Effects of 6 months of regular passive movements on ankle joint mobility in people with spinal cord injury: a randomized controlled trial

Harvey, L A; Herbert, Robert D.; Glinsky, Joanne; Moseley, Anne M.; Bowden, Jocelyn L.

doi:10.1038/sc.2008.71

Cited by 33 publications

(20 citation statements)

References 20 publications

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“…6,8,[12][13][14][15][16][17][18][19][20][21] These findings were confirmed by a recent Cochrane review that provided high-quality evidence that passive stretch produces negligible short-term (mean between-group difference 1 , 95% CI, 0-3) or long-term (mean between-group difference 0 , 95% CI, À2 to 2) changes in joint range of motion (ROM) when administered to people with a variety of neurological conditions. The typical dose of passive stretch applied in the reported trials was 30 minutes to 12 hours per day over 4-12 weeks (median duration 30 days); 22 this dosage of passive stretch may be insufficient.…”

supporting

confidence: 60%

An Intensive Programme of Passive Stretch and Motor Training to Manage Severe Knee Contractures after Traumatic Brain Injury: A Case Report

Leung

Harvey

Moseley

2013

Physiotherapy Canada

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Purpose: While contemporary management of contractures (a common secondary problem of acquired brain injury that can be difficult to treat) includes passive stretch, recent evidence indicates that this intervention may not be effective. This may be because clinical trials have not provided a sufficient dose or have not combined passive stretch with other treatments. The purpose of this case report is to describe a programme of intensive passive stretch combined with motor training administered over a 1.5-year period to treat severe knee contractures. Method: Five months after traumatic brain injury, an adolescent client with severe contractures in multiple joints underwent an intensive stretch programme for his knee contractures, including serial casting and splinting, which was administered for 10 months in conjunction with a motor training programme administered for 1.5 years. Results: The client regained full extension range in his knees and progressed from being totally dependent to walking short distances with assistance; these effects were maintained at follow-up 5.5 years after injury. Conclusion: The use of a high dose of passive stretch in conjunction with motor training may be an option to consider for correcting severe contractures following acquired brain injury.Key Words: brain injuries; contracture; exercise therapy; muscle stretching exercises. RÉ SUMÉObjectif : Bien que le contrô le des contractures (un problè me secondaire fré quent propre aux lé sions cé ré brales acquises et pouvant ê tre difficile à traiter) comprenne des é tirements passifs, des preuves ré centes indiquent que cette intervention pourrait ê tre inefficace. Cela pourrait s'expliquer par le fait que les essais cliniques n'ont pas utilisé des dosages suffisants ou qu'ils n'ont pas jumelé les é tirements passifs à d'autres traitements. L'objectif de ce rapport de cas consiste à dé crire un programme d'é tirements passifs intensifs allié à un entraînement moteur administré durant une pé riode d'un an et demi pour le traitement de contractures sé vè res au genou. Mé thodologie : Cinq mois aprè s un traumatisme cé ré bral, un client adolescent aux prises avec des contractures sé vè res à de multiples articulations a é té soumis à un programme intensif d'é tirements pour ses contractures au genou, y compris l'application successive de plâ tres et d'attelles. Le programme a é té administré pendant 10 mois, en mê me temps qu'un programme d'entraînement moteur qui a duré un an et demi. Ré sultats : Le client a retrouvé la pleine extension de son genou et ses progrè s se sont é tendus d'une dé pendance totale à la capacité de marcher sur de courtes distances sans aide; ces effets se sont prolongé s pendant un suivi de cinq ans et demi aprè s le traumatisme. Conclusion : L'utilisation des é tirements passifs à dosage é levé en mê me temps qu'un entraînement moteur pourrait ê tre une avenue à considé rer pour corriger les contractures sé vè res ré sultant d'un traumatisme cé ré bral.Contractures-a reduction in passive joint range d...

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supporting

confidence: 60%

An Intensive Programme of Passive Stretch and Motor Training to Manage Severe Knee Contractures after Traumatic Brain Injury: A Case Report

Leung

Harvey

Moseley

2013

Physiotherapy Canada

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“…Our results showed that stretch interventions may prevent degeneration of the joint capsule leading to contractures and may affect biochemical composition rather than the morphologic features of the cartilage, although we cannot conclude from this study whether stretching is harmful to the cartilage. Several clinical studies in patients with spinal cord injuries suggest a substantial positive effect on soft tissues in stretched positions for prolonged periods [10,11,13]. The treatments evaluated in our study, using this particular animal model, should be considered to be geared toward treatment of contractures that might form very early after spinal cord injury, not chronic contractures of long duration.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, it is believed that contractures can be prevented more readily than treated, and that less stretching is required to maintain rather than to increase the extensibility of soft tissues [12]. Considerable resources [12], including some rigorously designed clinical studies [1,10,11,13], have investigated the efficacy of stretching. However, it remains unclear whether the effects observed in these trials are clinically worthwhile, and the therapeutic effect of stretching on the pathophysiology of contractures has received little attention.…”

Section: Introductionmentioning

confidence: 99%

Amount of Torque and Duration of Stretching Affects Correction of Knee Contracture in a Rat Model of Spinal Cord Injury

Moriyama¹,

Tobimatsu²,

Ozawa³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Joint contractures are a common complication of many neurologic conditions, and stretching often is advocated to prevent and treat these contractures. However, the magnitude and duration of the stretching done in practice usually are guided by subjective clinical impressions. Questions/purposes Using an established T8 spinal cord injury rat model of knee contracture, we sought to determine what combination of static or intermittent stretching, varied by magnitude (high or low) and duration (long or short), leads to the best (1) improvement in the limitation in ROM; (2) restoration of the muscular and articular factors leading to contractures; and (3) prevention and treatment of contracture-associated histologic alterations of joint capsule and articular cartilage. Methods Using a rat animal model, the spinal cord was transected completely at the level of T8. The rats were randomly assigned to seven treatment groups (n = 4 per group), which were composed of static or intermittent stretching in combination with different amounts of applied torque magnitude and duration. We assessed the effect of stretching by measuring the ROM and evaluating the histologic alteration of the capsule and cartilage. Results Contractures improved in all treated groups except for the low-torque and short-duration static stretching conditions. High-torque stretching was effective against shortening of the synovial membrane and adhesions in the posterosuperior regions. Collagen Type II and VEGF in the cartilage were increased by stretching. Conclusions High-torque and long-duration static stretching led to greater restoration of ROM than the other torque and duration treatment groups. Stretching was more effective in improving articular components of contractures compared with the muscular components. Stretching in this rat model prevented shortening and adhesion of the joint capsule, and affected biochemical composition, but did not change morphologic features of the cartilage. Clinical Relevance This animal study tends to support the ideas that static stretching can influence joint ROM and histologic qualities of joint tissues, and that the way stretching is performed influences its efficacy. However, further studies are warranted to determine if our findings are clinically applicable.

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“…3,4 Impressions of change are commonly used as part of clinical trials in gerontology [5][6][7] and psychiatry, 6,8 but only rarely in SCI. 9,10 Although clinicians' and patients' impressions of change are subjective, they are nonetheless valuable and reflect the way clinical decisions are made in practice about ceasing, commencing or changing therapy. 5 Presumably, when clinicians or patients rate overall impressions of change in motor performance, they take into account neurological status as well as the time and effort devoted to therapy and implications of change on real life.…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ and patients’ impressions of change in motor performance as potential outcome measures for clinical trials

et al. 2010

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Study design: A cross-sectional descriptive study was undertaken. Objectives: The overall objective was to explore the potential usefulness of clinicians' and patients' impressions of change in motor performance for clinical trials. Specifically, the aim was to compare clinicians' and patients' impressions of change in motor performance with standardized outcome measures in people with spinal cord injury (SCI). Setting: Spinal injury units, Sydney, Australia. Methods: Thirty people undergoing rehabilitation after recent SCI were recruited. They were assessed on two occasions separated by between 1 and 5 months. On both occasions, patients were assessed sitting unsupported (n ¼ 25), transferring (n ¼ 23) and walking (n ¼ 12) using standardized outcome measures. On the second occasion, patients rated their impressions of change in each of the three motor tasks since their initial assessment. A 15-point scale was used. In addition, patients were videoed performing the three motor tasks on the two occasions. Two clinicians with SCI experience independently viewed the pairs of videos and rated their impressions of change using the same 15-point scale. Clinicians' and patients' impressions of change were compared with each other and to the standardized objective measures. Results: Clinicians' and patients' impressions of change were greater than change measured with standardized objective measures for all three motor tasks (Po0.01). In addition, patients' impressions of change were greater than clinicians' impressions of change for transferring, but comparable for unsupported sitting and walking. Conclusion: Clinicians' and patients' impressions of change in motor performance may have potential for evaluating treatment effectiveness in clinical trials.

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Effects of 6 months of regular passive movements on ankle joint mobility in people with spinal cord injury: a randomized controlled trial

Cited by 33 publications

References 20 publications

An Intensive Programme of Passive Stretch and Motor Training to Manage Severe Knee Contractures after Traumatic Brain Injury: A Case Report

An Intensive Programme of Passive Stretch and Motor Training to Manage Severe Knee Contractures after Traumatic Brain Injury: A Case Report

Amount of Torque and Duration of Stretching Affects Correction of Knee Contracture in a Rat Model of Spinal Cord Injury

Clinicians’ and patients’ impressions of change in motor performance as potential outcome measures for clinical trials

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