Prolonged Stretch Research Articles

Managing Long-term Orofacial Contractures and Microstomia Through Intraoral Stretching.

Microstomia and orofacial contractures continue to garner interest regarding the effectiveness of treatment methodologies utilized to impact functional change. Oral splints are an accepted tool in the management of microstomia. However, the concepts of which oral splints to use, timing of initiation, and duration of treatment have not gained a consensus. This article reviews approaches to oral splinting and an alternative intraoral approach using splints designed to provide a graded, low load, multidirectional, and prolonged stretch specifically in facial burn survivors including those with mature scars. Two participants participated in a trial using oral splints placed inside the mouth at established contracture points. Participants were requested to use the splints for 1h twice daily. Participants were photographed weekly producing 9 facial expressions, and distance between 13 facial landmarks was measured to evaluate change in tissue length. Numerical changes observed from beginning to end of the trial indicate positive and negative alterations, signifying lengthening or shortening of tissue. Negative changes denote reduction in distance between endpoints, while positive changes signify an increase. Participants verbalized functional improvements in oral motor and psychosocial function posttreatment. To date, oral splints can be custom fabricated for each individual patient. However, few oral splints are created to provide multidirectional stretch focusing on problem areas across the mid and lower face. The intraoral splints and regimen described here have the capability of providing a stretching intervention that could be applicable in various stages of burn recovery.

The Digital Revolution on Society through Digital Detox in the Modern Era

This study reveals on the negative impact of the digital revolution on society. This is a kind of the enablement of social isolation, addiction, and mental health issues. Technology has changed how people interact and communicate, often leading to increased social isolation and addiction to technological platforms such as social media. The study tells about the digital detox and how it tell us about a break from the screen will help people to bring balance to their digital and real-world lives. This way of soaking up real-time instead of screen time will ease anxiety, increase happiness, reduce multitasking, reduce those technology cravings, and allow you to connect more with the people in your life. This doesn't have to be a prolonged stretch or period where you quit technology entirely. But you can choose how long you feel comfortable doing a digital detox for anywhere from 24 hours to 1 week. Digital detox should not only refer to a time period during which a person refrains from using electronic devices, but also to time periods during which a person does not engage in certain types of applications, branded media, special features, interactions, and/or messages the studies is the lack of device-based measurements of smartphone use that would allow for reliable assessments of the duration of usage. Then also it is helpful to measure physiological indicators of health-related outcomes, and the study belongs to the aspect of compensatory behaviors during the digital detox intervention in this new era of technology use. While they sound like a good idea, digital detoxes are unsustainable because they cut us from the world. This can also have a negative impact on our overall mood, as well as leading to feelings of isolation and loneliness.

A Novel Adjunct for Treatment of Orofacial Contractures After a Facial Burn Injury

Purpose: Surgical management of scar tissue and contractures from facial burns has systematic approaches, yet nonsurgical management continues to lack consensus regarding therapeutic approaches capable of providing stretching of the facial skin and muscles for both treating and preventing microstomia and orofacial contractures. This exploratory study introduces an intraoral splinting system designed to provide low-load, prolonged stretching of orofacial skin and musculature to treat contractures following a facial burn injury. The treatment adjunct described here has potential application across disciplines treating microstomia and orofacial contractures. Method: An 18-year-old man with full-thickness head and neck burns participated in a 5-week trial using intraoral splints to provide stretch to areas of contracture in the mid and lower face. The trial commenced 4 and a half months after his burn injury. Prescriptive placement, sizing, and time for use of the splints were provided. Changes in distance between facial landmarks were identified for 13 measurements taken for nine facial expressions. Results: Lengthening or shortening of the distances between two landmarks indicated the potential benefit from intraoral splints. For the expression “open mouth wide,” increased distance between two end points was noted in 11 of 13 measurements, ranging from 1.6 to 10.8 mm. This represents a lengthening of tissue, allowing for wider oral opening. Negative measurements between two end points occurred in two of 13 measurements, demonstrating elevation of the left and right nostrils. Visual data also demonstrated the appearance of change. Conclusions: When treating microstomia and orofacial contractures, consideration should be given to the use and further exploration of a more targeted intraoral methodology that uses a low-load, prolonged stretch to improve functional and aesthetic deficits. Oral splinting using an intraoral methodology is underutilized in the burn patient population and has application in both the acute care and chronic phases of recovery.

Effect of Gleno-humeral-capsulo-Ligamentous Stretch Maneuvers on Range of motion in Bilateral Frozen Shoulder

Background: Painful restriction of shoulder movement, without an underlying cause, which results in complete loss of motion of the glenohumeral joint is called Frozen Shoulder. The process is started with an inflammation of the lining of the joint within the shoulder. Gradually this area thickens and results in the shoulder becoming stiffer and more painful. It is seen commonly at the age of 40-65 years and more often in women. Overall, this condition affects work, leisure, and quality of life. Frozen shoulder often progresses in three stages: the freezing, frozen and thawing phases. Risk factors for frozen shoulder are diabetes, thyroid, history of shoulder trauma, cervical radiculopathy, post-operative immobilization, and shoulder surgery. Cyriax described the typical capsular patterns of the gle¬no humeral joint in the frozen shoulder with abduction more limited than external rotation, and external rota¬tion more limited than internalrotation. This study aims to establish the effect of gleno humeral capsulo ligamentous stretch maneuvers on bilateral frozen shoulder. Methods: A total of 40 subjects diagnosed with bilateral frozen shoulder were selected for the study. Subjects received low load prolonged stretching, mobilization and shoulder range of motion exercises. Each session was conducted for 30 minutes duration, 5 days per week for 4 weeks. Outcome measures used were Numerical pain rating scale (NPRS), Goniometer and Shoulder Pain and Disability Index (SPADI). Results: The results of the study demonstrate that there was a significant effect of gleno humeral capsulo ligamentous stretch on numerical pain rating scale (p<0.0001), range of motion (Shoulder flexion, abduction, internal rotation and external rotation (p<0.0001), Shoulder pain and disability index (p<0.0001) during the pre and post intervention assessment. Conclusion: It is concluded that that the use of low load prolonged stretch and mobilization was very effective in reducing pain and improving range of motion. Shoulder range of motion exercises was effective in improving strength and flexibility of shoulder musculature. KEYWORDS: Low load prolonged stretch, mobilization, numerical pain rating scale, Shoulder pain and disability index, Bilateral frozen shoulder.

Diagnosis of Facial Recognition Using Deep Transfer Learning

Abstract: The connection among the face and infection that has been investigated a shockingly prolonged stretch of time back, which prompts the event. The objective is to explore the chance seeing contaminations by utilizing an unstructured 2D face pictures with critical figuring out frameworks. this paper, we recommend using huge exchange obtaining from feature assertion to play out the PC helped facial confirmation on different infections. In the tests, we play out the PC maintained facial considering on single (betathalassemia) and different sicknesses (beta-thalassemia, hyperthyroidism, Down syndrome, and leprosy) a genuinely little dataset General ahead of everyone else exactness by basic trade in view of facial confirmation shows up at much than 90%, beating the two clinicians and normal AI structures in the starters. In obliging, collecting a tangle of unambiguous face photos is confused, unnecessary, and tedious, and powers moral snags by prudence of the treatment of individual data. Accordingly, the face educational files finding related Investigations are classified and for the most part insignificant separating and the ones of other AI application locale. The headway of critical exchange applications of face recognition in learning with a small dataset could give an irrelevant expense and simple way for jumble screening and disclosure

Listening to the silent struggles of bipolar disorder through sonification of iMoodJournal data.

Listening to the silent struggles of bipolar disorder through sonification of iMoodJournal data.

Instantaneous effect of prolonged stretch on monosynaptic excitability in hemiplegic cerebral palsied children: Repeated measures design

Instantaneous effect of prolonged stretch on monosynaptic excitability in hemiplegic cerebral palsied children: Repeated measures design

Stretch-induced hypoalgesia: a pilot study.

Objectives Stretching is an intervention often used in various kinds of rehabilitation protocols and the effects on pain sensitivity has sparsely been investigated, especially when addressing potential effects on pain. The objective is to investigate the immediate effects of an axial and peripheral prolonged stretch on pressure pain sensitivity (PPT) and temporal summation (TS) on local and distal sites in healthy subjects. Methods Twenty-two healthy volunteers were recruited to participate in this pilot study. Two prolonged stretching protocols were performed: low back and wrist extensors stretches. PPT and pinprick TS were measured pre- and post-intervention at local and remote sites. Repeated measures analysis of variance (ANOVA) was used to examine the effects and significance of the interventions. Results The low back stretch induced an increase in PPT for both local and remote sites, and the wrist stretch produced a PPT increase only at the local site. TS did not change. Conclusions Low back stretching induced an increase in PPT at both local and remote sites whereas the wrist stretch only increased PPT locally, suggesting hypoalgesia at these sites. Further studies are needed to confirm the effect and mechanisms using randomised, controlled and parallel study design. Considering that pain sensitivity is different than clinical pain, results are difficult to extrapolate to clinical practice. Future studies testing clinical pain are needed to better understand the clinical implication of these results.

Low Load Prolonged Stretch vs. High Load Brief Stretch in Treatment of Knee Contracture after Burn

Abstract Background: Burn is defined as a traumatic injury to the skin or other organic tissue primarily caused by thermal or other acute exposures. Burns occur when some or all of the cells in the skin or other tissues are destroyed by heat, cold, electricity, radiation, or caustic chemicals. Burns are acute wounds caused by an isolated, non-recurring insult and progress rapidly through an orderly series of healing steps. Aim of Study: This study was conducted to investigate effect of low load prolonged stretchvs. High load brief stretch post burn knee contracture. Subjects and Methods: Thirty patients with knee contrac-ture following burn were conducted in the present study. All patients with age ranged from 25 to 45 years. They were selected from Om Al-Masreen Hospital, and Kasr El-Ainy Hospital. Patients assigned randomly into two groups (A and B) equal in number: Group (A) fifteen patients received low load prolonged stretch using weights (sand bags) 3 times/ week for 4 successful weeks. Group (B) fifteen patients received manual stretch 3 times/week for 4 successful weeks. Evaluation: Evaluations of both groups (A and B) were done before starting the treatment and at the end of study by Goniometer and Foot print to measure range of motion and cadence pre and post-treatment. Results: This study showed a statistically significant increase of knee joint ROM with percentage of improvement (14.4±4.89) in group (A), compared with group (B) with percentage of improvement (19.4±5.15). Conclusion: The present study concluded that low load prolonged stretch is more effective than high load brief stretch in treatment of knee contracture after burn.

Excitability and contractility in arterioles and venules from the urinary bladder.

The urinary bladder performs two key physiological functions: (1) to store urine, and (2) void urine at an appropriate time. While these two functions seem simple, both processes exert prolonged stretch and compressive forces on the urinary bladder vasculature that are greater than those seen by vessels in any other hollow organ. To compensate for these forces, the urinary bladder vasculature has adapted several key features that maintain blood flow during bladder filling and prevent damaging pressure fluctuations during emptying. This chapter first describes key anatomical features of the urinary bladder vasculature and how these features aid in maintaining blood flow in the milieu of the functioning bladder. Next, we investigate the mechanisms regulating excitability of urinary bladder arterioles with emphasis on the development and regulation of myogenic tone. We then discuss the physiological significance and excitability of urinary bladder capillaries and venules, and their important roles in maintaining tissue perfusion. Finally, the functionality of the urinary bladder vasculature will be explored in terms of bladder dysfunction, to understand if lower urinary tract symptoms associated with disease can be considered vascular in nature. Also included are perspectives on the urinary bladder itself as a model for understanding ischemia/reperfusion injury and the possibility that the urinary bladder holds a key to mitigating deleterious effects that result when blood flow is occluded and rapidly restored to other organs.

Effects of dynamic lycra orthosis as an adjunct to rehabilitation after botulinum toxin-A injection of the upper-limb in adults following stroke: A single-blinded randomized controlled pilot study

ABSTRACT Background Dynamic lycra splints are proposed to modify hypertonicity due to their characteristics – neutral warmth, circumferential pressure, and creating a low-intensity prolonged stretch on hypertonic muscles – to contribute to increased sensory awareness of the involved limb. Objectives The aim of this study was to investigate the effects of dynamic lycra orthosis as an adjunct to botulinum toxin-A injection and rehabilitation of the upper-limb in adults following stroke. Methods Patients who had suffered a stroke more than three months previously were randomized into two groups: lycra sleeve plus rehabilitation (n = 10) and only-rehabilitation group (n = 10). After botulinum toxin injection, both groups underwent an upper-limb rehabilitation program. The intervention group wore a lycra sleeve for eight hours a day, five days a week for three weeks in addition to the rehabilitation program. Fugl Meyer upper-limb motor score, Motricity index, Modified Ashworth scale, Box and Block test, Stroke Impact Scale and change in touch-detection thresholds of the fingers measured via Semmes-Weinstein monofilaments were assessed by blinded investigators at before treatment, post-treatment (at 3 weeks) and three months post-treatment. This trial is registered with Clinicaltrials.gov, number NCT03546959. Results There were no differences between groups in terms of Fugl Meyer upper-limb motor score, Motricity Index, Modified Ashworth scale, Box and Block test, Stroke Impact Scale and change in light touch threshold at any follow-up time points. Conclusions Using lycra splints as an adjunct to an upper-limb rehabilitation program after stroke did not provide additional benefit in spasticity, upper-limb motor function, light touch threshold of fingers or stroke-specific quality-of-life.

Sulodexide Improves Contraction and Decreases Matrix Metalloproteinase-2 and -9 in Veins Under Prolonged Stretch.

High pressure in the lower-limb veins is often associated with chronic venous insufficiency and varicose veins (VVs), making it important to search for the mechanisms and agents that control venous function. We have shown that protracted increases in venous stretch/wall tension reduce vein contraction and augment matrix metalloproteinase (MMP)-2 and -9. Also, MMP-2 and MMP-9 promote venodilation, a hallmark of VVs. Sulodexide (SDX) is a blend of glycosaminoglycans with efficient profibrinolysis and antithrombosis activities, but its actions on vein function and the mechanisms involved are unclear. We tested the hypothesis that SDX enhances venous contractile response by decreasing MMP expression/activity in veins subjected to protracted stretch. Rat inferior vena cava (IVC) rings were treated with SDX (0.001-1 mg/mL) or vehicle, equilibrated under control 0.5-g resting tension or protracted 2-g stretch for 18 hours, and the contractile response to 96-mM KCl and phenylephrine (Phe) in SDX-treated and nontreated veins was recorded. In IVC rings under control 0.5-g resting tension, SDX caused dose-dependent contraction, 96-mM KCl caused marked contraction (176-mg/mg tissue), and Phe caused dose-dependent contraction with a maximum (56-mg/mg tissue) at 10 M. In IVC subjected to protracted 2-g stretch, 96-mM KCl-induced contraction was reduced to 112 mg/mg and maximal Phe-induced contraction was decreased to 23 mg/mg. In IVC subjected to protracted 2-g stretch plus SDX, 96-mM KCl-induced contraction was restored to 228 mg/mg and maximal Phe-induced contraction was improved to 115 mg/mg. Gelatin zymography and Western blots revealed increases in MMP-2 and MMP-9 levels/gelatinolytic activity in veins subjected to protracted 2-g stretch and reversal to control levels in veins subjected to 2-g stretch plus SDX. Thus, SDX improves vein function and augments the contractile response in veins subjected to protracted stretch. The SDX-induced improvement of contraction and restoration of vein function appear to involve decreases in MMP-2 and MMP-9 and may contribute to the benefits of SDX in chronic venous insufficiency and VVs.

A New Asana for Treating the Neck & Shoulder Pain with Improved Flexibility

A new therapy for alleviating the neck & shoulder pain instantly based on the principles of yoga asana is presented. The method involves a sequence of skeletal movements of the neck and shoulder muscles to relieve any stress developed during the trauma or disturbing experience; excluding injuries causing damage to the tissue. Through prolonged stretch and relaxation, the muscles are freed from the constrained posture to bring about the symptomatic relief to the individual. It is found that the asana does not involves staining along the directions that lead to the injury as opposed to the well-known asanas such as Utthita Shishosana, Sasangasana, and Dhanurasana, Matsyasana, suggesting a huge potential to explore the pathophysiological benefits of the new asana in managing NSPs.

Responses of bladder smooth muscle to the stretch go through extracellular signal-regulated kinase (ERK)/p90 ribosomal S6 protein kinase (p90RSK)/Nuclear factor-κB (NF-κB) Pathway.

The present study was designed to study changes and its potential mechanisms in human bladder smooth muscle subjected to stretch. Bioinformatics analyses including differential expression analysis, overrepresentation enrichment analysis, principal component analysis, and weighted gene coexpression network analysis were used to analyze a microarray dataset (GSE47080) of partial bladder outlet obstruction (pBOO) in rat to find the potential changes of gene expressions. Bladder from pBOO model and human bladder smooth muscle cells (HBSMCs) subjected to sustained prolonged stretch were collected for Western blot analysis, real-time polymerase chain reaction, and fluorescence analysis to verify the changes of gene expressions and preliminarily study the potential role of signaling pathway regulation in treatment of pBOO. The bioinformatics analysis showed that chronic obstruction activated mitogen-activated protein kinase pathway and changed cytoskeleton structure in bladder smooth muscle. In in vivo experiments in mice, pBOO was verified by cystometry. Partial BOO activated the extracellular signal-regulated kinase (ERK)/p90 ribosomal S6 protein kinase (p90RSK)/nuclear factor-κB (NF-κB) signaling pathway in DM. The messenger RNA (mRNA) expressions of contractile phenotypic proteins increased after pBOO. In in vitro experiments of HBSMCs, mechanical stretch activated ERK/p90RSK/NF-κB in HBSMCs in a time-dependent manner. The mRNA expressions of α-smooth muscle actin and SM22 also increased and filamentous actin (F-actin) polymerization was enhanced as well. Inhibition of ERK/p90RSK/NF-κB pathway reversed mechanical stretch-induced changes of contractile phenotypic expression and F-action polymerization. Continuous stretch increases expressions of contractile phenotypic proteins and promotes the polymerization of F-actin. This process partially goes through ERK/p90RSK/NF-κB pathway.

Expression of extracellular matrix and adhesion proteins in pelvic organ prolapse

Pelvic organ prolapse (POP) is a common disorder in women. It is characterized by the descent of the vaginal wall with consequent drop of pelvic organs. Pregnancy, labour and childbirth seem to be important events leading to the development of POP, since they are associated with prolonged stretch and mechanical stress of muscles, ligaments and connective tissue supporting pelvic organs. In pubocervical fascia, we explored the expression level of extracellular matrix and adhesion molecules. Tissue samples were obtained from twenty patients with POP who underwent cystocele repair, and from twenty control subjects during hysterectomy surgery. The PCR array analysis was performed and data were confirmed by Real-Time PCR and Western Blot. Real-Time PCR results showed a significant upregulation for extracellular matrix protein 1 (ECM1) and integrin beta 3 (ITGB3) and a significant downregulation for FBLN5 in POP group. The decreased mRNA expression of FBLN5 in pathological samples was paralleled by a quantitative decrease in the corresponding protein, as Western Blot test highlighted. Our data provide an understanding of molecular mechanisms involved in POP-related pathophysiological processes and might represent an important tool to develop novel therapeutic agents for the treatment of this condition.

Adaptive reduction of human myometrium contractile activity in response to prolonged uterine stretch during term and twin pregnancy. Role of TREK-1 channel

Quiescence of myometrium contractile activity allows uterine expansion to accommodate the growing fetus and prevents preterm labor particularly during excessive uterine stretch in multiple pregnancy. However, the mechanisms regulating uterine response to stretch are unclear. We tested the hypothesis that prolonged uterine stretch is associated with decreased myometrium contractile activity via activation of TWIK-related K+ channel (TREK-1). Pregnant women at different gestational age (preterm and term) and uterine stretch (singleton and twin pregnancy) were studied, and uterine strips were isolated for measurement of contractile activity and TREK-1 channel expression/activity. Both oxytocin- and KCl-induced contraction were reduced in term vs preterm pregnancy and in twin vs singleton pregnancy. Oxytocin contraction was reduced in uterine segments exposed to 8 g stretch compared to control tissues under 2 g basal tension. TREK-1 mRNA expression and protein levels were augmented in Singleton-Term vs Singleton-Preterm, and in uterine strips exposed to 8 g stretch. The TREK-1 activator arachidonic acid reduced oxytocin contraction in preterm and term, singleton and twin pregnant uterus. The TREK-1 blocker l-methionine enhanced oxytocin contraction in Singleton-Term and twin pregnant uterus, and reversed the decreases in contraction in uterine strips exposed to prolonged stretch. Carboprost-induced uterine contraction was also reduced by arachidonic acid and enhanced by l-methionine. Thus, myometrium contraction decreases with gestational age and uterine expansion in twin pregnancy. The results suggest that prolonged stretch enhances the expression/activity of TREK-1 channel, leading to decreased myometrium contractile activity and maintained healthy term pregnancy particularly in multiple pregnancy.

Night Shift Naps Improve Patient and Workforce Safety.

Night Shift Naps Improve Patient and Workforce Safety.

Characterization of muscle ankyrin repeat proteins in human skeletal muscle.

Muscle ankyrin repeat proteins (MARPs) are a family of titin-associated, stress-response molecules and putative transducers of stretch-induced signaling in skeletal muscle. In cardiac muscle, cardiac ankyrin repeat protein (CARP) and diabetes-related ankyrin repeat protein (DARP) reportedly redistribute from binding sites on titin to the nucleus following a prolonged stretch. However, it is unclear whether ankyrin repeat domain protein 2 (Ankrd 2) shows comparable stretch-induced redistribution to the nucleus. We measured the following in rested human skeletal muscle: 1) the absolute amount of MARPs and 2) the distribution of Ankrd 2 and DARP in both single fibers and whole muscle preparations. In absolute amounts, Ankrd 2 is the most abundant MARP in human skeletal muscle, there being ~3.1 µmol/kg, much greater than DARP and CARP (~0.11 and ~0.02 µmol/kg, respectively). All DARP was found to be tightly bound at cytoskeletal (or possibly nuclear) sites. In contrast, ~70% of the total Ankrd 2 is freely diffusible in the cytosol [including virtually all of the phosphorylated (p)Ankrd 2-Ser99 form], ~15% is bound to non-nuclear membranes, and ~15% is bound at cytoskeletal sites, likely at the N2A region of titin. These data are not consistent with the proposal that Ankrd 2, per se, or pAnkrd 2-Ser99 mediates stretch-induced signaling in skeletal muscle, dissociating from titin and translocating to the nucleus, because the majority of these forms of Ankrd 2 are already free in the cytosol. It will be necessary to show that the titin-associated Ankrd 2 is modified by stretch in some as-yet-unidentified way, distinct from the diffusible pool, if it is to act as a stretch-sensitive signaling molecule.

OP.2D.03] PULSATILE STRETCH ALTERS EXPRESSION AND PROCESSING OF AMYLOID PRECURSOR PROTEIN IN HUMAN CEREBRAL ENDOTHELIAL CELLS

Amyloid β (Aβ) deposition is a hallmark of Alzheimer's disease (AD). Aβ is generated via enzymatic cleavage of amyloid precursor protein (APP). Increased APP expression is associated with elevated amyloid burden. Elevated pulsatility of arterial pressure, as a vascular factor indicative of vascular stiffness, is associated with AD. This study investigates whether increased magnitude of pulsatile stretch of human cerebral microvascular endothelial cells (hCMEC) alters expression and processing of APP.hCMECs were cultured on flexible silicone chambers and subjected to 5%, 10% or 15% cyclic stretch (ShellPA stretch system, Menicon Life Science) for 18 hours at 1 Hz (n = 5-11 for each stretch magnitude). Comparison was made with controls (0% stretch) to evaluate the effect of pulsatility on APP. APP expression was quantified using western blots with glyceraldehyde 3-phosphate dehydrogenase as the loading control. APP processing was evaluated in the cell culture supernatants by ELISA for secreted Aβ42. Results were analyzed using one way ANOVA (mean ± SEM, % control) or Pearson correlation.The densitometric analysis (expressed as a percentage of control values) of protein expression of APP showed that it was significantly higher at 10% of cyclic stretch (160.9 ± 21%) compared to both the static control (100%, p < 0.05) and 5% cyclic stretch magnitude (107.8 ± 12%, p < 0.05). The APP protein expression at 15% stretch magnitude (138.3 ± 12%) was slightly, but not significantly higher than the static control and 5% cyclic stretch. There was a significant correlation between the % stretch magnitude and secretion of A β42 (r = 0.4132, p < 0.0001).Increasing cyclic stretch of cerebral vascular ECs altered the expression of APP and the secretion of A β42. Prolonged cyclic stretch may induce APP expression and A β formation. Findings mechanistically support the association of elevated haemodynamic pulsatility and arterial stiffness with AD.

The Evidence for Prolonged Muscle Stretching in Ankle Joint Management in Upper Motor Neuron Lesions: Considerations for Rehabilitation

A normal functional ankle joint is a key factor for a successful gait. Many studies reported significant changes in ankle properties within the affected ankle upper motor neuron lesions (UMNs). As clinicians, muscles stretching approaches are of the most commonly used interventions in rehabilitation. However, there is a need for an in-depth evaluation of research on prolonged stretching in terms of the features of the stretching approaches such as duration and frequency as well as the compatible measures of a successful stretching approach. This review is an effort to synthesize findings from studies on “prolonged” stretching approaches in patients with UMNs including stroke, spinal cord injuries and traumatic brain injuries. The review also investigated the compatible features of successful stretching regimens in terms of reducing spasticity, improving the Active Range of Motion (AROM), Passive Range of Motion (PROM) and gait training of spastic patient with upper motor neuron lesions. Therefore, studies evaluating the effectiveness of “prolonged” stretching on spastic ankle planter flexor muscles and its complications were critically review and the level of evidence were analyzed. This review will add stronger understanding with regard to stretching considerations in rehabilitation following UMNs for clinicians as well researchers to propose exciting possibilities for future research.