Thermal Stimulation for Stroke Patients

Stroke patients from department of rehabilitation in Tzu Chi general hospital will be recruited and randomized into two groups, one for experimental group and the other for control group. In addition to receiving routine standard rehabilitation for both groups, the experimental group will receive additional hot- and cold-water stimulation alternatively for five times one session, consecutive four sessions a set, one set for 30 minutes a day and five sets a week for six weeks. The control group will be given ergometer exercises with the similar duration as experimental group. Both groups will be evaluated at baseline before TS and every two weeks till six weeks after TS, then at 3, 6 and 12 months for follow-up. A variety of evaluations used in the present study include Semmes-Weinstein monofilaments for sensory functions; Brunnstrom's stage, Fugl-Meyer Assessment Scale and Motricity Index were used for upper limb motor control and strength; Box and block test for hand dexterity. The modified Motor Assessment Scale and Barthel Index are utilized for evaluating general motor functions and daily activity performance, respectively. The modified Ashworth scale is used for change of muscle tone of upper limb.

Inclusion criteria

• a first-time ischemic or hemorrhagic stroke.
• no severe diabetes or peripheral vascular disease causing sensory deficits.
• no cognition problem and follow directions indicated by therapist during experiment.
• motor deficit of the upper limb under (including) Brunnstrom stage IV, either in the arm or hand.

Exclusion criteria

• a cardiac disease or orthopedic problem history,
• medically unstable such as experienced unstable angina, uncontrolled hypertension according to the treating physician, psychological history before stroke.