PROPRIOCEPTIVE-BASED TRAINING FOR THE RECOVERY OF VOLUNTARY MUSCLE CONTRACTION IN THE SUBACUTE PHASE AFTER STROKE

P. Kiper¹, A. Baba², L. Maistrello³, S. Rossi⁴, M. Agostini⁵, A. Turolla⁶, D. Falla⁷

¹IRCCS San Camillo Hospital, Healthcare Innovation Technology Lab, Venice, Italy, ²Azienda Ospedale Università Padova, Padova, Italy, ³IRCCS San Camillo Hospital, Venice, Italy, ⁴Fisio133, Venice, Italy, ⁵University of Padua, Neurophysiology and Movement Rehabilitation Group, Padova, Italy, ⁶Alma Mater Studiorum Università di Bologna, Department of Biomedical and Neuromotor Sciences – DIBINEM, Bologna, Italy, ⁷University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom

Background: Proprioceptive-based training (PBT) involves a specific proprioceptive treatment modality based on position recognition of the upper limb and simultaneous execution of the task with concurrent use of feedback. PBT requires that the position of both limbs is recognized in each movement phase, to stimulate proprioception of the affected arm.

Purpose: To evaluate the effect of PBT for recovery of voluntary muscle contraction and compare this with conventional unilateral treatment, in the subacute phase after stroke.

Methods: Stroke survivors (recruited within 6 months from stroke onset) and with severe upper extremity paresis were considered eligible. In the PBT group, patients were asked to generate a bilateral motor task that was executed coherently with the initialization of the patient’s movement and supported by the physiotherapist on the paretic side. Thus, the movements of both limbs were performed simultaneously, and the unaffected arm was considered as visual feedback. In the conventional treatment (CT) group, patients were treated according to post-stroke guidelines.
The treatments lasted 1 hour/day, 5 days/week for 3 weeks. The Fugl-Meyer Upper Extremity scale (F-M UE), Functional Independence Measure scale (FIM), Medical Research Council scale (MRC), Dynamometry measures (DYN), modified Ashworth scale and surface Electromyography (sEMG) of the biceps brachii, triceps brachii, flexor carpi ulnaris and radialis, extensor carpi ulnaris and radialis, digitorum flexors and digitorum extensors were administered at the beginning and at the end of training.

Results: Thirty-four patients with mean duration of 3.03±1.99 months since their stroke (24 ischemic and 10 hemorrhagic; 17 female and 17 male) were enrolled in the study and randomized to PBT (n=24) and CT (n=10) group, respectively.
Statistically significant improvement was observed within the PBT group for: sEMG amplitude of the biceps p=0.001, sEMG amplitude of the triceps p=0.002, MRC overall p=0.001, DYN p=0.001; F-M UE p=0.001; FIM p=0.001. The CT group improved in their: MRC overall score p=0.021, DYN p=0.022, Ashworth p=0.040).
Comparison between the groups showed significant difference for; sEMG triceps (p=0.039), MRC overall (p=0.001), DYN overall (p=0.001) and F-M UE (p=0.014).

Conclusions: PBT can promote voluntary muscle contraction in the early phase after stroke and may make the motor system more primed for future complex rehabilitation and functional recovery. The findings of this study revealed that PBT may be a feasible intervention, for stroke survivors.

Implications: PBT appears to be a feasible and effective treatment modality form for improving post-stroke motricity in the subacute phase. It might represent a favorable background for the development of an EMG-driven robotic device to be combined within the PBT approach.

Funding acknowledgements: This work was supported by the Italian Ministry of Health (Ricerca Corrente).

Keywords:
Neurorehabilitation
Stroke
Proprioception

Topics:
Neurology: stroke
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: IRCCS San Camillo Hospital

Committee: Ethics Committee of the IRCCS San Camillo Hospital

Ethics number: Protocollo 2012.07 BAT v.1.2