RESEARCH REPORT POSTER DISPLAY

DOES CLOSED KINETIC CHAIN ACTIVITY IMPROVE HAND FUNCTION IN PATIENTS WITH STROKE? A RANDOMIZED, DOUBLE-BLINDED, CONTROLLED STUDY. Alattas A¹, Sabbahi M², Roddey T², Hamilton M², Olson S², Alnaser M²; ¹King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. ²Texas Woman’s University

PURPOSE: Clinicians utilize closed kinetic chain (CKC) activities in stroke rehabilitation to enhance recovery, increase function of the hand, decrease muscular tone, and facilitate activation of weak muscles. However, there is no published study that has evaluated the effect of the CKC activity over an extended time period using electrophysiological tests, motor capacity, or functional status of the upper extremity. The aim of this study was to evaluate the effect of a four-week, CKC home training program on the reflexive, volitional, and functional levels of upper extremity capability for moderate-level stroke patients. The moderate-level was defined as obtaining a score between 10 and 18 out of 56 in the Fugl-Meyer score of the upper extremity section. RELEVANCE: Evidence-based support of common treatment procedures is needed stroke rehabilitation. PARTICIPANTS: Eleven subjects at least 1-year post-stroke (4 females and 7 males), mean age of 66 years (±10.3), and of any ethnicity participated as a sample of convenience from a local stroke support group in the study. Inclusion Criteria: normal or impaired sensation to light touch or pinprick, passive wrist extension of ≥40°, a score of ≥24 on the Mini-Mental State Examination (MMSE), had a stroke involving the middle cerebral artery as confirmed by magnetic resonance imaging (MRI) or computerized tomography (CT) report. METHODS: Using a double-blinded, placebo-controlled, randomized design, subjects were placed either in treatment or control groups. The treatment group (4 subjects) performed one minute of weight bearing on the palm of the hand with full elbow extension for five repetitions, using 10% of her/his body weight, three times per day. The control group performed bilateral shoulder flexion exercises with unimpaired arm assisting the impaired arm 30 times per session, 3 sessions per day. Four dependent variables were collected in a random sequence before and after one month of the treatment. The dependent variables included flexor carpi radialis (FCR) Hoffman reflex (H-reflex), surface electromyography (SEMG) from extensor indices and FCR muscles, Klein-Bell Activities of Daily Living (ADL) scale score, and Upper Extremity Fugl-Meyer scale score. The peak-to-peak amplitude of the FCR H-reflex was recorded from the impaired arm while bearing weight on the palm at 10% of body weight. Sixteen traces were collected during four trials (4 traces / trial). SEMG was recorded during the CKC activity. Four traces were collected during four trials (one trace/ trial) from both muscles. ANALYSIS: Two analyses of covariance (with pre-test as the covariate) were conducted for the FCR H-reflex and the SEMG data. Two Mann-Whitney U tests were conducted for the Fugl-Meyer scale score and Klein-Bell ADL score. Alpha was set at 0.0125 for each of the four tests. RESULTS: No statistically significant difference was found in the four tests after the intervention with p value of 0.053 for H-reflex, 0.075 for the EMG, 0.042 for Klein-Bell ADL scale, and 0.11 for the Fugl-Meyer scale. CONCLUSIONS: The CKC activity did not show significant effect measured by the four dependent variables although data show a trend toward improvement in the treatment group. IMPLICATIONS: More research needed KEYWORDS: Closed Kinetic Chain, electrophysiological test, stroke, functional tests, motor functional test. FUNDING ACKNOWLEDGEMENTS: A scholarship from King Faisal Specialist Hosptial and Research Center, Riayadh, Saudi Arabia. CONTACT: aaalattas@hotmail.com

ETHICS COMMITTEE: INSTITUTIONAL REVIEW BOARD at Texas Woman’s Unviersity, Houston, TX, USA.