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| Rebecca Dutton Home After a Stroke |
Rehabilitation may include regaining flexibility, strength, endurance, and coordination. When PTs treat orthopedic cases (e.g. broken hip) they focus on flexibility and strength. One hour treatment sessions provide some work on endurance, but therapists assume endurance will increase as clients move more at home. Coordination can be ignored because people with orthopedic injuries have intact brains.
To reduce pain and increase flexibility in the shoulder de Jong et. al. treated 46 stroke survivors (1). Subjects in the experimental group were placed in one of two positions (photo on left) and shoulder muscles were given electrical stimulation for 45 minutes twice a day every day for eight weeks. Subjects in the control group were placed in a sham position (photo on right) and forearm muscles were given electrical stimulation for the same amount of time. "In the experimental group some participants reported that they considered the intervention to be very arduous, pain and spasticity medication were prescribed more frequently, and protocol compliance was lower (p. 250)." If you have a tight shoulder can you imagine being trapped in either of the positions on the left for 90 minutes a day while your muscles were forced to contract for 45 minutes without a rest?
Shoulder flexibility and pain did not improve and neither did function during ADLs. Using electrical stimulation to force muscles to contract does nothing to retrain the brain. Assuming muscles can work together in a coordinated fashion is OK for orthopedic cases, but stroke survivors must learn to recruit and coordinate numerous muscles that have been paralyzed. PTs like de Jong typically ignore complex coordination because they treat in barren, unchanging environments that require only a few repetitive motions. Walking clients on flat floors in wide open spaces does not prepare PTs to think about the wide range of coordinated movements the upper extremities must perform. Working on one isometric contraction had very little chance of improving ADLs in stroke survivors.- de Jong LD, Dijkstra PU, Gerritsen J, Geurts A, Postema K. Combined arm stretch positioning and neuromuscular electrical stimulation during rehabilitation does not improve range of motion, shoulder pain or function in patients after stroke: a randomized trial. Journal of Physiotherapy. 2013;59:245-254.
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