercises in improving these parameters.
Researchers enrolled 30 patients who had a stroke: 15 in the experimental group (5 men, 10 women; mean [SD] age, 49.67 [13.01] years) and 15 in the control group (9 men, 6 women; mean [SD] age, 54.87 [9.13] years). Participants were evaluated before and after the program and at 2-month follow-up. Inclusion criteria included “presence of a stroke according to the diagnosis of an experienced neurologist,” spasticity in gastrocnemius muscle, ability to obey instructions and participate in rehabilitation, and appropriate general health to perform exercises. Exclusion criteria included ankle deformity or contracture, lower limb pain, participation in another program, use of antispastic drugs, or other central nervous system lesions.
The experimental group followed a warmup protocol with static stretching exercises (inducing maximum dorsiflexion of the ankle) before the functional exercises, which included sit-to-stand, slope walking, and climbing up stairs. The control group received their routine physical therapy program, which entailed electrical stimulation, gait training, and passive lower extremity stretching. There were 3 clinical evaluations (muscle tone via the Modified Modified Ashworth Scale, Achilles deep tendon reflex, and ankle clonus) and 2 functional outcome measurements (10-m walking timed test [WTT] and timed up-and-go test [TUG]). The experimental group showed significant improvement in ankle spasticity (P=.002), Achilles deep tendon reflex (P=.042), ankle range of motion (P<.001), WTT (P<.001), and TUG (P<.001). Functional exercises led to a significant reduction in the muscle tone scale score and in the time of the TUG and WTT. These findings suggest that functional stretching exercises improve ankle spasticity and ambulation in patients with chronic stroke symptoms. Furthermore, this improvement was maintained for 2 months after the cessation of training.
Limitations of this study include the very selective inclusion and exclusion criteria, making the results impactful but not generalizable. Additionally, the number of months of disease in the control group (mean [SD], 18.60 [16.50]) does not specify whether the patients had acute or chronic stroke symptoms, nor whether other symptoms manifested as a result of their stroke. Furthermore, the physical therapy intervention seems inadequate compared with the functional exercise intervention, which is more appropriate for rehabilitation.
Active functional activities are more effective in improving stroke-induced ankle spasticity than passive physical therapy stretching, gait training, and electrical stimulation. The implications of these findings challenge the osteopathic approaches that involve passive osteopathic manipulative treatment. Clinical trials comparing osteopathic manipulative treatment used alone and in addition to active functional rehabilitation in this patient population would be of interest.
Reference
1. Wu CL , HuangMH, LeeCL, LiuCW, LinLJ, ChenCH. Effect on spasticity after performance of dynamic-repeated-passive ankle joint motion exercise in chronic stroke patients. Kaohsiung J Med Sci. 2006;22:e610-e617.10.1016/S1607-551X(09)70361-4Search in Google Scholar
© 2018 American Osteopathic Association
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