Poster 393: Feldenkrais Scapular Manipulation for Reduction of Spasticity Post-Stroke

Poster 393: Feldenkrais Scapular Manipulation for Reduction of Spasticity Post-Stroke

PM&R Disclosures: K. J. McCain, None. Objective: To investigate the effectiveness of a novel locomotor treadmill training protocol applied in the acu...

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Disclosures: K. J. McCain, None. Objective: To investigate the effectiveness of a novel locomotor treadmill training protocol applied in the acute stage of recovery from stroke to produce symmetrical gait. Design: Case series. Setting: Inpatient rehabilitation center. Participants: 18 adults with first-time cortical and/or subcortical ischemic or hemorrhagic stroke admitted to an inpatient rehabilitation unit. Interventions: Thirty minutes of locomotor treadmill training with partial body weight support, initiated prior to formal over ground gait training, once daily each weekday during the inpatient rehabilitation stay. Main Outcome Measures: 3-dimensional gait analysis (symmetry and kinematics) at 6 months post insult and falls history by patient report. Results: 3-dimensional gait analysis data revealed better symmetry profiles at the hip, knee and ankle than have been documented after stroke. Of the 18 participants, 15 walked without the use of an assistive device and 11 walked without an ankle foot orthosis at 6 months. In addition, a total of 5 of 18 participants reported falls in the first 6 months after onset, representing an incidence of 28%. Conclusions: Application of locomotor treadmill training with partial BWS before over ground gait training was effective in producing more symmetrical gait than is typically observed post stroke. In addition, the participants required less upper extremity support to walk independently as well as fewer ankle foot orthoses than published reports of persons after stroke. Another positive finding was the reduced incidence of falls for the population compared to documented statistics. These positive outcomes were achieved by application of a feasible clinical intervention in the acute rehabilitation setting. Keywords: Rehabilitation, Stroke, Gait.

Poster 393 Feldenkrais Scapular Manipulation for Reduction of Spasticity Post-Stroke. Jason Siefferman, MD (Mount Sinai School of Medicine, New York, NY); Edward J. Li, BS; Preeti Raghavan, MD. Disclosures: J. Siefferman, None. Objective: To demonstrate the effect of Feldenkrais scapular manipulation on performance of a reach-to-target task. Design: Interrupted time series. Setting: Clinical laboratory within a tertiary care center. Participants: Subjects with chronic post-stroke hemiparesis and upper extremity Fu¨gl-Meyer scores less than 20. Interventions: Feldenkrais scapular manipulation. Main Outcome Measures: We examined smoothness of reach trajectory and upper extremity muscle activation patterns by surface electromyography while subjects performed a reach-to-target task before and after manipulation of the scapula. Passive range-of-motion (PROM) and spastic-

Vol. 1, Iss. 9S, 2009


ity (modified Ashworth scale, MAS) were also recorded at the shoulder, elbow, wrist and finger joints. Results: After manipulation, subjects increased activation of the middle and lower trapezii both prior to and during reach (P ⬍ .01), suggesting improved scapular stabilization. Co-activation during reach was reduced between biceps and triceps (P ⬍ .001), posterior and anterior deltoids (P ⬍ .005), pectoralis major and triceps (P ⬍ .005), and lateral and anterior deltoids (P ⬍ .005), suggesting suppression of abnormal post-stroke synergy patterns. Reach trajectories were also smoother (jerk metric, P ⬍ .01). MAS scores decreased significantly in the finger MCP and PIP joints (P ⬍ .01) with a trend toward significance in the shoulder, elbow, and wrist, suggesting reduction of spasticity. PROM values increased at the shoulder, elbow, and wrist (P ⬍ .1). Conclusions: Feldenkrais scapular manipulation may be effective in reducing spastic synergies and facilitating upper extremity performance post-stroke. Further study is needed to clarify the relationship between activation of scapular stabilizers and upper extremity spasticity. Keywords: Rehabilitation, Stroke, Muscle Spasticity, Scapula.

Poster 394 Generalized Weakness with Neuromuscular Junction Disorder and Urinary Incontinence Following Botulinum Toxin Type A Injections for Spasticity: Potentiation by Steroid Injection? A Case Report. Robert Lee, MD (The Rehabilitation Institute of Chicago/Northwestern University, Chicago, IL); Richard L. Harvey, MD; Christina M. Marciniak, MD. Disclosures: R. Lee, None. Patients or Programs: A woman in her 40s with subarachnoid hemorrhage in 2004 and left spastic hemiplegia. Program Description: Two months following botulinum toxin type A (Botox ®)(BTX) injections into the left calf, the patient presented for electrodiagnostic studies (EDX) to evaluate right upper and lower limb weakness. She had been treated with 400-600 units of intramuscular BTX into the left leg approximately every 3 months since 2007. On 10/3/08, she presented with left trochanteric bursitis and received a bursa injection containing 40 mg of depomedrol with 3 mL 1% lidocaine. Two weeks later she received her scheduled 600 units of BTX into toe and ankle plantar flexors and the posterior tiblialis. Two weeks following BTX, she developed urinary incontinence and right-sided weakness. Patient denied dysphagia and respiratory symptoms. Head CT showed no new abnormalities. Setting: Outpatient electrodiagnostic laboratory. Results: Physical examination at time of EDX demonstrated right upper and lower limb weakness (4- to 4⫹/5). Left limbs showed her post-stroke baseline strength and some plantarflexion spasticity. Bilateral upper and right lower limb motor and sensory nerve conduction studies were normal. Right