Carryover Effects of Cyclical Stretching of the Digits on Hand Function in Stroke Survivors



      To investigate the longevity and cumulative impact of multiple sessions of passive, cyclical stretching of the digits on hand function in subacute stroke survivors.


      Before-after trial with intervention repeated on 3 consecutive days.


      Research laboratory.


      Individuals (N=27) with moderate to severe hand impairment, 2 to 6 months (subacute, n=12) and >7 months (chronic, n=15) poststroke.


      Subjects wore an actuated glove orthosis that cyclically moved their fingers and thumb from a relaxed/flexed posture into neutral extension for 30 minutes on 3 consecutive days.

      Main Outcome Measures

      Three hand-specific tasks from the Graded Wolf Motor Function Test, Box and Block Test (BBT), grip strength, and lateral pinch strength. Recordings were taken before stretching and at 3 time points, each separated by 30 minutes after completion of stretching on each day.


      Significant improvement was observed immediately after the stretching for both groups. Improvements in the subacute group were largely maintained up to 1 hour poststretching, with significant carryover from day to day for some outcomes measures such as the BBT (P=.006) and grip strength (P=.012). In contrast, improvements after stretching for the chronic group were transient, with the changes largely dissipating over time and no significant cumulative effect across days.


      Cyclical stretching of the digits had a lasting and reinforcing effect on improving hand motor control for subacute stroke survivors. Incorporation of cyclical stretching before active hand therapy may prove to be a beneficial treatment for stroke survivors, especially during the subacute phase of recovery.


      List of abbreviations:

      ANOVA (analysis of variance), BBT (Box and Blocks Test), GWMFT (Graded Wolf Motor Function Test)
      To read this article in full you will need to make a payment


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wu C.L.
        • Huang M.H.
        • Lee C.L.
        • Liu C.W.
        • Lin L.J.
        • Chen C.H.
        Effect on spasticity after performance of dynamic-repeated-passive ankle joint motion exercise in chronic stroke patients.
        Kaohsiung J Med Sci. 2006; 22: 610-617
        • Bressel E.
        • McNair P.J.
        The effect of prolonged static and cyclic stretching on ankle joint stiffness, torque relaxation, and gait in people with stroke.
        Phys Ther. 2002; 82: 880-887
        • Yeh C.Y.
        • Tsai K.H.
        • Chen J.J.
        Effects of prolonged muscle stretching with constant torque or constant angle on hypertonic calf muscles.
        Arch Phys Med Rehabil. 2005; 86: 235-241
        • Lannin N.A.
        • Cusick A.
        • McCluskey A.
        • Herbert R.D.
        Effects of splinting on wrist contracture after stroke: a randomized controlled trial.
        Stroke. 2007; 38: 111-116
        • Horsley S.A.
        • Herbert R.D.
        • Ada L.
        Four weeks of daily stretch has little or no effect on wrist contracture after stroke: a randomised controlled trial.
        Aust J Physiother. 2007; 53: 239-245
        • Sheehan J.L.
        • Winzeler-Mercay U.
        • Mudie M.H.
        A randomized controlled pilot study to obtain the best estimate of the size of the effect of a thermoplastic resting splint on spasticity in the stroke-affected wrist and fingers.
        Clin Rehabil. 2006; 20: 1032-1037
        • Katalinic O.M.
        • Harvey L.A.
        • Herbert R.D.
        Effectiveness of stretch for the treatment and prevention of contractures in people with neurological conditions: a systematic review.
        Phys Ther. 2011; 91: 11-24
        • Bovend'Eerdt T.J.
        • Newman M.
        • Barker K.
        • Dawes H.
        • Minelli C.
        • Wade D.T.
        The effects of stretching in spasticity: a systematic review.
        Arch Phys Med Rehabil. 2008; 89: 1395-1406
        • Ada L.
        • Goddard E.
        • McCully J.
        • Stavrinos T.
        • Bampton J.
        Thirty minutes of positioning reduces the development of shoulder external rotation contracture after stroke: a randomized controlled trial.
        Arch Phys Med Rehabil. 2005; 86: 230-234
        • Kim E.H.
        • Chang M.C.
        • Seo J.P.
        • Jang S.H.
        • Song J.C.
        • Jo H.M.
        The effect of a hand-stretching device during the management of spasticity in chronic hemiparetic stroke patients.
        Ann Rehabil Med. 2013; 37: 235-240
        • Selles R.W.
        • Li X.
        • Lin F.
        • Chung S.G.
        • Roth E.J.
        • Zhang L.Q.
        Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: effects of a 4-week intervention program.
        Arch Phys Med Rehabil. 2005; 86: 2330-2336
        • Triandafilou K.M.
        • Ochoa J.
        • Kang X.
        • Fischer H.C.
        • Stoykov M.E.
        • Kamper D.G.
        Transient impact of prolonged versus repetitive stretch on hand motor control in chronic stroke.
        Top Stroke Rehabil. 2011; 18: 316-324
        • Kamper D.
        • Rymer W.
        Impairment of voluntary control of finger motion following stroke: role of inappropriate muscle coactivation.
        Muscle Nerve. 2001; 24: 673-681
        • Kamper D.G.
        • Fischer H.C.
        • Cruz E.G.
        • Rymer W.Z.
        Weakness is the primary contributor to finger impairment in chronic stroke.
        Arch Phys Med Rehabil. 2006; 87: 1262-1269
        • Kwakkel G.
        • Kollen B.
        • Twisk J.
        Impact of time on improvement of outcome after stroke.
        Stroke. 2006; 37: 2348-2353
        • Hesse S.
        • Werner C.
        • Pohl M.
        • Rueckriem S.
        • Mehrholz J.
        • Lingnau M.L.
        Computerized arm training improves the motor control of the severely affected arm after stroke: a single-blinded randomized trial in two centers.
        Stroke. 2005; 36: 1960-1966
        • Stinear C.
        • Ackerley S.
        • Byblow W.
        Rehabilitation is initiated early after stroke, but most motor rehabilitation trials are not: a systematic review.
        Stroke. 2013; 44: 2039-2045
        • Mirbagheri M.M.
        • Lilaonitkul T.
        • Rymer W.Z.
        Prediction of natural history of neuromuscular properties after stroke using Fugl-Meyer scores at 1 month.
        Neurorehabil Neural Repair. 2011; 25: 458-468
        • Gowland C.
        • VanHullenaar S.
        • Torresin W.
        • et al.
        Chedoke-McMaster Stroke Assessment: development, validation and administration manual.
        Chedoke-McMaster Hospitals and McMaster University, Hamilton1995
        • Group C-IMTR
        Manual Graded Wolf Motor Function Test.
        Birmingham Veteran's Administration Center, Birmingham2000
        • Bonifer N.
        • Anderson K.M.
        Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia.
        Phys Ther. 2003; 83: 384-398
        • Gao F.
        • Ren Y.
        • Roth E.J.
        • Harvey R.
        • Zhang L.Q.
        Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors.
        Clin Biomech. 2011; 26: 516-522
        • Nuyens G.E.
        • De Weerdt W.J.
        • Spaepen Jr., A.J.
        • Kiekens C.
        • Feys H.M.
        Reduction of spastic hypertonia during repeated passive knee movements in stroke patients.
        Arch Phys Med Rehabil. 2002; 83: 930-935
        • Alary F.
        • Doyon B.
        • Loubinoux I.
        • et al.
        Event-related potentials elicited by passive movements in humans: characterization, source analysis, and comparison to fMRI.
        NeuroImage. 1998; 8: 377-390
        • Mima T.
        • Sadato N.
        • Yazawa S.
        • et al.
        Brain structures related to active and passive finger movements in man.
        Brain. 1999; 122: 1989-1997
        • Weiller C.
        • Juptner M.
        • Fellows S.
        • et al.
        Brain representation of active and passive movements.
        NeuroImage. 1996; 4: 105-110
        • Conforto A.B.
        • Cohen L.G.
        • dos Santos R.L.
        • Scaff M.
        • Marie S.K.
        Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes.
        J Neurol. 2007; 254: 333-339
        • Koesler I.B.
        • Dafotakis M.
        • Ameli M.
        • Fink G.R.
        • Nowak D.A.
        Electrical somatosensory stimulation improves movement kinematics of the affected hand following stroke.
        J Neurol Neurosurg Psychiatry. 2009; 80: 614-619
        • Lewis G.N.
        • Byblow W.D.
        Modulations in corticomotor excitability during passive upper-limb movement: is there a cortical influence?.
        Brain Res. 2002; 943: 263-275
        • Rossini P.M.
        • Calautti C.
        • Pauri F.
        • Baron J.
        Post-stroke plastic reorganisation in the adult brain.
        Lancet Neurol. 2003; 2: 493-502
        • Guissard N.
        • Duchateau J.
        • Hainaut K.
        Mechanisms of decreased motoneurone excitation during passive muscle stretching.
        Exp Brain Res. 2001; 137: 163-169
        • Vujnovich A.L.
        • Dawson N.J.
        The effect of therapeutic muscle stretch on neural processing.
        J Orthop Sports Phys Ther. 1994; 20: 145-153
        • Kamper D.G.
        • Harvey R.L.
        • Suresh S.
        • Rymer W.Z.
        Relative contributions of neural mechanisms versus muscle mechanics in promoting finger extension deficits following stroke.
        Muscle Nerve. 2003; 28: 309-318
        • Seo N.J.
        • Rymer W.Z.
        • Kamper D.G.
        Delays in grip initiation and termination in persons with stroke: effects of arm support and active muscle stretch exercise.
        J Neurophysiol. 2009; 101: 3108-3115
        • Stinear C.M.
        • Barber P.A.
        • Coxon J.P.
        • Fleming M.K.
        • Byblow W.D.
        Priming the motor system enhances the effects of upper limb therapy in chronic stroke.
        Brain. 2008; 131: 1381-1390
        • Stinear J.W.
        • Byblow W.D.
        Rhythmic bilateral movement training modulates corticomotor excitability and enhances upper limb motricity poststroke: a pilot study.
        J Clin Neurophysiol. 2004; 21: 124-131
        • Stoykov M.E.
        • Stinear J.W.
        Active-passive bilateral therapy as a priming mechanism for individuals in the subacute phase of post-stroke recovery: a feasibility study.
        Am J Phys Med Rehabil. 2010; 89: 873-878
        • Boroojerdi B.
        • Diefenbach K.
        • Ferbert A.
        Transcallosal inhibition in cortical and subcortical cerebral vascular lesions.
        J Neurol Sci. 1996; 144: 160-170
        • Shimizu T.
        • Hosaki A.
        • Hino T.
        • et al.
        Motor cortical disinhibition in the unaffected hemisphere after unilateral cortical stroke.
        Brain. 2002; 125: 1896-1907
        • Hummel F.C.
        • Celnik P.
        • Pascual-Leone A.
        • et al.
        Controversy: noninvasive and invasive cortical stimulation show efficacy in treating stroke patients.
        Brain Stimul. 2008; 1: 370-382
        • Ward N.S.
        Neural plasticity and recovery of function.
        Prog Brain Res. 2005; 150: 527-535
        • Schaechter J.D.
        • van Oers C.A.
        • Groisser B.N.
        • et al.
        Increase in sensorimotor cortex response to somatosensory stimulation over subacute poststroke period correlates with motor recovery in hemiparetic patients.
        Neurorehabil Neural Repair. 2012; 26: 325-334