Does training to sustain the paretic upper limb on an unstable surface provoke contraction of muscles around the shoulder in patients with hemiplegia? A pilot randomized controlled trial

Introduction
Activities with unstable supports provoke greater muscle contractions than those with stable surfaces. Using unstable surfaces to provoke upper limb muscle contraction after hemiplegia has not been explored. Hence, this study tested the effect of efforts to maintain the hemiparetic hand on an unstable surface on proximal muscle contractions of upper limb in patients with acute stroke.

Methods
First-time stroke patients in the acute phase were randomly allocated into 2 groups. The control group (n = 18) received conventional physiotherapy, whilst the experimental group (n = 19) was given activities to maintain their hemiparetic side hand on an unstable surface in 5 different positions, in addition to conventional physiotherapy. Surface electromyogram was recorded from deltoid and upper trapezius on the hemiparetic side before and after 10 sessions of training.

Results
Overall, 14 patients (aged 57.71 ± 10.70 years) in the control group and 14 (55.78 ± 7.52 years) in the experimental group completed the training. Non-parametric tests for between-group analysis showed that the average electromyography output in the deltoid and trapezius muscles was higher in the experimental group compared with the control group (p < 0.05).

Conclusions
Training involving efforts to maintain the hemiparetic side hand on an unstable surface can be used to provoke activity in upper limb proximal muscles. This could be a simple training with minimal equipment and minimal manual assistance required, added to routine physiotherapy to facilitate proximal muscle contraction in patients with stroke during the acute phase.