Correlation of spasticity with hyperactive stretch reflexes and motor dysfunction in hemiplegia.

OBJECTIVES: To study the correlation between spasticity and motor dysfunction in the wrist-hand unit of adult hemiplegic patients, and to investigate the correlation between clinical spasticity and hyperactive stretch reflexes. STUDY DESIGN: A survey study with a sequential case series of subjects. SETTING: Neuromuscular Research Laboratory, School of Physical Therapy, Texas Woman's University, Houston, TX. SUBJECTS: Sequential sample recruited from local stroke support groups: 10 patients with chronic hemiplegia caused by cerebral vascular accident who had various degrees of spasticity in the wrist joint. OUTCOME MEASURES: Modified Ashworth Scale, amplitudes of stretch reflexes for wrist flexors, grip strength, active range of motion of the wrist joint, and Fugl-Meyer test. RESULTS: Strong reverse correlation was found between spasticity and grip strength, the Fugl-Meyer test scores, and the Box and Blocks test scores (p = .001 to .005). Results also indicated a strong and consistent correlation between spasticity and reflexive electromyographic activities of the stretch reflex recorded from active muscles (p = .005 and .007), but not between spasticity and torque response of the stretch reflex. CONCLUSIONS: The degree of wrist spasticity is associated with impaired hand function in hemiplegic patients, and hyperactive electromyographic response of the stretch reflex, recorded from active muscles, is a valid indicator of spasticity.     

Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity

Muscle spasticity is a common motor disorder following upper motor neuron syndrome. A reliable and valid clinical tool is essential to document the effect of therapeutic interventions aimed to improve function by reducing spasticity. The Modified Ashworth Scale (MAS) is the most widely used and accepted clinical scale of spasticity. The MAS has been recently modified. The aim of this investigation was to determine the interrater and intrarater reliability of clinical test of knee extensor post-stroke spasticity graded on a Modified Modified Ashworth Scale (MMAS). Two raters scored the muscle spasticity of 15 patients with ischaemic stroke. For the inter- and intrarater reliability, two raters agreed on 80.1% and 86.6%, respectively. The Kappa values were good (kappa=0.72, SE=0.14, p<0.001) between raters and very good (kappa=0.82, SE=0.12, p<0.001) within one rater. The values of Kendall tau-b correlation were acceptable for clinical use with 0.87 (SE=0.06, p<0.001) between raters and 0.92 (SE=0.05, p<0.001) within one rater. The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity. The results encourage further study on the reliability and the validity of the scale.     

Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity

Muscle spasticity is a common motor disorder following upper motor neuron syndrome. A reliable and valid clinical tool is essential to document the effect of therapeutic interventions aimed to improve function by reducing spasticity. The Modified Ashworth Scale (MAS) is the most widely used and accepted clinical scale of spasticity. The MAS has been recently modified. The aim of this investigation was to determine the interrater and intrarater reliability of clinical test of knee extensor post-stroke spasticity graded on a Modified Modified Ashworth Scale (MMAS). Two raters scored the muscle spasticity of 15 patients with ischaemic stroke. For the inter- and intrarater reliability, two raters agreed on 80.1% and 86.6%, respectively. The Kappa values were good (κ=0.72, SE=0.14, p<0.001) between raters and very good (κ=0.82, SE=0.12, p<0.001) within one rater. The values of Kendall tau-b correlation were acceptable for clinical use with 0.87 (SE=0.06, p<0.001) between raters and 0.92 (SE=0.05, p<0.001) within one rater. The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity. The results encourage further study on the reliability and the validity of the scale.     

A型肉毒毒素治疗脑卒中后不同状态上肢痉挛的疗效

目的观察国产A型肉毒毒素（CBTX-A）注射治疗脑卒中后不同功能状态的上肢痉挛的疗效。方法根据上肢功能情况将32例脑卒中患者分为功能较好组（n=13）和功能较差组（n=19），均给予国产A型肉毒毒素肱二头肌局部注射和康复治疗，分别在治疗前和治疗后8周采用主动关节活动度、改良Ashworth评分、Fugl—Meyer评定（FMA）及Mot—FIM-上肢评分法评定患者的上肢功能。结果治疗8周后，两组患者的主动关节活动范围和FMA评分均比治疗前提高（P〈0．05），但功能较好组功能性改善的程度优于功能较差组（P〈0．05）；改良Ashworth评分降低程度两组间的差异无显著性意义（P〉0．05）；Mot-FIM-上肢评分均比治疗前提高（P〈0．05），但两组间的差异亦无显著性意义（P〉0．05）。结论肱二头肌局部注射A型肉毒毒素对脑卒中后上肢伸肘肌功能较好的患者的疗效优于伸肘肌功能较差的患者。     

Insulin growth factors may explain relationship between spasticity and skeletal muscle size in men with spinal cord injury

The major objectives of this cross-sectional study were to (1) measure insulin-like growth factor-1 (IGF-1) in individuals with complete spinal cord injury (SCI) and spasticity and (2) determine the relationships between IGF-1 and cross-sectional areas (CSAs) of thigh skeletal muscle groups. Eight individuals with motor complete SCI underwent magnetic resonance imaging to measure the CSA of the whole thigh, knee extensor, and knee flexor skeletal muscle groups and dual-emission X-ray absorptiometry to measure fat-free mass. After participants fasted for 12 h, we measured their IGF-1 levels and determined spasticity using the Modified Ashworth Scale (MAS). Spearman rho correlations were used to test for the relationships among the tested variables, and independent t-tests were used to determine the difference in plasma IGF-1. Plasma IGF-1 was 44% greater in those with MAS scores of 2 or higher (p < 0.05). Plasma IGF-1 was positively related to knee extensor skeletal muscle CSA (r = 0. 83, p < 0.01). IGF-1 was strongly related to knee extensor and flexor spasticity (r = 0.88, p < 0.004). The findings suggest that IGF-1 is greater in SCI individuals with increased spasticity, and this may explain the strong positive relationships that were noted between spasticity and skeletal muscle CSA.     

不同体位下肢被动踏踩训练对脑卒中下肢痉挛的影响

目的:观察不同体位下肢被动踏踩训练对脑卒中患者患侧下肢痉挛的疗效。方法:脑卒中患者66例,随机分为直立组35例和坐位组31例,2组在接受常规康复训练的基础上分别进行直立位和坐位的下肢被动踏踩训练。分别在训练前、训练30min及4周后对患侧小腿三头肌、股四头肌、腘绳肌进行改良Ashworth痉挛评定。结果:治疗30min后,2组患者仅患侧小腿三头肌的Ashworth痉挛评分较治疗前明显降低(P<0.05),2组间比较差异无统计学意义;治疗4周后,2组患者除坐位组患侧股四头肌外其余各肌肉痉挛评分均较治疗前明显降低(P<0.05),直立组患侧小腿三头肌痉挛评分分值降低较坐位组更显著(P<0.05)。结论:直立和坐位下肢被动踩踏训练均能降低脑卒中患者偏瘫侧下肢的痉挛,其中直立下肢被动踏踩训练对缓解患侧小腿三头肌的痉挛效果更好。     

动作观察配合作业治疗对脑卒中患者上肢功能及日常生活能力的影响

目的 探讨动作观察配合作业治疗对脑卒中患者上肢功能及日常生活能力的影响。 方法 将42例脑卒中偏瘫患者按照随机数字表法分为实验组和对照组,每组21例。所有患者均接受常规康复治疗,实验组在此基础上增加动作观察配合作业治疗,对照组增加常规作业治疗。在治疗前和治疗8周后（治疗后）,采用Fugl-Meyer运动功能量表上肢部分（FMA-UE）、香港版偏瘫上肢功能测试（FTHUE-HK）和改良Barthel指数（MBI）评价患者的上肢运动功能和日常生活能力。 结果 治疗前,2组患者FMA-UE、FTHUE-HK、MBI结果比较,差异无统计学意义（P>0.05）。与组内治疗前比较,2组患者FMA-UE、FTHUE-HK、MBI均有所改善（P<0.05）。与对照组治疗后比较,实验组FMA-UE［（42.81±13.59）分］、FTHUE-HK［（5.00±1.38）级］、MBI［（73.86±18.83）分］较为优异（P<0.05）。 结论 动作观察配合作业治疗能更好地改善脑卒中患者的上肢功能及日常生活能力。     

脑卒中偏瘫患者下肢痉挛与步行速度的关系

目的探讨脑卒中偏瘫患者下肢痉挛与步行速度之间的关系。方法对 3 5例脑卒中偏瘫痉挛患者用改良Ashworth法评定下肢膝伸肌和足跖屈肌的痉挛程度 ;测定步行速度、步距和步频 ;分析膝伸肌和足跖屈肌痉挛与步行速度、步长和步频之间的相关性 ,以及决定步行速度、步长和步频的下肢痉挛因素。结果患者在自由步行时的步行速度与膝伸肌和足跖屈肌痉挛呈中度负相关 (r =-0 .43 2 ,P <0 .0 5 ;r =-0 .44 8,P <0 .0 5 ) ,其中膝伸肌痉挛仅与步频呈中度负相关 (r =-0 .415 ,P <0 .0 5 ) ,而足跖屈肌痉挛与步距和步频呈中度负相关 (r =-0 .41,P <0 .0 5 ;r =-0 .3 3 5 ,P <0 .0 5 )。最大步行速度时的步长和步频与膝伸肌和足跖屈肌痉挛之间无相关性 (r =-0 .118— 0 .3 0 7,P >0 .0 5 )。决定自由步行速度、步长的下肢痉挛因素是足跖屈肌痉挛 (分别为R2 =0 .2 0 ,P <0 .0 1;R2 =0 .168,P <0 .0 5 ) ;决定步频的是膝伸肌痉挛 (R2 =0 .172 ,P <0 .0 5 )。结论脑卒中偏瘫患者下肢痉挛对步行速度的影响力较小 ,在以改善患者步行能力为目的的治疗中 ,应重点关注痉挛以外的其他更重要的临床因素。     

The role of botulinum toxin a in the management of lower limb spasticity in patients with cerebral palsy

This study aimed to determine the effects of botulinum toxin-A (btA) on spasticity in children with cerebral palsy (CP). Thirty-five children with spastic CP were evaluated. The injection group consisted of 25 patients who were injected with btA and received conventional physical therapy. The control group consisted of 10 patients who were treated with conventional physical therapy only. In the injection group, btA was applied to the lower extremity spastic muscles at a total dose of 8-10 lU/kg. Spasticity was measured by the Ashworth scale. Gait function was evaluated by clinical gait assessment in all patients and temporal distance factors in 16 patients. All the parameters were recorded before treatment, after three days and after one month of therapy. Following injection of btA, significant improvement in all parameters was observed. No statistically significant progression was noted in the control group except clinical gait analysis scores. Comparing the three-day and one-month measurements of spasticity of the two groups, statistically significant results were obtained in favour of the injection group in all parameters except for clinical gait analysis scores. The findings of this study showed btA injection to be an effective treatment for reducing spasticity and improving gait function in patients with spastic CP     

Electromyography characterization of stretch responses in hemiparetic stroke patients and their relationship with the Modified Ashworth scale

OBJECTIVES: To determine the validity of the Modified Ashworth Scale as a measure of spasticity by determining its relationship to surface electromyography activity and contracture. DESIGN: A controlled study of hemiparetic stroke patients with spasticity. SETTING: A physiotherapy department in a secondary care hospital. SUBJECTS: Thirty-one stroke patients and 20 healthy volunteers. MAIN MEASURES: The resistance to passive movement around the knee and ankle of the affected and unaffected legs was rated using the Modified Ashworth Scale. Passive range of movement was measured with a goniometer. Surface electromyography recordings of four lower limb muscles were taken during passive stretches of the knee and ankle. RESULTS: Hemiparetic patients produced surface electromyography responses to stretch that were of greater amplitude (unaffected limbs: mean = 25.82 mV (43.85), affected limbs: mean = 24.77 mV (35.46)) than those of healthy volunteers (mean = 15.85 (29.96)). The affected muscles of hemiparetic patients were more likely to produce surface electromyography responses to stretch of a sustained duration (45% of cases) compared with unaffected limbs (24% of cases) and those of healthy volunteers (16% of cases). The Modified Ashworth Scale showed a positive correlation with the magnitude (p < 0.05) and duration (p < 0.001) of the surface electromyography response. High scores on the Modified Ashworth Scale were associated with contracture (p < 0.001). Contracted muscles produced significantly greater surface electromyography reflex responses compared with noncontracted muscles (p < 0.05). CONCLUSION: The Modified Ashworth Scale reflects spasticity in terms of surface electromyography stretch responses produced by passive movement, but the relationship of spasticity to contracture remains unclear.     

FES辅助踏车与MOTOmed智能训练系统对早期脑卒中患者下肢功能的对比研究

目的:探讨功能性电刺激(FES)辅助踏车对脑卒中偏瘫患者早期下肢运动功能以及日常生活活动能力的影响。方法:将早期脑卒中偏瘫患者40例随机分为观察组和对照组各20例。2组均采用常规个体化康复治疗,观察组加用FES踏车进行治疗,对照组给予MOTOmed下肢踏车治疗。治疗前后分别采用功能性步行分级量表(FAC)、Tinetti量表、Berg平衡量表、Fugl-Meyer评分法(FMA)及改良Barthel指数(MBI)进行评估。结果:治疗6周后,2组FAC等级较治疗前均有显著提高(P0.01),2组间比较差异无统计学意义。治疗后,2组Tinetti量表、FMA下肢评分、MBI及BBS评分均较治疗前明显提高(P0.01),且观察组高于对照组(P0.05,0.01)。结论:FES辅助踏车系统和MOTOmed智能训练系统均有助于脑卒中早期下肢功能的恢复,而FES辅助踏车系统对下肢功能的改善效果优于MOTOmed智能训练系统。     

Immediate effects of short period lower limb ergometer exercise in adolescent and young adult patients with cerebral palsy and spastic diplegia

[Purpose] To determine the effects of lower limb ergometer exercise on the spasticity and joint range of motion of the lower extremity and gait function in patients with cerebral palsy and spastic paralysis. [Participants and Methods] This study included 8 participants with cerebral palsy and spastic paralysis (GMFCS levels I to IV) who received care at the outpatient clinic. After a 5-min rest, the lower limb ergometer exercises were performed for 10 min. We measured the participants’ arterial blood pressure, pulse rate, passive range of knee joint extension, muscle tone using the Modified Ashworth scale (MAS) and Modified Tardieu scale (MTS), and 10-m walk test (10MWT). Measurements were collected three times (at baseline before exercise, immediately at the end of exercise, and 5 min after exercise during recovery). [Results] The 10-min lower limb ergometer exercise significantly improved the knee joint extension, MAS and MTS scores, and reduced lower extremity spasticity. Furthermore, it significantly increased the range of knee joint extension and decreased the 10MWT score. [Conclusion] The results showed that the 10-minute lower limb ergometer exercise is beneficial in reducing the spasticity of the lower limb muscles and in increasing the range of motion of knee extension in paraplegic patients with cerebral palsy, suggesting that its implementation in young children could prevent spasticity and enhance motor function.Key words: Spasticity, Rehabilitation, Muscle tone     

脑卒中患者肢体痉挛的发生率及其与功能的关系

目的：探讨脑卒中患者肢体痉挛的发生率及其与功能的关系。方法：评定50例急性脑卒中患者的肌张力，在病程6个月时采用改良Ashworth量表（MAS）、Fugl-meyer运动功能（FMA）及Barthel指数（BI）分别评定患者肌张力、运动功能和日常生活活动能力。结果：在病程满6个月时患者中大多数存在肢体肌张力增高，MAS分级与FMA和BI得分间呈显著负相关（P〈0.001）。结论：脑卒中偏瘫患者痉挛发生率较高，而且痉挛程度与运动功能和日常生活活动能力显著相关,康复治疗应关注痉挛问题。     

同步应用生物刺激反馈和空气压力波治疗脑卒中痉挛上肢

目的:探讨同步应用生物刺激反馈和空气压力波疗法对脑卒中患者上肢屈肌痉挛及运动功能的作用。方法:选择偏瘫上肢屈肌痉挛、改良Ashworth量表评定≥2级的脑卒中患者44例,随机分为A、B2组各22例,均按脑血管病常规处理和康复治疗。A组并同步应用生物刺激反馈仪训练患侧肱三头肌,空气压力波治疗仪牵张桡和尺侧腕屈肌、指浅屈肌等,30min;B组则先用生物刺激反馈仪治疗30min后休息15min,再空气压力波治疗仪治疗30min。2组均每日1次。结果:治疗3周后,2组患侧肘和手改良Ashworth量表分级较治疗前明显降低,Fugi-Meyer运动功能量表、Brunstrom上肢功能评价法和Barthel指数评分均显著提高(P0.01);A组Fugi-Meyer治疗前后差值明显高于B组,其疗效优于B组(均P0.05)。结论:同步与非同步应用生物刺激反馈疗法和空气压力波治疗均能缓解偏瘫上肢痉挛状态,提高运动功能,但同步应用的效果更明显。     

Effects of a novel forced intensive strengthening technique on muscle size and upper extremity function in a patient with chronic stroke

[Purpose] This research demonstrated a forced intensive strength technique as a novel treatment for muscle power and function in the affected upper extremity muscle to determine the clinical feasibility with respect to upper extremity performance in a stroke hemiparesis. [Subject and Methods] The subject was a patient with chronic stroke who was dependent on others for performing the functional activities of his affected upper extremity. The technique incorporates a comprehensive approach of forced, intensive, and strength-inducing activities to enhance morphological changes associated with motor learning of the upper extremity. The forced intensive strength technique consisted of a 6-week course of sessions lasting 60 minutes per day, five times a week. [Results] After the 6-week intervention, the difference between relaxation and contraction of the affected extensor carpi radialis muscle increased from 0.28 to 0.63 cm², and that of the affected triceps brachii muscle increased from 0.30 to 0.90 cm². The results of clinical tests including the modified Ashworth scale (MAS; from 1+ to 1), muscle strength (from 15 to 32 kg), the manual function test (MFT; scores of 16/32 to 27/32 score), the Fugl-Meyer assessment (FMA; scores of 29/66 to 49/66 score), and the Jebsen-Taylor hand function test (JTHFT; from 38/60 to 19/60 sec) were improved. [Conclusion] Our results suggest that the forced intensive strength technique may have a beneficial effect on the muscle size of the upper extremity and motor function in patients with chronic stroke.Key words: Upper extremity, Strength, Stroke     

Application of combined botulinum toxin type A and modified constraint-induced movement therapy for an individual with chronic upper-extremity spasticity after stroke

BACKGROUND AND PURPOSE: Constraint-induced movement therapy (CIMT) is a promising intervention for retraining upper-extremity function after a stroke. The purpose of this case report is to describe the use of a combination of botulinum toxin type A (BtxA) and a modified CIMT program for a patient with severe spasticity who was unable to use his right upper extremity. CASE DESCRIPTION: The 52-year-old patient, who had a stroke 4 years ago, did not meet the minimum motor criteria for CIMT benefit. After receiving BtxA injections targeting the elbow, wrist, and finger flexors, he completed a 4-week program of modified CIMT followed by a 5-month home exercise program. OUTCOMES: The patient exhibited improvement in muscle tone (the velocity-dependent resistance to stretch that muscle exhibits) and in scores on several upper-extremity function tests (Modified Ashworth Scale, Motor Activity Log, Wolf Motor Function Test, Action Research Arm Test, and Fugl-Meyer Assessment of Motor Recovery). He also reported making much progress in the functional use of the involved upper extremity. DISCUSSION: In a patient with severe flexor spasticity and nonuse of the dominant upper extremity after a stroke, a combined treatment of BtxA and modified CIMT may have resulted in improved upper-extremity use.     

等速肌力训练对脑梗死偏瘫功能恢复的影响及左右步幅差、步速与机体平衡能力、步行能力相关性分析

目的分析等速肌力训练对脑梗死偏瘫患者疗效评定效果,探讨其下肢功能间的相关性。方法选取我院2017年7月至2019年7月收治的90例脑梗死偏瘫患者为研究对象,随机将其均分为研究组和对照组,对照组实施常规康复训练,研究组实施股四头肌和腘绳肌肌力训练,对比两组相同训练时间日常生活活动能力(Barthel)评分和下肢运动功能评分(Fugl-Meyer)的下肢功能评分、疗效与下肢功能的相关性。结果研究组Barthel和Fugl-Meyer的下肢功能评分显著高于对照组,差异有统计学意义(P<0.05);研究组步态对称性、步速、平衡功能及步行能力改善效果均显著优于对照组,差异有统计学意义(P<0.05);左右步幅差、步速、平衡功能及步行能力之间均存在显著相关性(P<0.01)。结论脑梗死偏瘫应用等速肌力训练,可有效增强患肢膝屈伸肌群肌力,提高步态对称性、步速、步行能力及平衡功能恢复,促进回归正常生活和工作。     

Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patients

Purpose: To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on lower extremity (LE) spasticity, motor function and motor neurone excitability in chronic stroke patients.

Method: This study was a randomised sham-controlled cross-over trial with 1-week follow-up. A total of 20 post-stroke patients were randomised to receive active (n?=?10) or sham (n?=?10) rTMS. Fourteen of them (7 in each group) crossed over to the sham or active rTMS after a washout period of 1 month. Interventions consist of five consecutive daily sessions of active or sham rTMS to the unaffected lower extremity motor area (1000 pulses; 1 Hz; 90% of the tibialis anterior motor threshold). Outcome measures were modified modified ashworth scale (MMAS), the H-reflex, lower extremity section of Fugl–Mayer assessment (LE-FMA) and timed UP and GO (TUG) test. All outcomes were measured at three levels in each intervention period: pre- and post-intervention and 1-week follow-up.

Results: Friedman’s test revealed significant improvement in MMAS score only after active rTMS. This improvement lasted for one week after the active rTMS. Repeated measure analysis of variance (ANOVA) showed significant time*intervention interaction for LE-FMA. There are no differences between groups for the MMAS and LE-FMA. No significant change in H_max/M_max ratio and TUG test was noted.

Conclusion: Low-frequency rTMS over the LE motor area can improve clinical measures of muscle spasticity and motor function. More studies are needed to clarify the changes underlying this improvement in spasticity.

• Implications for Rehabilitation

• Spasticity is a common disorder and one of the causes of long-term disability after stroke.

• Physical therapy modalities, oral medications, focal intervention and surgical procedures have been used for spasticity reduction.

• Beneficial effect of the repetitive transcranial magnetic stimulation (rTMS) for post-stroke upper extremity spasticity reduction and motor function improvement was demonstrated in previous studies.

• This study shows amelioration of lower extremity spasticity and motor function improvement after five daily sessions of inhibitory rTMS to the unaffected brain hemisphere which lasted for at least 1 week following the intervention.

     

水中运动疗法联合电针对恢复期脑卒中患者下肢肌力和平衡功能的影响

目的:观察水中运动疗法对恢复期脑卒中下肢肌肉力量、痉挛程度及平衡功能的影响。方法:选取62例恢复期脑卒中患者,分为治疗组(水中运动疗法+常规康复治疗+电针治疗)、对照组(常规康复治疗+电针治疗),每组31例。治疗前及治疗6周后,分别采用等速肌力评定、改良Ashworth痉挛量表(MAS)、临床痉挛指数(CSI)、10m最大步行速度测定(MWS)、Berg平衡量表(BBS)对2组患者进行评定。结果:治疗后,2组患者下肢肌肉力量、MWS、BBS评分均较治疗前显著增加(均P0.05),MAS分级评分、临床痉挛指数CSI均较治疗前显著降低(P0.05);治疗后组间比较,观察组下肢肌肉力量、MWS、BBS评分均明显高于对照组(均P0.05),观察组MAS分级评分、CSI指数均低于对照组(均P0.05)。结论:水中运动疗法联合电针疗法可有效提高恢复期脑卒中患者下肢肌力,改善患者平衡功能。     

New design of home-based dynamic hand splint for hemiplegic hands: a preliminary study

[Purpose] Hemiplegia following a stroke can affect hand movement; therefore, reconstructing hand function is the most desired outcome for stroke patients. The purpose of this study was to explore the application of rehabilitation through the use of a dynamic hand splint and observes its effects on the muscle strength and functional activity of the affected hands. [Subjects and Methods] Chronic stroke patients who underwent a 3-month conventional rehabilitation using the dynamic hand splint were recruited . Evaluations (e.g., electromyography, grip and finger strength appraisals, and Fugl-Meyer assessment) were conducted before the test, and after the 1 and 3 month’s intervention. The hemiplegic hands intermediately and after the treatment to assess improvement in hand-muscle strength and functional increase of the hand movements were evaluated. Patient response to use of the dynamic hand splint was assessed using a satisfaction scale after treatment. [Results] The results for maximal voluntary contraction of the extensor and flexor muscles and wrist and finger strength showed a statistically significant increase from the pretest to after 1 and 3 month’s intervention. [Conclusion] Wearing a dynamic hand splint for home-use as a supplementary training program in addition to hospital-based rehabilitation can effectively increase the muscle strength of hemiplegic hands.Key words: Stroke, Dynamic hand splint, Maximal voluntary contraction