In chronic spastic paresis, intensity in rehabilitation programs leads to possible improvements in patients walking capacities. However, the implementation of intensive rehabilitation is limited by time and financial constraints of conventional physiotherapy programs. Thus, the use Guided Self-Rehabilitation Contract (GSC) programs makes it possible to overcome these disadvantages. GSC have proven their impact on functional activities using two rehabilitation technics: prolonged static stretch postures and motor training with fast alternating movements of maximal amplitude. The objective of this study was to compare the effects of 3 programs using GSC during 2 months on ambulation capacities in chronic spastic paresis: a program with prolonged static stretch postures, a motor training program with fast alternating movements of maximal amplitude and a combined program with prolonged static stretch postures and fast alternating movements of maximal amplitude.

Eleven patients with spastic hemiparesis were included in this prospective randomized simple-blinded study from January to June 2016. They had no botulinum toxin injection in the last 2 months. Each patient followed a 60-minutes working per day program using GSC for 2 months targeting the antagonists of active ankle dorsiflexion, knee flexion and hip flexion in the stretching group, the training group or the combined group. The primary outcome was the comparison of the maximal speed barefoot in the 10-meter ambulation test at D-15 and D60.

The median daily working duration was 39±18 minutes. No difference was found between groups on the maximal speed barefoot on the 10-meter ambulation test after 2 months of programs using GSC. The whole population increased its maximal speed barefoot on the 10-meter ambulation test (from 0.89±0.38m/s to 0.99±0.43m/s; P=0.006, Wilcoxon). The combined group and the training group increased their maximal speed on the 10-meter ambulation test barefoot by 16%, contrary to the stretching group which increased its maximal speed only by 5%.

No difference between the 3 programs was found although tendencies seems to be in favor of the combined group. A larger prospective study should be planned in order to confirm these tendencies.