Stroke Research & Therapy

Keywords

Dynamic neural mobilization; Rehabilitation; Spasticity; Stroke

Introduction

Stroke is caused by the disturbance of blood supply to brain [1]. Spasticity is one of the most common complications of stroke. Muscle hypertonia also results from shortening of muscle. It results from imbalance between excitation and inhibhition [2]. Abnormal and obligatory synergies develop with spasticity. Isolated movement of the limb gets impossible due to development of synergy. Patient fails to perform the functional task in response to environmental demands. The progression of recovery synergies become stronger with development of spasticity. Two distinct patterns of synergies can develop in each extremity; flexor synergy and extensor synergy. In stroke postural adjustment is impaired which leads to the development of postural abnormalities, balance problems and increased risk of fall [3].

Reflexes vary with the stage of recovery. At stage 1 hyporeflexia develops with flaccidity. As recovery progresses hyperreflexia develops with spasticity and synergies. In UMN syndrome clonus and positive Babinski sign occurs as stretch reflexes are hyperactive [4,5]. Sensory ataxia occurs due to proprioceptive loss. Problem develops in timing and sequence of muscles action which can impair function performance in cerebellar ataxia [6]. Sensations are frequently affected but not absent in stroke [7]. Generation of normal force to initiate and control movement gets impossible in stroke [8].

Action Research Arm Test (ARAT) is a 19 items tool which is used to assess gross and fine task performance in upper extremity after stroke [9]. There are 6 items for grasp, 4 items for grip and 6 items for pinching and 3 items in gross movement task which includes placing the arm on top of their head, behind their head or bring the arm to their mouth [10,11]. The ARAT has strong validity when compared with other upper extremity function scales [12]. Fugl Meyer Upper Extremity scale (FM-UE) is a stroke-specific scale used to evaluate motor performance, coordination, passive joint movement and joint pain [13,14]. FMA-UE reliability is (0.995-0.99615).

Range of motion can be improved with stretching with active (within limit of range) and passive range of motion exercises in stroke [16]. Thamar, et al in 2008 determined the effect of stretching in spasticity. Stretching exercises are effective but its long-term effects are unclear. Neuro dynamics comprises of three part system. Mechanical interface involve interaction between the nervous and musculoskeletal systems, neural structures and innervated tissues [17]. Dynamic closers are applied to treat tension dysfunction and dynamic openers are effective for pain relief. Present research investigated the correlation between Fugl Meyer Upper Extremity scale (FM-UE) and Action Research Arm Test (ARAT) used to assess the recovery of upper extremity function in stroke patients.

Methods

It was a randomized control trial. 41 stroke patients were recruited for the study. Data was collected from DHQ Hospital Jhelum and patients were randomized through simple random sampling to experimental and control group. Stroke patients from 6 to 12 months were included in this study. To control group conventional treatment (stretching and range of motion exercises) and to experimental group conventional treatment (stretching and range of motion exercises) with dynamic neural mobilization technique was applied, 10 rep per set, 1set per day, 3 days per week for 6 weeks [18,19]. 0, 3^rd and 6^th week assessment was done through Fugl Meyer Upper Extremity scale (FM-UE) and Action Research Arm Test (ARAT). Correlation analysis was done through SPSS version 21(Table 1).

Table 1: Demographic data of the 41 chronic stroke patients.

Results

FM-UE=Fugl Meyer Upper Extremity scale, ARAT=Action Research Arm test, Data is presented as Mean ± standard deviation.

Spearmen correlation analysis was done through SPSS version 21. The results of study indicates that there was high correlation between Fugl Meyer Upper Extremity (FM-UE) motor score and Action Research Arm Test (ARAT) as value of r was (0.737-0.771). There was high correlation between Fugl Meyer Upper Extremity (FM-UE) coordination and Action Research Arm Test (ARAT) as value of r was (0.637-0.659). There was moderate correlation between Fugl Meyer Upper Extremity (FM-UE) sensations and Action Research Arm Test (ARAT) as value of r was (0.306-0.393). There was low correlation between Fugl Meyer Upper Extremity (FM-UE) passive joint motion and Action Research Arm Test (ARAT) as value of r was (0.198-0.269). There was moderate to high correlation between Fugl Meyer Upper Extremity (FM-UE) joint pain and Action Research Arm Test (ARAT) as value of r was (0.416-0.579) (Table 2 and 3).

Table 2: Mean and standard deviation of the FM-UE scale and ARAT.

Table 3: Spearman’s correlation coefficient (r) and p value between FM-UE scale and ARAT.

FM-UE=Fugl Meyer Upper Extremity scale, ARAT=Action Research Arm test, Data is presented as spearman rho=r and p value.

• Significant correlation <0.01

• Significant correlation <0.05

• Non significant correlation >0.05

Discussion

The results of this study suggest that there was high correlation between FM-UE motor score and action research arm test, high correlation between FM-UE coordination and action research arm test, moderate correlation between FM-UE sensations and action research arm test, low correlation between FM-UE passive joint motion and action research arm test and moderate to high correlation between FM-UE joint pain and action research arm test. This study shows resemblance with some aspects of literature review as Wei, Xi-Jun et al. concluded that there was high correlation between action research arm test ARAT and Fugl Meyer assessment scale FMA as value of r was (0.91-0.96).

Justin A, Beebe et al. determined that responsiveness of action research arm test to change in upper extremity function in stroke patients during first 6 months of rehabilitation was high. This study determined that action research arm test can be used for the more comprehensive assessment of upper extremity function in stroke patient. The current study determined the correlation between Action Research Arm Test (ARAT) and Fugl Meyer Upper Extremity scale (FM-UE) and concluded that there was moderate to high correlation ARAT and FM-UE scale, both were sensitive to change in upper extremity function.

Meheroz H, Rabadi et al. compared action research arm test and Fugl Meyer assessment scale in acute stroke patients as a measure of upper extremity rehabilitation and determined that both action research arm test ARAT and Fugl Meyer assessment scale FMA were sensitive to change in upper extremity function in acute stroke patients. The current study determined the correlation between Action Research Arm Test (ARAT) and Fugl Meyer Upper Extremity Scale (FM-UE) and concluded that there was moderate to high correlation ARAT and FM-UE scale.

Johanna H, van der Lee et al. determined the responsiveness of ARAT and FMA to improvement in upper extremity function in stroke and concluded that action research arm test ARAT is more responsive to improvement in upper extremity function in chronic stroke patients (22 patients were included) than fugl Meyer assessment scale FMA. The current study determined the correlation between Action Research Arm Test (ARAT) and Fugl Meyer Upper Extremity Scale (FM-UE) and concluded that there was moderate to high correlation ARAT and FM-UE scale, both were sensitive to change in upper extremity function.

Conclusion

This study concluded that there was high correlation between FM-UE motor score and action research arm test, high correlation between FM-UE coordination and action research arm test, moderate correlation between FM-UE sensations and action research arm test, low correlation between FM-UE passive joint motion and action research arm test and moderate to high correlation between FM-UE joint pain and action research arm test.

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