Effects of the hybrid of neuromuscular electrical stimulation and noxious thermal stimulation on upper extremity motor recovery in patients with stroke: a randomized controlled trial

Background: Neuromuscular electrical stimulation (NMES) and noxious thermal stimulation (NTS) have been developed and incorporated in stroke rehabilitation.

Objective: This study aimed to compare the effects of NMES, NTS, and the hybrid of NMES and NTS (“Hybrid”) on motor recovery of upper extremity (UE) for patients with stroke.

Methods: We conducted a prospective, single-blind randomized controlled trial with concealed allocation. Forty-three patients with chronic stroke (onset >6 months) were randomly assigned to three groups (NMES, NTS, and “Hybrid”). In addition to conventional rehabilitation, participants received 30 min of NMES or 30 min of NTS or 15 min of NTS followed by 15 min of NMES. The treatment period was 8 weeks, 3 days/week, 30 min/time. The UE subscale of Fugl-Meyer assessment (UE-FMA, the primary outcome), Motricity index, modified Ashworth scale, and Barthel index were administered by a blinded assessor at baseline, posttreatment, and one-month follow-up.

Results: Most of the participants had mild-to-moderate disability in activity of daily living. No significant differences in the outcome measures at posttreatment and one-month follow-up were found among the NMES group (n = 13), NTS group (n = 13), and the hybrid of NMES and NTS group (n = 17). However, significant score changes in UE-FMA (p < 0.025) from baseline to posttreatment and one-month follow-up were found for the “Hybrid” group.

Conclusions: This study reveals that the hybrid of NMES and NTS therapy appears to be beneficial to UE recovery after stroke but is not superior to NMES or NTS alone.     

镜像训练对脑卒中患者上肢运动功能和心理状态的影响

目的 观察镜像训练对脑卒中患者上肢运动功能和心理状态的影响。方法 采用随机数字表将64例恢复期脑卒中偏瘫患者分为治疗组和对照组,每组各32例; 2组患者均给予相同常规康复治疗(偏瘫肢体功能综合训练、作业治疗、中低频电刺激治疗和气压泵治疗),对照组在此基础上增加2次/d,20min/次的镜像训练治疗; 以上治疗均5次/周,连续治疗4周; 2组患者均于治疗前和治疗4周后采用Fugl-Meyer量表上肢部分(FMA-UE)、Wolf运动功能测试量表(WMFT)、贝克抑郁量表(BDS)以及改良Barthel指数(MBI)进行评估。结果 治疗前2组FMA-UE评分、WMFT评分、BDS评分、MBI评分比较无明显差异(P>0.05); 治疗4周后除对照组BDS评分无明显变化,其余组别各评分均较治疗前有明显进步(P<0.05),且治疗组FMA-UE、WMFT、BDS、MBI评分与对照组比较有明显差异(P<0.05)。结论 镜像训练可明显提高脑卒中患者上肢运动功能,改善心理状态,提高生活质量。     

人-环境-作业模式促进脑卒中后手和上肢功能的康复

一侧肢体功能障碍是脑卒中后的典型症状,其中手和上肢功能障碍严重影响着作业表现,使患者的生活受到不同程度的限制。本文基于人-环境-作业(personenvironment-occupation,PEO)模式,从人、环境、作业活动和作业表现等方面,探讨脑卒中患者手和上肢功能的康复治疗,以期提升人们对中国脑卒中患者作业治疗内涵的理解。通过作业治疗,可以改善患者的行为表现,减轻功能受限程度,增强日常生活的活动能力,从而提高患者的生活质量。     

Mirror therapy and treadmill training for patients with chronic stroke: a pilot randomized controlled trial

Background: Previous lower-limb mirror therapy research has focused on non-weight bearing interventions.

Objectives: The primary aim of this study was to investigate the effect and feasibility of a combination of mirror therapy and treadmill training on post-stroke lower-limb recovery compared to a placebo intervention.

Methods: All patients (N = 30) walked on a treadmill for 30 min per day, 3 days per week, for 4 weeks. The mirror therapy and treadmill training group (n = 15) walked on the treadmill while viewing a reflection of their non-paretic limb in a mirror positioned in their mid-sagittal plane. The placebo group (n = 15) received no mirror visual feedback due to an altered mirror position. Primary outcome measures: Ten Metre Walk Test (10MWT) and Six Minute Walk Test (6MWT). Secondary outcome measures: Modified Ashworth Scale (MAS) and Fugl-Meyer Assessment-Lower Extremity (FMA-LE). Feasibility was appraised by examining participant compliance and any adverse events.

Results: No significant between group differences were demonstrated for the 10MWT, 6MWT or FMA-LE at post-training or 3-month follow-up assessment. A significant between group difference on the MAS was demonstrated in the reduction of ankle dorsiflexion muscle tone (p = 0.006) and ankle plantarflexion muscle tone (p = 0.01) in the mirror therapy group compared to the placebo group at post-training assessment but not at 3-month follow-up.

Conclusion: Our study reveals that in our group of patients with chronic stroke, mirror therapy combined with treadmill training facilitated significant reductions in ankle muscle tone (p < 0.05) compared to a placebo intervention.     

Effects of constraint-induced movement therapy for lower limbs on measurements of functional mobility and postural balance in subjects with stroke: a randomized controlled trial*

Background: Constraint-induced movement therapy (CIMT) is suggested to reduce functional asymmetry between the upper limbs after stroke. However, there are few studies about CIMT for lower limbs.

Objective: To examine the effects of CIMT for lower limbs on functional mobility and postural balance in subjects with stroke.

Methods: A 40-day follow-up, single-blind randomized controlled trial was performed with 38 subacute stroke patients (mean of 4.5 months post-stroke). Participants were randomized into: treadmill training with load to restraint the non-paretic ankle (experimental group) or treadmill training without load (control group). Both groups performing daily training for two consecutive weeks (nine sessions) and performed home-based exercises during this period. As outcome measures, postural balance (Berg Balance Scale – BBS) and functional mobility (Timed Up and Go test – TUG and kinematic parameters of turning – Qualisys System of movement analysis) were obtained at baseline, mid-training, post-training and follow-up.

Results: Repeated-measures ANOVA showed improvements after training in postural balance (BBS: F = 39.39, P < .001) and functional mobility, showed by TUG (F = 18.33, P < .001) and by kinematic turning parameters (turn speed: F = 35.13, P < .001; stride length: F = 29.71, P < .001; stride time: F = 13.42, P < .001). All these improvements were observed in both groups and maintained in follow-up.

Conclusions: These results suggest that two weeks of treadmill gait training associated to home-based exercises can be effective to improve postural balance and functional mobility in subacute stroke patients. However, the load addition was not a differential factor in intervention.     

Grip strength is a representative measure of muscle weakness in the upper extremity after stroke

Background: Muscle weakness is the most common impairment in the upper extremity after stroke, leading to a reduced ability to use the arm and the hand in daily activities. Grip strength is easier to measure than precise, but more time-consuming, isokinetic and isometric arm muscle strength measurements. It would therefore be advantageous in a clinical setting if grip strength could be used as a proxy for muscle strength in the entire upper extremity.

Objective: To investigate the association between grip strength and isometric and isokinetic arm muscle strength in persons with chronic stroke.

Methods: Forty-five persons with mild-to-moderate paresis in the upper extremity, at least 6 months post-stroke participated. Isometric grip strength was measured with a computerized grip dynamometer and arm strength (isometric shoulder abduction and elbow flexion as well as isokinetic elbow extension and flexion) with an isokinetic dynamometer. Pearson’s correlation coefficient was used to determine the association between the muscle strength measurements.

Results: There were significant correlations (p < .0001) between grip strength and all arm strength measurements in both the more affected (r = 0.77–0.82) and the less affected upper extremity (r = 0.65–0.82).

Conclusion: This cross-sectional study showed that grip strength is strongly associated with muscle strength in the arm in persons in the chronic phase after stroke. As grip strength is easy to measure and less time-consuming than arm muscle strength measurements, this implies that grip strength can be a representative measure of muscle weakness of the entire upper extremity in the chronic phase after stroke.     

Study to assess the effectiveness of modified constraint-induced movement therapy in stroke subjects: A randomized controlled trial

Background and Purpose:

The purpose of this study was to assess the effectiveness of modified constraint induced movement therapy (m-CIMT) in stroke subjects.

Materials and Methods:

A total of forty sub-acute stroke subjects were randomly assigned to either a m-CIMT (n = 20) or in a control group (n = 20). The m-CIMT group (14 men, 6 women; mean age = 55.2 years) consisted of structured 2 h therapy sessions emphasizing affected arm use, occurring 5 times/week for 2 weeks. A mitt was used to restrain the unaffected arm for 10 h/day for 2 week. The control group (11 men, 9 women; mean age = 56.4 years) consisted of conventional rehabilitation for time-matched exercise program. The outcome measures were evaluated at pre- and post-intervention by using the Wolf Motor Function Test (WMFT) and Fugl-Meyer assessment (FMA) of motor recovery after stroke.

Results:

After intervention significant effects were observed in m-CIMT group on WMFT (pre-test and post-test score was 28.04 ± 6.58, 13.59 ± 2.86; P =0.003). Similarly on FMA (pre- and post-test score was 31.15 ± 6.37, 55.7 ± 6.4; P = 0.00).

Conclusion:

There is a significant improvem ent in upper extremity function so it indicates that m-CIMT is effective in improving the motor function of the affected arm in stroke subjects. However, its long-term effect has not proved since there was no follow-up after intervention.     

Improvement of spontaneous language in stroke patients with chronic aphasia treated with music therapy: a randomized controlled trial

Aim of the study: The aim of this research is to evaluate the effects of active music therapy (MT) based on free-improvisation (relational approach) in addition to speech language therapy (SLT) compared with SLT alone (communicative-pragmatic approach: Promoting Aphasic's Communicative Effectiveness) in stroke patients with chronic aphasia. Materials and methods: The experimental group (n = 10) was randomized to 30 MT individual sessions over 15 weeks in addition to 30 SLT individual sessions while the control group (n = 10) was randomized to only 30 SLT sessions during the same period. Psychological and speech language assessment were made before (T0) and after (T1) the treatments. Results: The study shows a significant improvement in spontaneous speech in the experimental group (Aachener Aphasie subtest: p = 0.020; Cohen's d = 0.35); the 50% of the experimental group showed also an improvement in vitality scores of Short Form Health Survey (chi-square test = 4.114; p = 0.043). Conclusions: The current trial highlights the possibility that the combined use of MT and SLT can lead to a better result in the rehabilitation of patients with aphasia than SLT alone.     

镜像训练引导的运动想象疗法对急性缺血性脑卒中偏瘫患者上肢功能的康复效果

目的:本研究旨在对镜像训练引导的运动想象疗法是否能够更有效地改善急性缺血性脑卒中后偏瘫患者的上肢功能以及日常生活能力进行评价。方法:研究对象为2014年1月1日—2016年6月30日符合病例选择标准的76例急性缺血性脑卒中后偏瘫患者。将76例患者随机分入镜像训练引导的运动想象疗法组(38例)和单纯的运动想象疗法组(38例),在常规康复训练的基础上,分别接受镜像训练引导的运动想象疗法和单纯的运动想象疗法,共治疗4周。对2组治疗前后的美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、Barthel指数、上肢动作研究量表(Action Research Arm Test,ARAT)评分和Fugl-Meyer上肢运动功能评分进行比较。结果:2组患者治疗后的NIHSS评分、Barthel指数、ARAT评分和Fugl-Meyer上肢运动功能评分均较治疗前显著改善(P值均0.05)。镜像训练引导的运动想象疗法组治疗后的NIHSS评分、Barthel指数、ARAT评分和Fugl-Meyer上肢运动功能评分的改善幅度均显著大于单纯的运动想象疗法组(P值均0.05)。结论:镜像训练引导的运动想象疗法应用于急性缺血性脑卒中后偏瘫患者上肢功能的康复治疗,与单纯的运动想象疗法相比,可以更好地改善患者的上肢功能和生活自理能力。     

Cognitive behavioural techniques reduce exercise anxiety and improve adherence to a resistance training program for people with anxiety-related disorders: A randomized controlled trial

Exercise is a cost-efficient alternative to other interventions for anxiety-related disorders (ARDs; e.g., psychotherapy, pharmaceutical) that is also associated with health benefits. Several exercise modalities, including resistance training (RT), have demonstrated efficacy at reducing symptoms of ARDs; however, there are challenges associated with effectively implementing such protocols, most notably, exercise avoidance or early discontinuation. Researchers have identified exercise anxiety as a contributor to exercise avoidance for people with ARDs. Exercise-based interventions for people with ARDs may need to include strategies for helping these individuals cope with exercise anxiety to facilitate long-term exercise engagement; however, research in this area is lacking. The primary purpose of this randomized controlled trial (RCT) was to examine the effects of combining cognitive behavioural techniques (CBT) with a RT program on changes in exercise anxiety, exercise frequency, disorder-specific anxiety symptoms, and physical activity for people with ARDs. A secondary purpose was to explore group differences in exercise motivation and exercise self-efficacy across time. A total of 59 physically inactive individuals with ARDs were randomized into either RT + CBT, RT, or waitlist (WL). Primary measures were assessed at baseline, weekly during the 4-week active phase, and at 1-week, 1-month, and 3-month follow-ups. Findings indicate both RT and RT + CBT can reduce exercise anxiety; however, the addition of CBT techniques may help facilitate improvements in exercise self-efficacy, reductions in disorder-specific anxiety, and increases in long-term exercise behaviour and vigorous physical activity. These techniques may be useful for researchers and clinicians alike in supporting individuals with ARDs interested in using exercise to cope with elevated anxiety.     

Effects of chair yoga therapy on physical fitness in patients with psychiatric disorders: A 12-week single-blind randomized controlled trial

IntroductionSince falls may lead to fractures and have serious, potentially fatal outcomes, prevention of falls is an urgent public health issue. We examined the effects of chair yoga therapy on physical fitness among psychiatric patients in order to reduce the risk of falls, which has not been previously reported in the literature.MethodsIn this 12-week single-blind randomized controlled trial with a 6-week follow-up, inpatients with mixed psychiatric diagnoses were randomly assigned to either chair yoga therapy in addition to ongoing treatment, or treatment-as-usual. Chair yoga therapy was conducted as twice-weekly 20-min sessions over 12 weeks. Assessments included anteflexion in sitting, degree of muscle strength, and Modified Falls Efficacy Scale (MFES) as well as QOL, psychopathology and functioning.ResultsFifty-six inpatients participated in this study (36 men; mean ± SD age, 55.3 ± 13.7 years; schizophrenia 87.5%). In the chair yoga group, significant improvements were observed in flexibility, hand-grip, lower limb muscle endurance, and MFES at week 12 (mean ± SD: 55.1 ± 16.6 to 67.2 ± 14.0 cm, 23.6 ± 10.6 to 26.8 ± 9.7 kg, 4.9 ± 4.0 to 7.0 ± 3.9 kg, and 114.9 ± 29.2 to 134.1 ± 11.6, respectively). Additionally, these improvements were observable six weeks after the intervention was over. The QOL-VAS improved in the intervention group while no differences were noted in psychopathology and functioning between the groups. The intervention appeared to be highly tolerable without any notable adverse effects.ConclusionsThe results indicated sustainable effects of 20-min, 12-week, 24-session chair yoga therapy on physical fitness. Chair yoga therapy may contribute to reduce the risk of falls and their unwanted consequences in psychiatric patients.     

Growth hormone combined with child-specific motor training improves motor development in infants with Prader-Willi syndrome: A randomized controlled trial

Although severe motor problems in infants with Prader-Willi syndrome (PWS) are striking, motor development has never been studied longitudinally and the results of growth hormone (GH) treatment on motor development are contradictory. The authors studied whether GH treatment can enhance the effect of physical training on motor development in infants with PWS. Twenty-two infants were followed for two years during a randomized controlled trial. The treatment and control groups began GH after baseline or following a control period, respectively. Both groups followed a child-specific physical training program. Motor performance was measured every three months. Multi-level regression analysis revealed that motor development differed significantly between infants (p < .001), and this could be partially explained by baseline motor developmental level (p < .01). GH treatment enhanced the effects of child-specific physical training on both motor developmental rate and motor developmental potential. Moreover, this effect was more pronounced when GH treatment was initiated at a younger age.     

Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study

The use of activity-dependent interventions has shown some success in promoting recovery of upper limb function in chronic stroke patients. This study compared the neurophysiological and behavioural changes associated with two such rehabilitation protocols: unilateral and bilateral movement training. Twelve chronic stroke patients were randomly assigned to the two training protocols involving six daily practice sessions. Each session consisted of 50 trials of a dowel placement task performed either with both impaired and unimpaired arm moving synchronously (bilateral training group) or with only the impaired arm moving (unilateral training). Kinematic measurements of upper limb movements were made in four unilateral test trials performed prior to and following each practice session. Functional assessments of the impaired upper limb and neurophysiological assessments, using transcranial magnetic stimulation (TMS), of the affected and non-affected cortical hemispheres were made prior to and following the intervention sessions. Individuals receiving bilateral training showed a reduction in movement time of the impaired limb and increased upper limb functional ability compared to individuals receiving unilateral training. In some patients changes to upper limb function were associated with changes to the cortical representation of a target muscle in the non-affected hemisphere. Overall, these findings suggest that a short-term bilateral training intervention may be effective in facilitating upper limb motor function in chronic stroke patients.     

Methods for a multisite randomized trial to investigate the effect of constraint-induced movement therapy in improving upper extremity function among adults recovering from a cerebrovascular stroke

This article describes the study design, methodological considerations, and demographic characteristics of a phase III RCT to determine if 1) constraint-induced therapy (CI therapy) can be applied with therapeutic success 3 to 9 months after stroke across different sites, 2) gains that might occur persist over 2 years, 3) initial level of motor ability determines responsiveness to CI therapy, and 4) the treatment effect differs between those treated before 9 months and after 1 year. Six sites will screen and recruit poststroke survivors stratified on initial level of motor ability and after randomization allocate participants to immediate or delayed intervention. Primary outcomes include a laboratory-based measure of function (Wolf Motor Function Test [WMFT]) and a real-world participant-centered functional use measure (Motor Activity Log [MAI]). Secondary outcomes concern function, behavior, and compliance. This is the first multisite, single-blind RCT of a formal training intervention for upper extremity rehabilitation in subacute stroke in the United States.     

Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials

OBJECTIVE: The aim of this meta-analysis was to evaluate the clinical efficacy of constraint-induced movement therapy in acute and sub-acute stroke.DATA SOURCES: The key words were stroke, cerebrovascular accident, constraint-induced therapy, forced use, and randomized controlled trial. The databases, including China National Knowledge Infrastructure, Wan Fang, Weipu Information Resources System, Chinese Biomedical Literature Database, Pub Med, Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched for studies on randomized controlled trials for treating acute or sub-acute stroke published before March 2016. DATA SELECTION: We retrieved relevant randomized controlled trials that compared constraint-induced movement therapy in treatment of acute or sub-acute stroke with traditional rehabilitation therapy(traditional occupational therapy). Patients were older than 18 years, had disease courses less than 6 months, and were evaluated with at least one upper extremity function scale. Study quality was evaluated, and data that met the criteria were extracted. Stata 11.0 software was used for the meta-analysis. OUTCOME MEASURES: Fugl-Meyer motor assessment of the arm, the action research-arm test, a motor activity log for amount of use and quality of movement, the Wolf motor function test, and a modified Barthel index.RESULTS: A total of 16 prospective randomized controlled trials(379 patients in the constraint-induced movement-therapy group and 359 in the control group) met inclusion criteria. Analysis showed significant mean differences in favor of constraint-induced movement therapy for the Fugl–Meyer motor assessment of the arm(weighted mean difference(WMD) = 10.822; 95% confidence intervals(95% CI): 7.419–14.226), the action research-arm test(WMD = 10.718; 95% CI: 5.704–15.733), the motor activity log for amount of use and quality of movement(WMD = 0.812; 95% CI: 0.331–1.293) and the modified Barthel index(WMD = 10.706; 95% CI: 4.417–16.966). CONCLUSION: Constraint-induced movement therapy may be more beneficial than traditional rehabilitation therapy for improving upper limb function after acute or sub-acute stroke.     

Effect on anxiety and depression of a multifactorial risk factor intervention program after stroke and TIA: a randomized controlled trial

Objectives: Depression and anxiety related to stroke are caused by vascular lesions and psychological reactions. Treatment of vascular and modifiable behavioral risk factors reduces the risk of stroke and may also reduce the risk of emotional changes after stroke. We aimed to investigate whether a multifactorial risk factor intervention program in patients with first-ever stroke or transient ischemic attack (TIA) can influence post-stroke anxiety and depressive symptoms in patients one year post-stroke.

Method: The study population consisted of first-ever stroke and TIA patients allocated in a randomized, evaluator-blinded, controlled trial to care as usual or a structured and multidisciplinary follow-up including intensive treatment of vascular risk. The primary endpoint (cognition) has previously been reported. The secondary endpoint, reported here, was changes in the Hospital Anxiety and Depression Scale (HADS) from baseline to 12-month follow-up.

Results: One hundred and ninety-five patients were randomized. The estimated difference between treatment groups, in changes in HADS, from baseline to 12 months was ?1.32 (95% confidence interval: ?2.61, ?0.04; P = 0.044) in favor of the intervention group. One year post-stroke, 4/85 (4.7%) patients in the intervention group and 12/89 (13.5%) in the control group suffered from depression (P = 0.045), while 7/85 (8.2%) patients in the intervention group and 13/89 (14.6%) patients in the control group suffered from anxiety (P = 0.19).

Conclusion: A structured, multidisciplinary, multifactorial risk factor program including vascular risk factor management may be associated with reduced HADS scores and a lower prevalence of depressive symptoms one year after stroke.     

The effect of a whole-body vibration therapy on the sitting balance of subacute stroke patients: a randomized controlled trial

Background: The use of a whole-body vibration (WBV) therapy has recently been applied and investigated as a rehabilitation method for subacute stroke patients.

Objective: To evaluate the effects of a WBV therapy on recovery of balance in subacute stroke patients who were unable to gain sitting balance.

Methods: The conventional rehabilitation group (CG) received conventional physical therapy, including sitting balance training by a physical therapist, for 30 min a one session, for twice a day for five days a week for two weeks. The whole-body vibration group (VG) received one session of conventional physical therapy, and received WBV therapy instead of conventional physical therapy for 30 min a day for five days a week for two weeks.

Results: There were 15 patients in the CG and 15 patients in the VG who completed the two-week therapy. After the two-week therapy, both groups showed functional improvement. Patients in the VG improved functional ambulation categories, Berg balance scale, trunk impairment scale scores. But, no statistically significant correlations between the therapeutic methods and outcomes were observed in either group.

Conclusion: Our results suggest that WBV therapy led to improvement of the recovery in balance recovery for subacute stroke patients. Because the WBV therapy was as effective as conventional physical therapy, we can consider a WBV therapy as a clinical method to improve the sitting balance of subacute stoke patients.     

Effects of capsaicin on swallowing function in stroke patients with dysphagia: A randomized controlled trial

Background/AimsDysphagia is a common complication after acute stroke. While there are several innovative treatments being tested to improve the swallowing function of stroke patients with dysphagia, our aim is to explore the use of readily available natural capsaicin in stroke patients with dysphagia.Study designA randomized, double-blind study.MethodsSixty-nine hospitalized stroke patients were enrolled in this study. The capsaicin intervention group received thermal tactile stimulation with supplementation of natural capsaicin and additional nectar viscosity boluses. The control group received stimulation and boluses with placebo. Swallowing function was evaluated before and after the 3-week treatment, using Volume-Viscosity Swallow Test, Eating Assessment Tool, Standardized Swallowing Assessment, and Water Swallow Test.ResultsThe score decreases in the Eating Assessment Tool and Standardized Swallowing Assessment of the capsaicin intervention group were significantly greater than that of the placebo control group (P < .01). Among the 60 patients, the capsaicin intervention group exhibited effectiveness in a higher number of patients (n = 27, 90%) than the placebo group (n = 9, 30%, P < .001).ConclusionsRegular use of natural capsaicin could promote the recovery of swallow function in stroke patients with dysphagia. The ample availability of natural capsaicin could provide a low cost, easily accessible, and safe alternative method to address dysphagia in stoke patients.     

Four-week training involving ankle mobilization with movement versus static muscle stretching in patients with chronic stroke: a randomized controlled trial

Background: Patients with stroke generally have diminished balance and gait. Mobilization with movement (MWM) can be used with manual force applied by a therapist to enhance talus gliding movement. Furthermore, the weight-bearing position during the lunge may enhance the stretch force.

Objectives: This study aimed to compare the effects of a 4-week program of MWM training with those of static muscle stretching (SMS). Ankle dorsiflexion passive range of motion (DF-PROM), static balance ability (SBA), the Berg balance scale (BBS), and gait parameters (gait speed and cadence) were measured in patients with chronic stroke.

Methods: Twenty patients with chronic stroke participated in this study. Participants were randomized to either the MWM (n = 10) or the SMS (n = 10) group. Patients in both groups underwent standard rehabilitation therapy for 30 min per session. In addition, MWM and SMS techniques were performed three times per week for 4 weeks. Ankle DF-PROM, SBA, BBS score, and gait parameters were measured after 4 weeks of training.

Results: After 4 weeks of training, the MWM group showed significant improvement in all outcome measures compared with baseline (p < 0.05). Furthermore, SBA, BBS, and cadence showed greater improvement in the MWM group compared to the SMS group (p < 0.05).

Conclusions: This study demonstrated that MWM training, combined with standard rehabilitation, improved ankle DF-PROM, SBA, BBS scores, and gait speed and cadence. Thus, MWM may be an effective treatment for patients with chronic stroke.