Effect of maintained stretch on the range of motion of the human ankle joint.

The effectiveness of maintained stretch in expanding the range of motion of the human ankle joint was assessed in a population of normal adults. Controlled movements were imposed upon the ankle, and triceps surae and tibialis anterior electromyograms were monitored to ensure that only passive joint properties generated ankle torque. We found that a majority of subjects (7 of 12) showed evidence of muscle activity sufficient to distort a subjective assessment of changes in range of motion. For the remaining five subjects, a 60-s maintained stretch produced a small decrease in the torque subsequently generated by an imposed dorsiflexing movement, but this effect was transient and largely disappeared following 300 s of rest at a neutral position. This short-term effect is consistent with the viscoelastic properties of collagenous material stretched during such treatment and is unlikely to lead to long-term increases in range of motion. RELEVANCE: The results of these experiments indicate that subjective assessments of changes in joint range of motion may be distorted by voluntary and reflexive muscle activation. Moreover the presumed increases in range of motion produced by maintained stretch in our normal subjects were small and transient. These results suggest that future assessments of the long-term efficacy of this treatment must monitor muscle activity and take into account known viscoelastic properties of collagenous materials.

The assessment and treatment of patients who have sensory loss following cortical lesions.

The assessment of tactile and proprioceptive sensory function in patients with severe sensory deficits resulting from cortical lesions is reviewed. The importance of using age-appropriate normative data to interpret the scores on these tests is discussed in the context of the frequency of ipsilateral disturbances in somesthetic sensation following unilateral cerebral lesions. Tactile and proprioceptive sensory deficits not only affect the processing of sensory information but also result in impairments in manual control. Fine-motor skills, such as those required for grasping and manipulating small objects, must therefore be evaluated in these patients. The treatment of patients with severe sensory deficits focuses on improving the perception of sensory information arising from receptors in the hand and on retraining motor function. The procedures used for sensory re-education and retraining are described.

Evaluating sustained touch-pressure in severe sensory deficits: meeting an unanswered need.

Sensation is critical to the functional abilities of the hand. Although evaluation techniques are available to measure a patient's ability to appreciate moving touch (MT), no test is available to assess appreciation of sustained touch-pressure (STP). A new device, designed to apply constant stimuli of known intensity, was developed and used to evaluate STP appreciation in an experimental and a control group. The experimental group consisted of six patients with severe sensory deficits due to cortical dysfunction. Each subject was evaluated for STP appreciation on the tip of the index finger of the affected side of the body. The results showed that five of the patients had some STP appreciation; the sixth had none. Furthermore, in the patient group, STP appreciation faded with time; appreciation was much greater four and six seconds after the stimulus onset than it was after 18 to 20 seconds. In the control group the sensation did not fade away. The lowest weight tested (23 g) was seldom detected by three of the five patients although it was readily sensed by all healthy individuals. An unexpected finding was that the 350-g weight was more difficult to appreciate for three of the five subjects than were the 150-g and 250-g weights. This experiment demonstrated that STP, an important component of sensation, can be evaluated quickly and accurately in the clinical environment and that the magnitude of the deficit in STP is correlated with the severity of the disability in the patient seeking physiotherapy.

Sensory loss in the hand after sensory stroke: therapeutic rationale.

Rehabilitation programs require techniques for reeducation of sensory appreciation. Current treatments focus on the return of motor function despite the fact that the full potential of motor function is not used in limbs with sensory deficits. A rationale based upon current neurophysiologic concepts is presented with a program of sensory reeducation of the hand. The organization and use of sensory inputs is analyzed to determine the modalities critical to hand function and the body surfaces important for daily tasks. The treatment program is rationalized in terms of the rules governing somatosensory cortical reorganization after trauma, and a case history is presented. Therapy begins with the delivery of sensory inputs to many receptors and pathways from important sensory surfaces. Inputs are delivered at an intensity sufficient for appreciation in a task structured to motivate the patient. Initially, electric stimuli are used. Then cutaneous mechanoreceptors are stimulated by stroking selected skin surfaces with inputs that have high frictional or shearing components, such as Velcro. As therapy progresses, tools are modified to enhance sensory appreciation during retraining of important tasks. Skills related to tactile form recognition and exploration are carefully shaped. A pilot project with six patients suggests some recovery of sensation and manipulative functions.