Profile of upper limb recovery and development of secondary impairments in patients after stroke with a disabled upper limb: An observational study

Predictors of upper limb motor recovery in stroke survivors: a pre-post test study design

OBJECTIVES

The study aimed to assess the predictors of upper limb motor recovery in stroke survivors.

DESIGN

Pre-post test study design.

SETTING

Conducted in two centres (First Level Hospital and University Teaching Hospital in Lusaka).

PARTICIPANTS

Patients living with stroke accessing physiotherapy services at the two public hospitals. A total of 52 patients were recruited at the start of the study, 6 were lost to follow-up and 46 completed the study.

INTERVENTION

Conventional physiotherapy for 8 weeks (5 September 2022-28 October 2022).

PRIMARY OUTCOME

Motor function measured using a Fugl-Meyer assessment of the upper extremity.

RESULTS

Analysis was conducted on 46 participants. A significant difference was observed between the level of motor function at baseline and after 8 weeks of treatment (p=0.0183). At baseline, 50% of participants had mild motor function, which improved after 8 weeks, with 69.6% having mild motor function. Stroke patients with severe motor function impairment at baseline were associated with 0.01 times likelihood of having mild motor function impairment after 8 weeks of physiotherapy treatment (AOR 0.01; 95 % CI 0.00 to 0.16; p=0.002).

CONCLUSION

The motor function of stroke patients continues to improve over time. This study demonstrated that initial upper limb motor function impairment could be used as a predictor for upper limb motor function.

Assessment approaches for hemiplegic shoulder pain in people living with stroke - A scoping review

PURPOSE

Hemiplegic shoulder pain (HSP) is reported in up to 40% of people with stroke. Causes of HSP are often multifactorial. To inform appropriate treatment, reliable/valid assessments are critical. The aim of this scoping review was to collate assessment approaches used in studies where the primary outcome was HSP, and to identify how frequently each assessment approach was used.

METHODS

A systematic search, including studies from 2000-2023 was conducted of the MEDLINE, EMBASE, CINAHL, AMED, Biomed Central, and Cochrane Library databases, with four key terms used: "assess", "stroke", "pain" and "shoulder". All primary studies published in English language fulfilling the reviews inclusion criteria were included. Six reviewers extracted the data.

RESULTS

A total of 29 assessment methods for HSP were identified from 124 studies. The common assessments were: Visual Analogue Scale (n = 75, 60%), Passive Range of Movement (n = 65, 52%), Fugl-Meyer Assessment (n = 32, 26%), glenohumeral subluxation (n = 30, 24%) and Numerical Rating Scale (n = 27, 22%).

CONCLUSION

A wide range of assessment approaches was identified for HSP, and some are used more than others. A fully comprehensive assessment that considers different aspects of pain including severity and timing, functioning, and the psychological burden, is needed in this area of practice to be able to guide appropriate treatment.

The Effectiveness of Ultrasound-Guided Subacromial-Subdeltoid Bursa Combined With Long Head of the Biceps Tendon Sheath Corticosteroid Injection for Hemiplegic Shoulder Pain: A Randomized Controlled Trial

Background

Subacromial-subdeltoid (SASD) bursa and long head of the biceps tendon (LHBT) sheath corticosteroid injection are commonly used to treat shoulder pain associated with arthritic shoulder conditions, but effectiveness in the stroke population is unclear. This study aimed to investigate the clinical effectiveness of ultrasound-guided SASD bursa combined with LHBT sheath corticosteroid injection for hemiplegic shoulder pain (HSP) compared with SASD bursa injection alone.

Methods

60 patients with HSP were randomly allocated to the dual-target group (n = 30) and single-target group (n = 30). The single-target group received SASD bursa corticosteroid injection alone, and the dual-target group received SASD bursa and LHBT sheath corticosteroid injection. The primary endpoint was pain intensity measured on a visual analog scale (VAS). The secondary endpoint was passive range of motion (PROM) of the shoulder, Upper Extremity Fugl-Meyer assessment (UEFMA) score, and Modified Barthel Index (MBI) score. PROM and pain intensity VAS were assessed at baseline and weeks 1, 4, and 12 post-treatment. UEFMA and MBI were recorded at baseline and weeks 4 and 12 post-treatment.

Results

A total of 141 patients with HSP were screened, and 60 patients were included. Significant differences in the VAS, PROM, UEFMA and MBI were observed at all follow-ups in both groups. The dual-target group showed a significant difference in VAS score compared with the single-target group (3.3 vs. 3.7, p = 0.01) at week 4 and week 12 (2.5 vs. 3.2, p < 0.001). Moreover, the dual-target group showed statistically significant differences in flexion (p < 0.001) at week 12, extension rotation (p < 0.001) at week 12, and abduction at week 1 (p = 0.003) and weeks 4 and 12 (p < 0.001) compared with the single-target group. There were significant differences in FMA and MBI scores in the two groups before and after treatment (p < 0.001), with a more significant increase in the dual-target group compared with the single-target group (p < 0.001) at week 12.

Conclusion

The combination of SASD bursa and LHBT sheath corticosteroid injection is superior to SASD bursa injection alone in reducing shoulder pain and improving functional activities in patients with HSP.

Clinical Trial Registration

www.chictr.org.cn, Unique identifier: ChiCTR2100047125.

Impact of shoulder subluxation on peripheral nerve conduction and function of hemiplegic upper extremity in stroke patients: A retrospective, matched-pair study

Purpose: To investigate the impact of shoulder subluxation (SS) on peripheral nerve conduction and function of the hemiplegic upper extremity (HUE) in poststroke patients.Methods: Thirty post-stroke patients were selected (SS group: 15 patients, non-SS group: 15 patients, respectively). Evaluation of nerve conduction in upper limbs: the compound muscle action potential (CMAP) amplitude and latency of suprascapular, axillary, musculocutaneous, radial, median, and ulnar nerves; the motor and sensory conduction velocity and the sensory nerve action potential (SNAP) amplitude of median, ulnar, and radial nerves. The Brunnstrom stage scale was used to evaluate the HUE motor function.Results: Compared with the healthy side, the CMAP and SNAP amplitudes of tested nerves on the HUE in both groups were lower, and the CMAP latency of the suprascapular, axillary and musculocutaneous nerves on the HUE in the SS group was longer (P < 0.05). Compared with the HUE in non-SS group, the CMAP amplitude of tested nerves (except ulnar) was decreased more (P < 0.05), the motor conduction velocity of the median nerve was lower (P < 0.05), and the Brunnstrom stage of the HUE was lower in SS group (P < 0.05).Conclusions: Stroke may lead to extensive abnormal nerve conduction on the HUE, and SS may aggravate the abnormality, which may disturb the recovery of upper limb function.

The use of shoulder orthoses post-stroke: effects on balance and gait. A systematic review

INTRODUCTION

Since there is no clear conclusion concerning the use of arm slings in the prevention or reduction of shoulder subluxation or shoulder pain in stroke patients, it seems important to explore other potentially beneficial effects. Earlier research already suggested that the upper limb might play a considerable role in efficient balance and gait in stroke patients. Therefore, the aim of this systematic review was to investigate the effects of wearing an arm sling on balance and/or gait in stroke patients. This information could support the decision-making concerning the use of shoulder orthoses after stroke.

EVIDENCE ACQUISITION

Four electronic databases (Pubmed/MEDLINE, Embase, Web of Science and CINAHL/EBSCO) were searched until April 8^th, 2019. Search alerts were set and followed until January 2020 to assure no new eligible articles were published. Reference lists of included studies were hand searched. All studies examining the effect of wearing an upper limb orthosis on balance and gait in stroke patients were included. Two reviewers independently identified eligible studies and extracted data. The methodological quality of included trials was assessed using the QualSyst assessment tool for quantitative studies. Prospero registration number: CRD42019130282.

EVIDENCE SYNTHESIS

Ten studies, examining 283 stroke patients with moderate to low level of upper limb impairment, were included in the quantitative synthesis of the results. The pooled mean time since stroke was 21.88±9.03 months. Only minor effects on balance or gait related outcome parameters could be detected in favor of wearing an arm sling. However, these changes did not exceed the minimal clinical important difference (MCID).

CONCLUSIONS

So far no strong evidence is available regarding a potential benefit of wearing an arm sling on balance and gait for stroke patients. However, further research with longer intervention periods, can be useful to determine if stroke patients in the early phases after stroke or with persistent UL paresis might possibly benefit from wearing an arm sling.