Objective To evaluate the impact of a daily self-stretching program within a Guided Self-rehabilitation Contract (GSC), on functional muscle length in patients with chronic spastic paresis. Methods Retrospective chart review of 16 chronic paretic patients (7 W, age 40 ± 8 years, time since lesion 57 ± 35 months) who consecutively participated to a Guided Self-rehabilitation Contract for at least one year (2 years follow-up for 10 of them). By this contract, patients were committed to clinicians to achieve every day a self-stretching programbased on self-stretching postures (> 10 mn/muscle/day) and excentric stretching exercises on some selected muscles (“self-stretched” muscles). Each program was specific for each patient. Functional muscle length XV1 (angle of arrest after slow and strong stretch) measured by the clinician at every visit on 5 key muscles of the lower limb (soleus, gastrocnemius, hamstrings, vastus, rectus femoris), they have been selected or not for the self-stretching program, was the main outcome measure. Coefficient of shortening (CS) was calculated CR = (XN-XV1)/XN (XN, normal passive amplitude). After one and two years, muscles has been considered as responders if, from baseline, ΔXV1 > 108 for hamstrings, vastus and rectus femoris, and > 58 for soleus and gastrocnemius. Results In retrospect, at baseline, CS for the non-stretched muscles group was 0.12 ± 0.03 (mean ± SD) vs 0.20 ± 0.02 in the self-stretched muscles group (P = 0,028, t test). The percent of responders in the self-stretched muscles group was significantly higher than in the non-stretched muscles group after one and two years of GSC (42% vs 20%, P = 0.025; 50% vs 20%, P = 0.035 respectively, Chi2). After one year, the CS of the self-stretched muscles group decreased about 18%, vs 5% for the non-stretched muscles group (P = 0.028, Mann-Whitney). Regarding individual muscles data, raw functional lengthening after two years of daily self-stretched (n = 10) were: hamstrings, +9 ± 6; vastus, +6 ± 2; rectus femoris, +13 ± 7; soleus, +2 ± 2; gastrocnemius, +3 ± 1. Conclusion A customized program of self-stretching daily practiced by chronic paretic patients for at least one year within a Guided Self-rehabilitation Contract might allow a significant functional muscle lengthening. These results need to be confirmed by a prospective controlled study.
Pradines, M., Baude, M., Mardale, V., Hutin, E., & Gracies, J. M. (2015). Daily static and eccentric self-stretching program and changes in muscle functional length in chronic spastic paresis after one year of Guided Self-rehabilitation Contract’s practice. Annals of Physical and Rehabilitation Medicine, 58, e87. https://doi.org/10.1016/j.rehab.2015.07.213