Joint Range of Motion in Flaccid Hemiplegia

The effect of muscle tone on passive range of motion (PROM) in affected joints and comparison joints on the unaffected side was investigated in 15 patients with flaccid paralysis hemiplegia. PROM was measured in the shoulder and hip in flexion, extension, abduction, adduction and internal and external rotation using the plastic universal goniometer. PROM in the elbow and knee was assessed in flexion and extension. Wrist PROM was measured in flexion, extension and radial and ulnar deviation. Additionally, ankle dorsiflexion, plantarflexion, eversion and inversion PROM were assessed. Decreased muscle tone significantly affected shoulder (p = 0.006), wrist (p = 0.032) and hip (p = 0.003) PROM. Significant differences between the affected and unaffected sides were found in shoulder PROM in extension (p = 0.014), adduction (p = 0.001) and internal (p = 0.034) and external rotation (p = 0.007). Wrist PROM was significantly different in flexion (p = 0.048) and extension (p = 0.001), and hip PROM was significantly different in abduction (p = 0.029), adduction (p = 0.012) and external rotation (p = 0.001). Surprisingly, although muscle tone had no influence on ankle PROM, there was a significant difference in ankle plantarflexion PROM (p = 0.013). In conclusion, in flaccid hemiplegia, decreased muscle tone affects the PROM in the shoulder, wrist and hip. Differences in PROM between the unaffected and affected side are evident in shoulder extension, adduction and internal and external rotation, wrist flexion and extension, hip abduction, adduction and external rotation, and ankle plantarflexion.