THE EFFECTS OF SUBTALAR JOINT MOBILIZATION ON PATIENTS WITH CHRONIC STROKE
Condition: Hemiplegia, Spastic
MeSH terms: Hemiplegia
Study type: Interventional

Summary: 
      Adequate ankle motion for normal gait ranges from 10° to 15° of dorsiflexion passive range of
      motion (DF-PROM) to allow the tibia to move over the talus. However, limited ankle mobility
      is a common impairment in patients with stroke whose DF-PROM has been shown to be
      approximately half of that in healthy subjects. As a result, these patients have impaired
      dynamic balance in standing or gait. Mulligan first proposed mobilization with movement (MWM)
      as a joint mobilization technique. Talocrural MWM to facilitate DF-ROM is performed by
      applying a posteroanterior tibia glide over a fixed talus while the patient actively moves
      into a dorsiflexed position while standing. Talocrural MWM has been applied to chronic ankle
      instability and has been proven effective in improving DF-PROM and standing balance. Subtalar
      MWM to facilitate DF-ROM is performed by bringing foot to dorsiflexion-abduction-eversion by
      flexing patient' knee.

      The effects of subtalar MWM have not been investigated in patients with stroke. Therefore,
      the purpose of the present study is to examine the effects of subtalar MWM on muscle
      strength, balance, functional performance, and gait parameters in patients with chronic
      stroke.
    

Detailed description: 
      Neural factors, such as spasticity, or an increase in the sensitivity of the myotatic reflex,
      can contribute significantly to calf muscle stiffness. Likewise, non-neural factors, such as
      immobilization and age-induced changes in the mechanical properties of muscle and connective
      tissue, are known to increase resistance to joint movement and to contribute to the limited
      DF-PROM. Both neural and non-neural factors can impair ankle motion, resulting in balance
      impairments during standing or gait. Limited DF-PROM can alter foot positioning in weight
      bearing, resulting in hyperextension of the knee, and decreased ability to shift the center
      of gravity (COG) during standing and gait. A variety of interventions, such as stretching and
      joint mobilization, have been attempted to attenuate the effects of limited DF-PROM and to
      reduce further deterioration in patients post stroke. Both stretching and joint mobilization
      have been proven effective for improving ankle passive range of motion in patients with
      stroke; however, there is a limit to the durability of the effect and improvements in
      functional ability. For this reason, improvements in joint range of motion (ROM) must be
      accompanied by gains in muscle strength to improve functional ability. This is especially
      true for patients with hemiplegia who are not capable of weight bearing symmetrically and
      require additional training, including repetitive and continuous weight bearing on the
      paretic lower limb.

      Adequate ankle motion for normal gait ranges from 10° to 15° of dorsiflexion passive range of
      motion (DF-PROM) to allow the tibia to move over the talus. However, limited ankle mobility
      is a common impairment in patients with stroke whose DF-PROM has been shown to be
      approximately half of that in healthy subjects. As a result, these patients have impaired
      dynamic balance in standing or gait. Mulligan first proposed mobilization with movement (MWM)
      as a joint mobilization technique. Talocrural MWM to facilitate DF-ROM is performed by
      applying a posteroanterior tibia glide over a fixed talus while the patient actively moves
      into a dorsiflexed position while standing. Talocrural MWM has been applied to chronic ankle
      instability and has been proven effective in improving DF-PROM and standing balance. Subtalar
      MWM to facilitate DF-ROM is performed by bringing foot to dorsiflexion-abduction-eversion by
      flexing patient' knee.

      The effects of subtalar MWM have not been investigated in patients with stroke. Therefore,the
      purpose of the present study is to examine the effects of subtalar MWM on muscle strength,
      balance, functional performance, and gait parameters in patients with chronic stroke.
    

Intervention name(s): Talocrural joint MWM mobilization; Subtalar joint MWM mobilization
Intervention type(s): Other; Other
Intervention description(s): There were two groups for this study. In addition to Bobath Concept, talocrural joint mobilization was performed.; There were two groups for this study. In addition to treatment of control group, subtalar joint mobilization was performed.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized
Masking: Single (Care Provider)
Primary purpose: Treatment
Keywords: hemiplegia; foot; mobilization