Rehabilitation of a Post-stroke Patient with Upper Extremity Hemiparetic Movement Dysfunctions by Orthokinetic Orthoses

Abstract

The purpose of this study was to investigate the efficacy of orthokinetic orthoses (cuffs) applied to the upper extremity (UE) of a60-year-old man who had movement dysfunctions secondary to right hemiparesis 6 years post-left hemispheric cerebrovascular accident (CVA). The patient presented for orthokinetics treatment after the outcomes of prolonged occupational therapy and physical therapy had reached a plateau, leaving him with residual lack of functional control of the paretic UE. The treatment comprised application of three orthokinetic cuffs to the affected paretic musculatures, designed to compensate both for impaired agonist recruitment and for impaired antagonist inhibition. The first step in a two-step design was a short-duration pilot study of single-subject design, which served to assess the patient's responsiveness to the orthokinetics treatment. The single-subject design used was an interrupted time series, consisting of nontreatment, placebo treatment, sham treatment, and orthokinetics treatment phases. The inferences supported causality and specificity of orthokinetics treatment to this patient, at a significance level of p≤ 0.01 (two-tailed test). The second step, which followed the short-duration pilot trial, was a clinical treatment course of longer duration, based on the orthokinetics technique of the pilot study. It resulted in partial restoration of voluntary mobility of the paretic UE, and assistive functional use in the patient's occupation. Recommendations are presented for the clinical use of orthokinetic orthoses in the therapy of stroke patients with paretic UE pathokinesiologic conditions.