*Corresponding author: Nikhil Patil
Dr.Ulhas Patil College of Physiotherapy, Jalgaon
ISSN: 0976-3031
Research Article
TO COMPARE THE EFFECTIVENESS OF CONTRACTURE PREVENTIVE POSITIONING
PROCEDURE FOR HEMIPLEGIC ARM WITH CONVENTIONAL THERAPY
Nikhil Patil*., Kalyani Nagulkar., Neha Ingale and Sachin Chaudhary
Dr.Ulhas Patil College of Physiotherapy, Jalgaon
DOI: http://dx.doi.org/10.24327/ijrsr.2018.0903.1860
ARTICLE INFO ABSTRACT
The purpose of the study is to compare the effectiveness of contracture preventive positioning
procedure for hemiplegic arm with conventional therapy. An experimental study was carried out
with 30 stroke patients for duration of 3 weeks. 30 patients was divided into two groups i.e. group A
which is control group and group B which is experimental group. For group A conventional
treatment was given such as passive range of motion. Group B received passive range of motion and
positioning. Passive range of motion by goniometer, Modified Ashworth scale, Burnstorm stages of
recovery was use as outcome measures. Established stroke patients by means of CT and MRI,
Spasticity under Ashworth scale between grade 1 to3 where included in the study were as patients
on antispasticity drugs or pain reducing drugs were excluded from the study. Both the results i.e pre
and post was compared with Modified Ashworth scale and Burnstorm stage of recovery scale.
Conclusion it was seen that both the groups showed improvement in their respective analysis, but in
between group analysis it was seen that no one group is better than the other, so we can safely
presume that positioning with conventional treatment may not be only better than conventional
treatment it is still as effective as conventional in improving the patient condition to prevent
contracture in stroke.
INTRODUCTION
Stroke, also known as a cerebrovascular accident (CVA),
occurs when the arteries leading to certain areas of the brain
rupture (hemorrhagic stroke) or get blocked (ischemic stroke).
Without sufficient oxygen supply, brain cells die. Depending
on the amount of brain tissue damage, the stroke results in
weakness or paralysis of the body.
1
Stroke is a major public
health concern. Most of the surviving patients make incomplete
recovery, and need assistance in activities of daily life
(ADL).Contracture refers to the loss of joint range of motion
resulting from changes in the mechanical properties of soft
tissues which cross the joint. Long-term disability associated
with failure to regain use of the arm is a major problem
following stroke. This could involve a reduction in rest length
or increase in stiffness of muscles or tendons.
3
Upper-limb
contractures are common. The abnormal position of the
hemiplegic hand and wrist due to spasticity and muscle
contractures may interfere with daily activities and hygiene
maintenance, both negatively influencing the quality of life.
Different approaches are used to inhibit spasticity, prevent
contractures, reduce pain and edema, or improve hygiene
maintenance of the hand in stroke patients with a nonfunctional
spastic upper limb.
3,4
In conjunction with contracture,
resistance to passive movement and spasticity develops in some
patients. Spasticity was found to be present in 26% of acute
hemiparetic patients and in 28% three months after stroke.
1
Spasticity (or more specifically, hypertonus) seems to be
another cofactor in the development of hemiplegic shoulder
pain.
5
It is related to a decrease in joint passive range of motion
and correlates both to motor impairments and limitations in
activities of daily living (ADL). Post stroke contracture is a
result of loss of range of motion (ROM) due to pain and wrong
positioning. The proportion of patient with contracture in the
hemiplegic arm approximately 5 months post stroke was
reported to be high. Along with contracture, spasticity also
develops in some patients.
4
In presence of severe loss of
strength and dexterity after stroke the wrist and finger flexor
muscles are at risk of developing contracture because the hand
usually rest on lap. In this position the wrist and finger are in
flexion so the flexor muscles are effectively immobilized in the
shorten part of the range. Therefore are shortly undergo some
adaptation. Hence prevention of contracture and maintaining an
optimal pain free joint range of motion is an important
therapeutic intervention in stroke rehabilitation.
6
Available Online at http://www.recentscientific.com
International Journal of
Recent Scientific
Research
International Journal of Recent Scientific Research
Vol. 9, Issue, 3(K), pp. 25448-25453, March, 2018
Copyright © Nikhil Patil et al, 2018, this is an open-access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is
properly cited.
DOI: 10.24327/IJRSR
CODEN: IJRSFP (USA)
Article History:
Received 15
th
December, 2017
Received in revised form 25
th
January, 2018
Accepted 23
rd
February, 2018
Published online 28
th
March, 2018
Key Words:
Hemiplegic Arm, Burnstrom, Modified
Ashworth Scale, Contracture Preventing
Positioning.