Abstract
Purpose: To develop a continuous passive motion (CPM) device for the passive motion of the paretic ankle-foot and investigate the effect of continuous passive motion of bedridden, hemiparetic acute stroke patients. Methods: 49 patients with stroke were investigated. Results in stroke patients (device group) were compared with those of 15 control subjects (manual group) also with stroke but not treated by device. The period of the treatment was 7 days; the duration was 30 minutes per day by CPM device in the device group. The efficacy of the device was evaluated by scales used in the clinical routine (6th item of National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale (MAS), modified Rankin Scale (mRS)). Ankle’s passive range of motion (PROM) and flexible equinovalgus deformitiy were measured every day with a goniometer. Results: 6th item of NIHSS score improved by -0.76 (SD = 0.56) points in the device group (p < 0.001) compared to the baseline values; the mean change in the manual group was -0.33 (SD = 0.62) points (p = 0.055). The mean of MAS decreased significantly by -0.53 (SD = 1.12) point in the device group (p < 0.001). The ankle’s mean plantar flexion PROM increased by 3.41 (SD = 5.19) degrees in the device group (p < 0.001). Significant improvement of the mean dorsiflexion in the PROM of the ankle was also detected (p = 0.019). The equinovalgus improved significantly by -5.12 (SD = 8.02) degrees (p < 0.001) in the device group. The scores of the mRS also improved significantly in the device group (p < 0.001). Conclusion: In the early phase of rehabilitation, ankle-foot continuous passive motion device treatment combined with manual therapy improved the ankle’s PROM better than manual therapy alone; in addition, device treatment decreased the foot’s equinovalgus, improved the 6th item NIHSS score, and decreased the severity of spasticity.
Highlights
Stroke is an important health care issue resulting in chronic disability and its early rehabilitation is still a challenge.The most common motor impairment is the hemiparesis of the upper and lower limb
Definition of mild and moderate paresis (6th item of National Institutes of Health Stroke Scale (NIHSS)): 1) Point: drift; leg falls by the end of the 5-second period but does not hit the bed 2) Points: some effort against gravity; leg falls to bed by 5 seconds but has some effort against gravity Definition of severe paresis (6th item of NIHSS): 3) Points: no effort against gravity; leg falls to bed immediately 4) Points: no movement [15]
Because of the wide individual variability of the passive range of motion and equinovalgus position, first we compared patient by patient changes before and after therapy, we evaluated the differences and compared them with those observed in the manual group
Summary
Stroke is an important health care issue resulting in chronic disability and its early rehabilitation is still a challenge. The most common motor impairment is the hemiparesis of the upper and lower limb. The impaired lower limb is a major challenge in the rehabilitation of post stroke patients. The paresis endangers patients in terms of survival and improvement outlooks. Spasticity, deep venous thrombosis, and decubitus ulcers can all be contributed to by the decreased ability of lower leg movements [1]. Spasticity disrupts the functional use of weakened muscles mainly in the distal joints of the paretic lower limb. Structural changes to muscle fibers and connective tissue may contribute to alterations in intrinsic mechanical properties [2]
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