The Effects of Manual Therapy on Stroke Patients Who Have Upper Extremity Impairment

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Author Name : Madeline Elder
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BS, MS, PhD Student? : BS
Affiliation : WKU
Abstract : BACKGROUND: The number of strokes that occur in the United States each year is on the rise and although stroke prevention has been extensively studied, rehabilitation professionals often rely on the continued discovery of evidence-based practices to improve functional outcomes for stroke patients. A novel practice that has long held a place in rehabilitation is known as manual therapy (e.g., deep tissue massage, myofascial release). Despite growing evidence that supports various uses of manual therapy in apparently healthy individuals and athletes, the methods have not been widely studied in rehabilitation practices following stroke diagnosis. PURPOSE: The purpose of this study is to determine the effects of novel manual therapy approaches in patients who have experienced decreased mobility and function in their upper body, post stroke diagnosis. METHODS: Patients from Southern Kentucky Rehabilitation Hospital who had experienced a stroke within the last two weeks were invited to participate in the study. Participants were randomly assigned to a routine stroke rehabilitation group (control) or a routine stroke rehabilitation group with an emphasis on manual therapy (experimental). Participants completed a total of 8-10 treatments with clinicians over a two-week period. The Fugl-Meyer Upper Extremity Scale and Modified Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) were used for pre- and post-assessments. RESULTS: Participants (n=7; 57% male, 43% female) completed the QuickDASH (QD) and Fugl-Meyer (FM) assessments before the start of therapy (QDpre, FMpre) and after therapy ended (QDpost, FMpost). There was a significant difference between QDpre and QDpost (t = 2.69, p = .036) and between FMpre and FMpost (t = -4.44, p = 0.004). There were no significant group differences for QDpre (C = 62.877 ± 13.698; E = 70.455 ± 7.655; t = -0.95, p = 0.388) and QDpost (C = 47.727 ± 32.057; E = 51.135 ± 17.161; t = -0.184, p = 0.861). There were no significant group differences for FMpre (C = 6.666 ± 11.547; E = 10.750 ± 6.702; t = -0.597, p = 0.577) and FMpost (C = 13.000 ± 12.523; E = 18.500 ± 7.506; t = -0.733, p = 0.497). CONCLUSIONS: Although improvements were seen between pre and post assessment, they were present in both the control and experimental groups. An emphasis on manual therapy alone in post stroke rehabilitation cannot be considered the key responsible factor for improvements in physical and motor functioning among participants in this study. This suggests that while it is known that manual therapy is beneficial, it is still unclear on the specific amount, duration, and intensity needed for optimal results in the return of upper extremity function.

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