These drawings are taken from Margaret Johnstones book "Restoration Of Motor Function in a Stroke Patient "- Third Edition 1987
Churchill Livingstone
In our hospital the technical department constructed the Rocking machine using these drawings.
The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke. In a single-blind, randomized, controlled multicenter trial, 100 consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group. The intervention was applied for 6 weeks. Patients were evaluated for level of impairment (Brunström-Fugl-Meyer test) and disability (Action Research Arm Test, Barthel Index) before, midway, and after the intervention period and a follow up 6 and 12 months after stroke. The results showed that Patients in the experimental group performed better on the Brunström-Fugl- Meyer test than those in the control group throughout the study period but differences were significant only at follow up. Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability. The effect of the therapy was attributed to the repetitive stimulation of muscle activity. The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi -inattention. No adverse effects due to the intervention were found. It was concluded that adding a specific intervention during the acute phase after stroke improved motor recovery, which was apparent 1 year later. These results emphasise the potential beneficial effect of therapeutic intervention for the arm. (Stroke 1998; 29:785-792) Key words: clinical trials - rehabilitation - stroke
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The address for STROKE: http://www.strokeaha.org
As a Johnstone instructor I would like to add some comments on this study, as I believe this therapeutic intervention is an interesting application, to add to the treatment of Stroke patients for Occupational therapists or Physiotherapists.
I have used this application in Denmark for many years. It is very easy to integrate this treatment in the daily therapy. It only takes the time to transfer the patient to the rocking chair and to position the patient correctly. Once properly seated, the patients can practice on their own. This allows them to benefit from more therapy and facilitates a more active role and a sense of responsibility for the treatment.
The fact that this treatment modality has proven to be particularly efficient in patients with a severe motor deficit and hemianopia or hemi-inattention, it is even more interesting, since these patients have more difficulties with selftraining.
The intervention was carried out on a daily basis 5 days a week during a period of 6 weeks.
Each treatment session was given for 30 minutes and was an addition to the usual rehabilitation procedures.
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These drawings are taken from Margaret Johnstones book "Restoration Of Motor Function in a Stroke Patient "- Third Edition 1987 Churchill Livingstone |
In our hospital the technical department constructed the Rocking machine using these drawings. |
Positioning:
The application is shown in the figure above.
(Pillows are placed under the paralysed arm for a correct position.)
The hemiplegic arm is well supported in an inflatable splint. The arm is positioned on pillows with the shoulder in 80 degrees flexion and slight abduction. The elbow is extended inside the airsplint.
The wrist is put into slight extension, when the distal part of the splint is fixed with two straps in a gutter. The wrist is only bended a few degrees when using it for the hypotonic patient, as too much dorsiflexion can damage the wrist. The legs are positioned in 90 degrees of flexion in hips and knees so that the patient can push through the heels.
The patients are asked to perform rocking movements for 30 minutes, pushing with the heels and /or the hemiplegic arm. The chair is balanced in a way that during the rocking movements patients fall slightly forward and have to actively push backwards. Patients are encouraged to do this with their hemiplegic arm. The therapist can guide the movement of the rocking chair initially.Rhythmic music during rocking, may help the movement to be continued.
THE MAIN CONCLUSIONS OF THE STUDY WERE:
Motor recovery in the arm was found to be significantly better in the experimental group compared to the control group, even one year after the onset of stroke.
The efficacy of the therapy was mainly attributed to the repetitive stimulation of muscle activity in the arm.
The therapeutic intervention was more effective in patients with a severe motor deficit and hemi-inattention or hemianopia. Patients with a spastic or flaccid arm, patients with or without sensory loss, and patients with or without cognitive deficit seem to benefit equally from this therapy.
These conslusions are good arguments to integrate this treatment modality in our therapy. It is my hope that more therapists will use this application in the future because there is growing evidence that muscle weakness rather than spasticity plays a dominant role in impairment of active voluntary movements and even among chronic stroke patients, forced use strategies could reverse the effect of learned nonuse.
NOTE
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One of the problems using this construction can be the transfer of the patient in the rocking chair. This problem has been solved by Johnstoneinstructor Franziska Wälder from Zürich and Louis Besson by invention of a special rocking chair " Dondolergo" The chair is adjustable in height and the armrests can be taken off and adjusted in height. For more information look on the Johnstone website " Dondolergo".
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