Abstract
Objective
To examine the effects of thermal stimulation (TS) on the lower extremity (LE) movement
and function in patients with stroke.
Design
A double-blinded randomized controlled trial.
Setting
A university hospital.
Participants
Patients (N=34) at least 3 months after stroke were randomly assigned into the experimental
and the control groups.
Interventions
In addition to regular rehabilitation, the experimental group received a 30-minute
noxious TS protocol (heat pain 46–47°C/cold pain 2–3°C) 3days/wk for 8 weeks, and
the control group received a 30-minute innocuous TS protocol (heat 40–41°C/cold 23–24°C)
3d/wk for 8 weeks.
Main Outcome Measures
The Low Extremity subscale of the Stroke Rehabilitation Assessment of Movement (LE-STREAM),
the Mobility subscale of STREAM (Mob-STREAM), the Functional Ambulation Category (FAC),
the Barthel Index (BI), the Postural Assessment Scale for Stroke Patients (PASS),
and the Modified Ashworth Scale (MAS) were administered by a blinded rater at baseline,
posttreatment (8wk), and follow-up (12wk).
Results
Twenty-three participants completed the study protocol and all outcome measurements.
No preexisting group differences between the experimental group (n=11) and the control
group (n=12) were found on demographic and clinical variables. Compared with baseline,
the experimental group showed significant improvements at posttreatment and follow-up
on the LE-STREAM, Mob-STREAM, FAC, and BI (P<.05) while the control group showed no significant improvements for all outcome measures.
As for the between-group comparison, significant differences were seen at follow-up
(12wk) on the LE-STREAM, Mob-STREAM, BI, and MAS.
Conclusions
Our findings indicate that an 8-week program of noxious TS combined with a traditional
stroke rehabilitation program can improve the LE-related movement and function in
patients with stroke for more than 3 months.
Keywords
List of abbreviations:
BI (Barthel Index), FAC (Functional Ambulation Category), LE (lower extremity), LE-STREAM (Low Extremity subscale of the Stroke Rehabilitation Assessment of Movement), MAS (Modified Ashworth Scale), Mob-STREAM (Mobility subscale of the Stroke Rehabilitation Assessment of Movement), PASS (Postural Assessment Scale for Stroke Patients), TS (thermal stimulation), VAS (visual analog scale)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Recovery of walking function in stroke patients: the Copenhagen stroke study.Arch Phys Med Rehabil. 1995; 76: 27-32
- Outcome and time course of recovery in stroke, part II: time course of recovery. The Copenhagen stroke study.Arch Phys Med Rehabil. 1995; 76: 406-412
- Recent progress in physical therapy of the upper-limb rehabilitation after stroke: emphasis on thermal intervention.J Cardiovasc Nurs. 2006; 21: 469-473
- A comparative fMRI study of cortical representations for thermal painful, vibrotactile, and motor performance tasks.Neuroimage. 1999; 10: 460-482
- Functional MRI study of thalamic and cortical activations evoked by cutaneous heat, cold, and tactile stimuli.J Neurophysiol. 1998; 80: 1533-1546
- Effect of thermal stimulation on upper extremity motor recovery 3 months after stroke.Stroke. 2010; 41: 2378-2380
- Facilitation of sensory and motor recovery by thermal intervention for the hemiplegic upper limb in acute stroke patients: a single-blind randomized clinical trial.Stroke. 2005; 36: 2665-2669
- Facilitation of motor and balance recovery by thermal intervention for the paretic lower limb of acute stroke: a single-blind randomized clinical trial.Clin Rehabil. 2011; 25: 823-832
- The effectiveness of thermal stimulation for the moderately to severely paretic leg after stroke: serial changes at one-year follow-up.Arch Phys Med Rehabil. 2012; 93: 1903-1910
- Differentiating noxious- and innocuous-related activation of human somatosensory cortices using temporal analysis of fMRI.J Neurophysiol. 2002; 88: 464-474
- An fMRI study of the anterior cingulate cortex and surrounding medial wall activations evoked by noxious cutaneous heat and cold stimuli.Pain. 2000; 85: 359-374
- Distinct and shared cerebral activations in processing innocuous versus noxious contact heat revealed by functional magnetic resonance imaging.Hum Brain Map. 2010; 31: 743-757
- Pain measurement and assessment.Raven, New York1983
- Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure.Phys Ther. 1999; 79: 8-23
- Inter-rater reliability and validity of the Stroke Rehabilitation Assessment of Movement (STREAM) Instrument.J Rehabil Med. 2002; 34: 20-24
- The Stroke Rehabilitation Assessment of Movement (STREAM): a comparison with other measures used to evaluate effects of stroke and rehabilitation.Phys Ther. 2003; 83: 617-630
- Test-retest reliability of the Stroke Rehabilitation Assessment of Movement (STREAM).Formos J Phys Ther. 2006; 31: 351-356
- Clinical gait assessment in the neurologically impaired: reliability and meaningfulness.Phys Ther. 1984; 64: 35-40
- Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke.Arch Phys Med Rehabil. 2007; 88: 1314-1319
- The Barthel ADL Index: a reliability study.Int Disabil Stud. 1988; 10: 61-63
- Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel index, and 10 item Barthel index in patients with stroke.J Neurol Neurosurg Psychiatry. 2002; 73: 188-190
- Psychometric characteristics of the Barthel activities of daily living index in stroke patients.J Formos Med Assoc. 2001; 100: 526-532
- Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS).Stroke. 1999; 30: 1862-1868
- Analysis and comparison of the psychometric properties of three balance measures for stroke patients.Stroke. 2002; 33: 1022-1027
- Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity.Arch Phys Med Rehabil. 1999; 80: 1013-1016
- Reorganization and enhanced functional connectivity of motor areas in repetitive ankle movements after training in locomotor attention.Brain Res. 2009; 1297: 124-134
- Effects of somatosensory stimulation on use-dependent plasticity in chronic stroke.Stroke. 2006; 37: 246-247
- Brain activity during stepping: a novel MRI-compatible device.J Neurosci Methods. 2011; 201: 124-130
- Effects of somatosensory stimulation on motor function after subacute stroke.Neurorehabil Neural Repair. 2010; 24: 263-272
- Motor control: theory and practical applications.2nd ed. Lippincott Williams & Wilkins, Philadelphia2001
- Differential cerebellar activation related to perceived pain intensity during noxious thermal stimulation in humans: a functional magnetic resonance imaging study.Neurosci Lett. 2003; 335: 202-206
- fMRI of thermal pain: effects of stimulus laterality and attention.Neuroimage. 2002; 15: 293-301
- Brain activity changes associated with treadmill training after stroke.Stroke. 2009; 40: 2460-2467
Article info
Publication history
Published online: November 26, 2012
Footnotes
Supported by the Kaohsiung Municipal Hsiao-Kang Hospital (grant no. Kmhk-98-005) and National Health Research Institutes (grant no. NHRI-EX101-9907PI) in Taiwan.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
