Degree of muscle shortening in chronic hemiparesis in patients not treated with guided self-rehabilitation contracts (GSC)
Mr Jordan VIELOTTEa, Mr Blaise BIGNAMIa, Mr Etienne JAMES-BELINa, Dr Caroline COLASa, Dr Catherine-Marie LOCHEa, Prof Jean-Michel GRACIESa
a Hôpitaux Universitaires Henri Mondor - Service de Rééducation Neurolocomotrice
Objectives. Antagonist muscle resistance, including due to muscle contracture, is a fundamental factor of motor impairment in spastic paresis. We aimed to quantify the degree of shortening in the main muscles involved in chronic hemiparesis (>1 year post lesion), in patients following a conventional system of rehabilitation.
Methods. From their first clinic visit in the neurorehabilitation unit of the PM&R department we retrospectively collected the assessments of passive range of motion (XV1) - based on the 5-step clinical assessment, including the Tardieu Scale - against 8 key antagonists in the lower limb (n= 19 patients with chronic hemiparesis, age 48±13, mean±SD; time since lesion 3.7±3.8 years) and 13 antagonists in the upper limb (n= 13 patients, age 39±13, mean±SD; time since lesion 5.2±3.9 years ), then derived coefficients of shortening (CSH) by referring them to the normal expected amplitude (XN), CSH = (XN-XV1)/XN.
Results. The higher coefficients of shortening were : vertical adductors (Latissimus dorsi - Pectoralis major - Teres major), 36±3% ; shoulder extensors with flexed elbow (long head of triceps; latissimus dorsi) 33±4% ; horizontal adductors (Pectoralis major), 23±1 % ; Gastrocnemius, 20±1% ; Soleus, 15±2% ; Gluteus maximus, 16±3% ; Rectus femoris 12±1% and Pronator teres 12±4%.
Conclusion. Shoulder extensors, plantar flexors and gluteus maximus in patients untreated with self-stretching postures have undergone major muscle shortening in chronic hemiparesis. A future study could assess the effectiveness of stretching postures taught and applied from the early phase of stroke on shortening of these muscles.
Gracies JM, Blondel R, Gault-Colas C, Bayle N. Contrat d’Autorééducation Guidée dans la parésie spastique. De Boeck Editions, ©Association Neurorééducation en Mouvement, 2013, 108p, ISBN 978-2-35327-169-6.
Gracies JM, Bayle N, Vinti M, Alkandari S, Vu P, Loche CM, Colas C. Five-step clinical assessment in spastic paresis. Eur J Phys Rehab Med. 2010;46(3):411-21.
Keywords : Muscle shortening ; chronic hemiparesis