Early Shortening of Wrist Flexor Muscles Coincides With Poor Recovery After Stroke.
Karin L de Gooijer-van de Groep, Jurriaan H de Groot, Hanneke van der Krogt and 3 others
PMID 29938584WHAT IT FOUND
Patients whose arm recovery after stroke was poor already had shorter wrist flexor muscles and stiffer wrist tissue around week 4 or 5.
Reflex torque differences appeared later, around week 12. With 36 patients, this cannot show that shortening caused poor recovery.
Key findings
01At 26 weeks, patients with poor prognosis and poor recovery had higher flexor reflex torque, higher peripheral tissue stiffness, and shorter flexor muscles than patients with good recovery.
02From week 4 onward, the poor recovery group had smaller flexor slack length; from week 5 to week 26 it had higher peripheral tissue stiffness; and at weeks 12 and 26 it had higher flexor reflex torque.
03Subgroup analysis showed no substantial differences between intervention and control groups.
STILL TO COME
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What it does not show
Only 36 patients were included, with 15 in the good prognosis/good recovery group, 12 in the poor prognosis/good recovery group, and 9 in the poor prognosis/poor recovery group. Missing measurements exceeded 70% in the first 3 weeks, so the analysis started at week 4 and may miss the earliest changes. The model estimated lumped flexor and extensor muscle groups, not individual wrist muscles. Peripheral tissue stiffness was measured at 0° wrist angle, so differences at each patient's rest angle may be different. Background muscle activation was removed from EMG and not included in reflex torque, although rest EMG did not differ between groups. The study cannot show that muscle shortening caused poor recovery, or that CIMT or EMG-NMS changed the stiffness measures. The sample was too small to confirm how stiffness changed over time in each group, and subgroup analysis showed no substantial differences between intervention and control groups.
Declared interests
The authors declared no potential conflicts of interest. Funding came from the Dutch Technology Foundation STW, the Dutch organization for Health Research and Development ZonMW, and a Dutch Brain Foundation grant.
The easy way to misread this
Do not conclude that wrist flexor shortening caused poor recovery or that CIMT or EMG-NMS changed it. This was a cohort of 36 patients within a trial, and subgroup analysis showed no substantial differences between intervention and control groups.