Circumferential pressure treatment reduces post-stroke spasticity: a pilot randomized controlled trial

Introduction. Circumferential pressure is used to promote the inhibition of the spastic muscle. The purpose of this study was to evaluate the immediate effect of circumferential pressure applied by Johnstone pressure splint on the tonus level, reflex excitability, and electromyographic activity of plantar flexor and dorsiflexor muscles in post-stroke patients. Methods. An experimental single-blinded study with random allocation of patients to a control group (conventional inhibition techniques) or experimental group (conventional inhibition techniques along with circumferential pressure) was performed. All patients received one 25-minute therapeutic session. The muscle tonus according to the Modified Ashworth Scale, soleus H-reflex, and electromyographic signals during the sit-to-stand movement of plantar flexor-dorsiflexor muscles were evaluated before and after treatment. Results. overall, 30 stroke survivors (20 men, 10 women; age: 60.3 ± 5.7 years; evolution time: 27.8 ± 14.7 months) were studied. The muscle tone decreased in both groups, but the experimental group exhibited a greater reduction. The experimental group presented a significant increase in the H-wave duration and maximal H/maximal M wave ratio of the H-reflex as compared with the control group. No significant difference was observed in muscular electrical activity. Conclusions. one session of combined therapy contributes to a reduction in the tone of plantar flexor muscles and the reflex activity, without altering the muscle activity.