Effects of Self-Assisted Shoulder Elevation of the Affected Side Combined with Balance Training on Associated Reactions of Upper Limb and Walking Function in Chronic Stroke Patients: A Randomized Controlled Trial.

BACKGROUND Associated reactions of the upper limb are frequently seen in stroke patients, especially during dynamic activities, such as walking. The aim of this study was to assess the effect of a method to inhibit the affected upper limb flexors combined with balance training on associated reactions of the affected upper limb and walking function in chronic stroke patients. MATERIAL AND METHODS 60 patients were randomly allocated into 3 groups (n=20 per group): control group (no upper limb intervention), back group (the unaffected hand assists the affected upper limb in the low back and keep it in an extended position) and shoulder elevation group using the inhibition method (the unaffected hand assists the affected shoulder to elevate above 90°). Before and after the four-week balance training, the surface electromyography was used to evaluate the rate of contraction of affected elbow flexors. Fugl-Meyer Assessment of Upper Extremity (FMA-UE), 10 Meter Walking Test (10MWT) and Barthel Index (BI) were used to measure functional status. RESULTS The shoulder elevation group had significant improvement in the percentage changes in the rate of contraction of the affected elbow flexors, 10WMT and FMA-UE (p<0.05) compared with back group and control group. We found no significant difference of 10WMT and FMA-UE between back group and control group. CONCLUSIONS The combination of the new inhibition method and the standing balance training could reduce the abnormal activity of affected elbow flexors during walking, increase walking speed, and improve the affected upper limb motor function.