Effect of integrated manual and verbal cueing on functional transfers in chronic stroke survivors: a randomized controlled study

Abstract

Purpose The profession of physical therapy has historically relied on manual facilitation to improve motor control strategies and performance in persons rehabilitating from a stroke, yet there is insufficient evidence to support its use during functional task training. The purpose of this study was to determine the effects of integrated cueing (verbal and manual) and verbal cueing approaches during sit-to-stand training on midline alignment & muscle activation in chronic stroke survivors. Methods Twenty-one chronic right-brained stroke survivors with hemiplegia were randomly assigned to the Integrated Cueing or Verbal Only group and outcome measures were recorded using an 18-Camera Motion Capture System, force plates, and surface electromyography (EMG). Results Both groups demonstrated a significant improvement in symmetry toward the midline after thirty training repetitions. Significant improvements in muscle activation were found in two muscle groups on the affected side of the body in the Integrated Cueing group, gastrocnemius and rectus femoris. Conclusion Both the Verbal Only and Integrated Cueing groups made significant progress toward more symmetrical movement, yet more significant changes in the activation of hemiparetic extensor muscles were seen in the Integrated Cueing group. These findings support the use of manual cueing in movement activation and performance during the training of functional tasks. IMPLICATIONS FOR REHAB Physical therapists commonly use manual tactile cues to facilitate movement performance but there is currently insufficient evidence to support this use with stroke survivors. In a relatively small sample size, both verbal cues and integrated cues (verbal plus manual) improved symmetry during sit to stand in chronic right brain stroke survivors. Integrated cueing enhanced motor activation and performance during sit to stand better than verbal cues alone. Manual tactile cueing should be considered during functional task retraining.