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Aquatic Therapy Improves Outcomes for Subacute Stroke Patients by Enhancing Muscular Strength of Paretic Lower Limbs Without Increasing Spasticity: A Randomized Controlled Trial

Zhang, Yue MD; Wang, Yi-Zhao MS; Huang, Li-Ping PhD; Bai, Bei MPH; Zhou, Shi PhD; Yin, Miao-Miao MD; Zhao, Hua BS; Zhou, Xiao-Na MD; Wang, Hong-Tu MD

American Journal of Physical Medicine & Rehabilitation: November 2016 - Volume 95 - Issue 11 - p 840–849
doi: 10.1097/PHM.0000000000000512
Original Research Articles
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Purpose The aim of this study was to evaluate the effects of an aquatic exercise program designed to enhance muscular strength in paretic lower limbs in subacute stroke patients.

Method Thirty-six subacute stroke patients were randomly divided to a conventional or an aquatic group (n = 18 each). Outcome measures were assessed at baseline and after 8 wks of training. For the paretic lower limbs, maximum isometric voluntary contraction strength of the rectus femoris and biceps femoris caput longus and the tibialis anterior and lateral gastrocnemius was measured. Cocontraction ratios during knee extension and flexion and ankle dorsiflexion and plantarflexion were calculated respectively. In addition, Modified Ashworth Scale, Functional Ambulation Category, and Barthel Index were assessed.

Results Compared with the conventional intervention, the aquatic intervention resulted in significantly higher knee extension (P = 0.002) and ankle plantarflexion torque (P = 0.002), accompanied with a significantly lower knee extension cocontraction ratio in the paretic limb (P = 0.000). Functional Ambulation Category (P = 0.009) and Barthel Index (P = 0.024) were greater in aquatic group than conventional group posttreatment. Modified Ashworth Scale scores did not show any differences between groups.

Conclusions Aquatic exercise enhanced muscle strength in paretic lower limbs and improved muscle cocontraction without increasing spasticity in subacute stroke patients.

Supplemental digital content is available in the text.

From the Department of Rehabilitation, Huanhu Hospital, Tianjin, China (YZ, Y-ZW, M-MY, HZ, X-NZ, H-TW); Department of Health and Exercise Science, Tianjin University of Sport, China (L-PH); Department of Science and Technology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China (BB); and Department of Exercise Science and Sport Management School of Health and Human Sciences, Southern Cross University, Lismore, Australia (SZ).

All correspondence and requests for reprints should be addressed to: Li-Ping Huang, PhD, Department of Health and Exercise Science, Tianjin University of Sport, No. 51, Weijinnanlu, Hexi District, Tianjin, 300381 China.

This research was supported by grants from Tianjin Higher Education Innovative Team Fund and China National Key Technology R&D Program (2012BAK21B00).

Disclosures: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com).

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