The effect of a stretching device on hand spasticity in chronic hemiparetic stroke patients

Abstract

We attempted to evaluate the effect of a stretching device for treatment of hand spasticity in chronic stroke patients. We recruited 21 chronic hemiplegic stroke patients with severe finger flexor spasticity and randomly assigned them to the intervention group (10 patients) and control group (11 patients). The stretching device consisted of a resting hand splint, finger stretcher, and frame. The stretching state was maintained for 30 seconds and relaxed for the next 30 seconds. This stretching and relaxation were repeated for 20 minutes (one session). The stretching program was practiced 2 sessions/day and 6 days/week for 3 weeks for the patients of the intervention group. The effect of this stretching device was assessed using the modified Ashworth scale (MAS) score of finger flexor muscles. Patients in both groups were assessed six times within an interval of one week and patients in the intervention group were assessed two times before starting the stretching program. The two-way repeated measures analysis of variance (ANOVA) test for evaluation of the effect of intervention across all time-points between the two groups showed a significant interaction between time and effect of intervention (P < 0.001). Within the intervention group, the average of mean MAS score at Pre-1 and Pre-2 were 2.83 and 2.93, respectively (the difference between Pre-1 and Pre-2 was not significant (P > 0.05)), and this improved significantly to 1.97 at Inter-1, 1.55 at Inter-2, 1.20 at Inter-3, and 1.97 at Post-1 (P < 0.001) using the one-way repeated measures ANOVA test for evaluation of the effect of intervention across all time-points. We found that our stretching device was effective in relieving hand spasticity in chronic stroke patients.

The Effect of a Hand-Stretching Device During the Management of Spasticity in Chronic Hemiparetic Stroke Patients

“…They reported that the device was effective at reducing ankle spasticity and improving gait ability, based on a before and after exercise comparison in 12 chronic stroke patients. In 2011, our research team, Jung et al [18] demonstrated the effectiveness of a hand-stretching device for the management of hand spasticity in 21 chronic stroke patients. However, their device and stretching protocol had problems, described above, which limited the usefulness of the device in stroke patients.…”

“…The reliability of MAS for joints in the upper extremity has been well demonstrated in several studies [19-22]. Jung et al [18] also used MAS for assessing changes of spasticity of MCP joint after stretching. The passive range of motion (PROM) was checked at each assessment day in all patients of both groups.…”

“…Fundamentally, the modified stretching device consists of a resting hand splint, a finger and thumb stretcher, and a frame similar to that of the previous stretching device [18]. To achieve firm hand fixation during stretching and to improve handling of the device, a rotational steel bar connected to a gear equipped with a ratchet is included.…”

“…However, manual stretching exercises require a therapist to perform repetitive exercises on a regular basis, and outcomes depend on therapist experience [13,17]. To overcome these drawbacks, some stretching devices have been developed, and their effectiveness has been demonstrated [13,14,17,18]. …”

“…We recently developed a stretching device for the management of hand spasticity and our research team, Jung et al [18] demonstrated the beneficial effects of this device in 21 chronic stroke patients. However, this device was found to have some limitations in chronic stroke patients.…”