Daily static and eccentric self-stretching program and changes in muscle functional length in chronic spastic paresis after one year of Guided Self-rehabilitation Contract’s practice

Ms Maud PRADINESa, Dr Marjolaine BAUDEa, Dr Valentina MARDALEa, Dr Emilie HUTINb, Prof Jean-Michel GRACIESa

a Hôpitaux Universitaires Henri Mondor, Service de rééducation Neurolocomotrice, b Hôpitaux Universitaires Henri Mondor, Laboratoire Analyse et Restauration du Mouvement

Objective: To evaluate the impact of a daily self-stretching program within a Guided Self-rehabilitation Contract (GSC), on functional muscle length in patients with chronic spastic paresis.

Methods: Retrospective chart review of 16 chronic paretic patients (7W, age 40±8 years, time since lesion 57±35 months) who consecutively participated to a Guided Self-rehabilitation Contract for at least one year (2 years follow-up for 10 of them). By this contract, patients were committed to clinicians to achieve every day a self-stretching program based on self-stretching postures (>10 mn/muscle/day) and excentric stretching exercises on some selected muscles (« self-stretched » muscles). Each program was specific for each patient. Functional muscle length XV1 (angle of arrest after slow and strong stretch) measured by the clinician at every visit on 5 key muscles of the lower limb (soleus, gastrocnemius, hamstrings, vastus, rectus femoris), they have been selected or not for the self- stretching program, was the main outcome measure. Coefficient of shortening (CS) was calculated CR= (XN-XV1)/XN (XN, normal passive amplitude).After one and two years, muscles has been considered as responders if, from baseline, ΔXV1>10° for hamstrings, vastus and rectus femoris, and >5° for soleus and gastrocnemius.

Results: In retrospect, at baseline, CS for the non-stretched muscles group was 0.12±0.03 (mean±SD) vs 0.20±0.02 in the self-stretched muscles group (p=0,028, t test). The percent of responders in the self-stretched muscles group was significantly higher than in the non-stretched muscles group after one and two years of GSC (42% vs 20%, p=0.025; 50% vs 20%, p=0.035 respectively, Chi2). After one year, the CS of the self-stretched muscles group decreased about 18%, vs 5% for the non-stretched muscles group (p=0.028, Mann Whitney). Regarding individual muscles data, raw functional lengthening after two years of daily self-stretched (n=10) were: hamstrings, +9°±6; vastus, +6°±2; rectus femoris, +13°±7; soleus, +2°±2; gastrocnemius, +3°±1.

Conclusion: A customized program of self-stretching daily practiced by chronic paretic patients for at least one year within a Guided Self-rehabilitation Contract might allow a significant functional muscle lengthening. These results need to be confirmed by a prospective controlled study.

Keywords : Guided Self-rehabilitation Contract, self-stretch, spastic paresis, functional muscle length