Analysis of Functional Tasks to Provoke Contraction in Paretic Anterior Tibial Muscles in Individuals with Early Subacute Stroke: A Quasi-experimental Study

Introduction: Improving control of ankle dorsiflexors is crucial
for enhancing gait and posture control after a stroke. Several
training methods have been explored for their efficacy in
promoting contraction of the weakened dorsiflexor muscles.
However, majority of studies have been done in chronic stroke
survivors, leaving a need to study their effect in early subacute
phase of stroke.
Aim: To test the effectiveness of commonly used functional tasks in
stimulating dorsiflexor activity in early subacute phase of stroke.
Materials and Methods: The present quasi-experimental
study was conducted with 27 subjects recruited at an acute
stroke care set-up at Sri Ramachandra Medical centre, Tamil
Nadu, India. India. Twenty-seven subjects with first-time stroke
with hemiplegia/paresis with Brunnstrom stage less than 2
were enrolled in the study from March 2023 to July 2023.
Dorsiflexor activity was tested in five different functional task.
The evaluation of muscle activity was conducted using Surface
Electromyography (SEMG). The average output in microvolts
(µV) of SEMG was recorded and taken for analysis. Analysis of
Variance (ANOVA) and Post-hoc Tuckey were used to compare
the differences in dorsiflexor activity between each functional
task. Statistical significance was kept at p<0.05.
Results: All the five functional task provoked dorsiflexor
activity. Among the five functional tasks, stand and reach (18.49
µV) elicited a more pronounced contraction in the dorsiflexors.
Wall-leaning in a standing position (15.5 µV), reaching while
sitting (14.2 µV), transitioning from sitting to standing (12.8 µV),
and triple flexion in the supine position (10.42 µV) also elicited
dorsiflexor activity in decreasing level of efficacy. Moreover, they
did not exhibit a statistically significant difference in quantum of
EMG activity recorded when tested with ANOVA at p<0.05.
Conclusion: All the five functional tasks provoked dorsiflexor
activity in early subacute phase of stroke in a varying level. In
particular stand and reach was the most effective functional
task to provoke paretic side dorsiflexor activity.