The Effect of a Hand-Stretching Device During the Management of Spasticity in Chronic Hemiparetic Stroke Patients

다국어 초록 (Multilingual Abstract)

Objective To describe a hand-stretching device that was developed for the management of hand spasticity in chronic hemiparetic stroke patients, and the effects of this device on hand spasticity. Methods Fifteen chronic hemiparetic stroke patients with finger flexor spasticity were recruited and randomly assigned to an intervention group (8 patients) or a control group (7 patients). The stretching device consists of a resting hand splint, a finger and thumb stretcher, and a frame. In use, the stretched state was maintained for 10 minutes per exercise session, and the exercise was performed twice daily for 4 weeks. Spasticity of finger flexor muscles in the two groups was assessed 3 times, 4 weeks apart, using the Modified Ashworth Scale (MAS). Patients in the intervention group were assessed twice (pre-1 and pre-2) before and once (post-1) after starting the stretching program. Results Mean MAS (mMAS) scores at initial evaluations were not significantly different at pre-1 in the intervention group and at 1st assessment in the control group (p>0.05). In addition, no significant differences were observed between mMAS scores at pre-1 and pre-2 in the intervention group (p>0.05). However, mMAS scores at post-1 were significantly lower than that at pre-2 in the intervention group (p<0.05). Within the control group, no significant changes in mMAS scores were observed between 1st, 2nd, and 3rd assessments (p>0.05). In addition, mMAS scores at post-1 in the intervention group were significantly decreased compared with those at the 3rd assessment in the control group (p<0.05).Conclusion The devised stretching device was found to relieve hand spasticity effectively in chronic hemiparetic stroke patients.

참고문헌 (Reference)

1 Lance JW., "What is spasticity?" 335 : 606-, 1990

2 Ng SS., "Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke" 38 : 2953-2959, 2007

3 Turk R., "Therapeutic effectiveness of electric stimulation of the upper-limb poststroke using implanted microstimulators" 89 : 1913-1922, 2008

4 Mori F., "The use of repetitive transcranial magnetic stimulation(rTMS)for the treatment of spasticity" 175 : 429-439, 2009

5 Sahrmann SA., "The relationship of voluntary movement to spasticity in the upper motor neuron syndrome" 2 : 460-465, 1977

6 Mehrholz J., "The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury" 19 : 63-72, 2005

7 Pin T., "The effectiveness of passive stretching in children with cerebral palsy" 48 : 855-862, 2006

8 Bressel E., "The effect of prolonged static and cyclic stretching on ankle joint stiffness, torque relaxation, and gait in people with stroke" 82 : 880-887, 2002

9 Jung YJ., "The effect of a stretching device on hand spasticity in chronic hemiparetic stroke patients" 29 : 53-59, 2011

10 장성호, "The Effect of Selective Tibial Neurotomy and Rehabilitation in a Quadriplegic Patient with Ankle Spasticity Following Traumatic Brain Injury" 연세대학교의과대학 45 (45): 743-747, 2004

11 O’Dwyer NJ., "Spasticity and muscle contracture following stroke" 119 (119): 1737-1749, 1996

12 Landau WM., "Spasticity : the fable of a neurological demon and the emperor’s new therapy" 31 : 217-219, 1974

13 Oki A., "Selective dorsal rhizotomy in children with spastic hemiparesis" 6 : 353-358, 2010

14 Gregson JM., "Reliability of the tone assessment scale and the Modified Ashworth Scale as clinical tools for assessing poststroke spasticity" 80 : 1013-1016, 1999

15 Nuyens GE., "Reduction of spastic hypertonia during repeated passive knee movements in stroke patients" 83 : 930-935, 2002

16 Monaghan K., "Physical treatment interventions for managing spasticity after stroke" 7 : 1-25, 2011

17 Gallichio JE., "Pharmacologic management of spasticity following stroke" 84 : 973-981, 2004

18 Bohannon RW., "Interrater reliability of a Modified Ashworth Scale of muscle spasticity" 67 : 206-207, 1987

19 Kaya T., "Inter-rater reliability of the Modified Ashworth Scale and modified Modified Ashworth Scale in assessing poststroke elbow flexor spasticity" 34 : 59-64, 2011

20 Zhang LQ., "Intelligent stretching of ankle joints with contracture/spasticity" 10 : 149-157, 2002

21 Selles RW., "Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke : effects of a 4-week intervention program" 86 : 2330-2336, 2005

22 Tsai KH., "Effects of a single session of prolonged muscle stretch on spastic muscle of stroke patients" 25 : 76-81, 2001

23 Wu CL., "Effect on spasticity after performance of dynamic-repeated-passive ankle joint motion exercise in chronic stroke patients" 22 : 610-617, 2006

24 Jang SH., "Alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle to treat ankle spasticity in patients with hemiplegic stroke" 85 : 506-508, 2004

25 Lannin NA., "A systematic review of upper extremity casting for children and adults with central nervous system motor disorders" 21 : 963-976, 2007

26 Harvey LA., "A randomized trial assessing the effects of 4 weeks of daily stretching on ankle mobility in patients with spinal cord injuries" 81 : 1340-1347, 2000