Ochi A1,2, Fukumoto M2, Takami R2, Ohko H1, Hayashi T1, Yamada K1,2
1Seijoh University, Department of Care and Rehabilitation, Tokai-City, Japan, 2Wakokai Yamada Hospital, Department of Rehabilitation, Gifu, Japan
Background: Ankle stretching through weight bearing using a tilt table is often performed from the early stage after stroke onset. Ankle plantarflexor stretching extends the maximum range of motion (ROM) during ankle dorsiflexion, decreases muscle-tendon unit stiffness due to passive torque reduction, and improves spasticity of the affected limb in patients with stroke as measured by modified Ashworth Scale (MAS). Previous studies showed that the H-reflex of the soleus muscle in the affected limb decreases during voluntary arm cycling in patients with stroke. As H-reflex reflects motoneuron pool excitability, H-reflex reduction may enhance the expansion effect of soft tissue extensibility by stretching. It was hypothesized that stretching with arm cycling would result in greater ROM and more decreased stiffness in the affected limb of patients with stroke compared with the usual stretching with rested arm.
Purpose: This study aimed to ascertain whether ankle stretching combined with arm cycling results in greater improvements in maximum dorsiflexion ROM, calf muscle stiffness, and gait velocity in the affected limb of patients with stroke compared to that without arm cycling.
Methods: Nine patients (5 males, age 61.1 ± 11.8 years, BMI 23.0 ± 1.7 kg/m2, time since stroke 8.7 ± 2.5 week, ankle MAS 1~2) who had stroke for the first time and were admitted to rehabilitation wards participated in this study. The inclusion criteria included ability to walk a 10-m distance independently without ankle-foot orthosis. Random ABAB reversal design was used in this study. Participants performed a 10-min ankle stretching using their own weight (non-use arm cycling [NAC], period A), and 10-min arm cycling was added to the stretching performed in period A (added arm cycling [AAC], period B). The participants were instructed to perform the arm cycling as voluntarily as possible with servo motor assistance at 60 revolutions per minute. The affected side of the upper limb was securely fastened to the pedal with a rubber belt. Pre- and post-stretching maximum ROM for ankle dorsiflexion and passive plantarflexor torque were measured using a custom-made passive torque indicator. Stiffness was calculated based on passive torque-angle relationships.
Results: As a reference, the pre-stretching data for maximum ROM and stiffness were 18.1 ± 3.2 deg and 48.2 ± 14.9 Nm/rad in all patients. Maximum ROM and stiffness significantly improved after stretching in both conditions. Differences in stiffness between conditions were observed, and the rate of change in stiffness was significantly greater in AAC (-16.8%) than in NAC (-7.9%) (p 0.05). No significant difference in the rate of change in maximum ROM between AAC (11.4%) and NAC (10.3%) was observed.
Conclusion(s): Ankle stretching through weight bearing with arm cycling could more effectively reduce calf muscle stiffness of the affected lower limb in patients with stroke compared with the usual stretching with rested upper limb.
Implications: This stretching technique could be conveniently used in the clinical setting, has a low cost, and has clinical importance. Future research needs to investigate whether long-term stretching interventions using this stretching technique would result in long-term effects on ROM and stiffness.
Keywords: Ankle stretching, Arm cycling, Stroke
Funding acknowledgements: This work was supported by Seijoh University Joint Research Promoting Grant.
Purpose: This study aimed to ascertain whether ankle stretching combined with arm cycling results in greater improvements in maximum dorsiflexion ROM, calf muscle stiffness, and gait velocity in the affected limb of patients with stroke compared to that without arm cycling.
Methods: Nine patients (5 males, age 61.1 ± 11.8 years, BMI 23.0 ± 1.7 kg/m2, time since stroke 8.7 ± 2.5 week, ankle MAS 1~2) who had stroke for the first time and were admitted to rehabilitation wards participated in this study. The inclusion criteria included ability to walk a 10-m distance independently without ankle-foot orthosis. Random ABAB reversal design was used in this study. Participants performed a 10-min ankle stretching using their own weight (non-use arm cycling [NAC], period A), and 10-min arm cycling was added to the stretching performed in period A (added arm cycling [AAC], period B). The participants were instructed to perform the arm cycling as voluntarily as possible with servo motor assistance at 60 revolutions per minute. The affected side of the upper limb was securely fastened to the pedal with a rubber belt. Pre- and post-stretching maximum ROM for ankle dorsiflexion and passive plantarflexor torque were measured using a custom-made passive torque indicator. Stiffness was calculated based on passive torque-angle relationships.
Results: As a reference, the pre-stretching data for maximum ROM and stiffness were 18.1 ± 3.2 deg and 48.2 ± 14.9 Nm/rad in all patients. Maximum ROM and stiffness significantly improved after stretching in both conditions. Differences in stiffness between conditions were observed, and the rate of change in stiffness was significantly greater in AAC (-16.8%) than in NAC (-7.9%) (p 0.05). No significant difference in the rate of change in maximum ROM between AAC (11.4%) and NAC (10.3%) was observed.
Conclusion(s): Ankle stretching through weight bearing with arm cycling could more effectively reduce calf muscle stiffness of the affected lower limb in patients with stroke compared with the usual stretching with rested upper limb.
Implications: This stretching technique could be conveniently used in the clinical setting, has a low cost, and has clinical importance. Future research needs to investigate whether long-term stretching interventions using this stretching technique would result in long-term effects on ROM and stiffness.
Keywords: Ankle stretching, Arm cycling, Stroke
Funding acknowledgements: This work was supported by Seijoh University Joint Research Promoting Grant.
Topic: Neurology: stroke; Disability & rehabilitation
Ethics approval required: Yes
Institution: Seijoh University
Ethics committee: Ethical Review Board of Seijoh University
Ethics number: 2016A0029
All authors, affiliations and abstracts have been published as submitted.
