<![CDATA[[ARTICLE] Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients

Abstract

Background

Approximately half of stroke patients show impaired upper limb and hand function. Task-oriented training focuses on functional tasks, while joint mobilization technique aims to restore the accessory movements of the joints.

Objective

To investigate the effect of adding joint mobilization to task-oriented training to help the patients in reaching a satisfactory level of recovery for their hand function.

Patients and methods

Thirty chronic stroke patients with paretic hand participated in the study; they were divided equally into study and control groups. The study group received joint mobilization followed by task-oriented training for the affected hand. Meanwhile, the control group received task-oriented training only. Both groups received their treatment in the form of 3 sessions per week for 6 successive weeks. The primary outcome measures were hand function that was assessed by Jebsen-Taylor hand function test (JTT) and active and passive wrist extension range of motion (ROM) that was measured by a standard goniometer. The secondary outcome measure was the grip strength of the hand that was assessed by a JAMAR adjustable hand dynamometer.

Results

There was a significant improvement in all the outcome measurements in both groups that were more evident in the study group.

Conclusion

Combining joint mobilization with task-oriented training had a highly significant effect in improving the hand function in chronic stroke patients compared to task-oriented training alone.

Introduction

Stroke is defined as a neurological deficit attributed to an acute vascular focal injury of the central nervous system [1]. It is a worldwide common disease that leads to serious disabilities [2]. Hemiparesis is the most common motor impairment after a stroke and frequently leads to persistent hand dysfunction [3]. Nearly about 50% of stroke patients show impaired upper limb and hand function and up to 74% rely on long-term help to perform their activities of daily living (ADL) [4, 5]. The hand functions are complex as we use our hands in a vast variety of tasks such as grasping, pushing, holding objects, and expressing emotions [6].

Task-oriented training is a type of physiotherapy that encourages the active participation and focuses on functional tasks rather than simple repetitive training of normal motion patterns [7]. Joint mobilizations are used as an intervention to improve the range of motion (ROM), decreasing pain, and ultimately improving the upper extremity functions [8]. Joint mobilization technique proposed by Maitland is based on a graded system and is intended to restore the accessory movements of the joints by performing passive, rhythmic, and oscillatory movements [9].

After stroke, reduced ROM at joints occurs and it can be complicated by joint contractures. This occurs due to many factors such as reduced muscle length and increased stiffness of muscle and/or connective tissue. Such post stroke consequences can be solved by moving the joints through a full ROM with pressure at the end of range using the manual therapy [10]. Mobilization may help stroke patients in reducing the joint stiffness [11]. Moreover, it provides afferent input that can be used in facilitating the motor activity [12, 13]. Accordingly, we aimed to investigate the effect of adding joint mobilization to task-oriented training in order to help those patients in reaching a satisfactory level of recovery for their hand functions.[…]