Isokinetic muscular strengthening of upper limb versus passive movement in chronic stroke patients. Randomised controlled trial.

OBJECTIVE: The sensori-motor impairment of upper limb (UL) affects more than 50% of patients after stroke. The objective of this work was to study the efficiency of isokinetic muscle strengthening (IMS) in the chronic phase of stroke in this population.

MATERIAL/PATIENTS AND METHODS: The patients underwent 6 weeks of outpatient rehabilitation, 3 days per week, combining physiotherapy (twice/day) and occupational therapy every day. The program was completed by 30 minutes elbow and wrist concentric slow speed IMS of flexor and extensor muscles, in the study group versus 30 minutes passive mobilisation of the joints carried out by the same isokinetic dynamometer in the control group.

INCLUSION CRITERIA: Age>18 years, post stroke period>6 months, muscle strength>2/5 manual testing, spasticity<3/5 on the Ashworth scale. Lack of motion range limitations and cognitive disorders.

PRINCIPAL JUDGEMENT CRITERIA: The UL Fugl Meyer (FM) score gain at the end of the program (6 weeks).

SECONDARY CRITERIA: FM at 3 and 6 months, Box and Block test, Barthel Index and measures of muscle strength at 6 weeks, 3 and 6 months.

RESULTS: Twenty patients were included: 16 men, 13 left hemiplegia, 16 ischemic strokes, average age 63. The gain in the FM score at 6 weeks was comparable between the two groups: 3.5 point (±4.4) versus +6 (±4.5) in the control group (P=0.224). We have not observed shoulder pain or increase spasticity. No significant differences between the two groups has been demonstrated on secondary endpoints. All patients improved their FM score (4.7; P<0.001) and Box and Block test (3 cubes; P=0.013) at the end of the program. This benefit was maintained at 3 and 6 months.

DISCUSSION - CONCLUSION: Combined with an intensive multidisciplinary rehabilitation program, IMS of UL is not more efficient than passive mobilisation of the wrist and elbow late after stroke. Our study also suggests the value of an intensive, out-patient rehabilitation treatment program in chronic phase after stroke, in cases of mild to moderate motor deficit of UL, remains beneficial over 6 months post-program.