Exceptional improvement in chronic stroke through Guided Self-rehabilitation Contract: A Case Report Study

If you have a competent? doctor at all, s/he will get the EXACT PROTOCOLS for this so they can be handed to you as you depart the hospital. But you don't have a competent doctor, do you?

Exceptional improvement in chronic stroke through Guided Self-rehabilitation Contract: A Case Report Study

Caroline Gault-Colas ^1* Maud Pradines ^1,2 Marjolaine Baude ^1,2 Jean-Michel Gracies ^1,2

• ¹ Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
• ² Université Paris-Est Créteil Val de Marne, Créteil, Ile-de-France, France

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A 44-year-old woman suffered carotid dissection causing deep and superficial right middle cerebral artery stroke in October 2013, despite thrombolysis and thrombectomy. Sixteen months later, massive left upper extremity impairment persisted (Video 1). She then agreed to embark upon a Guided Self-rehabilitation Contract. This is a moral contract where the physician or therapist identifies specific muscles, particularly hypo-extensible and disabling that act as antagonists to functional activities, then teaches and prescribes quantified daily high-load selfstretch postures for these muscles, alternating with repeated maximal amplitude movement exercises against their resistance. In turn, the patient commits to practicing the prescribed program and to delivering a diary of the stretch postures and alternating movement exercises performed each day. Over four years of GSC, the patient practiced upon prescription against a total of seven upper limb antagonists to common functional movements: shoulder extensors, shoulder internal rotators, elbow flexors, elbow pronators, wrist and finger flexors, and interossei muscles. She manually filled up her diary 99% of days. Each day, she practiced an average of 20 minutes of high-load static self-stretch per muscle, alternating with about 50 maximal active efforts against the resistance of each targeted muscle's resistance. Overall, her mean static self-stretch time was 81±2 (mean±SEM) minutes/day and her mean number of active maximal efforts was 285±78/day, for a total daily self-rehabilitation time of over two hours a day. Five years after her stroke, she had recovered all left upper extremity use in daily activities (Video 2) and resumed her previous job as a nurse's aide. She now spontaneously uses her left hand in most tasks. Functional MRI (March 2020) demonstrated bilateral primary motor and motor supplementary area activation upon left hand exercise. Prolonged static self-stretch increased muscle extensibility (muscle plasticity) while maximal amplitude, alternating movement training reduced co-contraction in these muscles (neural plasticity).

Keywords: Stroke, chronic, hemiparesis, Self rehabilitation, Guided Self rehabilitation Contracts, Spastic paresis, Upper limb, case report

Received: 15 Feb 2024; Accepted: 21 Aug 2024.

Copyright: © 2024 Gault-Colas, Pradines, Baude and Gracies. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.