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Kim CY, Choi SB, Lee ES. Prevalence and predisposing factors of post-stroke complex regional pain syndrome: Retrospective case-control study. J Stroke Cerebrovasc Dis 2024; 33:107522. [PMID: 38141321 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/05/2023] [Accepted: 11/28/2023] [Indexed: 12/25/2023] Open
Abstract
INTRODUCTION Poststroke complex regional pain syndrome (CRPS) is an important complication in stroke survivors. The identification of factors associated with post-stroke CRPS is important for preventive measures and early diagnosis. METHODS A total of 141 first-ever stroke survivors in the subacute stage were retrospectively analyzed. Demographic data, diagnosis time, duration of hospitalization, location of brain lesion, etiology, comorbidities, and blood test findings were investigated. Clinical data included Medical Research Council (MRC) grade, Fugl-Meyer assessment (FMA), National Institute for Health Stroke Scale (NIHSS), Berg Balance Scale (BBS). RESULTS Among 141 patients with subacute stroke, 22 were diagnosed with CRPS, with a prevalence of 15.6 %. The mean time to diagnosis was 38.6 (±16.5) days. The prevalence according to the degree of paralysis was 33.3 % in MRC grades 0 and 1, 8.6 % in grade 2, and 0 % in grade 3 or higher. The incidence rates within 1 month after stroke were 1.42 % and 22.47 % between 1 and 3 months after stroke, respectively. The independent risk factors for CRPS were hospitalization duration and FMA, NIHSS, and BBS scores. The sensitivity and specificity of the NIHSS score for predicting post-stroke CRPS were 86.4 % and 59.7 %, respectively, with an optimal cutoff value of 7.5. CONCLUSIONS CRPS of the affected upper limb in stroke patients is associated with stroke severity, including paralysis, and the incidence increases over time during the subacute phase. Additionally, having sufficient strength to move through a full range of motion against gravity had a protective effect against CRPS.
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Affiliation(s)
- Chan Yong Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine Hospital, Republic of Korea
| | - Seong Bok Choi
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine Hospital, Republic of Korea
| | - Eun Sun Lee
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine Hospital, Republic of Korea.
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Bozon O, Casamenti V, Coroian F, Laffont I, Coulet B. Arthroscopic shoulder suspensioplasty in painful hemiplegic shoulder subluxation-a case series. JSES Int 2024; 8:80-84. [PMID: 38312297 PMCID: PMC10837734 DOI: 10.1016/j.jseint.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Inferior glenohumeral subluxation (GHS) can cause disabling pain in hemiplegics. Conservative treatments have not been proven to be effective or maintained over time. A few studies have shown the benefits of surgical treatment. The objective of our study was to evaluate the medium-term clinical and radiological results of arthroscopic glenohumeral suspensioplasty surgery by biceps tenodesis in the setting of painful GHS in hemiplegics. Methods We conducted a retrospective study of patients who underwent arthroscopic glenohumeral suspensioplasty. The assessment, at a minimum of 1 year, included a clinical evaluation (pectoralis major spasticity, pain, range of motion, satisfaction) and a radiographic evaluation (Dursun classification, height of subacromial space). Results Five patients with a mean age of 51 years (36-72 years) were included at a mean follow-up of 40 months (12-70). Satisfaction was good in 80% of patients. Pain decreased in all patients, but not significantly. Four patients (80%) would repeat the procedure if it were necessary. In all patients, a reduction in GHS over time was observed, with a reduction in subacromial height, except in 1 patient who suffered a tenodesis rupture during a fall. Conclusion Our results suggest that arthroscopic glenohumeral suspensioplasty by biceps tenodesis may be a therapeutic option in hemiplegic patients with painful GHS.
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Affiliation(s)
- Olivier Bozon
- Upper Limb Surgery Unit, Department of Orthopaedic Surgery, Hospital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Vittoria Casamenti
- Physical Medicine and Rehabilitation Department, Hospital Lapeyronie, Montpellier, France
| | - Flavia Coroian
- Physical Medicine and Rehabilitation Department, Hospital Lapeyronie, Montpellier, France
- Institut de Neuro-Orthopédie Montpellier INOM, Hospital Lapeyronie, Montpellier, France
| | - Isabelle Laffont
- Physical Medicine and Rehabilitation Department, Hospital Lapeyronie, Montpellier, France
- Institut de Neuro-Orthopédie Montpellier INOM, Hospital Lapeyronie, Montpellier, France
| | - Bertrand Coulet
- Upper Limb Surgery Unit, Department of Orthopaedic Surgery, Hospital Lapeyronie, CHU Montpellier, Montpellier, France
- Institut de Neuro-Orthopédie Montpellier INOM, Hospital Lapeyronie, Montpellier, France
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Bandini V, Carpinella I, Marzegan A, Jonsdottir J, Frigo CA, Avanzino L, Pelosin E, Ferrarin M, Lencioni T. Surface-Electromyography-Based Co-Contraction Index for Monitoring Upper Limb Improvements in Post-Stroke Rehabilitation: A Pilot Randomized Controlled Trial Secondary Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:7320. [PMID: 37687775 PMCID: PMC10490112 DOI: 10.3390/s23177320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 09/10/2023]
Abstract
Persons post-stroke experience excessive muscle co-contraction, and consequently the arm functions are compromised during the activities of daily living. Therefore, identifying instrumental outcome measures able to detect the motor strategy adopted after a stroke is a primary clinical goal. Accordingly, this study aims at verifying whether the surface electromyography (sEMG)-based co-contraction index (CCI) could be a new clinically feasible approach for assessing and monitoring patients' motor performance. Thirty-four persons post-stroke underwent clinical assessment and upper extremity kinematic analysis, including sEMG recordings. The participants were randomized into two treatment groups (robot and usual care groups). Ten healthy subjects provided a normative reference (NR). Frost's CCI was used to quantify the muscle co-contraction of three different agonist/antagonist muscle pairs during an object-placing task. Persons post-stroke showed excessive muscle co-contraction (mean (95% CI): anterior/posterior deltoid CCI: 0.38 (0.34-0.41) p = 0.03; triceps/biceps CCI: 0.46 (0.41-0.50) p = 0.01) compared to NR (anterior/posterior deltoid CCI: 0.29 (0.21-0.36); triceps/biceps CCI: 0.34 (0.30-0.39)). After robot therapy, persons post-stroke exhibited a greater improvement (i.e., reduced CCI) in proximal motor control (anterior/posterior deltoid change score of CCI: -0.02 (-0.07-0.02) p = 0.05) compared to usual care therapy (0.04 (0.00-0.09)). Finally, the findings of the present study indicate that the sEMG-based CCI could be a valuable tool in clinical practice.
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Affiliation(s)
- Virginia Bandini
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
| | - Ilaria Carpinella
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
| | - Alberto Marzegan
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
| | - Johanna Jonsdottir
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
| | - Carlo Albino Frigo
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy;
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, IRCCS, 16132 Genoa, Italy;
| | - Elisa Pelosin
- IRCCS Ospedale Policlinico San Martino, IRCCS, 16132 Genoa, Italy;
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132 Genova, Italy
| | - Maurizio Ferrarin
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
| | - Tiziana Lencioni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy; (V.B.); (I.C.); (A.M.); (J.J.); (T.L.)
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Sui M, Jiang N, Yan L, Liu J, Luo B, Zhang C, Yan T, Xiang Y, Li G. Effect of Electroacupuncture on Shoulder Subluxation in Poststroke Patients with Hemiplegic Shoulder Pain: A Sham-Controlled Study Using Multidimensional Musculoskeletal Ultrasound Assessment. Pain Res Manag 2021; 2021:5329881. [PMID: 34840636 PMCID: PMC8626186 DOI: 10.1155/2021/5329881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/22/2021] [Accepted: 11/03/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to use multidimensional musculoskeletal ultrasound imaging technique to investigate the effect of electroacupuncture (EA) on shoulder subluxation in poststroke patients with hemiplegic shoulder pain. METHODS In this prospective single-blind, randomized, sham-controlled study, thirty-four patients with shoulder subluxation and hemiplegic shoulder pain were recruited and randomly assigned into the EA group or the sham EA (SEA) group. In the EA group, EA was applied to the Jian yu (LI15), Bi nao (LI14), Jian zhen (SI9), and Jian liao (TE14) acupoints. In the SEA group, the EA was applied 15 mm away from the Lou gu (SP7), Di ji (SP8), Jiao xin (KI8), and Zhu bin (KI9) acupoints. Both groups underwent treatment 30 minutes/day, five days a week, for two weeks using dense waves with a frequency of 2/100 Hz. A Visual Analogue Scale (VAS) was used to evaluate the effectiveness of treatment in reducing shoulder pain. Musculoskeletal ultrasound was used to evaluate the changes of measures of shoulder subluxation in multidimensions (i.e., the acromiohumeral distance, AHD; acromion-greater tuberosity, AGT; and acromion-lesser tuberosity, ALT). Both the within- and between-groups treatment effects were assessed. RESULTS The pain intensity measured by VAS and shoulder subluxation measured by musculoskeletal ultrasound (i.e., AHD, AGT, and ALT) showed significant (p < 0.05) within-group difference in both groups. The between-group difference appeared in the pain intensity (p < 0.05), while it disappeared in the three measures of shoulder subluxation (p > 0.05). CONCLUSIONS Using VAS for measuring pain intensity and multidimensional musculoskeletal ultrasound imaging technique for measuring shoulder subluxation, this study finds that the hemiplegic shoulder pain can be improved significantly by the EA while the shoulder subluxation cannot be. Our findings further reveal the analgesic mechanism of EA on hemiplegic shoulder pain following stroke.
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Affiliation(s)
- Minghong Sui
- Department of Rehabilitation Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital (Shenzhen Nanshan People's Hospital), Shenzhen 518052, China
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS) and the SIAT Branch, Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen 518055, China
| | - Naifu Jiang
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS) and the SIAT Branch, Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen 518055, China
- Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen 518055, China
| | - Luhui Yan
- Department of Rehabilitation Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital (Shenzhen Nanshan People's Hospital), Shenzhen 518052, China
| | - Jiaqing Liu
- Department of Rehabilitation Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital (Shenzhen Nanshan People's Hospital), Shenzhen 518052, China
| | - Bin Luo
- Department of Rehabilitation Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital (Shenzhen Nanshan People's Hospital), Shenzhen 518052, China
| | - Chenxi Zhang
- Department of Rehabilitation Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital (Shenzhen Nanshan People's Hospital), Shenzhen 518052, China
| | - Tiebin Yan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yun Xiang
- Department of Rehabilitation Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital (Shenzhen Nanshan People's Hospital), Shenzhen 518052, China
- Department of Sports Rehabilitation, School of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, China
| | - Guanglin Li
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS) and the SIAT Branch, Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen 518055, China
- Guangdong-Hong Kong-Macao Joint Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen 518055, China
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A Meta-Analysis and Meta-Regression of Frequency and Risk Factors for Poststroke Complex Regional Pain Syndrome. Medicina (B Aires) 2021; 57:medicina57111232. [PMID: 34833449 PMCID: PMC8622266 DOI: 10.3390/medicina57111232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: This article aimed to investigate the risk factors for poststroke complex regional pain syndrome (CRPS). Materials and Methods: We searched electronic databases including PubMed, Medline, Web of Science, Cochrane Library, and Embase up to 27 October 2021. We enrolled analytical epidemiological studies comprising cohort, case-control, and cross-sectional studies. A quality assessment was performed using the Newcastle–Ottawa Quality Assessment Scale for cohort and case-control studies and the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Binary outcomes were reported as odds ratios (ORs), and continuous outcomes were described as standardized mean differences (SMDs) with 95% confidence intervals. For the meta-regression, beta coefficient and p value were adopted. Results: We included 21 articles comprising 2225 participants. Individuals with shoulder subluxation and spasticity were found to have higher risks for poststroke CRPS. Spasticity with higher modified Ashworth scale score, lower Brunnstrom hand stage, and inferior Barthel index scores were observed in patients with poststroke CRPS. The pooled incidence proportion in nine articles was 31.7%, and a correlation was found between effect sizes and the ratio of women and the proportion of left hemiparesis. The summarized prevalence in nine cross-sectional studies was 33.1%, and a correlation was observed between prevalence and the subluxation ratio and Brunnstrom stage. Conclusions: Based on our meta-analysis, being female, left hemiparesis, shoulder subluxation, spasticity, a lower Brunnstrom stage of distal upper limb, and an inferior Barthel index are all features for poststroke CRPS. Larger studies with greater statistical power may confirm our findings and clarify some other unknown risk factors for poststroke CRPS.
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Do JG, Choi JH, Park CH, Yoon KJ, Lee YT. Prevalence and Related Factors for Poststroke Complex Regional Pain Syndrome: A Retrospective Cross-Sectional Cohort Study. Arch Phys Med Rehabil 2021; 103:274-281. [PMID: 34480888 DOI: 10.1016/j.apmr.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/19/2021] [Accepted: 08/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the prevalence of poststroke complex regional pain syndrome (CRPS) to estimate related factors for poststroke CRPS in patients with first-ever stroke. DESIGN This was a retrospective cross-sectional cohort study of adult patients (age >18y) with stroke who were admitted to rehabilitation unit from December 2014 to May 2018 in Korea. SETTING Single acute rehabilitation unit of university hospital. PARTICIPANTS Participants (N=313) diagnosed with first-ever stroke were identified from the stroke rehabilitation registry of our institute. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Prevalence of poststroke CRPS based on clinical features and 3-phase bone scintigraphy and the related factors of poststroke CRPS. RESULTS A total of 313 records were analyzed, including demographic, clinical characteristics, and functional variables. Poststroke CRPS was found in 8.94% (28 of 313) patients with first-ever stroke. Logistic regression analysis showed that Fugl Meyer Assessment of Upper Extremity (FMA-UE) score was a significant associated factor for the presence of CRPS (odds ratio, 0.96; 95% confidence interval, 0.94-0.98; P=.003). The cutoff value of 76 points for FMA-UE score yielded moderate accuracy in identifying of poststroke CRPS (92.6% sensitivity, 65.8% specificity, and 0.85 area under the curve). CONCLUSIONS The prevalence of poststroke CRPS was 8.94% in patients with first-ever stroke. The FMA-UE score was associated with the poststroke CRPS. Therefore, in patients with low FMA-UE score, prevention and high suspicion of post-stroke CRPS is necessary.
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Affiliation(s)
- Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Jae Hyeong Choi
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul-Hyun Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Jae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Neuroanatomical correlates of poststroke complex regional pain syndrome: a voxel-based lesion symptom-mapping study. Sci Rep 2021; 11:13093. [PMID: 34158602 PMCID: PMC8219671 DOI: 10.1038/s41598-021-92564-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a common poststroke complication. However, the neural substrates associated with CRPS remain unclear. We investigated the neural correlates associated with poststroke CRPS using voxel-based lesion‒symptom mapping (VLSM) analysis. Among 145 patients with ischemic stroke, 35 were diagnosed with CRPS and categorized into the poststroke CRPS group, and the remaining 110 into the control group. We compared the clinical characteristics between the groups. VLSM analysis was performed to identify the brain region associated with the development of poststroke CRPS. The clinical findings suggested that the poststroke CRPS group had lower muscle strength; lower scores on Fugl‒Meyer assessment, Manual Function Test, Mini-Mental Status Examination; and higher incidence of absent somatosensory evoked potentials in the median nerve than the control group. The head of the caudate nucleus, putamen, and white matter complexes in the corona radiata were significantly associated with poststroke CRPS development in ischemic stroke patients. These results facilitate an understanding of poststroke CRPS pathophysiology. Monitoring patients with lesions in these structures may aid the prevention and early treatment of poststroke CRPS.
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Neural substrates for poststroke complex regional pain syndrome type I: a retrospective case-control study using voxel-based lesion symptom mapping analysis. Pain 2021; 161:1311-1320. [PMID: 31985589 DOI: 10.1097/j.pain.0000000000001816] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Poststroke complex regional pain syndrome (CRPS) is characterized by swelling, pain, and changes in the skin that appear on the affected wrist and hand. In this retrospective study, we analyzed the relationship between poststroke CRPS and the location of stroke lesion. From all patients admitted to our hospital from 2009 to 2019, we recruited 80 patients affected by their first unilateral stroke who met the inclusion/exclusion criteria. Thirty-eight patients diagnosed with CRPS after stroke were assigned to the experimental group according to the "Budapest criteria" adopted by the International Association for the Study of Pain, and 42 patients without CRPS were included as controls. Regions of interest were manually drawn on T1-weighted magnetic resonance images, and data were normalized to a standard brain template. In the poststroke CRPS group, the relationship between the location of brain lesion and pain severity was analyzed using Freedman-Lane multivariable regression adjusting for Medication Quantification Scale rating, which was the only parameter to show a statistically significant correlation with pain intensity. A threshold of P < 0.01 was considered statistically significant for all voxel-based lesion symptom mapping tests, corrected for multiple comparisons with 5000 permutations. Analyses using voxel-wise subtraction and Liebermeister statistics indicated that the corticospinal tract (CST) was associated with the development of poststroke CRPS. Statistically significant correlations were found between pain intensity and the CST and the adjacent lentiform nucleus. Our results suggest that the CST may be a relevant neural structure for development of poststroke CRPS and the intensity of pain caused by the syndrome.
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Kim DH, Jang SH. Effects of Mirror Therapy Combined with EMG-Triggered Functional Electrical Stimulation to Improve on Standing Balance and Gait Ability in Patient with Chronic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3721. [PMID: 33918288 PMCID: PMC8038158 DOI: 10.3390/ijerph18073721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/28/2022]
Abstract
This study was performed to evaluate the effects of EMG-triggered functional electrical stimulation on balance and gait ability on patient with Chronic Stroke. A total of 60 chronic stroke patients were divided into mirror treatment and functional electrical (MT-EF) Group, MT group, CON group. Each group performed 60 min a day five times a week for eight weeks. MT-FE group was performed 30 min five times a week for eight weeks in mirror therapy process with EMG-FES. MT group performed 30 min five times a week for eight weeks in mirror therapy process. CON group was performed 30 min five times a week for eight weeks in conservative treatment. To measure the balance ability, Biorescue (COP, LOS), Berg balance scale (BBS) and FRT, and the gait ability test was performed by 10 m walk test. MT-FE group revealed significant differences in COP, LOS, BBS, FRT and 10 m walk test as compared to the MT and CON groups (p < 0.05). Our results showed that MT-FE was more effective on COP, LOS, BBS, FRT and 10 m walk test in patients with chronic stroke. Our results also showed that MT-EF group was more effective on balance and gait ability in patients with chronic stroke. We suggest that this study can be used for intervention data for recovering balance and gait ability in chronic stroke patients.
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Affiliation(s)
- Dong-Hoon Kim
- Department of Physical Therapy, Gimcheon University, 214, Daehak-ro, Gimcheon 39528, Korea;
| | - Sang-Hun Jang
- Department of Physical Therapy, College of Health and Life Science, Korea National University of Transportation, 61, Daehak-ro, Jeungpyeong-gun, Chungbuk 27909, Korea
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Altas EU, Onat ŞŞ, Konak HE, Polat CS. Post-stroke complex regional pain syndrome and related factors: Experiences from a tertiary rehabilitation center. J Stroke Cerebrovasc Dis 2020; 29:104995. [PMID: 32807418 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/23/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE In this study, it is aimed to determine the risk factors associated with CRPS after stroke and the clinical parameters of the patients and the treatment agents used for CPRS METHOD: 213 hemiplegic patients with CRPS diagnosed in Group 1 and 213 hemiplegic patients without CRPS in group 2 (control group) were included in the study designed retrospectively. Demographic data of the patients, Brunnstrom stage, Modified Ashworth scale, Barthel index were recorded from patients files. Associated risk faktors with CRPS such as Shoulder subluxation, adhesive capsulitis, fracture, deep vein thrombosis, spasticity, neglect, visual field defect, heterotopic ossification, entrapment neuropathies, brachial plexus damage, pressure wound, lower respiratory tract infection (LRTI), urinary tract infection, epilepsy, and depression were questioned. In addition, clinical findings, medical treatments, and physical therapy agents used were recorded. RESULTS The average age of the participants was 67.9 ± 10.3 in group 1 and 66.1 ± 9.9 in group 2. According to the multivariate logistic regression analysis, the presence of the duration of hemiplegi, the duration of hospitalization, shoulder subluxation, soft tissue lesion, adhesive capsulitis, spasticity, entrapment neuropathy, brachial plexus ınjury, protein energy malnutrition, LRTI, urinary infection, depression, coronary artery disease were significantly increased the development of CRPS (p<0.05). As a clinical parameter, edema was present in 95.3% of the patients, while trophic change was the lowest in 1.9%. While sensory reeducation was used in all patients in physical therapy, ganglion blockade was the lowest with 0.9% of patients. In medical treatment, the use of oral paracetamol was 28.2%, while the use of gabapentin was the last with 8.9%. CONCLUSIONS In our study, the risk factors of CRPS after hemiplegia, which are as important as its treatment, as well as its diagnosis and prevention, are shown.
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Affiliation(s)
- Elif Umay Altas
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Türkocağı street No:3, Sıhhiye, Ankara, Turkey.
| | - Şule Şahin Onat
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Türkocağı street No:3, Sıhhiye, Ankara, Turkey
| | - Hatice Ecem Konak
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Türkocağı street No:3, Sıhhiye, Ankara, Turkey
| | - Cemile Sevgi Polat
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Türkocağı street No:3, Sıhhiye, Ankara, Turkey
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Cole A, Cox T. Treatment of Glenohumeral Subluxation: A Review of the Literature and Considerations for Pediatric Population. Am J Phys Med Rehabil 2019; 98:706-714. [PMID: 31318752 DOI: 10.1097/phm.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this review was to identify treatment strategies in the research literature to inform all health professionals on best practice strategies when addressing glenohumeral subluxation. DESIGN Articles were identified by searching electronic databases. Two reviewers independently appraised the methodological quality of the selected studies. Discrepancies were resolved after corroboration of results. RESULTS Research literature pertaining to five major treatment strategies was found (n = 40 peer-reviewed publications), spanning evidence levels I-V. The greatest number of studies concerned neuromuscular electrical stimulation (n = 19), five of which were level I studies, followed by manual preventive strategies, such as slings (n = 20), three of which were level I studies. CONCLUSIONS These findings indicate that the most high-quality research supports using neuromuscular electrical stimulation or manual preventive studies, although no studies used direct comparison methods to ascertain relative merits of each type of intervention when compared with others. No evidence suggested that harm was done by using neuromuscular electrical stimulation or manual preventive methods. This literature review suggests that the identified treatment strategies should be considered by clinicians as the treatment of choice for GHS. No literature was identified that reviewed treatment strategies in a pediatric population; however, the authors considerations for treatment in the pediatric population were included.
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Affiliation(s)
- Andrew Cole
- From the Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, California
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Abstract
Upper motor neuron disease or injury can lead to muscle spasticity or nonfunction throughout the body. Imbalance in muscle forces predisposes patients to development of functional deficiencies, contractures, pain, and poor hygiene. The approach to neuro-orthopaedic patients is by necessity multidisciplinary, because a variety of nonsurgical and surgical options are available. In evaluating each patient, surgeons must consider the extent and quality of any deformity, potential for improvement in function, the ability to alleviate pain, and potential for improvement in hygiene and cosmesis. Surgical techniques include tendon lengthenings, releases, transfers, osteotomies, and bony fusions.
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Affiliation(s)
- Matthew T Winterton
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA
| | - Keith Baldwin
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, 2 Wood Center, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Pulsed radiofrequency applied to the dorsal root ganglia for treatment of post-stroke complex regional pain syndrome: A case series. J Clin Anesth 2016; 33:192-7. [PMID: 27555163 DOI: 10.1016/j.jclinane.2016.03.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE Complex regional pain syndrome is a painful and disabling syndrome where the patient presents with neuropathic pain, edema, or vasomotor or pseudomotor abnormalities that are often refractory to treatment. Complex regional pain syndrome type 1 may occurs in stroke patients. Radiofrequency is a therapeutic modality that has been used for years for diseases associated with neuropathic pain. DESIGN Case series report. SETTING Selcuk University Hospital. PATIENTS A 69-year-old woman and a 48-year-old women who suffered post-stroke complex regional pain syndrome type 1. INTERVENTIONS Pulsed radiofrequency current application to the cervical dorsal root ganglia. MEASUREMENTS Pain reduction. MAIN RESULTS The patients had complete resolution of their symptoms, which was maintained at 10 and 5 months of follow-up. CONCLUSIONS These cases illustrates that pulsed radiofrequency applied to cervical dorsal root ganglia might play a significant role in multi-modal approach of complex regional pain syndrome type 1 management after stroke. Further randomized, controlled studies are needed to support this argument.
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Jang YY, Kim TH, Lee BH. Effects of Brain-Computer Interface-controlled Functional Electrical Stimulation Training on Shoulder Subluxation for Patients with Stroke: A Randomized Controlled Trial. Occup Ther Int 2016; 23:175-85. [PMID: 26876690 DOI: 10.1002/oti.1422] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to investigate the effects of brain-computer interface (BCI)-controlled functional electrical stimulation (FES) training on shoulder subluxation of patients with stroke. Twenty subjects were randomly divided into two groups: the BCI-FES group (n = 10) and the FES group (n = 10). Patients in the BCI-FES group were administered conventional therapy with the BCI-FES on the shoulder subluxation area of the paretic upper extremity, five times per week during 6 weeks, while the FES group received conventional therapy with FES only. All patients were assessed for shoulder subluxation (vertical distance, VD; horizontal distance, HD), pain (visual analogue scale, VAS) and the Manual Function Test (MFT) at the time of recruitment to the study and after 6 weeks of the intervention. The BCI-FES group demonstrated significant improvements in VD, HD, VAS and MFT after the intervention period, while the FES group demonstrated significant improvements in HD, VAS and MFT. There were also significant differences in the VD and two items (shoulder flexion and abduction) of the MFT between the two groups. The results of this study suggest that BCI-FES training may be effective in improving shoulder subluxation of patients with stroke by facilitating motor recovery. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yun Young Jang
- Graduate School of Physical Therapy, Sahmyook University, Seoul, Korea
| | - Tae Hoon Kim
- Graduate School of Physical Therapy, Sahmyook University, Seoul, Korea.,The Post-Professional Doctor of Physical Therapy Program, Stockton University, Galloway, NJ, USA
| | - Byoung Hee Lee
- Graduate School of Physical Therapy, Sahmyook University, Seoul, Korea
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Esin RG, Sitnova MA, Esin OR. [The principles of pharmacotherapy of poststroke shoulder pain]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:41-45. [PMID: 26356159 DOI: 10.17116/jnevro20151155141-45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyze the results of examination and treatment of patients with poststroke shoulder pain. MATERIAL AND METHODS The study included 213 patients who have had a stroke, including 16.4% patients with poststroke shoulder pain in early recovery period and 35.9% patients with poststroke shoulder pain in late recovery period. Therapeutic efficacy of amitriptyline, lidocaine (intravenously), pregabalin, tizanidine and non-steroid anti-inflammatory drugs was assessed. RESULTS AND CONCLUSION Dysfunction of nervous system plays the main role in this pain syndrome. The efficacy of the drugs in the early/late recovery period was estimated as follows: nonsteroidal anti-inflammatory drugs - 33%/12%, amitriptyline - 24%/42%, gabapentin - 10%/13%, lidocaine - 95%/100%, tizanidine - 29%/33%. Seventy-six percent of patients were free of pain after treatment using a regimen suggested by the authors.
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Affiliation(s)
- R G Esin
- Kazan State Medical Academy, Kazan; Hospital for war veterans
| | | | - O R Esin
- Kazan (Volga Region) Federal University, Kazan
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Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis 2015; 39:190-201. [PMID: 25766121 DOI: 10.1159/000375397] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/20/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pain is a common complication after stroke and is associated with the presence of depression, cognitive dysfunction, and impaired quality of life. It remains underdiagnosed and undertreated, despite evidence that effective treatment of pain may improve function and quality of life. SUMMARY We provide an overview of the means for clinical assessment and risk factors for the development of post-stroke pain, then review the newest available literature regarding the commonest post-stroke pain syndromes, including central post-stroke pain, complex regional pain syndrome, musculoskeletal pain including shoulder subluxation, spasticity-related pain, and post-stroke headache, as well as the available epidemiology and current treatment options. Key Messages: In the best interests of optimizing quality of life and function after stroke, clinicians should be aware of pain as a common complication after stroke, identify those patients at highest risk, directly inquire as to the presence and characteristics of pain, and should be aware of the options for treatment for the various pain syndromes.
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Affiliation(s)
- Rebecca A Harrison
- Division of Neurology, University of British Columbia, Vancouver, B.C., Canada
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Chae J, Yu DT. Neuromuscular Electrical Stimulation for Motor Restoration in Hemiparesis. Top Stroke Rehabil 2015; 8:24-39. [PMID: 14523728 DOI: 10.1310/rexb-akv9-2xbe-u5qa] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article assesses the clinical efficacy of established neuromuscular electrical stimulation (NMES) technologies for motor restoration in hemiparesis and provides an overview of evolving technologies. Transcutaneous NMES facilitates motor recovery. However, its impact on physical disability remains uncertain. Transcutaneous NMES also decreases shoulder subluxation, but its effect on shoulder pain remains uncertain. Clinically deployable upper extremity neuroprosthesis systems will not be available until sometime in the distant future. However, there is stronger evidence for the clinical utility of lower extremity neuroprosthesis systems. Evolving technology utilizes semi-implanted or fully implanted systems with more sophisticated control paradigms. Initial experiences with these systems are reviewed and directions for future research are discussed in this article.
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Affiliation(s)
- John Chae
- Physical Medicine and Rehabilitation and Biomedical Engineering, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
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Kumar P, Saunders A, Ellis E, Whitlam S. Association between glenohumeral subluxation and hemiplegic shoulder pain in patients with stroke. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331913x13608385943254] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Han EY, Jung HY, Kim MO. Absent median somatosensory evoked potential is a predictor of type I complex regional pain syndrome after stroke. Disabil Rehabil 2013; 36:1080-4. [PMID: 24050813 DOI: 10.3109/09638288.2013.829530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The objective was to determine whether the abnormal finding of somatosensory evoked potentials (SEPs) associated with the development of type I complex regional pain syndrome (CRPS) after stroke. METHODS This was a retrospective study conducted from January, 2003, to December, 2007. Seventy patients were confirmed as CRPS type I, and one hundred and eighty-two patients were assigned to the control group. The initial clinical data were reviewed including age, gender, main type of stroke, lateralization and location of the lesion, presence of glenohumeral subluxation, and the development of CRPS. Somatosensory evoked potentials tests (SEP) in median nerve (N20) and posterior tibial nerve (P37) were performed. RESULTS CRPS groups revealed significantly higher incidence of the absent and abnormal hemiplegic median SEP, hemorrhagic stroke, and glenohumeral subluxation (GHS). Binary logistic regression analysis indicated that GHS (exp.(B)=4.083, p<0.01) with the absent median SEP (exp.(B)=3.246, p<0.01) were significant independent predictors of CRPS onset. CONCLUSIONS In conclusion, GHS and the absent median SEP at sub-acute phase of stroke were primary predictors of the onset of post-stoke CRPS. Implications for Rehabilitation Recent investigations have suggested that autonomic, motor and somatosensory abnormalities of CRPS are impairments involving the central nervous system (CNS) as well as the peripheral neurogenic inflammatory process. However, the understanding of the pathophysiology of CRPS is still far from complete. The absence of SEP at the sub-acute stage of stroke correlated with the onset of post-stroke CRPS type I. The SEP evaluation at the sub-acute period after stroke might be generally used for predicting the concomitant development of post-stroke CRPS type I as well as functional recovery after stroke.
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Affiliation(s)
- Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, University of Jeju College of Medicine , Jeju , Republic of Korea and
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Dohle CI, Rykman A, Chang J, Volpe BT. Pilot study of a robotic protocol to treat shoulder subluxation in patients with chronic stroke. J Neuroeng Rehabil 2013; 10:88. [PMID: 23914834 PMCID: PMC3751786 DOI: 10.1186/1743-0003-10-88] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 06/14/2013] [Indexed: 12/17/2022] Open
Abstract
Background Shoulder subluxation is a frequent complication of motor impairment after stroke, leading to soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain, thus limiting use of the affected extremity beyond weakness. In this pilot study, we determined whether robotic treatment of chronic shoulder subluxation can lead to functional improvement and whether any improvement was robust. Methods 18 patients with chronic stroke (3.9 ± 2.9 years from acute stroke), completed 6 weeks of robotic training using the linear shoulder robot. Training was performed 3 times per week on alternate days. Each session consisted of 3 sets of 320 repetitions of the affected arm, and the robotic protocol alternated between training vertical arm movements, shoulder flexion and extension, in an anti-gravity plane, and training horizontal arm movements, scapular protraction and retraction, in a gravity eliminated plane. Results Training with the linear robot improved shoulder stability, motor power, and resulted in improved functional outcomes that were robust 3 months after training. Conclusion In this uncontrolled pilot study, the robotic protocol effectively treated shoulder subluxation in chronic stroke patients. Treatment of subluxation can lead to improved functional use of the affected arm, likely by increasing motor power in the trained muscles.
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Kumar P, Swinkels A. A critical review of shoulder subluxation and its association with other post-stroke complications. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x405883] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Fotiadis F, Grouios G, Ypsilanti A, Hatzinikolaou K. Hemiplegic shoulder syndrome: possible underlying neurophysiological mechanisms. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331905x43445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Stolzenberg D, Siu G, Cruz E. Current and future interventions for glenohumeral subluxation in hemiplegia secondary to stroke. Top Stroke Rehabil 2012; 19:444-56. [PMID: 22982832 DOI: 10.1310/tsr1905-444] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Poststroke shoulder pain is a common issue and can be caused by glenohumeral subluxation. This entity hinders function and quality of life and is caused by changes in tone and loss of fi ne control of the shoulder joints' supporting structures after a stroke. Current treatments are limited in number and effectiveness and have significant problems and limitations to their use. Furthermore, prior to percutaneous implantable neuromuscular electrical stimulation, there was no evidence for any treatment to provide relief for chronic hemiplegic shoulder pain from glenohumeral subluxation. This clinical review provides a comprehensive review of the anatomy, pathogenesis, clinical features, management, and clinical efficacy of current treatment modalities.
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Affiliation(s)
- David Stolzenberg
- Department of Physical Medicine and Rehabilitation, Temple University Hospital/ MossRehab, Philadelphia, Pennsylvania
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Rundquist PJ, Dumit M, Hartley J, Schultz K, Finley MA. Three-dimensional shoulder complex kinematics in individuals with upper extremity impairment from chronic stroke. Disabil Rehabil 2012; 34:402-7. [PMID: 22351959 DOI: 10.3109/09638288.2011.607214] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate shoulder complex kinematics in persons with chronic upper extremity (UE) impairments due to stroke and determine if kinematics predicts motor function based on the Fugl-Meyer Motor Assessment (FMA). METHODS Sixteen stroke survivors with chronic UE impairments (age range = 46-80 years, male = 8, female = 8, mean (SD) 66 (40) months post-stroke) performed the UE portion of the FMA with the shoulder/elbow subscale (FM_se) documented. Three-dimensional kinematics of the shoulder complex was collected with the Motion Monitor™ (Innsport, Chicago, IL, USA). Participants performed three repetitions of arm elevation in the frontal, sagittal and self-selected planes. The third repetition was analyzed. Scapular and humeral kinematics were calculated in the self-selected plane. Scapulohumeral rhythm was analyzed at peak elevation. Backward stepwise regression analysis predicted kinematic contributions to the FM_se. RESULTS Mean (SD) FM_se score was 25.3 1(10.9). Peak humeral elevation ranged from 45.6° to 129.2° (median 106.7°). Scapulohumeral rhythm was 4.1:1 when humeral elevation ranged from 45° to 50°, 1.5:1 from 80° to 95° and 2.1:1 from 105° to 130°. Humeral elevation, scapular upward rotation and scapular internal rotation predicted 65.4% of FM_se score variability. CONCLUSIONS Persons with chronic UE impairments from stroke demonstrated reduced peak elevation and altered scapulohumeral rhythm. Three predictors of the FM_se were humeral elevation, scapular upward rotation and scapular internal rotation.
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Affiliation(s)
- Peter J Rundquist
- University of Indianapolis, Krannert School of Physical Therapy, Indianapolis, IN 46227, USA.
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Hartwig M, Gelbrich G, Griewing B. Functional orthosis in shoulder joint subluxation after ischaemic brain stroke to avoid post-hemiplegic shoulder–hand syndrome: a randomized clinical trial. Clin Rehabil 2012; 26:807-16. [DOI: 10.1177/0269215511432355] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To examine whether the use of a shoulder joint functional orthosis over four weeks can mitigate the development or progression of the shoulder–hand syndrome in patients with shoulder joint subluxation after stroke. Design: Two-armed randomized controlled trial. Setting: Rehabilitation unit of a neurological hospital, single centre. Subjects: Forty-one patients with caudal subluxation of the glenohumeral joint and hemiparesis of the upper extremity after ischaemic brain stroke. Interventions: Support by functional orthosis Neuro-Lux (Sporlastic, Nürtingen, Germany) on top of usual care according to current guidelines (experimental, n = 20) versus usual care alone (control, n = 21). Main measures: Weekly shoulder–hand syndrome scores (severity of clinical symptoms ranging from 0 to 14), discomfort caused by the orthosis, and its usage rate. The primary outcome was the average shoulder–hand syndrome score on days 14, 21 and 28, adjusted for the baseline shoulder–hand syndrome score. Results: The adjusted mean shoulder–hand syndrome score was lower by 3.1 in the intervention compared to the control subjects (95% confidence interval 1.9 to 4.3, P < 0.0001). Marginal or no discomfort from treatment with the orthosis was reported in 15 patients (75%), and only a single patient (5%) felt severe discomfort during the entire treatment. Use of the orthosis during the prescribed time was 89%. Conclusions: The orthosis examined in this trial has been successfully shown to reduce and prevent the development of clinical symptoms of shoulder–hand syndrome. Timing and duration of application of the orthosis as well as its combination with other therapeutic measures should be investigated in future clinical trials.
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Affiliation(s)
- Maik Hartwig
- Neurologische Klinik Bad Neustadt, Bad Neustadt, Germany
| | - Götz Gelbrich
- University of Leipzig, Clinical Trial Centre, Leipzig, Germany
| | - Bernd Griewing
- Neurologische Klinik Bad Neustadt, Bad Neustadt, Germany
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Kim MK, Jung JM, Chang JS, Lee SK. Radiographic Imaging Analysis after Sling Exercises for Hemiplegic Shoulder Subluxation. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.1099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Jae-min Jung
- Department of Physical Therapy, Daegu University
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Abstract
The prevalence of hemiplegic shoulder pain is approximately 22%-23% in the general population of stroke survivors and approximately 54%-55% among stroke patients in rehabilitation settings. Hemiplegic shoulder pain causes a reduced quality-of-life, poor functional recovery, depression, disturbed sleep, and prolonged hospitalization. Herein, we attempted to understand, based on a literature review and experts' opinion, the pathologic processes underlying hemiplegic shoulder pain and the major associated factors contributing to its development. The systematization of underlying pathologies was proposed, which might eventually enable a more constructive clinical approach in evaluating and treating patients with hemiplegic shoulder pain.
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Matayoshi S, Shimodozono M, Hirata Y, Ueda T, Horio S, Kawahira K. Use of calcitonin to prevent complex regional pain syndrome type I in severe hemiplegic patients after stroke. Disabil Rehabil 2010; 31:1773-9. [PMID: 19479511 DOI: 10.1080/09638280902795573] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the effects of calcitonin in preventing complex regional pain syndrome type I (CRPS) in patients with severe hemiplegia following stroke. METHODS In this observer-blinded, controlled study comparison with historical controls between April 2003 and May 2004, subjects comprised consecutive patients with post-stroke hemiplegia admitted between June 2004 and September 2005, with any upper limb or finger graded as Brunnstrom stage (BrST) III or below. One group was administered intramuscular injection of 20 units of elcatonin (EL) (Asu(1-7) eel calcitonin) weekly from immediately after admission to discharge, together with rehabilitation therapy. The control group received rehabilitation therapy alone. Patients were observed during the in-hospital rehabilitation period. The main outcome measure was onset of CRPS. RESULTS Incidence of CRPS in all patients with post-stroke hemiplegia during the control period was about 8.2%, similar to recent studies. Limited to serious hemiplegic patients graded as BrST III or below, incidence of CRPS was significantly lower in the EL group (12.5%) than in controls (57.1%). No significant differences in patient background were seen between groups. CRPS was completely prevented when EL injection was started <or=4 weeks after stroke, but prophylactic effects were weak when EL was started >6 weeks after stroke. CONCLUSION Intramuscular calcitonin appears to suppress onset of CRPS after stroke, particularly when started early after stroke.
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Affiliation(s)
- Satoru Matayoshi
- Department of Rehabilitation and Physical Medicine, Faculty of Medicine, Kagoshima University, Makizono-cho, Kagoshima, Japan
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Poststroke shoulder pain in Turkish stroke patients: relationship with clinical factors and functional outcomes. Int J Rehabil Res 2009; 32:309-15. [DOI: 10.1097/mrr.0b013e32831e455f] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Relationship Among Shoulder Proprioception, Kinematics, and Pain After Stroke. Arch Phys Med Rehabil 2009; 90:1557-64. [DOI: 10.1016/j.apmr.2009.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 03/23/2009] [Accepted: 04/02/2009] [Indexed: 11/19/2022]
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Niessen MH, Veeger DH, Koppe PA, Konijnenbelt MH, van Dieën J, Janssen TW. Proprioception of the shoulder after stroke. Arch Phys Med Rehabil 2008; 89:333-8. [PMID: 18226659 DOI: 10.1016/j.apmr.2007.08.157] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 08/28/2007] [Accepted: 08/28/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate position sense and kinesthesia of the shoulders of stroke patients. DESIGN Case-control study. SETTING A rehabilitation center. PARTICIPANTS A total of 22 inpatients with stroke and 10 healthy control subjects. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Angular displacement (in degrees) for threshold to detection of passive motion (TDPM) tests and absolute error (in degrees) for passive reproduction of joint position tests. RESULTS For patients, the TDPM for internal and external rotation was significantly higher for both the contralateral (paretic) side (internal, 7.92 degrees +/-7.19 degrees ; external, 8.46 degrees +/-8.87 degrees ) and the ipsilateral (nonparetic) side (internal, 4.86 degrees +/-5.03 degrees ; external, 6.09 degrees +/-9.15 degrees ) compared with the control group (internal, 1.83 degrees +/-1.09 degrees ; external, 1.71 degrees +/-.85 degrees ). Also, for internal rotation, TDPM was significantly higher for patients on the contralateral side compared with the ipsilateral side. For passive reproduction of joint position tests, no differences were found. CONCLUSIONS Both the contralateral and ipsilateral shoulders of stroke patients showed impaired TDPM. Passive reproduction of joint position does not seem to be affected as a result of a stroke. The control of the muscle spindles and central integration or processing problems of the afferent signals provided by muscle spindles might cause these effects.
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Affiliation(s)
- Martijn H Niessen
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands.
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Rajaratnam BS, Venketasubramanian N, Kumar PV, Goh JC, Chan YH. Predictability of Simple Clinical Tests to Identify Shoulder Pain After Stroke. Arch Phys Med Rehabil 2007; 88:1016-21. [PMID: 17678664 DOI: 10.1016/j.apmr.2007.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify simple diagnostic musculoskeletal tests that can be performed early after stroke to predict patients' likelihood of reporting early signs of hemiplegic shoulder pain. DESIGN Case control. SETTING Multicenter acute care hospitals. PARTICIPANTS A total of 152 adults after a first episode of stroke, of whom 135 met the inclusion criteria. Thirty patients were assigned to the experimental group because they reported moderate intensity of hemiplegic shoulder pain at rest. The remaining 105 patients made up the control group. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Therapists measured the performance of combined upper-limb movement including the hand-behind-neck (HBN) maneuver, passive pain-free ranges of shoulder motion, 3 musculoskeletal tests, and the strength of deltoid muscles during each patient's hospital stay. The numeric rating scale (NRS) identified those who reported moderate or greater intensities of hemiplegic shoulder pain during rest and during assessment. RESULTS In our study, 22.2% (95% confidence interval, 15.5-30.2) of the patients reported hemiplegic shoulder pain, on average 1 week after the onset of stroke. Positive Neer test (NRS score >or=5) during the HBN maneuver and a difference of more than 10 degrees of passive range of external rotation between shoulders had a 98% probability of predicting the presence of hemiplegic shoulder pain (receiver operating characteristic, .994; sensitivity, 96.7%; specificity, 99.0%; positive predictive value, 96.7%; negative predictive value, 99.0%; P<.001). CONCLUSIONS Three diagnostic clinical tests that can be performed during a bedside evaluation increase the likelihood of determining those who complain of hemiplegic shoulder pain after an acute episode of stroke.
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Paci M, Nannetti L, Taiti P, Baccini M, Rinaldi L. Shoulder subluxation after stroke: relationships with pain and motor recovery. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2007; 12:95-104. [PMID: 17536647 DOI: 10.1002/pri.349] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Glenohumeral subluxation (GHS) is a frequent complication in patients with post-stroke hemiplegia, but its role in functional recovery is still unclear. The aim of the present investigation was to understand the relationship of GHS with shoulder pain and arm motor recovery. METHOD A case-control study design was used. A sample of 107 hemiplegic adults with recent stroke (less than 30 days from onset) was differentiated into two groups according to the presence of GHS. Motor recovery was assessed using the upper extremity part of the Fugl-Meyer Assessment Scale and the presence of shoulder pain was recorded at admission (T1), at discharge (T2) and at follow-up, 30-40 days after discharge (T3). RESULTS GHS was present in 52 patients (48.6%) and correlated significantly to shoulder pain at TI, at T2 and at T3 (p < 0.001). Moreover, GHS at admission accounted for nearly 50% of shoulder pain at T3 (adjusted R2 = 0.458; p < 0.001). The presence of GHS was independently associated with the upper extremity score of the Fugl-Meyer Assessment Scale at follow-up (adjusted R2 = 0.766; p < 0.001). CONCLUSIONS GHS is a factor associated with shoulder pain development and with arm motor recovery and should be treated in the acute stage of hemiplegia.
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Affiliation(s)
- Matteo Paci
- Department of Rehabilitation Medicine, Prato Hospital, Prato, Italy.
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Kocabas H, Levendoglu F, Ozerbil OM, Yuruten B. Complex regional pain syndrome in stroke patients. Int J Rehabil Res 2007; 30:33-8. [PMID: 17293718 DOI: 10.1097/mrr.0b013e3280146f57] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to investigate the incidence, and the factors influencing the development, of complex regional pain syndrome-I in the upper extremity in hemiplegic patients within the first 28 weeks following a stroke. We followed up 82 stroke patients. All patients were evaluated at weeks 2, 6, 14 and 28 after suffering a stroke. Outcomes were assessed using passive range of motion of shoulder, presence of subluxation, Ashworth score, Motricity index arm score, Brunnstrom stages and depression score. The incidence of complex regional pain syndrome-I was 48.8% in the first 28 weeks. Significant correlation was found between complex regional pain syndrome-I and the presence of subluxation, Ashworth score, Motricity index arm score, Brunnstrom stage and depression score (r=0.259, P=0.019; r=0.271, P=0.014; r=-0.393, P<0.001; r=-0.385, P<0.001; r=0.293, P=0.008, respectively). In this study, there was a relationship between complex regional pain syndrome-I and subluxation, loss of range of motion, spasticity of shoulder muscles and muscle strength. In order to prevent the development of complex regional pain syndrome-I, exercises directed at increasing the range of motion for the glenohumeral joint, strengthening shoulder muscles and reduction of spasticity will establish the integrity of the shoulder joint.
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Affiliation(s)
- Hilal Kocabas
- Department of Physical Medicine and Rehabilitation, Selcuk University Meram Faculty of Medicine, Konya, Turkey
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Abstract
There is a high incidence of reflex sympathetic dystrophy of the upper limbs in patients with hemiplegia, and its painful and functional consequences present a problem to specialists in physical medicine and rehabilitation. This study was designed to assess the role of several factors in the occurrence of reflex sympathetic dystrophy in patients with hemiplegia. Ninety-five consecutive stroke patients (63 male and 32 female, mean age 59+/-12 years) admitted to our hospital were evaluated. Of the study group, 29 patients (30.5%) were found to develop reflex sympathetic dystrophy. There were no significant differences between the hemiplegic patient groups with or without reflex sympathetic dystrophy regarding age, gender, etiology, side of involvement, disease duration and the presence of comorbidities. The recovery stages of hemiplegia, as shown by Brunnstrom functional classification, were significantly different between the two groups; patients in lower recovery stages tended to develop reflex sympathetic dystrophy more frequently (P<0.01). Additionally, the presence of flaccidity was also a significant factor in the development of reflex sympathetic dystrophy. Glenohumeral subluxation was present in 37 patients (38.9%) in our study group and the presence of this complication was related to the occurrence of reflex sympathetic dystrophy. The presence of glenohumeral subluxation was significantly higher in patients with reflex sympathetic dystrophy (21/29, 72.4%) when compared to the patients without reflex sympathetic dystrophy (16/66, 24.2%) (P<0.001). Also, hemiplegic patients with more severe shoulder subluxation were significantly more likely to develop reflex sympathetic dystrophy. These results suggest that lower recovery stages, reduced tonus and glenohumeral subluxation significantly contribute to the occurrence of reflex sympathetic dystrophy in the hemiplegic patient. We believe that preventive and treatment measures should consider these factors as they seem to have in common a higher risk of traumatizing the paralyzed upper limb and causing reflex sympathetic dystrophy.
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Dieruf K, Poole JL, Gregory C, Rodriguez EJ, Spizman C. Comparative Effectiveness of the GivMohr Sling in Subjects With Flaccid Upper Limbs on Subluxation Through Radiologic Analysis. Arch Phys Med Rehabil 2005; 86:2324-9. [PMID: 16344030 DOI: 10.1016/j.apmr.2005.07.291] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Revised: 06/14/2005] [Accepted: 07/07/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To test the effectiveness of the GivMohr sling in reducing subluxation while providing joint compression through a flaccid limb, using the criterion standard of radiography for measuring subluxation. DESIGN Anteroposterior 0 degree radiographs were taken of each subject: 1 of the unaffected shoulder and 3 of the affected shoulder; 1 without a sling, 1 with the GivMohr sling, and 1 with the Rolyan humeral cuff sling. SETTING Two large rehabilitation centers. PARTICIPANTS Twenty-five adult volunteers with a flaccid upper limb (UL) secondary to cerebrovascular accident or other pathology. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Vertical and horizontal subluxation were measured in millimeters on each of the 4 radiographs for each subject. RESULTS A 1-way analysis of variance revealed a significant main effect for vertical but not horizontal subluxation. Post hoc tests showed that the GivMohr sling measures were similar to measures for the uninvolved shoulder, but significantly different from measures for the Rolyan and the involved shoulder. CONCLUSIONS These results show that a properly fitted GivMohr sling reduces subluxation without overcorrecting. This new sling provides an alternative treatment option for persons with flaccid ULs that may prevent secondary complications and improve outcomes.
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Affiliation(s)
- Kathy Dieruf
- Physical Therapy Program, University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA.
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Ada L, Foongchomcheay A, Canning C. Supportive devices for preventing and treating subluxation of the shoulder after stroke. Cochrane Database Syst Rev 2005; 2005:CD003863. [PMID: 15674917 PMCID: PMC6984447 DOI: 10.1002/14651858.cd003863.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Supportive devices such as slings, wheelchair attachments and orthoses have been used to treat subluxation of the shoulder after stroke. OBJECTIVES To investigate the effect of supportive devices in preventing subluxation, re-positioning the head of humerus in the glenoid fossa, decreasing pain, increasing function and adversely increasing contracture in the shoulder after stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched on 22 March 2004). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2004), MEDLINE (1966 to March 2004), CINAHL (1982 to March 2004), EMBASE (1974 to March 2004), AMED (1985 to March 2004) and the Physiotherapy Evidence Database (PEDro, March 2004). We also handsearched conference proceedings and contacted authors for additional information. SELECTION CRITERIA Studies were included if they were: randomised, quasi-randomised or controlled trials; participants had a stroke; intervention was supportive devices; and subluxation, pain, function or contracture were measured. DATA COLLECTION AND ANALYSIS Two independent reviewers examined the identified studies which were assessed for methodological quality and analysed as (1) supportive devices versus no supportive devices or (2) two supportive devices. MAIN RESULTS Four trials (one on slings, three on strapping - 142 participants) met the inclusion criteria. One trial testing a hemisling versus no device reported that no participants had subluxation greater than 10 mm, the same number had lost more than 30 degrees of shoulder external rotation (Peto odds ratio (OR) = 1.00, 95% confidence interval (CI) 0.1 to 9.3), and more participants in the hemisling group had pain (Peto OR = 8.7, 95% CI 1.1 to 67.1). The other three showed that strapping was effective in delaying the onset of pain (weighted mean difference (WMD) = 14 days, 95% CI 9.7 to 17.8), but was ineffective in reducing pain severity (WMD = -0.7 cm on a visual analogue scale, 95% CI -2.0 to 0.7), increasing upper limb function (WMD = 0.8, 95% CI -1.5 to 3.1) or affecting the degree of contracture (WMD = -1.4 degrees, 95% CI -10.9 to 8.1) at the shoulder. AUTHORS' CONCLUSIONS There is insufficient evidence to conclude whether slings and wheelchair attachments prevent subluxation, decrease pain, increase function or adversely increase contracture in the shoulder after stroke. There is some evidence that strapping the shoulder delays the onset of pain but does not decrease it, nor does it increase function or adversely increase contracture.
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Affiliation(s)
- L Ada
- School of Physiotherapy, The University of Sydney, PO Box 170, Lidcombe, NSW, Australia, 1825.
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Abstract
OBJECTIVE Shoulder pain is a common complication after stroke that can limit the patients' ability to reach their maximum functional potential and impede rehabilitation. The aim of our study was to examine the occurrence of hemiplegic shoulder pain in a group of Turkish patients and clarify contributing factors such as glenohumeral subluxation, reflex sympathetic dystrophy, tonus changes, motor functional level, limitation in shoulder range of motion, thalamic pain, neglect, and time since onset of hemiplegia. The effect of shoulder pain on the duration of rehabilitation stay was also identified. DESIGN A total of 85 consecutive patients with hemiplegia admitted to a national rehabilitation center were evaluated for the presence of shoulder pain. A brief history of pain was taken for each patient, and each patient was evaluated by radiographic and ultrasonographic examination. The subjects with shoulder pain were compared with those without pain in regard to certain of the above variables. RESULTS Of the 85 patients with stroke, 54 patients (54/85, 63.5%) were found to have shoulder pain. Shoulder pain was significantly more frequent in subjects with reflex sympathetic dystrophy, lower motor functional level of shoulder and hand (P < 0001), subluxation, and limitation of external rotation and flexion of shoulder (P < 0,05). Age was also a significant factor in the development of shoulder pain. We were unable to demonstrate a significant relationship between shoulder pain and sex, time since onset of disease, hemiplegic side, pathogenesis, spasticity, neglect, and thalamic pain. There was no prolongation of rehabilitation stay in patients with shoulder pain. CONCLUSION These results indicate that shoulder pain is a frequent complication after stroke and that it may develop from a variety of factors. To prevent and alleviate shoulder pain, efforts should be directed toward proper positioning of the shoulder, range of motion activities, and the avoidance of immobilization.
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Affiliation(s)
- Meltem Dalyan Aras
- Department of Physical Medicine, Ankara Physical Medicine and Rehabilitation, Education, and Research Hospital, Turkey
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Initial drop of blood pressure during head-up tilt in patients with cerebrovascular accidents. Environ Health Prev Med 2004; 9:228-33. [PMID: 21432307 DOI: 10.1007/bf02898104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 07/05/2004] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To investigate cardiovascular responses to orthostatic stress in patients with cerebrovascular accidents (CVA). METHODS Twelve male patients with CVA, 11 healthy elderly and 12 healthy young males participated in the present study. The CVA patients had suffered stroke with hemiplegia at least 11 months prior to the study, their medical conditions were stable, and no subjects were taking medications affecting the cardiovascular system. Heart rate (HR) was determined using RR intervals from the ECG. Stroke volume (SV) was estimated by an impedance method, and cardiac output (CO) was calculated by multiplying SV by HR. Blood pressure (BP) was determined by the auscultatory method. SV, HR, CO and BP were measured every 2 min before and during 7 min of 60-degree head-up tilt (HUT). RESULTS SV decreased and HR increased immediately after starting HUT in all groups. CO in healthy elderly and young subjects immediately decreased during HUT also, and the decrease was sustained throughout the head-up period. However, CO in CVA patients remained constant throughout the experiment. HUT immediately decreased SBP in all groups and the magnitude of initial SBP reduction in CVA patients was greater than that in the other groups. CONCLUSIONS We identified an initial reduction of BP during HUT in CVA patients and the recovery of BP by 3 min of head-up tilt. We emphasize that adjustment to orthostatic stress in CVA patients should be practiced by HUT, as our findings showed that CVA patients maintained physiological orthostatic tolerance except for the initial fall in BP.
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Abstract
Shoulder pain is a common complication in poststroke hemiplegia that reduces functional recovery. Many types of shoulder pathology have been suggested as causes of shoulder pain in hemiplegia,including shoulder subluxation, capsulitis, tendinitis, rotator cuff injury, bursitis, impingement syndrome, spasticity, complex regional pain syndrome, brachial plexus injury, and proximal mononeuropathies. More than one type of pathology may exist in a given patient. Shoulder pain improves in many cases with prompt diagnosis and appropriate management. Although the relationship between subluxation and pain is controversial, upper limb support to reduce subluxation is the standard of care and may prevent the development of pain and secondary complications. Further work is needed to elucidate the natural history of shoulder pain in hemiplegia, including the identification of physiologic common denominators that can lead to improved strategies to treat and prevent shoulder pain.
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Affiliation(s)
- David Yu
- Department of Rehabilitation Medicine, University of Washington, and Rehabilitation Medicine, Harborview Medical Center, Seattle, USA.
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Ada L, Foongchomcheay A. Efficacy of electrical stimulation in preventing or reducing subluxation of the shoulder after stroke: a meta-analysis. THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY 2003; 48:257-67. [PMID: 12443520 DOI: 10.1016/s0004-9514(14)60165-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
After stroke, up to 81% of individuals develop shoulder subluxation, a condition frequently associated with poor upper limb function. Recently, electrical stimulation has been applied to shoulder muscles to treat shoulder subluxation. The purpose of this meta-analysis was to examine the efficacy of surface electrical stimulation for the prevention or reduction of shoulder subluxation after stroke. A meta-analysis of all eligible randomised or quasi-randomised trials of electrical stimulation for the treatment of shoulder subluxation identified by computerised and hand searches of the literature was carried out. The primary outcome measure of interest was subluxation. Seven (four early and three late) trials met the inclusion criteria. The mean PEDro score out of 10 for quality of the methods was 5.8 for the four early trials and 4.3 for the three late trials. Data were pooled when subluxation was measured in millimetres. Analysis found that, when added to conventional therapy, electrical stimulation prevented on average 6.5mm of shoulder subluxation (weighted mean difference, 95% CI 4.4 to 8.6) but only reduced it by 1.9mm (weighted mean difference, 95% CI -2.3 to 6.1) compared with conventional therapy alone. Therefore, evidence supports the use of electrical stimulation early after stroke for the prevention of, but not late after stroke for the reduction of, shoulder subluxation.
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Abstract
OBJECTIVE The objective of this review was to summarise the best available research related to the prevention and management of shoulder pain in the hemiplegic patient. INCLUSION CRITERIA This review considered all studies that included hemiplegic patients post-cerebral vascular accident (CVA). Interventions of interest were any treatments or programs used to manage or prevent shoulder pain secondary to hemiplegia. The primary outcomes of interest were those related to pain. This review considered any randomised controlled trials (RCT) that evaluated the effectiveness of interventions that addressed shoulder pain in hemiplegic patients. In the absence of RCT, other research designs such as non-randomised controlled trials, time series and case series were also considered for inclusion in a narrative summary. SEARCH STRATEGY The search sought to find both published and unpublished studies. Databases were searched up to February 2002 and included Medline, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic Collections Online, Turning Research Into Practice (TRIP), Dissertation Abstracts and Proceedings First. The reference lists of all studies identified were searched for additional studies. ASSESSMENT OF METHODOLOGICAL QUALITY All studies were checked for methodological quality by two reviewers and data was extracted using a data extraction tool. RESULTS Current research evaluating the effectiveness of treatment interventions on hemiplegic shoulder pain is very limited. The studies were very diverse in their nature of research. There has been no replication of studies, with the studies found using different populations, interventions or outcome measures. Not one study could be compared with another. Meta-analysis was unable to be performed not only because of inadequate reporting of results, but more often due to differences between the studies' participants and the range of interventions used. The diversity in interval post-CVA also makes it difficult to make any comparisons between studies. For this reason the review is in narrative form. CONCLUSIONS With this limited evidence, no single intervention has been identified that offers a dramatic effect in terms of treating pain in the hemiplegic shoulder. There is potential for some benefits for the patient's functional and comfort status, thereby improving their quality of life and maximising their social participation.Preventive interventions demonstrated that a shoulder positioning policy had no statistically significant effect on pain. Strapping within 48 h significantly delayed the onset of pain and current research evaluating exercise is not limited to just one area of exercise, but a diverse range, making it difficult to make any comparisons. Some studies did suggest evidence of improvement, albeit limited. However, some of the exercise techniques aggravated shoulder pain. Treatment interventions demonstrated that electromyogram biofeedback cannot be evaluated as a stand-alone therapy as it is used in conjunction with relaxation therapy. Intra-articular Triamcinolone Acetonide injections in a small RCT have not been proven to be beneficial, and are associated with a high incidence of side-effects. Different exercise techniques may aggravate shoulder pain more than others (e.g. Bobath technique compared to cryotherapy). The systematic review on the effectiveness of functional electrical stimulation was used for prevention and treatment and concluded that there is currently no evidence for effect.
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Affiliation(s)
- Tamara Page
- Centre for Evidence-based Nursing South Australia (a collaborating centre of The Joanna Briggs Institute), Adelaide, South Australia, Australia
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Ada L, Foongchomcheay A, Canning C. Supportive devices for preventing and treating subluxation of the shoulder after stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2002. [DOI: 10.1002/14651858.cd003863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Iwata M, Kondo I, Sato Y, Satoh K, Soma M, Bar-Or O. Prediction of reflex sympathetic dystrophy in hemiplegia by evaluation of hand edema. Arch Phys Med Rehabil 2002; 83:1428-31. [PMID: 12370880 DOI: 10.1053/apmr.2002.34830] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the predictive value of measurements of hand edema for the development of reflex sympathetic dystrophy (RSD). DESIGN Cohort study. SETTING Departments of rehabilitation medicine in 3 general hospitals and 1 rehabilitation hospital in Japan. PARTICIPANTS Thirty-four stroke patients. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Measurement of the circumference of the middle finger was used to evaluate hand edema. The degree of hand edema was expressed by the ratio of circumference of the middle finger (RCMF) in the affected side to that in the uninvolved extremity. RESULTS Eight of 34 patients developed clinical RSD from 2 to 4 months after stroke. Hand edema showed a significant relationship to the development of RSD (ie, the patients who had an RCMF of above 1.06 at 4 weeks poststroke had significantly higher incidence of RSD than those with a lower RCMF; P=.0127). CONCLUSION It is possible to predict the development of RSD in hemiplegia by measuring hand edema 4 weeks poststroke.
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Affiliation(s)
- Manabu Iwata
- Department of Physical Therapy, School of Health Sciences, Hirosaki University, Hirosaki-shi , Japan
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Abstract
OBJECTIVE To investigate the effect of an arm sling on gait patterns of patients with hemiplegia. DESIGN Crossover design of 3-dimensional gait analysis and concomitant video recordings performed during a single session. SETTING Rehabilitation ward gait laboratory of a university hospital. PARTICIPANTS Thirty-one patients (20 men, 11 women) with hemiplegia with an average age of 53.1+/-9.7 years and 31 age-, sex-, height-, and weight-matched able-bodied persons. INTERVENTIONS All patients with hemiplegia and able-bodied controls walked at self-selected speed over a 10-m walkway, either with or without an arm sling. MAIN OUTCOME MEASURES Time-distance, kinematic, and kinetic parameters of gait. RESULTS The able-bodied group did not show any difference in gait parameters while using the sling. However, in patients with hemiplegia wearing a sling, walking speed and stance period of the paretic side increased, double support time of the paretic side decreased, excursion of the center of gravity (COG) decreased, and weight bearing of the paretic side increased. CONCLUSIONS An arm sling improved gait, especially during gait training sessions of patients with hemiplegia who have impaired body image and excessive motion of the COG.
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Affiliation(s)
- Güneş Yavuzer
- Department of Physical Medicine and Rehabilitation, Ankara University Medical School, Turkey.
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