Phd ceremony L.D. de Jong:Contractures and hypertonia of the arm after stroke. Development, assessment and treatment
|Mo 03-03-2014 17:00 - 18:00
After having suffered a stroke, a considerable number of patients lose the ability to use their affected arm for functional activities. A lack of arm motor recovery and the subsequent immobilization makes the arm prone to the development of impairments such as hypertonia, muscle contractures and shoulder pain. Muscle contracture is an important contributor to hypertonia, is associated with shoulder pain and results in a decreased joint passive range of motion (PROM). Prediction and prevention of contracture and hypertonia development are important because these impairments can threaten the long-term handling and assistive use of the affected arm. Interventions aimed at preventing arm muscle contractures may also prevent the development of hypertonia and hemiplegic shoulder pain. Valuable conclusions about changes in PROM can only be drawn when the underlying goniometric measurements are reliable. This thesis presents the results of a cohort study and two reliability studies that were nested in two randomized controlled trials (RCT's). The results of the cohort study showed that hypertonia develops in a considerable number of patients and that its risk can be predicted at 48 hours after the stroke. The results of the two RCT's showed that the contracture preventive interventions did not lead to any clinical relevant advantages for the patients. The PROM measurements that were performed during the RCT's were reliable and resulted in valuable data that can be used to judge whether the magnitude of changes in arm PROM of their patients are greater than what can be explained by measurement error.