Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
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An Unconventional Approach Considering Flexor Spasticity and Flexion Synergies of the Upper Extremity Following a Stroke: A Randomized Double-blind Pilot Study

  • Rha, Young Hyoun (Department of Physical Therapy, Busan Veterans Hospital) ;
  • Lee, Keun Hee (Department of Physical Therapy, Pediatric Motor Development Center) ;
  • Shin, Jun Bum (Department of Physical Therapy, ONEXT Rehabilitation Laboratory Center) ;
  • Park, Kang Hui (Department of Physical Therapy, Dongju College) ;
  • Kim, Byung Sun (Department of Physical Therapy, Gwanghye General Hospital) ;
  • Ha, Jae Chan (Department of Physical Therapy, Dong-A University Hospital)
  • Received : 2022.01.17
  • Accepted : 2022.02.14
  • Published : 2022.05.20
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Abstract

Background: Although various conventional approaches have been employed to reduce spasticity in neurological rehabilitation, only a few studies have shown scientific evidence for its effectiveness. Thus, we introduced a different concept (Ueda method) of rehabilitation therapy that can complement the limitations of conventional therapy. Objects: This study aimed to investigate the immediate effects of the application of the Ueda method on patients with spasticity after stroke via an electrophysiological study. Methods: We conducted a randomized double-blind pilot study in two rehabilitation hospitals involving 30 stroke patients who were randomly allocated to the Ueda (n = 15) and convention (n = 15) groups. Electromyographic data of six examined muscles in both upper extremities of all patients were recorded. The A-ApA index and activation ratios of upper extremity muscles were evaluated and compared between the groups to confirm post-intervention changes in upper-extremity flexor spasticity and flexion synergies. Repeated-measures analysis of variance was conducted to confirm the therapeutic effect (2 × 2) as a function of group (Ueda vs. convention) and time (pre-/post-intervention) on all outcome measures (p < 0.05). Results: In the Ueda group, the mean A-ApA index values differed significantly before and after the intervention (p = 0.041), indicating a weak evidence level; however, the effect size was medium (d = -0.503). The interaction effects of the A-ApA index between the Ueda and convention groups and between pre-intervention and post-intervention stages were significant (p = 0.012). The effect size was large (np2 = 0.220). In the Ueda group, the activation ratios of the anterior deltoid fiber significantly decreased after the intervention in all reaching tasks. Conclusion: The Ueda method reduces upper-extremity flexor spasticity and changes its synergy in stroke patients and should be considered a rehabilitation therapy for spastic stroke patients.

Keywords

Acknowledgement

This study was supported by a Veterans Health Service Medical Center Research Grant, Republic of Korea, grant number VHSMC18025.

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