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Europa Medicophysica 2003 June;39(2):95-100


language: English

Correlation between voluntary movement of the paretic leg and functional outcome after rehabilitation in motor hemisyndromes of vascular origin

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.

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