Abstract: Rehabilitation after stroke remains a challenge. Passive Movements are commonly used to help the stroke survivor recover from Physiologic impairments caused by the lesion of the CNS. When spastic Hypertonia is identified, joint mobilisations and muscle stretching are considered an integral part of the patient’s daily management, continuous passive motion is one of them. The present study sought to assess the effects of continuous passive motion on spasticity in stroke patients.
Objectives of the study:
1. To study the H-Reflex parameters and H/M ratio in spastic hemiplegics both on the affected and normal side.
2. To study the association of H/M Ratio to clinical grades by MAS.
3. To study the effect of continuous passive motion on H-reflex, H/M Ratio and spasticity.
Study Design: Interventional cross-sectional.
Methodology: The total study Sample was 21 participants – 13 Males and 8 Females. All the participants were the spastic hemiplegic patients in the study group and the normal lower limb served as the control. A detailed Neurological examination was done. The H-reflex study and the clinical grades by MAS (Modified Ashworth Scale) was done before and after passive movements on CPM device. Passive movements were given for 20 Minutes.
Main outcome measures: MAS, Soleus H-Reflex, Hmax:Mmax ratio.
Results: The spastic hemiplegics by MAS were in the range of 1+ to 2 before the CPM. Also, the H amplitude and H/M ratio studied, was mean 6.00 +4.81, SE 1.05 and 0.51 + 0.5, SE 0.10 before CPM respectively. Following CPM of 20 minutes, MAS were in the range of 1 to 1+. Also, the H amplitude and H/M ratio were 4.18+3.37, SE 0.73 (P-value 0.001) and 0.28+0.21, SE 0.04(p-value 0.019) respectively. Comparison of MAS and H/M ratio was also studied and showed there was strong relationship between the spasticity by MAS and H/M ratio post CPM (p-value 0.001), However Pre-CPM it was not significant (0.17).
Conclusion: The study indicates that continuous passive movement brought about significant alterations in spasticity post CPM. Subjectively all the patients reported significant benefits from 20 minutes of CPM in the form of reduced heaviness of the affected limb with improved strength and easy walking. The measures used, MAS and the H/M ratio used to grade spasticity were significantly reduced and correlated post CPM.
Keywords: H-reflex, Spastic hemiplegia, MAS, Hmax: Mmax ratio, CPM device.
Title: To Study the H-Reflex in Spastic Hemiplegics Before and after Passive Movements on CPM Device
Author: Dr. Vaishali Suthar
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
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