Tele-Rehabilitation Strategies for a Patient With Post-stroke Spasticity: A Powerful Tool Amid the COVID-19 Pandemic

Abstract

During the COVID-19 pandemic, stroke remains a leading cause of death and disability. Since the approach towards patients, treatments, and follow-up regimens has changed, tele-rehabilitation became a pillar for patients with ongoing recovery processes and rehabilitation strategies, especially for post-stroke patients. We describe the case of a 50-year-old male, suffering from right spastic hemiplegia and patellar clonus, for whom rehabilitation services were delivered both in‐person (conventional physical therapy and radial extracorporeal shock wave therapy) as well as with the aid of a tele-rehabilitation program. Assessments were conducted remotely via a self-adapted treadmill and stabilometric equipment, both connected to the Internet. At discharge and at 20 weeks follow-up, the patient showed decreased spasticity grade, improvement in sensorimotor function, balance, functional mobility, clonus score, ambulation distance, and decreased pain intensity. The case highlights the utility of tele-rehabilitation strategies in complementing and enhancing the effects of conventional physical therapy and radial extracorporeal shock wave therapy (rESWT) in post-stroke spasticity.

Effectiveness of Radial Extracorporeal Shock Wave Therapy and Visual Feedback Balance Training on Lower Limb Post-Stroke Spasticity, Trunk Performance, and Balance: A Randomized Controlled Trial

“…Another explanation for more significant improvement of ankle PROM may be related to the effects of rESWT on the entire muscle and the superficial tissue area. These results are in accordance with other studies [ 30 , 40 ]. In a previous study, rESWT seemed to provide greater improvement in ankle PROM than fESWT [ 29 ].…”

“…The clinical improvement of MAS grade was three times greater in the experimental group compared to the control group showing the effectiveness of the rESWT component on spasticity management and also the dynamic real-time feedback through balance training. These results are consist with those from other clinical trials [ 10 , 29 , 40 ]. Although knee PROM showed no statistically significant improvement after the interventions, ankle PROM showed statistically significant improvement, which could be explained by the site of rESWT application and its effects on plantar flexor muscles and thus, on augmented ankle PROM.…”

“…However, to assess the effect on the muscle, reliable measurements of muscle thickness on ultrasonography are correlated with the time frame, as well as the side of the body [ 41 ]. Several studies have already showed that both rESWT and fESWT were effective as novel, non-invasive therapies for spasticity management in post-stroke patients [ 29 , 31 , 40 ]. In terms of lower limb pain intensity, the VAS showed better scores in the experimental group, twice as ameliorated than in the control group which received sham rESWT and Prokin visual feedback training, the results being consistent with another trial which also showed the beneficial effects of rESWT on this endpoint [ 42 ].…”

Conventional physical therapy combined with extracorporeal shock wave leads to positive effects on spasticity in stroke survivors: a prospective observational study

“… 4 , 5 Quantitative gait analysis systems include instrumented treadmills as a new alternative to previous overground gait analysis systems, and also promote the assessments and effective therapeutic delivery of care to neurological patients after discharge. 3 , 5 , 6 Objective, quantitative parameters are needed to ensure good quality in clinical practice since the most commonly used methods for gait analysis were based either on visual observation or questionnaires, which are considered poorly reliable and insufficient methods. 7 Currently, the gold standard for measuring and evaluating spatiotemporal and kinematic gait parameters is represented by various 3D motion capture systems.…”

“…One of the key changes implemented by the health care systems in order to promote rehabilitation continuity, was the rapid expansion of several TR programs and tele-assessments strategies. 5 , 6 Systems such as newly instrumented treadmills for spatiotemporal, kinematic, and kinetic parameters assessment with good levels of agreement, seem a new alternative to previous overground gait analysis systems. 3 Integrating clinical assessment and virtual evaluation can easily offer objective data by tracking progress and also give the possibility to a tailored treatment for patients based on their performance at different moments.…”