Interests of Strengthening Isokinetic Upper Extremity Hemiparetic Sequelae in Patients

Study Overview
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Brief Summary
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Stroke (CVA) is the leading cause of death and the leading cause of disability in developed countries as in developing countries (WHO, 2000). In the aftermath of a stroke, patients keep a permanent disability in 75% of cases and only one quarter of them is able to resume work. The post stroke sequelae are sensory-motor and cognitive. According to literature data, 75-83% of patients who survive a stroke learn to walk only 25 to 45% recover use of their upper limb in activities of daily living (Friedman, 1990). The existence of a phase called plateau in motor recovery after stroke has been suggested (Colautti, 2001). This would occur beyond the 4 th month and would correspond to a phase where the rehabilitation techniques used in the subacute phase are deemed less effective. Recently, Page (2004) speculated that this plateau phase is rather the consequence of adaptation to the type of patient follow-up training and not that of a limit to the possibilities of recovery. In an observational study on the recovery of upper limb conducted over a period of 4 years, Broeks (2004) showed a possible recovery beyond 16 weeks post stroke. The results of studies on different techniques for rehabilitation of chronic stroke patients tend to confirm the hypothesis of page. Therefore, varying the training parameters (type, intensity, frequency) could improve the functional capabilities of these patients, even at a distance of stroke. Strength training is part of the management of hemiparetic patients. The results of several studies show an improvement in muscle strength and functional ability to walk after a building program isokinetic lower limb (Sharp, 1997). The objective of our project is to evaluate the effectiveness of a building program of isokinetic muscle on the paretic limb motor recovery in hemiparetic patients over 6 months of a stroke.

Official Title
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Interests of Strengthening Isokinetic Upper Extremity Hemiparetic Sequelae in Patients

Conditions
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Partial Deficiency of Muscle Strength

Intervention / Treatment
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* Other: isokinetic strength training
* Other: passive motion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with more than 6 months post stroke, Muscular control greater than or equal to 3 on the extensors and elbow flexors, Muscular control greater than or equal to 3 on the flexors and extensors of the wrist, Spasticity less than or equal to 3 on the muscle groups mentioned above, s Active abduction of the shoulder above 60 ° and painless Absence of cognitive impairment (MMS> 22 without any trouble phasic) No orthopedic limitations at the elbow and wrist, Exclusion Criteria: Progressive neurological or systemic involvement, Orthopedic limitations at the elbow or wrist Cognitive, Hemineglect, Severe aphasia with impaired comprehension,

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: With isokinetic strength training<br>60 minutes isokinetic strength training on concentric mode | Other: isokinetic strength training<br>* The experimental group will follow a program of 18 sessions (3 sessions per week for 6 weeks) with a physiotherapy treatment (30 minutes) and occupational therapy (30 minutes), and a building session isokinetic concentric mode extensor and flexor muscles of the elbow extensors and wrist flexors.<br>|
| Placebo Comparator: without isokinetic strength training<br>passive motion 60 minutes | Other: passive motion<br>* The control group will follow a program of 18 sessions of physiotherapy and occupational therapy combined with 18 sessions of passive motion in flexion-elbow extension, wrist flexion-extension on the isokinetic device<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| upper limb motor function | improving upper limb motor recovery at the end of the program is evaluated by the Fugl-Meyer test.This test evaluates motor impairment of the hemiplegic upper limb, balance, sensitivity, passive joint mobility and joint pain at mobilization. | 6 weeks |