Effects of Noxious Versus Innocuous Thermal Stimulation on Lower Extremity Motor Recovery 3 Months After Stroke

• Published in: Archives of physical medicine and rehabilitation Vol. 94; no. 4; pp. 633 - 641
• Main Authors: Hsu, Hsin-Wen, PT, MS, Lee, Chia-Ling, MD, MS, Hsu, Miao-Ju, PT, PhD, Wu, Hung-Chia, PT, MS, Lin, Roxane, PT, MS, Hsieh, Ching-Lin, OT, PhD, Lin, Jau-Hong, PT, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2013
• Subjects: Adult; Aged; Cryotherapy; Double-Blind Method; Female; Follow-Up Studies; Humans; Hyperthermia, Induced; Lower extremity; Lower Extremity - physiopathology; Male; Middle Aged; Paresis - etiology; Paresis - physiopathology; Paresis - rehabilitation; Physical Medicine and Rehabilitation; Recovery of function; Recovery of Function - physiology; Rehabilitation; Stimulation; Stroke; Stroke - complications; Stroke - physiopathology; Stroke Rehabilitation; Time Factors; Treatment Outcome; Walking - physiology; Stroke; BI; Recovery of function; Stimulation; FAC; Modified Ashworth Scale; VAS; Lower extremity; visual analog scale; Mobility subscale of the Stroke Rehabilitation Assessment of Movement; Barthel Index; PASS; LE-STREAM; LE; thermal stimulation; Functional Ambulation Category; Mob-STREAM; Rehabilitation; Low Extremity subscale of the Stroke Rehabilitation Assessment of Movement; MAS; Postural Assessment Scale for Stroke Patients; TS
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2012.11.021

Abstract Objective To examine the effects of thermal stimulation (TS) on the lower extremity (LE) movement and function in patients with stroke. Design A double-blinded randomized controlled trial. Setting A university hospital. Participants Patients (N=34) at least 3 months after stroke were randomly assigned into the experimental and the control groups. Interventions In addition to regular rehabilitation, the experimental group received a 30-minute noxious TS protocol (heat pain 46–47°C/cold pain 2–3°C) 3days/wk for 8 weeks, and the control group received a 30-minute innocuous TS protocol (heat 40–41°C/cold 23–24°C) 3d/wk for 8 weeks. Main Outcome Measures The Low Extremity subscale of the Stroke Rehabilitation Assessment of Movement (LE-STREAM), the Mobility subscale of STREAM (Mob-STREAM), the Functional Ambulation Category (FAC), the Barthel Index (BI), the Postural Assessment Scale for Stroke Patients (PASS), and the Modified Ashworth Scale (MAS) were administered by a blinded rater at baseline, posttreatment (8wk), and follow-up (12wk). Results Twenty-three participants completed the study protocol and all outcome measurements. No preexisting group differences between the experimental group (n=11) and the control group (n=12) were found on demographic and clinical variables. Compared with baseline, the experimental group showed significant improvements at posttreatment and follow-up on the LE-STREAM, Mob-STREAM, FAC, and BI ( P <.05) while the control group showed no significant improvements for all outcome measures. As for the between-group comparison, significant differences were seen at follow-up (12wk) on the LE-STREAM, Mob-STREAM, BI, and MAS. Conclusions Our findings indicate that an 8-week program of noxious TS combined with a traditional stroke rehabilitation program can improve the LE-related movement and function in patients with stroke for more than 3 months.