Quantifying the effectiveness of the sustained muscle stretching treatments in stroke patients with ankle hypertonia

Sustained muscle stretch (SMS) is commonly used to reduce hypertonia. The present study evaluates the effectiveness of three different SMS protocols, namely constant-angle, cyclic, and constant-torque stretching, in the immediate reducing of ankle hypertonia. Forty-seven hemiplegic subjects, 53.7+/-10.3 years old and 22.4+/-16.0 months after stroke, with hypertonic ankle joints were recruited to undergo three SMS applied to protocols treatment their hypertonic ankle joints using an integrated treatment/assessment system. The immediate post-treatment effectiveness of each stretching protocol was assessed by reference to the pre-treatment Modified Ashworth Scale (MAS), passive range of motion (ROM), and reactive torque measurement, from which the viscous-elastic components of the ankle joint were derived. All three SMS protocols successfully reduced MAS grade. Additionally, each stretching method yielded an increase in ankle ROM, from 9.7 degrees to 16 degrees , 9.6 degrees to 14.8 degrees , and 9.2 degrees to 18.3 degrees for the constant-angle, cyclic-stretching, constant-torque protocols, respectively, and reduction of the elastic and viscous properties of the ankle joint dorsiflexion (p<0.05). The changes in the ROM, elasticity, and viscosity were most pronounced in the case of the constant-torque stretching protocol. In addition to clinical scales, current biomechanical assessments indicate that three SMS protocols are all effective in reducing the immediate viscoelastic components of hypertonic ankle joints. Our quantitative analysis further shows that of the three treatment protocols, the constant-torque treatment is the most effective.