Table 1.
Characteristics of studies using stretching for the treatment of triceps spasticity after stroke.
| Author | Sample | Intervention and dosage | Comparator | Outcomes |
Follow-up (months) |
Within group difference (over time) |
Between group difference after treatment |
|---|---|---|---|---|---|---|---|
| Pradines et al. (15) (RCT) | 23 (12/11 IG/CG) patients with spasticity for at least 1 year (Tardieu angle ≥5°) | Usual care three times a week + 15-min stretching Once a day, for 1 year (self-managed) |
CG: Usual care three times a week, for 1 year | Tardieu Angle, Fascicle Length (FL), Muscle Thickness (MT), 10 mAS |
12 | IG: Tardieu Angle (soleus, gastrocnemius) ↓, soleus FL, gastrocnemius FL, soleus MT, 10 mAS ↑, gastrocnemius MT ↔ CG: Tardieu Angle, FL, MT, 10 mAS ↔ |
Tardieu Angle, FL, soleus MT, 10 mAS† |
| Ghasemi et al. (16) (RCT) | 45 (30/15 IG/CG) patients with spasticity for at least 3 months (MMAS≥1) | 3-min functional stretching Three times a week, for 1 month |
CG: Usual care | MMAS, Achilles Tendon Reflex (ATR) excitability, presence of clonus, pROM, H-reflex latency, H/M ratio, PA, MT, FL |
2 | IG: MMAS, ATR excitability, H-reflex latency, H/M ratio, PA, MT, FL ↔
Clonus ↓ pROM ↑ CG: MMAS, ATR excitability, clonus, pROM, H-reflex latency, H/M ratio, PA, MT, FL ↔ |
No statistical difference |
| Pradines et al. (17) | 27 patients with spasticity (TS ≥ 5°) |
15-min stretching Once a day, for 1 year (self-managed) |
n.a. | Tardieu Angle Coefficient of shortening (Csh), 10 maS |
12, 24, 36 | Tardieu Angle, Csh ↓
10 maS ↑ |
n.a. |
| Gao et al. (18) | 10 patients with spasticity | 60-min stretching (12 repetitions lasting 5 min each) with smart devices One single session |
CG: 10 healthy subjects | Torque-angle ratio (stiffness) Achilles tendon length |
n.a. | IG: Stiffness ↓
Achilles tendon length ↔ |
n.a. |
| Bakheit et al. (19) (RCT) | 66 (22/22/22 IG1/IG2/IG3) patients with spasticity for at least 6 weeks (MAS>1) | IG1: 20-min isotonic stretching (with weight bearing) IG2: 20-min stretching (without weight bearing) IG3: 20-min isokinetic stretching One single session with smart devices |
CG: 21 healthy subjects | H/M ratio H-reflex latency |
One day | IG1, IG2, IG3: H/M ratio, H-reflex latency ↔
CG: H/M ratio, H-reflex latency ↔ |
No statistical difference |
| Chung et al. (20) | 12 patients with chronic spasticity (MAS>1) | 30-min stretching with smart devices One single session |
CG: 10 healthy subjects | Peak reflex torque, ATR threshold Torque-angle ratio (stiffness), pROM, MVC |
n.a. | IG: Peak reflex torque, stiffness ↓
ATR threshold ↔ pROM, MVC ↑ CG: Peak reflex torque, ATR threshold, pROM, stiffness, MVC ↔ |
n.a. |
| Maynard et al. (21) | 66 (22/22/22 IG1/IG2/IG3) patients with spasticity for at least 6 weeks (MAS > 1) | IG1: 20-min isotonic stretching (with weight bearing) IG2: 20-min stretching (without weight bearing) IG3: 20-min isokinetic stretching One single session with smart devices |
CG: 21 healthy subjects | Kinematic, dynamic and spatio-temporal parameters through gait analysis | One day | IG1, IG2, IG3: all parameters ↔
CG: all parameters ↔ |
No statistical difference |
| Selles et al. (22) | 10 patients with spasticity (MAS ≥ 1) |
45-min stretching with smart devices 3 times a week, for 1 month |
n.a. | Torque-angle ratio (stiffness) pROM, aROM, MVC, ATR excitability, 10 mAS, VAS |
n.a. | Stiffness ↓
pROM, MVC, 10 mAS, VAS ↑ Viscosity, aROM, ATR excitability ↔ |
n.a. |
| Yeh et al. (23) | 30 patients with spasticity for at least 6 months (MAS > 1) | IG1: 30-min constant-angle stretching with smart devices One single session |
IG2: 30-min constant-torque stretching with smart device, one single session after 1 week | MAS pROM, Reactive Torque |
n.a. | IG1: MAS, RT ↓
pROM ↑ IG2: MAS, RT ↓ pROM ↑ |
RT§ |
| Bressel et al. (24) | 10 patients with spasticity for at least 3 months (MAS ≥ 1) | IG1: 30-min static stretching with smart devices One single session |
IG2: 30-min cycling stretching, one single session after 1 week | Ankle joint angle and passive torque (stiffness) EMG activity, 10 MWT |
n.a. | IG: Stiffness ↓
10MWT ↔ IG2: Stiffness ↓ 10MWT ↔ |
No statistical difference |
| Zhang et al. (25) | 4 patients with chronic spasticity | Stretching with smart devices One single session |
n.a. | Torque-angle ratio (stiffness) aROM, pROM, ATR excitability |
n.a. | Stiffness, viscosity, ATR excitability ↓
aROM, pROM ↑ |
n.a. |
| Tsai et al. (26) | 17 patients with spasticity (1 ≤ MAS ≤ 4) |
30-min stretching on a tilt-table One single session |
n.a. | MAS pROM, H/M ratio, F/M ratio |
n.a. | MAS ↔
pROM, F/M ratio ↑ H/M ratio ↓ |
n.a. |
↑
Statistically significant increase.
↓
Statistically significant decrease.
↔
No statistical difference.
†
IG overcomes comparator.
§
Comparator overcomes IG.
IG, Intervention Group; CG, Control Group; n.a. not available; RCT, Randomized Controlled Trial; 10 mAS, 10-meter Ambulation Scale; FL, Fascicle Length; MT, Muscle Thickness; MMAS, Modified Modified Ashworth Scale; pROM, passive Range of Motion; ATR, Achilles Tendon Reflex; PA, Pennation Angle; Csh, Coefficient of Shortening; MAS, Modified Ashworth Scale; aRoM, active Range of Motion; MVC, Maximal Voluntary Contraction; VAS, Visual Analog Scale; RT, Reactive Torque; EMG, Electromyography; 10 MWT, 10-meter Walking Test.