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Ann Rehabil Med : Annals of Rehabilitation Medicine

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"Passive"

Case Report

Soleus Myopathy Induced by Passive Stretch in a Stroke Patient: A case report.
Kim, Young Jun , Park, Insun , Lee, Young Joon , Kim, Chan Hwan , Choi, Jang Seok , Jo, Geun Yeol
J Korean Acad Rehabil Med 1999;23(3):664-669.

We present a 50-year-old woman who sustained spastic left hemiplegia secondary to the right thalamic hemorrhage 6 years ago. She complained of persistent severe left calf pain after serial casting for the treatment of shortened plantar flexors of the left ankle. Two months later, magnetic resonance T1-weighted images showed diffuse high signal intensity involving the whole muscle bulk of the soleus and normal signal intensity of thin atrophied gastrocnemius. Needle electromyography of the soleus revealed myopathic patterns. Histologic findings of the soleus showed necrotic muscle fibers with phagocytosis, endomyseal collagen and fat deposition. We concluded that prolonged passive stretch of spastic plantar flexors of the ankle under serial casting induced soleus myopathy with segmental myonecrosis, and which developed left calf pain. Selective induction of soleus myopathy could be explained by the higher stretch tension produced by ankle dorsiflexion in the soleus compared to the gastrocnemius because of different proximal ends.

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Original Articles
Comparison of Ultrasonographic Findings with Clinical Findings in Hemiplegic Shoulder.
Ko, Myoung Hwan , Kim, Ji Yeon , Park, Sung Hee , Kim, Nam Gyun , Seo, Jeong Hwan
J Korean Acad Rehabil Med 2006;30(3):213-218.
Objective
To identify the etiology of hemiplegic shoulder pain by ultrasonographic and clinical examinations and to determine the correlation between ultrasonographic findings and clinical factors in patients with hemiplegic shoulder. Method: Seventy hemiplegic patients with shoulder pain or without shoulder pain were enrolled. All of patients were evaluated by ultrasonography. We analyzed clinical factors including visual analogue scale (VAS) of hemiplegic shoulder pain, shoulder subluxation measured by plain X-ray, shoulder manual muscle test (MMT), passive range of motion (PROM) of the shoulder joint and complex regional pain syndrome (CRPS). Results: 51.0% of patients with shoulder pain showed ab-normal ultrasonographic findings, while 9.5% of patients without shoulder pain. Those with abnormal ultrasonographic findings had significantly decreased shoulder PROM in flexion, abduction, external rotation and internal rotation and more severe subluxation of hemiplegic shoulder (p＜0.05). Conclusion: After investigating the hemiplegic shoulder through ultrasonography, painful hemiplegic shouder had high incidence of abnormal ultrasonographic characteristics. Ultrasonography is more worthwhile and useful as an primary diagnostic method, especially when there is severe shoulder subluxation and the limitation of PROM of shoulder in hemiplegic patients. (J Korean Acad Rehab Med 2006; 30: 213-218)
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The Effect of Passive Stretching on the Spasticity of Ankle Plantar Flexor Muscles.
Lee, Seong Jae , Kwon, Bum Sun , Park, Choong Hyun
J Korean Acad Rehabil Med 2001;25(6):987-992.

Objective: This study was designed to evaluate the effect of stretching on decreasing spasticity of ankle plantar flexor muscles by biomechanical assessments.

Method: Twenty two ankle joints of nineteen patients with upper motor neuron lesion were included. The spasticity was assessed both clinically and biomechanically before and after stretching of ankle plantar flexor muscles by tilt table. For clinical assessment modified Ashworth scale (MAS) was used. For biomechanical assessment, ankle plantar flexor muscles were stretched isokinetically while EMG signals were recorded simultaneously and peak eccentric torque, stiffness index and stretch reflex threthold speed (SRTS) were measured.

Results: Two cases showed improvement in MAS after stretching but the others did not. SRTS of ankle plantar flexor was increased significantly while peak eccentric torque and stiffness index were unchanged.

Conclusion: Passive stretching of ankle plantar flexor muscles decreased the stretch threshold, that is a neural component of spasticity but it did not decrease the mechanical component of spasticity.

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Effect of Passive Leg Range of Motion Exercise in Hemiplegic Patients.
Kim, Kweon Young , Kim, Do Gyun , Shin, Soo Beom
J Korean Acad Rehabil Med 2001;25(6):928-933.

Objective: The purpose of this study was to examine the change of heart rate, mean arterial pressure, respiration rate, and spasticity at passive leg range of motion exercise for one month in hemiplegic patients.

Method: Subjects were composed of twenty hemiplegic patients who had spasticity above two grade in modified Ashworth scale. Passive leg range of motion exercise was performed with passive cycle leg exerciser (Autocybex) at the speed of 40 rpm. Training program consisted of two sessions a day, and each session was done for twenty minutes. The heart rate, mean arterial pressure, and respiration rate were checked for each subject before and after passive leg range of motion exercise at initial state and after one month. Spasticity was measured at knee joint of the affected side at initial state and after one month.

Results: The resting heart rate, mean arterial pressure and respiration rate were significantly decreased after one month (p＜0.05). The changes of heart rate, mean arterial pressure, and respiration rate after passive leg range of motion exercise were significantly decreased after one month (p＜0.05). The grade of spasticity was decreased after one month (p＜0.05).

Conclusion: We concluded that passive leg range of motion exercise during one month stabilized heart rate, mean arterial pressure, and respiration rate, and reduced spasticity.

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Passive Knee Joint Proprioception Test in Normal Adults.
Park, Heon Jong , Kim, Don Kyu , Seo, Kyung Mook , Kang, Si Hyun , Seo, Jong Hyun
J Korean Acad Rehabil Med 2009;33(6):698-703.
Objective
To establish appropriate test angle of passive knee proprioception test and to compare with active knee proprioception test. Method: Thirty one healthy volunteers were tested in seated position on isokinetic machine. For passive test, the knee joints were placed in starting angle of 0o, 30o in flexion test and 90o, 60o in extension test. To memorize target angle, they were passively positioned to the target angle and left hold for 10 seconds, and returned to starting position. After these processes, knee joints were passively moved toward flexion and extension target angle. The subjects were instructed to press stop button when the memorized angles were reproduced. The tests were performed 3 times for each 6 different test angle. The active test were performed with the same memorized process but the subjects moved actively to reproduce target angles. The absolute angular errors (AAE) between target angle and produced angle were measured and compared. Results: In passive proprioception test, the AAEs were increased according to the test angle differences were increased from 30o to 60o. In the same target angle difference, there were no differences between starting positions. When the results of passive test were compared with active test, there were no significant differences in the flexion test, but larger angular error were measured in extension test. Conclusion: The passive knee proprioception test could be useful for patients with lower extremity weakness. Considering the possible error of large angular difference, the testing angular differences should be properly selected. (J Korean Acad Rehab Med 2009; 33: 698-703)
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Improvement of the Femoral Venous Flow after Passive Exercise of the Paralytic Lower Limb in Stroke Patients.
Ko, Myoung Hwan , Kim, Seong Kyun , Park, Sung Hee , Seo, Jeong Hwan
J Korean Acad Rehabil Med 2009;33(1):59-63.
Objective
To study the effects of a passive exercise in hemiplegic lower limb on the blood flow velocity in the femoral vein compared with functional electrical stimulation. Method: Twenty stroke patients (men 11, women 9) were enrolled. The patients lied down on a table for 15 minutes. Then the investigator performed passive exercise, flexion and extension of the hip, knee and ankle joint of the hemiplegic limb, for 5 minutes with frequency of 1 Hz. At least 24 hours later, functional electrical stimulation was performed to tibialis anterior and gastrocnemius muscles for 20 minutes. We collected the peak blood velocities of the femoral vein before and 0, 15, 30, 45, and 60 minutes after each procedure. Results: The peak blood flow velocities of the femoral vein before passive exercise were 10.3±1.34 cm/sec and 15.4± 2.22, 14.5±1.86, 13.0±1.58, 11.4±1.23, 10.4±1.17 cm/sec at 0, 15, 30, 45, 60 minutes after exercise. There were significant differences until 30 minutes after exercise (p＜0.01). The velocities of the femoral vein were 10.6±1.36, 18.2±2.34, 16.6±2.1, 14.6±1.7, 12.6±1.7, 11.5±1.5 cm/sec for before and 0, 15, 30, 45, 60 minutes after functional electrical stimulation. There were significant differences until 45 minutes after FES (p＜0.01). Conclusion: The passive exercise of hemiplegic lower limb for 5 minutes was effective for increase of femoral blood flow. It may be a good method for preventing a DVT after stroke. (J Korean Acad Rehab Med 2009; 33: 59-63)
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