Within-session effects of selected physical rehabilitation interventions for a dysfunctional arm post-stroke on arm movement and muscle firing patterns

Abstract

Upper extremity (UE) impairments and activity limitations are a common problem in individuals following a cerebrovascular accident (CVA). Eighty-five percent of individuals with CVA report UE functional limitations that are associated with decreased health-related quality of life. Occupational therapy (OT) and physical therapy (PT) approaches are typically aimed to treat impairments, activity limitations, and participation restrictions following a CVA. This study examines the effects of five therapeutic approaches on upper extremity (UE) movement and muscle activation patterns in persons with CVAs: (1) proprioceptive neuromuscular facilitation (PNF); (2) neurodevelopmental treatment (NDT); (3) functional electrical stimulation (FES); (4) weight-bearing and (5) modified Constraint-Induced Movement Therapy (mCIMT). This is a case report involving a 61-year-old male who underwent 30-minute intervention sessions for each approach stated above. Electromyography (EMG) and 3D motion capture data were collected pre- and post-intervention and at 30 minute follow-up. Data were analyzed for reaching a cup at waist level, maximum shoulder flexion, and moving cup to mouth as in drinking. No significant differences were seen for UE movements across all interventions for kinematic or EMG data. There appears to be a trend towards normal elbow movement following NMES, mCIMT and PNF and increased variability in shoulder flexion in mCIMT and NDT interventions. Weight-bearing provided the least amount of evidence for improved kinematic motion. Improvement in elbow kinematics may indicate proximal stability following PNF, FES, and mCIMT allows for increased distal mobility at the elbow. Some interventions produced trends that indicate better UE movement. Increased proximal stability may have caused better distal mobility as shown by improved elbow movement. Increased variability of shoulder flexion may indicate the participant learned different options to perform the same movement. Further research is needed o provide a more transparent understanding of the efficacy of interventions for individuals with hemiparesis following a CVA.