http://www.sciencedirect.com/science/article/pii/S1877065715001013
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Objectives
Antagonist
muscle resistance, including due to muscle contracture, is a
fundamental factor of motor impairment in spastic paresis. We aimed to
quantify the degree of shortening in the main muscles involved in
chronic hemiparesis (>1 year post-lesion), in patients following a
conventional system of rehabilitation.
Methods
From
their first clinic visit in the neurorehabilitation unit of the
PM&R department we retrospectively collected the assessments of
passive range of motion (XV1) – based on the 5-step clinical assessment, including the Tardieu Scale – against 8 key antagonists in the lower limb (n = 19
patients with chronic hemiparesis, age: 48 ± 13, mean ± SD; time since
lesion 3.7 ± 3.8 years) and 13 antagonists in the upper limb (n = 13 patients, age: 39 ± 13, mean ± SD; time since lesion 5.2 ± 3.9 years), then derived coefficients of shortening (CSH) by referring them to the normal expected amplitude (XN), CSH = (XN-XV1)/XN.
Results
The
higher coefficients of shortening were: vertical adductors (latissimus
dorsi – pectoralis major – teres major), 36 ± 3%; shoulder extensors
with flexed elbow (long head of triceps; latissimus dorsi) 33 ± 4%;
horizontal adductors (pectoralis major), 23 ± 1%; gastrocnemius,
20 ± 1%; soleus, 15 ± 2%; gluteus maximus, 16 ± 3%; rectus femoris,
12 ± 1% and pronator teres, 12 ± 4%.
Conclusion
Shoulder
extensors, plantar flexors and gluteus maximus in patients untreated
with self-stretching postures have undergone major muscle shortening in
chronic hemiparesis. A future study could assess the effectiveness of
stretching postures taught and applied from the early phase of stroke on
shortening of these muscles.
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