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Phys. Ther. Korea 2022; 29(2): 147-155

Published online May 20, 2022

https://doi.org/10.12674/ptk.2022.29.2.147

© Korean Research Society of Physical Therapy

An Unconventional Approach Considering Flexor Spasticity and Flexion Synergies of the Upper Extremity Following a Stroke: A Randomized Double-blind Pilot Study

Young Hyoun Rha1 , PT, PhD, Keun Hee Lee2 , PT, PhD, Jun Bum Shin3 , PT, MSc, Kang Hui Park4 , PT, PhD, Byung Sun Kim5 , PT, Jae Chan Ha6 , PT

1Department of Physical Therapy, Busan Veterans Hospital, 2Department of Physical Therapy, Pediatric Motor Development Center, 3Department of Physical Therapy, ONEXT Rehabilitation Laboratory Center, 4Department of Physical Therapy, Dongju College, 5Department of Physical Therapy, Gwanghye General Hospital, 6Department of Physical Therapy, Dong-A University Hospital, Busan, Korea

Correspondence to: Young Hyoun Rha
E-mail: ssu42th@hanmail.net
https://orcid.org/0000-0002-5687-639X

Received: January 17, 2022; Revised: February 13, 2022; Accepted: February 14, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Although various conventional approaches have been employed to reduce spasticity in neurological rehabilitation, only a few studies have shown scientific evidence for its effectiveness. Thus, we introduced a different concept (Ueda method) of rehabilitation therapy that can complement the limitations of conventional therapy. Objects: This study aimed to investigate the immediate effects of the application of the Ueda method on patients with spasticity after stroke via an electrophysiological study.
Methods: We conducted a randomized double-blind pilot study in two rehabilitation hospitals involving 30 stroke patients who were randomly allocated to the Ueda (n = 15) and convention (n = 15) groups. Electromyographic data of six examined muscles in both upper extremities of all patients were recorded. The A-ApA index and activation ratios of upper extremity muscles were evaluated and compared between the groups to confirm post-intervention changes in upper-extremity flexor spasticity and flexion synergies. Repeated-measures analysis of variance was conducted to confirm the therapeutic effect (2 × 2) as a function of group (Ueda vs. convention) and time (pre-/post-intervention) on all outcome measures (p < 0.05).
Results: In the Ueda group, the mean A-ApA index values differed significantly before and after the intervention (p = 0.041), indicating a weak evidence level; however, the effect size was medium (d = –0.503). The interaction effects of the A-ApA index between the Ueda and convention groups and between pre-intervention and post-intervention stages were significant (p = 0.012). The effect size was large (np2 = 0.220). In the Ueda group, the activation ratios of the anterior deltoid fiber significantly decreased after the intervention in all reaching tasks.
Conclusion: The Ueda method reduces upper-extremity flexor spasticity and changes its synergy in stroke patients and should be considered a rehabilitation therapy for spastic stroke patients.

Keywords: Motor dysfunction, Muscle spasticity, Neurological rehabilition, Stroke, Ueda method

Article

Original Article

Phys. Ther. Korea 2022; 29(2): 147-155

Published online May 20, 2022 https://doi.org/10.12674/ptk.2022.29.2.147

Copyright © Korean Research Society of Physical Therapy.

An Unconventional Approach Considering Flexor Spasticity and Flexion Synergies of the Upper Extremity Following a Stroke: A Randomized Double-blind Pilot Study

Young Hyoun Rha1 , PT, PhD, Keun Hee Lee2 , PT, PhD, Jun Bum Shin3 , PT, MSc, Kang Hui Park4 , PT, PhD, Byung Sun Kim5 , PT, Jae Chan Ha6 , PT

1Department of Physical Therapy, Busan Veterans Hospital, 2Department of Physical Therapy, Pediatric Motor Development Center, 3Department of Physical Therapy, ONEXT Rehabilitation Laboratory Center, 4Department of Physical Therapy, Dongju College, 5Department of Physical Therapy, Gwanghye General Hospital, 6Department of Physical Therapy, Dong-A University Hospital, Busan, Korea

Correspondence to:Young Hyoun Rha
E-mail: ssu42th@hanmail.net
https://orcid.org/0000-0002-5687-639X

Received: January 17, 2022; Revised: February 13, 2022; Accepted: February 14, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Although various conventional approaches have been employed to reduce spasticity in neurological rehabilitation, only a few studies have shown scientific evidence for its effectiveness. Thus, we introduced a different concept (Ueda method) of rehabilitation therapy that can complement the limitations of conventional therapy. Objects: This study aimed to investigate the immediate effects of the application of the Ueda method on patients with spasticity after stroke via an electrophysiological study.
Methods: We conducted a randomized double-blind pilot study in two rehabilitation hospitals involving 30 stroke patients who were randomly allocated to the Ueda (n = 15) and convention (n = 15) groups. Electromyographic data of six examined muscles in both upper extremities of all patients were recorded. The A-ApA index and activation ratios of upper extremity muscles were evaluated and compared between the groups to confirm post-intervention changes in upper-extremity flexor spasticity and flexion synergies. Repeated-measures analysis of variance was conducted to confirm the therapeutic effect (2 × 2) as a function of group (Ueda vs. convention) and time (pre-/post-intervention) on all outcome measures (p < 0.05).
Results: In the Ueda group, the mean A-ApA index values differed significantly before and after the intervention (p = 0.041), indicating a weak evidence level; however, the effect size was medium (d = –0.503). The interaction effects of the A-ApA index between the Ueda and convention groups and between pre-intervention and post-intervention stages were significant (p = 0.012). The effect size was large (np2 = 0.220). In the Ueda group, the activation ratios of the anterior deltoid fiber significantly decreased after the intervention in all reaching tasks.
Conclusion: The Ueda method reduces upper-extremity flexor spasticity and changes its synergy in stroke patients and should be considered a rehabilitation therapy for spastic stroke patients.

Keywords: Motor dysfunction, Muscle spasticity, Neurological rehabilition, Stroke, Ueda method

Fig 1.

Figure 1.Shoulder girdle technique.
Physical Therapy Korea 2022; 29: 147-155https://doi.org/10.12674/ptk.2022.29.2.147

Fig 2.

Figure 2.Upper-extremity technique. [A] Flexion position. [B] Extension position.
Physical Therapy Korea 2022; 29: 147-155https://doi.org/10.12674/ptk.2022.29.2.147

Fig 3.

Figure 3.Consolidated Standards of Reporting Trials flow diagram. EMG, electromyography.
Physical Therapy Korea 2022; 29: 147-155https://doi.org/10.12674/ptk.2022.29.2.147

Table 1 . Characteristics of the study sample (N = 28).

Ueda group
(n = 14)
Convention group (n = 14)
Demographic characteristic
Age (y)49 ± 8.3154 ± 9.95
Sex
Female2 (14%)5 (36%)
Male12 (86%)9 (64%)
Medical characteristic
Time after onset (mo)21 ± 10.3022 ± 18.13
Side of injury
Right8 (57%)9 (64%)
Left6 (43%)5 (36%)
MBI68 ± 8.0465 ± 7.81
Pre_MAS1.93 ± 0.731.92 ± 0.86
Post_MAS1.57 ± 0.942.08 ± 1.04

Values are presented as mean ± standard deviation or number (%). A score of 0 indicates MAS grade 0; score of 1, MAS grade 1; score of 2, MAS grade 1+; score of 3, MAS grade 2; score of 4, MAS grade 3; and score of 5, MAS grade 4. MBI, modified Barthel index; MAS, modified Ashworth scale..


Table 2 . Mean changes in the A-ApA index after the intervention in both groups.

Group Before (n = 14)After (n = 14)tp-value


Mean ± SD95% CIMean ± SD95% CI
Convention0.68 ± 0.120.62–0.740.72 ± 0.170.63–0.81–1.4330.175
Ueda0.77 ± 0.120.71–0.830.69 ± 0.190.59–0.792.2860.041

Mean ± SD, mean ± standard deviation; CI, confidence interval..


Table 3 . The A-ApA index before and after the intervention between the Ueda method and conventional method.

ParameterSSdfMean squareFp-value
Before-after0.00310.0030.5930.448
Methods before-after0.04110.0417.3140.012
Error0.145260.006

SS, sum of square; df, degree of freedom..


Table 4 . Changes in the activation ratios of the upper-extremity muscles in the Ueda group.

Before (n = 14)After (n = 14)tp-valued


Mean ± SD95% CIMean ± SD95% CI
Reach 1
Ant.Del0.36 ± 0.120.30–0.420.31 ± 0.070.27–0.352.3010.040–0.509
Reach 2
Ant.Del0.38 ± 0.120.32–0.440.31 ± 0.080.27–0.352.8180.016–0.686
Reach 3
Ant.Del0.31 ± 0.100.26–0.360.23 ± 0.070.19–0.273.0980.009–0.927
Reach 4
Ant.Del0.35 ± 0.110.29–0.410.29 ± 0.070.25–0.332.2670.043–0.651

Mean ± SD, mean ± standard deviation; CI, confidence interval; Ant.Del, anterior deltoid..


Table 5 . Changes in the activation ratios of the upper-extremity muscles in the convention group.

Before (n = 14)After (n = 14)tp-valued


Mean ± SD95% CIMean ± SD95% CI
Reach 1
Ant.Del0.27 ± 0.080.23–0.310.25 ± 0.060.22–0.281.2640.230–0.283
Reach 2
Ant.Del0.27 ± 0.090.22–0.320.26 ± 0.080.22–0.300.6830.508–0.117
Reach 3
Ant.Del0.24 ± 0.070.20–0.280.22 ± 0.060.19–0.250.9640.354–0.307
Reach 4
Ant.Del0.23 ± 0.080.19–0.270.25 ± 0.060.22–0.280.6760.5120.283

Mean ± SD, mean ± standard deviation; CI, confidence interval; Ant.Del, anterior deltoid..