Stroke Structured Abstract - S #14
Resisted and rapid exercises may improve finger straightening; unresisted, slow extension exercises may target finger straightening
CITATION: Trombly, C. A. & Quintana, L. A. (1983). The effects of exercise on finger extension of CVA patients. American Journal of Occupational Therapy, 37, 195-202.
LEVEL OF EVIDENCE: IC2c
What are the effects of 5 types of exercise (resisted grasp, resisted extention, unresisted grasp-release, unresisted rapid extention, unresisted slow extention) on the finger extension of post-cerebrovascular accident (CVA) patients?
Repeated-measures design with random assignment to sequence.
SAMPLING PROCEDURE/INCLUSION CRITERIA
Stroke patients who met inclusion criteria were recruited from the outpatient population of Braintree Hospital, Braintree, MA. Inclusion criteria included: diagnosed CVA, ability to understand directions, sitting tolerance of 3 hours, freedom from significant contractures, pain, and skin allergies in the affected extremity, and return of hand function between levels III and V of Brunnstrom's classification.
N = 10
Male = NR
Female = NR
Mean age = 53.1
LCVA = 5
RCVA = 5
Attrition = 0
NR = Not Reported
Electromyographic activity (EMG) of flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and extensor digitorum (ED). (Reliability not reported.)
Range of motion (ROM) by electrogoniometry of finger extension - adding together the degrees of movement of the proximal interphalangeal (PIP) and metacarpal phalangeal (MP) joints of the middle finger during opening of the hand from full flexion. (Reliability not reported.)
Condition 1: Resisted grasp - maximally resisted grasp of a 2.5cm cylinder.
Condition 2: Resisted extension - finger extension maximally resisted by rubber bands placed around the distal phalanges of the fingers and thumb.
Condition 3: Unresisted grasp-release - grasp and release of a lightweight 6cm cylinder.
Condition 4: Unresisted rapid extension - unresisted rapid finger extension to flick ping pong balls toward a target.
Condition 5: Unresisted slow extension - unresisted slow extension to move ping pong balls toward a target.
WHO DELIVERED INTERVENTION
FREQUENCY & DURATION
Three repetitions of each condition, followed by an open-hand, close-hand, open-hand sequence, and a 2-minute rest between the next condition. All within one 3-hour period.
During resisted extension, the ED was recruited at a significantly higher percentage than the FDP, but not significantly more than the FDS (F [2,14] = 4.78, p = .03, r = .59).
Rapid extension (contraction time = 0.4 seconds) recruited a significantly higher percentage of the ED than the FDS, but not more than the FDP (F [2,12] = 4.73, p = .03, r = .59).
Slow extension (contraction time = 2.0 seconds) recruited a significantly higher percentage of the ED than either of the flexors (F [2,14] = 19.13, p = .0001, r = .99).
During resisted grasp, all three muscles were highly recruited, none significantly more than the others (F [2,12] = .58, p > .57).
Grasp of a lightweight cylinder recruited none of the three muscles significantly more than any others (F [2,8] = 1.04, p > .39); all were at relatively low levels of activity.
Release of the lightweight cylinder recruited a significantly higher percentage of ED output than either flexor (F [2,10] = 6.03, p < .02).
Comparisons to determine which muscle was recruited significantly more by each of the five exercises:
- ED was recruited significantly more during rapid extension than during grasp of the lightweight cylinder (p > .05).
- FDP was recruited significantly more during resisted grasp compared with any other exercise (p < .01) and more during rapid extension than during either slow extension or grasp-release (p < .05).
- FDS was recruited significantly more during resisted grasp than slow extension and release of the lightweight cylinder (p < .05).
There were no significant changes in range of motion of extension, carryover of muscle activity during rhythmical opening and closing of the hand, or amount of time required to open the hand as a result of these exercises.
Within Groups/Conditions/Times: Not tested
THREATS TO VALIDITY
Results indicated that resisted and rapid exercise recruited high percentages of output of all three muscles. Slow, unresisted extension exercises preferentially recruited the extensor digitorum. No exercise caused significant immediate changes in range of motion (movement). Resisted grasp did not limit the patients' ability to extend their fingers.
This study suggests the use of exercise to facilitate stroke patients' hand muscle activity. However, more muscle activity did not produce changes in movement. Therapists should choose the type of exercise according to therapeutic purpose.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
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