Abstract
Background In individuals with hemiparetic stroke, reaching with the paretic arm can be impaired by abnormal muscle coactivation. Prior trails for improving upper extremity functions after stroke have underestimated the role of gravitational force in motor planning and execution. Objective The aims this trial were to study the effect of gravity as a facilitator for elbow extension and to estimate the immediate and retention effects of task specific training of elbow extensors on upper extremity function after stroke. Methods Twenty-six right handed patients with first ever stroke represented the sample of the study. The participants were randomly assigned into two equal groups. The study group received treatment through two phases. Phase one included training for the elbow extensors in an antigravity position. Phase two included a set of task specific exercise for 16 weeks. The control group received traditional passive stretch and range of motion exercises. Manual dexterity and upper limb function were assessed by Nine-Hole Peg Test and Fugl-Meyer upper extremity. Goniometry was used for measuring elbow extension and forearm supination active ranges of motion. Results Significant improvements were observed in Nine-Hole Peg Test, Fugl-Meyer upper extremity, and ranges of motion at postintervention and follow-up compared to preintervention at P≤0.05. Conclusions The results of this study provide an evidence that antigravity positions can be used as a centrally presented facilitator of elbow extension. Additionally, task specific training was effective in improving upper extremity function and elbow extension range of motion.
Highlights
Stroke is a universal health problem because of its impact on quality of life and the increase of falls, in addition to many systemic complications [1,2,3]
Patients with moderate cognitive deficits; visual field defect; visuospatial neglect; finger flexor spasticity [21]; spastic dystonia, or any other condition interfering with upper extremity movements other than stroke were excluded from the study
As the movement performed against gravity, the brain contemplates the direction of movement with respect to gravity and possesses different sensors and mechanisms for sensing torques due to gravity acting on the limb to formulate an appropriate motor plan
Summary
Stroke is a universal health problem because of its impact on quality of life and the increase of falls, in addition to many systemic complications [1,2,3]. Weakness, or paralysis, spasticity and loss of selective individual movement or abnormal coordination were clinically recognized motor deficits. The aims this trial were to study the effect of gravity as a facilitator for elbow extension and to estimate the immediate and retention effects of task specific training of elbow extensors on upper extremity function after stroke. Phase one included training for the elbow extensors in an antigravity position. Significant improvements were observed in Nine-Hole Peg Test, Fugl-Meyer upper extremity, and ranges of motion at postintervention and follow-up compared to preintervention at P≤0.05. The results of this study provide an evidence that antigravity positions can be used as a centrally presented facilitator of elbow extension. Task specific training was effective in improving upper extremity function and elbow extension range of motion
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