Keywords

cerebral vascular accident (CVA), hemiparesis, muscle, range of motion (ROM), spasticity

Authors

1. Schindler-Ivens, Sheila PT, PhD
2. Desimone, Davalyn PT
3. Grubich, Sarah PT
4. Kelley, Carolyn PT
5. Sanghvi, Namita MS
6. Brown, David A. PT, PhD

Abstract

Background: Physical therapists may prescribe stretching exercises for individuals with stroke to improve joint integrity and to reduce the risk of secondary musculoskeletal impairment. While deficits in passive range of motion (PROM) exist in stroke survivors with severe hemiparesis and spasticity, the extent to which impaired lower extremity PROM occurs in community-ambulating stroke survivors remains unclear. This study compared lower extremity PROM in able-bodied individuals and independent community-ambulatory stroke survivors with residual stroke-related neuromuscular impairments. Our hypothesis was that the stroke group would show decreased lower extremity PROM in the paretic but not the nonparetic side and that decreased PROM would be associated with increased muscle stiffness and decreased muscle length.

Methods: Individuals with chronic poststroke hemiparesis who reported the ability to ambulate independently in the community (n = 17) and age-matched control subjects (n = 15) participated. PROM during slow (5 degrees/sec) hip extension, hip flexion, and ankle dorsiflexion was examined bilaterally using a dynamometer that measured joint position and torque. The maximum angular position of the joint (ANG_max), torque required to achieve ANG_max (T_max), and mean joint stiffness (K) were measured. Comparisons were made between able-bodied and paretic and able-bodied and nonparetic limbs.

Results: Contrary to our expectations, between-group differences in ANG_max were observed only during hip extension in which ANG_max was greater bilaterally in people post-stroke compared to control subjects (P <= 0.05; stroke = 13 degrees, able-bodied = -1 degree). T_max, but not K, was also significantly higher during passive hip extension in paretic and nonparetic limbs compared to control limbs (P <= 0.05; stroke = 40 Nm, able-bodied = 29 Nm). Compared to the control group, T_max was increased during hip flexion in the paretic and nonparetic limbs of post-stroke subjects (P <= 0.05, stroke = 25 Nm, able-bodied = 18 Nm). K in the nonparetic leg was also increased during hip flexion (P <= 0.05, nonparetic = 0.52 Nm/degree, able-bodied = 0.37 Nm/degree.)

Conclusion: This study demonstrates that community-ambulating stroke survivors with residual neuromuscular impairments do not have decreased lower extremity PROM caused by increased muscle stiffness or decreased muscle length. In fact, the population of stroke survivors examined here appears to have more hip extension PROM than age-matched able-bodied individuals. The clinical implications of these data are important and suggest that lower extremity PROM may not interfere with mobility in community-ambulating stroke survivors. Hence, physical therapists may choose to recommend activities other than stretching exercises for stroke survivors who are or will become independent community ambulators.