OSTEOPATHIC SHOULDER MANIPULATION FOR CHRONIC STROKE PATIENTS WITH UPPER EXTREMITY SPASTICITY

In case you want to try this yourself and see if your therapist does this. Of course this is chronic so long past time for your insurance to cut off therapy. Plateau you know.

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 OSTEOPATHIC SHOULDER MANIPULATION FOR CHRONIC STROKE PATIENTS WITH UPPER EXTREMITY SPASTICITY

Nicholas R. Beatty, MSc; Wolfgang Gilliar, DO;Jason Siefferman, MD; Preeti Raghavan, MD
Objective:
 Local treatment of spasticity with botulinum toxin injection reduces spasticity but also causes weakness. Exercise therapies such as constraint-induced therapy are limited by spasticity and abnormal muscle synergy patterns. The challenge is to facilitate practice while reducing barriers such as increased weakness, spasticity and abnormal muscle synergies. We hypothesized that the Spencer technique will reduce spasticity, increase PROM and improve movement efficiency by reducing muscle co-activation in patients with spastic hemiparesis, compared with sham treatment.
 Design:
 Ten patients with chronic spastic hemiparesis(Fugl-Meyer score=31.2±8.01) participated in the study. All ten received the sham protocol, and 5 additionally received the Spencer technique, an osteopathic manipulative treatment (SpencerOMT). Spencer-OMT was performed by passively guiding the subject’s UE through all degrees of freedom to the maximum passive range, of motion (PROM),followed by both nonrapid joint mobilization and muscle energy techniques (MET). Before and after each intervention, PROM and spasticity (Modified Ashworth Scale, MAS), were measured at the shoulder, elbow, wrist, and fingers, and subjects completed ten trials of a reach-to-target task. Muscle activity during reach was measured with surface electro-myography and performance was videotaped. Wilcox on Signed Rank tests were used to compare changes with SpencerOMT v sham, and signifi-cance was set at p<0.05.
 Results:
 Spencer OMT led to significantly increased PROM in shoulder extension, abduction, internal and external rotation, elbow extension, and wrist extension, but not in fingerextension. Spasticity (MAS) was significantly reduced in shoulder adductors, elbow flexors, and wrist flexors. Coactivation between the lateral deltoid and biceps/brachioradialis decreased significantly, with a trend in decreased coactivation of the biceps and triceps, suggesting modification of post stroke synergy patterns.
 Conclusions:
 The Spencer osteopathic manipulation is an effective noninvasive technique for immediate reduction in global UE spasticity and abnormal muscle synergy, and may be usefully combined with other exercise techniques to facilitate post stroke rehabilitation.