Effects of noxious versus innocuous thermal stimulation on lower extremity motor recovery 3 months after stroke

Abstract

Objective: To examine the effects of thermal stimulation (TS) on the lower extremity (LE) movement and function in patients with stroke.

Design: A double-blinded randomized controlled trial.

Setting: A university hospital.

Participants: Patients (N=34) at least 3 months after stroke were randomly assigned into the experimental and the control groups.

Interventions: In addition to regular rehabilitation, the experimental group received a 30-minute noxious TS protocol (heat pain 46-47°C/cold pain 2-3°C) 3days/wk for 8 weeks, and the control group received a 30-minute innocuous TS protocol (heat 40-41°C/cold 23-24°C) 3d/wk for 8 weeks.

Main outcome measures: The Low Extremity subscale of the Stroke Rehabilitation Assessment of Movement (LE-STREAM), the Mobility subscale of STREAM (Mob-STREAM), the Functional Ambulation Category (FAC), the Barthel Index (BI), the Postural Assessment Scale for Stroke Patients (PASS), and the Modified Ashworth Scale (MAS) were administered by a blinded rater at baseline, posttreatment (8wk), and follow-up (12wk).

Results: Twenty-three participants completed the study protocol and all outcome measurements. No preexisting group differences between the experimental group (n=11) and the control group (n=12) were found on demographic and clinical variables. Compared with baseline, the experimental group showed significant improvements at posttreatment and follow-up on the LE-STREAM, Mob-STREAM, FAC, and BI (P<.05) while the control group showed no significant improvements for all outcome measures. As for the between-group comparison, significant differences were seen at follow-up (12wk) on the LE-STREAM, Mob-STREAM, BI, and MAS.

Conclusions: Our findings indicate that an 8-week program of noxious TS combined with a traditional stroke rehabilitation program can improve the LE-related movement and function in patients with stroke for more than 3 months.