THE EFFECTS OF SUBTALAR JOINT MOBILIZATION ON PATIENTS WITH CHRONIC STROKE

NCT ID: NCT03788629

Last Updated: 2020-04-07

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 28 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-06-30
• Study Completion Date: 2018-09-20

Brief Summary

Adequate ankle motion for normal gait ranges from 10° to 15° of dorsiflexion passive range of motion (DF-PROM) to allow the tibia to move over the talus. However, limited ankle mobility is a common impairment in patients with stroke whose DF-PROM has been shown to be approximately half of that in healthy subjects. As a result, these patients have impaired dynamic balance in standing or gait. Mulligan first proposed mobilization with movement (MWM) as a joint mobilization technique. Talocrural MWM to facilitate DF-ROM is performed by applying a posteroanterior tibia glide over a fixed talus while the patient actively moves into a dorsiflexed position while standing. Talocrural MWM has been applied to chronic ankle instability and has been proven effective in improving DF-PROM and standing balance. Subtalar MWM to facilitate DF-ROM is performed by bringing foot to dorsiflexion-abduction-eversion by flexing patient' knee.

The effects of subtalar MWM have not been investigated in patients with stroke. Therefore, the purpose of the present study is to examine the effects of subtalar MWM on muscle strength, balance, functional performance, and gait parameters in patients with chronic stroke.

Detailed Description

Neural factors, such as spasticity, or an increase in the sensitivity of the myotatic reflex, can contribute significantly to calf muscle stiffness. Likewise, non-neural factors, such as immobilization and age-induced changes in the mechanical properties of muscle and connective tissue, are known to increase resistance to joint movement and to contribute to the limited DF-PROM. Both neural and non-neural factors can impair ankle motion, resulting in balance impairments during standing or gait. Limited DF-PROM can alter foot positioning in weight bearing, resulting in hyperextension of the knee, and decreased ability to shift the center of gravity (COG) during standing and gait. A variety of interventions, such as stretching and joint mobilization, have been attempted to attenuate the effects of limited DF-PROM and to reduce further deterioration in patients post stroke. Both stretching and joint mobilization have been proven effective for improving ankle passive range of motion in patients with stroke; however, there is a limit to the durability of the effect and improvements in functional ability. For this reason, improvements in joint range of motion (ROM) must be accompanied by gains in muscle strength to improve functional ability. This is especially true for patients with hemiplegia who are not capable of weight bearing symmetrically and require additional training, including repetitive and continuous weight bearing on the paretic lower limb.

Adequate ankle motion for normal gait ranges from 10° to 15° of dorsiflexion passive range of motion (DF-PROM) to allow the tibia to move over the talus. However, limited ankle mobility is a common impairment in patients with stroke whose DF-PROM has been shown to be approximately half of that in healthy subjects. As a result, these patients have impaired dynamic balance in standing or gait. Mulligan first proposed mobilization with movement (MWM) as a joint mobilization technique. Talocrural MWM to facilitate DF-ROM is performed by applying a posteroanterior tibia glide over a fixed talus while the patient actively moves into a dorsiflexed position while standing. Talocrural MWM has been applied to chronic ankle instability and has been proven effective in improving DF-PROM and standing balance. Subtalar MWM to facilitate DF-ROM is performed by bringing foot to dorsiflexion-abduction-eversion by flexing patient' knee.

The effects of subtalar MWM have not been investigated in patients with stroke. Therefore,the purpose of the present study is to examine the effects of subtalar MWM on muscle strength, balance, functional performance, and gait parameters in patients with chronic stroke.

Conditions

Hemiplegia, Spastic

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Study Group 1

Bobath Concept+ Talocrural joint Mulligan MWM techniques were applied to this group.

Group Type: EXPERIMENTAL

Talocrural joint MWM mobilization

Intervention Type: OTHER

There were two groups for this study. In addition to Bobath Concept, talocrural joint mobilization was performed.

Study Group 2

Subtalar joint Mulligan MWM techniques were applied to this group in addition to Bobath Concept+ Talocrural joint Mulligan MWM techniques

Group Type: ACTIVE_COMPARATOR

Subtalar joint MWM mobilization

Intervention Type: OTHER

There were two groups for this study. In addition to treatment of control group, subtalar joint mobilization was performed.

Interventions

Talocrural joint MWM mobilization

There were two groups for this study. In addition to Bobath Concept, talocrural joint mobilization was performed.

Intervention Type: OTHER

Subtalar joint MWM mobilization

There were two groups for this study. In addition to treatment of control group, subtalar joint mobilization was performed.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• hemiplegic stroke (>6 months post stroke),
• ability to perform a single-leg lunge on the paretic lower limb onto a stool from a standing position,
• ability to walk without an assistive device for more than 10 m,
• limited dorsiflexion passive ROM with contracture of the paretic ankle, and capability of following simple verbal instructions.

Exclusion Criteria

• visual impairment,
• unilateral neglect,
• aphasia.
• contraindications for joint mobilization (i.e., ankle joint hypermobility, trauma, or inflammation),
• ankle sprain in the previous 6 weeks,
• any history of ankle surgery,
• and those concurrently receiving similar interventions outside of the present study

• Minimum Eligible Age: 40 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Hacettepe University

OTHER

Sponsor Role: lead

Responsible Party

Caner Karartı

Caner Karartı, Hacettepe University

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Caner KARARTI

Kırşehir, , Turkey (Türkiye)

Countries

Turkey (Türkiye)

Other Identifiers

2018500

Identifier Type: -

Identifier Source: org_study_id