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Official Journal of the , , , ,
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Online ISSN 1973-9095
Boccignone A., Carpenedo C., Khan Sefid M., Ortolani M.
Department of Orthopedics and Traumatology Division of Physio-Kinesy Therapy University Hospital, ASL 16, Padua, Italy
Aim. This study aimed to find a correlation between early voluntary movement of the paretic leg and functional outcomes after rehabilitation for hemisyndromes of vascular origin. The most common attitude of the stabilized hemiplegic patient is spastic hypertonia of the flexor muscles of the upper limb and of the extensor muscles of the lower limb. We define voluntary movement in synergistic scheme of the extensor muscles of the leg as the recruitment of muscle groups with anti-gravitational function of the lower limbs (femoral quadriceps, triceps, thigh abductors, anterior tibial, toe flexor), in the ways foreseen by the synergistic scheme of the extensor muscles. We define voluntary movement out of scheme of the extensor muscles of the leg as the possibility to recruit a muscle or muscle group outside this synergistic scheme. Based on early clinical observation, our hypothesis is that in hemiplegic patients the ability to voluntarily recruit paretic leg muscles out of the extensor synergistic scheme is predictive for major recovery of upright position, more efficient walking, and global improvement in individual independence. The aim of our study was to identify an evaluation scale for so-called voluntary movement of the paretic leg that can be performed at the first physiatrist visit, and to verify its predictive potential for functional outcomes, using an internationally validated scale, the Functional independence measure (FIM).
Methods. One-hundred patients were recruited for the study. The clinical voluntary movement test we evaluated examines 3 levels of leg movement: no movement, assisted and unassisted movement in scheme, and assisted and unassisted movement out of scheme. The FIM is a disability scale comprising 18 items assigned values on a scale from 18 to 126; it is suited for revealing even small functional recoveries in disabled patients.
Results. The final FIM scores on discharge compared with base-line voluntary movement (no movement, in and out of scheme, assisted and unassisted) were: FIM = 39.5 (SD 17.6) for no voluntary movement; FIM = 77.5 (SD 23.2) for in scheme; FIM = 86.6 (SD 24.5) for out of scheme. Statistical analysis using Student’s t test for paired data showed these results were statistically significant with p<0.01, p<0.001 and p<0.01, respectively. Analysis using Spearman’s rank order correlation coefficient showed a high level of correlation between early voluntary movement and final FIM on discharge (0.999184).
Conclusion. Voluntary movement was shown to be a sensitive predictor for functional outcome in hemiplegic patients treated at a physical medicine and rehabilitation facility. The validity of voluntary movement was confirmed by the correlation between final FIM scores on discharge and early voluntary movement, especially for patients with moderate-to-severe voluntary movement deficit.