Highlights
- •No benefit of isokinetic strengthening of elbow and wrist muscles in chronic stroke.
- •Isokinetic strengthening of the upper arm may be harmful in patients with chronic stroke.
- •A 6-week program of intensive rehabilitation in chronic stroke is promising.
Abstract
Objective
To assess the benefit of isokinetic strengthening of the upper limb (UL) in patients
with chronic stroke as compared to passive mobilization.
Design
Randomized blinded assessor controlled trial.
Setting
Physical Medicine and Rehabilitation departments of 2 university hospitals.
Participants
Patients (N=20) with incomplete hemiplegia (16 men; mean age, 64y; median time since
stroke, 32mo).
Interventions
A 6-week comprehensive rehabilitation program, 3d/wk, 3 sessions/d. In addition, a
45-minute session per day was performed using an isokinetic dynamometer, with either
isokinetic strengthening of elbow and wrist flexors/extensors (isokinetic strengthening
group) or passive joint mobilization (control group).
Main Outcome Measures
The primary endpoint was the increase in Upper Limb Fugl-Meyer Assessment (UL-FMA)
score at day 45 (t1). Secondary endpoints were increases in UL-FMA scores, Box and
Block Test scores, muscle strength, spasticity, and Barthel Index at t1, t2 (3mo),
and t3 (6mo).
Results
Recruitment was stopped early because of excessive fatigue in the isokinetic strengthening
group. The increase in UL-FMA score at t1 was 3.5±4.4 in the isokinetic strengthening
group versus 6.0±4.5 in the control group (P=.2). Gains in distal UL-FMA scores were larger (3.1±2.8) in the control group versus
0.6±2.5 in the isokinetic strengthening group (P=.05). No significant group difference was observed in secondary endpoints. Mixed
models confirmed those results. Regarding the whole sample, gains from baseline were
significant for the UL-FMA at t1 (+4.8; P<.001), t2, and t3 and for the Box and Block Test at t1 (+3; P=.013) and t2.
Conclusions
In a comprehensive rehabilitation program, isokinetic strengthening did not show superiority
to passive mobilization for UL rehabilitation. Findings also suggest a sustained benefit
in impairments and function of late UL rehabilitation programs for patients with stroke.
Keywords
List of abbreviations:
BBT (Box and Block Test), UL (upper limb), UL-FMA (Upper Limb Fugl-Meyer Assessment)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
- Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review.Neurorehabil Neural Repair. 2008; 22: 111-121
- Post-stroke hemiplegia rehabilitation: evolution of the concepts.Ann Phys Rehabil Med. 2014; 57: 520-529
- Guidelines for Adult Stroke Rehabilitation and Recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2016; 47: e98-e169
- Repetitive task training for improving functional ability after stroke.Cochrane Database Syst Rev. 2016; : CD006073
- Interventions for improving upper limb function after stroke.Cochrane Database Syst Rev. 2014; : CD010820
- Effects of robot-assisted therapy for the upper limb after stroke.Neurorehabil Neural Repair. 2017; 31: 107-121
- Innovative technologies applied to sensorimotor rehabilitation after stroke.Ann Phys Rehabil Med. 2014; 57: 543-551
- Strengthening interventions increase strength and improve activity after stroke: a systematic review.Aust J Physiother. 2006; 52: 241-248
- Isokinetic muscle strengthening after acquired cerebral damage: a literature review.Ann Phys Rehabil Med. 2012; 55: 279-291
- Muscle strengthening for hemiparesis after stroke: a meta-analysis.Ann Phys Rehabil Med. 2016; 59: 114-124
- Upper extremity function in stroke subjects: relationships between the International Classification of Functioning, Disability, and Health Domains.J Hand Ther. 2011; 24 (quiz 265): 257-264
- Loss of strength contributes more to physical disability after stroke than loss of dexterity.Clin Rehabil. 2004; 18: 300-308
- Effects of functional and analytical strength training on upper-extremity activity after stroke: a randomized controlled trial.Braz J Phys Ther. 2016; 20: 543-552
- Comparison of the effects between isokinetic and isotonic strength training in subacute stroke patients.J Stroke Cerebrovasc Dis. 2015; 24: 1317-1323
- Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study.Lancet. 2009; 373: 1105-1110
- Electromyographic analysis of upper limb muscles during standardized isotonic and isokinetic robotic exercise of spastic elbow in patients with stroke.J Electromyogr Kinesiol. 2014; 24: 11-17
- Effects of the bilateral isokinetic strengthening training on functional parameters, gait, and the quality of life in patients with stroke.Int J Clin Exp Med. 2015; 8: 16871-16879
- Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke.Braz J Phys Ther. 2014; 18: 268-275
- Interrater reliability of a Modified Ashworth Scale of muscle spasticity.Phys Ther. 1987; 67: 206-207
- The assessment of aphasia and related disorders.Lea & Febiger, Philadelphia1972
- Behavioral assessment of unilateral neglect: study of the psychometric properties of the Catherine Bergego Scale.Arch Phys Med Rehabil. 2003; 84: 51-57
- “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Effects of isokinetic strength training on walking in persons with stroke: a double-blind controlled pilot study.J Stroke Cerebrovasc Dis. 2001; 10: 265-273
- The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance.Scand J Rehabil Med. 1975; 7: 13-31
- Estimating the minimal clinically important difference of an upper extremity recovery measure in subacute stroke patients.Top Stroke Rehabil. 2011; 18: 599-610
- Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke.Phys Ther. 2012; 92: 791-798
- Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke.Neurorehabil Neural Repair. 2009; 23: 435-440
- Functional evaluation: the Barthel Index.Md State Med J. 1965; 14: 61-65
- Statistical Power Analysis for the Behavioral Sciences.Lawrence Erlbaum Associates, Hillsdale1988
- Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke.Arch Phys Med Rehabil. 2002; 83: 952-959
- Reconsidering the motor recovery plateau in stroke rehabilitation.Arch Phys Med Rehabil. 2004; 85: 1377-1381
- Robot-assisted therapy for long-term upper-limb impairment after stroke.N Engl J Med. 2010; 362: 1772-1783
- Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial.JAMA. 2006; 296: 2095-2104
- Home-based therapy programmes for upper limb functional recovery following stroke.Cochrane Database Syst Rev. 2012; : CD006755
- Use it and/or lose it—experience effects on brain remodeling across time after stroke.Front Hum Neurosci. 2014; 8: 379
- Dose-response study of mobilisation and tactile stimulation therapy for the upper extremity early after stroke: a phase I trial.Neurorehabil Neural Repair. 2011; 25: 314-322
- Effects of mobilization and tactile stimulation on chronic upper-limb sensorimotor dysfunction after stroke.Arch Phys Med Rehabil. 2013; 94: 693-702
- Reliability of muscle strength assessment in chronic post-stroke hemiparesis: a systematic review and meta-analysis.Top Stroke Rehabil. 2016; 23: 26-36
- Isometric and isokinetic muscle strength in the upper extremity can be reliably measured in persons with chronic stroke.J Rehabil Med. 2015; 47: 706-713
- Defining and measuring residual deficits of the upper extremity following stroke: a new perspective.Top Stroke Rehabil. 2009; 16: 167-176
Article info
Publication history
Published online: September 22, 2017
Footnotes
Supported by the Montpellier University Hospital, Montpellier, France (Nb: 2009-A01297-50).
Clinical Trial Registration No.: NCT01554137.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
