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
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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
