Objective: To evaluate the effect of treatment with a portable device called Stimulo on range of motion, muscle strength and spasticity in the ankle joint and its effect on walking ability, balance, activities of daily living (ADL) and health-related quality of life in stroke patients.
Design: A randomized controlled pilot study.
Setting: A research centre.
Subjects: Ambulatory or partly ambulatory chronic stroke patients with remaining spasticity and/or decreased range of motion in the hemiparetic leg/ankle.
Interventions: Standardized and individualized programme including active and passive range of motion of the ankle with a portable device (Stimulo), performed three times a week for 30 min, over a six-week period.
Main measures: Range of motion, muscle strength, spasticity, gait variables, balance, ADL and health-related quality of life.
Results: Eighteen subjects were included in the study with a mean age of 75 years. The compliance rate was 94-99%. There were no significant differences between the groups.
Conclusion: The study showed no significant effect of an ankle-exercise intervention programme with Stimulo. Further studies with a larger sample size are of importance before any further conclusions can be drawn.
Hendricks HT, van Limbeek J, Geurts AC, Zwarts MJ. Motor recovery after stroke: a systematic review of the literature. Arch Phys Med Rehabil2002; 83: 1629-1637.
3.
Bugge C, Hagen S, Alexander H.Measuring stroke patients' health status in the early post-stroke phase using the SF36. Int J Nurs Stud2001; 38: 319-327.
4.
Carod-Artal J, Egido JA, Gonzalez JL, Varela de Seijas E. Quality of life among stroke survivors evaluatedyear after stroke: experience of a stroke unit. Stroke2000; 31: 2995-3000.
5.
Kim P, Warren S, Madill H, Hadley M.Quality of life of stroke survivors. Qual Life Res 1999; 8: 293-301. King RB. Quality of life after stroke. Stroke1996; 27: 1467-1472.
6.
Desrosiers J, Malouin F, Bourbonnais D, Richards CL, Rochette A, Bravo G.Arm and leg impairments and disabilities after stroke rehabilitation: relation to handicap. Clin Rehabil2003; 17: 666-673.
7.
Vattanasilp W, Ada L, Crosbie J.Contribution of thixotropy, spasticity, and contracture to ankle stiffness after stroke. J Neurol Neurosurg Psychiatry2000; 69: 34-39.
8.
Sommerfeld DK, Eek EU, Svensson AK, Holmqvist LW, von Arbin MH. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke2004; 35: 134-139.
9.
Watkins CL, Leathley MJ, Gregson JM, Moore AP, Smith TL, Sharma AK. Prevalence of spasticity post stroke. Clin Rehabil2002; 16: 515-522.
10.
Canning CG, Ada L, O'Dwyer N.Slowness to develop force contributes to weakness after stroke. Arch Phys Med Rehabil1999; 80: 66-70.
11.
Michael KM, Allen JK, Macko RF. Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil2005; 86: 1552-1556.
12.
Hsu AL, Tang PF, Jan MH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil2003; 84: 1185-1193.
13.
Dobkin BH, Firestine A, West M, Saremi K, Woods R.Ankle dorsiflexion as an fMRI paradigm to assay motor control for walking during rehabilitation. Neuroimage2004; 23: 370-381.
14.
Lin SI. Motor function and joint position sense in relation to gait performance in chronic stroke patients. Arch Phys Med Rehabil2005; 86: 197-203.
15.
Nadeau S, Arsenault AB, Gravel D, Bourbonnais D.Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke. Am J Phys Med Rehabil1999; 78: 123-130.
16.
Ouellette MM, LeBrasseur NK, Bean JF et al. High-intensity resistance training improves muscle strength, self-reported function, and disability in long-term stroke survivors. Stroke2004; 35: 1404-1409.
17.
Tsai KH, Yeh CY, Chang HY, Chen JJ. Effects of a single session of prolonged muscle stretch on spastic muscle of stroke patients. Proc Natl Sci Counc Repub China B2001; 25: 76-81.
18.
Bressel E, McNair PJ. The effect of prolonged static and cyclic stretching on ankle joint stiffness, torque relaxation, and gait in people with stroke. Phys Ther2002; 82: 880-887.
19.
Zhang LQ, Chung SG, Bai Z, Xu D et al. Intelligent stretching of ankle joints with contracture/spasticity. IEEE Trans Neural Syst Rehabil Eng2002; 10: 149-157.
20.
Maynard V, Bakheit AMO, Shaw S.Comparison of the impact of a single session of isokinetic or isotonic muscle stretch on gait in patients with spastic hemiparesis. Clin Rehabil2005; 19: 146-154.
21.
Morris SL, Dodd KJ, Morris ME. Outcomes of progressive resistance strength training following stroke: a systematic review. Clin Rehabil2004; 18: 27-39.
22.
Sullivan M, Karlsson J.The Swedish SF-Health Survey III. Evaluation of criterion-based validity: results from normative population. J Clin Epidemiol1998; 51: 1105-1113.
23.
Gandek B, Ware JE Jr, Aaronson NK et al. Tests of data quality, scaling assumptions, and reliability of the SF-in eleven countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol1998; 51: 1149-1158.
24.
Kidd D, Stewart G, Baldry J et al. The Functional Independence Measure: a comparative validity and reliability study. Disabil Rehabil1995; 17: 10-14.
25.
Grimby G, Gudjonsson G, Rodhe M, Sunnerhagen KS, Sundh V, Ostensson ML. The functional independence measure in Sweden: experience for outcome measurement in rehabilitation medicine. Scand J Rehabil Med1996; 28: 51-62.
26.
Daving Y, Andrén E, Grimby G.Inter-rater agreement using the Instrumental Activity Measure. Scand J Occup Ther2000; 7: 33-38.
27.
Rossier P, Wade DT. Validity and reliability comparison ofmobility measures in patients presenting with neurologic impairment. Arch Phys Med Rehabil2001; 82: 9-13.
28.
Steffen TM, Hacker TA, Mollinger L.Age and gender-related test performance in communitydwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther2002; 82: 128-137.
29.
Ng SS, Hui-Chan CW. The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. Arch Phys Med Rehabil2005; 86: 1641-1647.
30.
Franchignoni F, Tesio L, Martino MT, Ricupero C.Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females. Aging (Milano)1998; 10: 26-31.
31.
Rossiter-Fornoff JE, Wolf SL, Wolfson LI, Buchner DM. A cross-sectional validation study of the FICSIT common data base static balance measures. J Gerontol1995; 50A: M291-M297.
32.
Gajdosik RL, Bohannon RW. Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity. Phys Ther1987; 67: 1867-1872.
33.
Elveru RA, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting. Subtalar and ankle joint measurements. Phys Ther1988; 68: 672-677.
34.
Phillips WT, Batterham AM, Valenzuela JE, Burkett LN. Reliability of maximal strength testing in older adults. Arch Phys Med Rehabil2004; 85: 329-334.
35.
Braith RW, Graves JE, Leggett SH, Pollock ML. Effects of training on the relationship between maximal and submaximal strength. Med Sci Sports Exerc1993; 25: 132-138.
36.
Blackburn M, van Vliet P, Mockett SP. Reliability of measurements obtained with the modified Ashworth scale in the lower extremities of people with stroke. Phys Ther2002; 82: 25-34.
37.
Gregson JM, Leathley M, Moore AP, Sharma AK, Smith TL, Watkins CL. Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing post stroke spasticity. Arch Phys Med Rehabil1999; 80: 1013-1016.
38.
Gregson JM, Leathley MJ, Moore AP, Smith TL, Sharma AK, Watkins CL. Reliability of measurements of muscle tone and muscle power in stroke patients. Age Ageing2000; 29: 223-228.
39.
Hughes MD. Multiplicity in clinical trials. In Armitage P, Colton T eds. Encyclopedia of biostatistics, second edition. John Wiley & Sons, 2005: 3446-3451.
40.
World Health Organization. International classification of functioning, disability and health: ICF. WHO Library Cataloguing-in-Publication Data, 2001.
41.
Kautz SA, Patten C.Interlimb influences on paretic leg function in poststroke hemiparesis. J Neurophysiol2005; 93: 2460-2473.
