Medication by Physical Exercise of the Upper Limb in Deforming Spastic Paresis (Stroke); Conventional Physiotherapy Versus Supervised Self- rehabilitation: A Multicentre Prospective, Controlled and Randomized, Single-blind Study over a Period of One Year

Background: Some patients who have had a stroke develop paresis. With time it can become spastic and even distorting. Spastic deforming paresis is often accentuated in the upper limb. It is a real brake in the performance of daily activities, with a psychological impact. The physical therapy of the upper limb today, appears like a real sea snake. Hence the strategies of physical medication must be thought out, studied and developed on a daily basis to overcome this unsightly condition. Objective: Is conventional physiotherapy more effective than supervised self-rehabilitation, in terms of functional recovery in deforming spastic paresis after stroke of the upper limb? This was the major question / objective of this study. Methods: Our study was a multicenter, prospective, interventional, controlled, and randomized, single-blind study. Comparing conventional physiotherapy versus supervised self-rehabilitation over a 12-month period. We recruited 37 patients in France and Spain more than 6 months after their stroke. The judgment tool used during all phases (1st day; 6 months; 9 months and 12 months) of the assessment was the modified Frenchay scale (MFS). Results: The mean age of our cohort was 69 ± 7 years and the mean mounts after stroke was 11,9 ± 5 months. Supervised self-rehabilitation was significantly superior to conventional physiotherapy during the three evaluations carried out on the modified Frenchay scales. At 6 months: 5.99 ± 4.7 Vs 6.97 ± 2.1 (P <0.5). At 9 months: 6.71 ± 9.4; against 7.83 ± 4.1 (P <0.5). Three months after the follow up, we reassessed the patients to see the residual effect, the retention of acquired knowledge and behavioral adaptation after the protocol: 6.57 ± 11, Vs 7.9 ± 6 (P= 0,14). Conclusion: Supervised self-rehabilitation is more effective than conventional physiotherapy. Because from 6 months, and 9 months, a statistically significant difference is demonstrated. this difference persists even 3 months after stopping the follow-up. For the techniques used in the supervised self-rehabilitation group: learning a motor skill could strengthen the circuits of spinal interneurons that facilitate movement. We realized that learning a simple and reciprocating movement, associated with activo-dynamic stretching, done several times a day on target muscles (antagonists were more significant than traditional physiotherapy which, it was rather holistic and nonspecific) would produce an influence in the spinal cord. And, over time, would promote reciprocal inhibition between antagonist and agonist muscles. All the same, further studies with a larger cohort must be carried out in order to conclude on this mentioned neurophysiological hypothesis.