Immediate effect of contactual hand-orientating response facilitation on wrist muscle activity in individuals with chronic stroke and severe motor deficits

Purpose Contactual hand-orientating response (CHOR) is a fundamental component of the Bobath concept which has been reported to promote hand function. This study aimed to assess activity and co-activation during CHOR facilitation of extensor digitorum (ED) which represented wrist extensors, and flexor digitorum superficialis (FDS) which represented wrist flexors.Method CHOR facilitation of the paretic hand in 18 patients with chronic stroke with severe upper limb motor deficits, active contraction in the non-paretic hand and 18 healthy individuals wrist extensor and flexor muscles were compared using surface electromyography.Results The co-contraction index of wrist extensors and flexors in the paretic hand in patients with chronic stroke was significantly greater during CHOR facilitation than in the healthy individuals (mean (SD) = 51.88 (6.02) and 46.75 (5.50), respectively), p = .012). Significantly greater wrist flexor and extensor muscle activity were seen in the paretic hand during CHOR facilitation compared with resting (median = 0.803 vs 0.133; median = 0.856 vs 0.225, respectively) (p < .001).Conclusion CHOR facilitation appears to selectively enhance wrist extensor and wrist flexor activity in patients with stroke despite showing a greater co-activation. These findings support the immediate effect of movement facilitation to enhance muscle activity in patients with severe motor deficits post stroke.