Effect of ankle stretching combined with arm cycling on the improvement of calf muscle stiffness in patients with stroke: a pilot study

Abstract

[Purpose] This study aimed to ascertain whether ankle stretching combined with arm cycling compared with that without arm cycling results in greater improvement in maximum dorsiflexion range of motion (ROM), calf muscle stiffness, and gait velocity in the affected limb of patients with stroke. [Participants and Methods] Random ABAB reversal design was used in this study involving nine patients with stroke. Participants performed 10 min of ankle plantar flexor stretching through weight bearing using the tilt table under the following 2 conditions: with or without arm cycling at 60 revolutions per minute. Pre- and post-stretching maximum ROM and passive plantar flexion torque were measured using a custom-made passive torque indicator. Stiffness was calculated based on passive torque-angle relationships. [Results] Maximum ROM and stiffness significantly improved after stretching in both conditions, whereas no changes in gait velocity were found. The difference in pre- and post-stretching stiffness was significantly greater in the stretching with arm cycling group. Change in maximum ROM showed no difference between both stretching conditions. [Conclusion] This study indicates that ankle plantar flexor stretching combined with arm cycling was more effective than that without cycling in improving calf muscle stiffness in the affected limb of patients with stroke.

Neurologic and musculoskeletal effects of tilt-table standing on adults: a systematic review

“…1). Ultimately 20 articles were identified as relevant on the basis of inclusion and exclusion criteria [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . The articles are summarized in Table 1.…”

“…Tilt-table standing sessions were sometime limited by orthostatic intolerance 15,19) , but sessions typically involved standing times of 20 to 40 minutes and table angles of 70° or more from horizontal. In 8 studies participants stood on a wedge or incline plates 6,7,9,14,[16][17][18]23) .…”

“…The effect examined most consistently in the included articles was ankle dorsiflexion range of motion. Two studies reported ankle range of motion to increase over the course of a single standing session 17,23) . Of studies focused on changes in ankle range of motion over multiple standing sessions, 4 reported a small increase in ankle dorsiflexion range of motion 9,14,20,21) and 1 documented a small decrease 7) .…”

“…Closely related to range of motion is ankle stiffness. Two studies showed resistance to passive ankle dorsiflexion to decrease significantly over the course of a tilt-table session 17,18) . Odéen and Knutsson reported the decreases to be greater in patients who stood on the tilt table with the ankle dorsiflexed rather than plantarflexed 18) .…”

“…Motor recovery, as reflected in various index scores (eg, Fugl-Meyer, Barthel, and NIH Stroke Scale), has been demonstrated (albeit not consistently) to improve following tilt-table standing 11,12) . Although not consistently or significantly, specific activities such as walking 14,16,17) , transferring 8) , and standing up 21) have been shown to improve in some studies.…”