Impact of Early SEA (Supination, External Rotation, Abduction) Posture on Severity of Post-stroke Upper Limb Spasticity: A Randomised Controlled Study

Background Post-stroke spasticity is a frequent complication of stroke. Early interventions aimed at positioning the limb in a reflex-inhibiting posture may help reduce the severity of spasticity.

Purpose This trial aimed to evaluate the efficacy of the supinated forearm, extended fingers and elbow and an abducted and externally rotated shoulder, with the wrist in neutral position (SEA posture), in preventing the severity of upper limb spasticity in acute stroke patients with flaccid weakness.

Methods In this prospective, single-centre, randomised, open-label controlled trial with blinded outcome assessment, 76 acute stroke patients aged 18-80 years presenting within 72 hours with flaccid upper limb weakness were enrolled. Patients were randomised 1:1 to receive either the SEA posture intervention using a splint for at least 210 minutes daily plus conventional physiotherapy (n = 38) or conventional physiotherapy alone (n = 38). The primary outcome was spasticity measured by the Modified Ashworth Scale (MAS) at three and six months. Secondary outcomes included the Modified Rankin Scale (mRS) and the Barthel Index.

Results After six months, 66 patients completed follow-up (34 intervention, 32 control). Groups were comparable at baseline. The intervention group showed significantly lower spasticity scores at the elbow, forearm, wrist and fingers at both three and six months (p < .05). Barthel Index scores were significantly better in the intervention group, while mRS scores did not differ between the groups. No adverse effects related to splinting were noted.

Conclusion Early application of the SEA posture reduces the severity of upper limb spasticity after acute stroke and improves functional independence.