Abstract
Introduction.
The effects of long-term stretching (>6 months) in hemiparesis are
unknown. This prospective, randomized, single-blind controlled trial
compared changes in architectural and clinical parameters in plantar
flexors of individuals with chronic hemiparesis following a 1-year
guided self-stretch program, compared with conventional rehabilitation
alone.
Methods. Adults with chronic stroke-induced hemiparesis
(time since lesion >1 year) were randomized into 1 of 2, 1-year
rehabilitation programs: conventional therapy (CONV) supplemented with
the Guided Self-rehabilitation Contract (GSC) program, or CONV alone. In
the GSC group, specific lower limb muscles, including plantar flexors,
were identified for a diary-based treatment utilizing daily, high-load,
home self-stretching. Blinded assessments included (1) ultrasonographic
measurements of soleus and medial gastrocnemius (MG) fascicle length and
thickness, with change in soleus fascicle length as primary outcome;
(2) maximum passive muscle extensibility (XV1, Tardieu Scale); (3) 10-m maximal barefoot ambulation speed.
Results.
In all, 23 individuals (10 women; mean age [SD], 56 [±12] years; time
since lesion, 9 [±8] years) were randomized into either the CONV (n =
11) or GSC (n = 12) group. After 1 year, all significant between-group
differences favored the GSC group: soleus fascicle length, +18.1mm [9.3;
29.9]; MG fascicle length, +6.3mm [3.5; 9.1]; soleus thickness, +4.8mm
[3.0; 7.7]; XV1 soleus, +4.1° [3.1; 7.2]; XV1 gastrocnemius, +7.0° [2.1; 11.9]; and ambulation speed, +0.07m/s [+0.02; +0.16].
Conclusions.
In chronic hemiparesis, daily self-stretch of the soleus and
gastrocnemius over 1 year using GSC combined with conventional
rehabilitation increased muscle fascicle length, extensibility, and
ambulation speed more than conventional rehabilitation alone.
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