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Funao H, Tsujikawa M, Momosaki R, Shimaoka M. Virtual reality applied to home-visit rehabilitation for hemiplegic shoulder pain in a stroke patient: a case report. J Rural Med 2021; 16:174-178. [PMID: 34239631 PMCID: PMC8249364 DOI: 10.2185/jrm.2021-003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives: Virtual reality (VR) has been shown to facilitate rehabilitation
at hospitals by distracting patients’ attention from pain and by providing a virtual
environment favorable for motivating the patients to continue rehabilitation. However, the
application of VR in a home-visit rehabilitation remains to be validated. Here, we report
a case in which home-visit rehabilitation using immersive VR was effective for post-stroke
hemiplegic shoulder pain. Case presentation: After treatment, at a general hospital, for the
hypertensive hemorrhage in the right brain capsule that resulted in the residual attention
deficit disorder and left hemiplegia, a 63-year-old woman was cared for with a home-visit
rehabilitation in a rural area. The patient had persistent pain in her left shoulder,
which increased during activities of daily living and during rehabilitation, and the pain
precluded rehabilitation. A VR relaxation program was delivered to the patient to
alleviate pain during rehabilitation. Her shoulder pain was successfully alleviated using
VR during training for muscle stretching and passive joint mobilization. Conclusion: The application of VR to home rehabilitation in rural areas may
augment the effectiveness of home rehabilitation by alleviating pain during the procedure
and sustaining the motivation for home rehabilitation.
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Affiliation(s)
- Hiroki Funao
- Course of Nursing Science, Graduate School of Medicine, Mie University, Japan
| | - Mayumi Tsujikawa
- Course of Nursing Science, Graduate School of Medicine, Mie University, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Graduate School of Medicine, Mie University, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology, Graduate School of Medicine, Mie University, Japan
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2
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Deer TR, Eldabe S, Falowski SM, Huntoon MA, Staats PS, Cassar IR, Crosby ND, Boggs JW. Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain with Percutaneous Peripheral Nerve Stimulation. J Pain Res 2021; 14:721-736. [PMID: 33737830 PMCID: PMC7966353 DOI: 10.2147/jpr.s297091] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 12/23/2022] Open
Abstract
Peripheral nerve stimulation (PNS) is an effective tool for the treatment of chronic pain, although its efficacy and utilization have previously been significantly limited by technology. In recent years, purpose-built percutaneous PNS devices have been developed to overcome the limitations of conventional permanently implanted neurostimulation devices. Recent clinical evidence suggests clinically significant and sustained reductions in pain can persist well beyond the PNS treatment period, outcomes that have not previously been observed with conventional permanently implanted neurostimulation devices. This narrative review summarizes mechanistic processes that contribute to chronic pain, and the potential mechanisms by which selective large diameter afferent fiber activation may reverse these changes to induce a prolonged reduction in pain. The interplay of these mechanisms, supported by data in chronic pain states that have been effectively treated with percutaneous PNS, will also be discussed in support of a new theory of pain management in neuromodulation: Peripherally Induced Reconditioning of the Central Nervous System (CNS).
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Steven M Falowski
- Department of Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Marc A Huntoon
- Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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3
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Anwer S, Alghadir A. Incidence, Prevalence, and Risk Factors of Hemiplegic Shoulder Pain: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144962. [PMID: 32660109 PMCID: PMC7400080 DOI: 10.3390/ijerph17144962] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/11/2023]
Abstract
The current systematic review aimed to investigate the incidence, prevalence, and risk factors causing hemiplegic shoulder pain (HSP) after stroke. Two independent authors screened titles and abstracts for the eligibility of the included studies in the electronic databases PubMed and Web of Science. Studies which reported the incidence, prevalence, and risk factors of HSP following stroke were included. The included studies were assessed using the Newcastle–Ottawa Scale for evaluating the quality of nonrandomized studies in meta-analyses. Eighteen studies were included in the final synthesis. In all studies, the number of patients ranged between 58 and 608, with the mean age ranging from 58.7 to 76 years. Seven included studies were rated as “good “quality, while one study rated “fair” and 10 studies rated “poor” quality. Eight studies reported incidence rate while 11 studies reported the prevalence of HSP following a stroke. The incidence of HSP was ranging from 10 to 22% in the metanalysis of the included studies. The prevalence of HSP was ranging from 22 to 47% in the metanalysis of the included studies. The most significant predictors of HSP were age, female gender, increased tone, sensory impairment, left-sided hemiparesis, hemorrhagic stroke, hemispatial neglect, positive past medical history, and poor National Institutes of Health Stroke Scale score. The incidence and prevalence of HSP after stroke vary considerably due to various factors. Knowledge of predictors is important to minimize the risk of developing HSP following a stroke.
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Affiliation(s)
- Shahnawaz Anwer
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
- Department of Building and Real Estate, Hong Kong Polytechnic University, Kowloon, Hong Kong
- Correspondence:
| | - Ahmad Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
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Wu T, Song HX, Li YZ, Ye Y, Li JH, Hu XY. Clinical effectiveness of ultrasound guided subacromial-subdeltoid bursa injection of botulinum toxin type A in hemiplegic shoulder pain: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e17933. [PMID: 31702679 PMCID: PMC6855603 DOI: 10.1097/md.0000000000017933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Hemiplegic shoulder pain (HSP), which occurs in most patients with hemiplegia, causes considerable distress and worsens outcomes in rehabilitation. Although they have received the treatments such as anti-inflammatory drugs or physical therapy, many of the individuals remain suffering from shoulder pain 6 months after acute stroke event. In this retrospective study, we evaluated the effectiveness of ultrasound guided subacromial-subdeltoid (SASD) bursa injections with botulinum toxin type A (BoNT/A) compared to steroids for refractory HSP.The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires in our rehabilitation center. In total, 38 patients who received ultrasound guided SASD bursa injection (BoNT/A group, n = 18; corticosteroid group, n = 20) were included. The pain visual analog scale (VAS) score at rest and during arm passive abduction, Fugl-Meyer score of upper limbs (F-M score) were evaluated before, 2, 4, 8, and 12 weeks after injection.Both 2 groups obtained a significant improvement of VAS score at rest or during arms passive abduction compared to baseline score (within group compare, P < .05). There were no significant differences of pain score improvement between two groups at week 2, 4, 8, and 12 after injection either at rest or during passive arm abduction (between 2 groups compare, P > .05). There were also no differences in results of the post treatment F-M score between 2 groups (between 2 groups compare, P > .05). Similarly, during the follow-up period no collateral effects were reported after BoNT/A injection.SASD bursa BoNT/A injection can substantially reduce the pain as corticosteroid in patients with HSP. BoNT/A injection could be a useful strategy for replacing steroids as a treatment for refractory HSP especially in the patients who cannot tolerate the steroids injection.
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Affiliation(s)
- Tao Wu
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University,
| | - Hai-Xin Song
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University,
| | - Yang Zheng Li
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University,
| | - Ye Ye
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University,
| | - Jian-Hua Li
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University,
| | - Xing Yue Hu
- Department of Neurology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hang Zhou, Zhe Jiang, PR China
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5
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Hwang YI, Yoon J. Changes in gait kinematics and muscle activity in stroke patients wearing various arm slings. J Exerc Rehabil 2017; 13:194-199. [PMID: 28503532 PMCID: PMC5412493 DOI: 10.12965/jer.1734898.449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/31/2017] [Indexed: 11/22/2022] Open
Abstract
Stroke patients often use various arm slings, but the effects of different slings on the joint kinematics and muscle activity of the arm in the gait have not been investigated. The effects of joint kinematics and muscle activity in the gait were investigated to provide suggestions for gait training for stroke patients. In all, 10 chronic stroke patients were voluntarily recruited. An eight-camera three-dimensional motion analysis system was used to measure joint kinematics while walking; simultaneously, electromyography data were collected for the anterior and posterior deltoids and latissimus dorsi. The amplitude of pelvic rotation on the less-affected side differed significantly among the different arm slings (P<0.05). Changes in the knee kinematics of the less-affected side also differed significantly (P<0.05), while there were no significant differences in the muscle activity of the affected arm. In stroke patients, an extended arm sling is more useful than no sling or a flexed arm sling in terms of the amplitude of the rotation of the less-affected pelvic side in the stance phase while walking. The less-affected knee joint is flexed more without a sling than with any sling. All arm slings support the extension of the contralateral knee.
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Affiliation(s)
- Young-In Hwang
- Department of Physical Therapy, College of Biohealth Science, Hoseo University, Asan, Korea
| | - Jangwhon Yoon
- Department of Physical Therapy, College of Biohealth Science, Hoseo University, Asan, Korea
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6
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Effect of kinesio tape application on hemiplegic shoulder pain and motor ability: a pilot study. Int J Rehabil Res 2017; 39:272-6. [PMID: 27075946 DOI: 10.1097/mrr.0000000000000167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of our single-group pre-post design pilot study was to evaluate the short-term effect of kinesio taping (KT) application on pain and motor ability of hemiplegic shoulder pain (HSP) patients. Eleven poststroke patients with HSP hospitalized in the Department of Neurology C, Loewenstein Rehabilitation Hospital, Raanana, Israel, received a KT application in addition to their usual rehabilitation protocol. KT, consisting of one to three strips according to a predefined algorithm, was applied to the painful shoulder region. A 10 cm Visual Analog Scale of shoulder pain at rest and at arm movement, active and passive pain-free abduction range of motion, Box & Blocks, and Fugl-Meyer upper extremity motor assessment were performed before treatment and 24 h after wearing the KT. After applying the KT, there was no significant change in any variables. Short-term KT application, used in our study, produced no change in shoulder pain, range of motion, or ability of upper limb in HSP patients. Additional studies should evaluate the effect of long-term application and different types of KT applications on HSP.
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7
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Jang MH, Lee CH, Shin YI, Kim SY, Huh SC. Effect of Intra-articular Hyaluronic Acid Injection on Hemiplegic Shoulder Pain After Stroke. Ann Rehabil Med 2016; 40:835-844. [PMID: 27847713 PMCID: PMC5108710 DOI: 10.5535/arm.2016.40.5.835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/10/2016] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the efficacy of intra-articular hyaluronic acid (IAHA) injection for hemiplegic shoulder pain (HSP) after stroke. Methods Thirty-one patients with HSP and limited range of motion (ROM) without spasticity of upper extremity were recruited. All subjects were randomly allocated to group A (n=15) for three weekly IAHA injection or group B (n=16) for a single intra-articular steroid (IAS) injection. All injections were administered by an expert physician until the 8th week using a posterior ultrasonography-guided approach. Shoulder joint pain was measured using the Wong-Baker Scale (WBS), while passive ROM was measured in the supine position by an expert physician. Results There were no significant intergroup differences in WBS or ROM at the 8th week. Improvements in forward flexion and external rotation were observed from the 4th week in the IAHA group and the 8th week in the IAS group. Subjects experienced a statistically significant improvement in pain from the 1st week in the IAS and from the 8th week in IAHA group, respectively. Conclusion IAHA seems to have a less potent ability to reduce movement pain compared to steroid in the early period. However, there was no statistically significant intergroup difference in WBS and ROM improvements at the 8th week. IAHA might be a good alternative to steroid for managing HSP when the use of steroid is limited.
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Affiliation(s)
- Myung Hun Jang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Chang-Hyung Lee
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Chul Huh
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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8
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Jeon HJ, An S, Yoo J, Park NH, Lee KH. The effect of Monkey Chair and Band exercise system on shoulder range of motion and pain in post-stroke patients with hemiplegia. J Phys Ther Sci 2016; 28:2232-7. [PMID: 27630403 PMCID: PMC5011567 DOI: 10.1589/jpts.28.2232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/07/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] A simple rehabilitation device system for strengthening upper limb muscles in hemiplegic patients was developed. This system, which stimulates active exercise while accounting for intensity, time, and frequency, was examined in the present pilot study. [Subjects and Methods] Patients had shoulder pain and limited shoulder movement. Changes in range of motion (ROM) and scores of a visual analog scale (VAS) for pain were evaluated in the experimental and control groups every four weeks for twelve weeks. The modified motor assessment scale (MMAS) was used before and after experiments. [Results] Significant differences between experimental times in ROM for shoulder flexion, abduction, and adduction on the paralyzed side were observed in the experimental group at every time point. Pain VAS scores in the experimental group improved progressively and significantly with time, indicating a consistently increasing effect of exercise. There were significant differences between the MMAS scores before and after completion of the program in the experimental group. [Conclusion] Muscle strengthening is important in hemiplegic patients, and active exercise was more efficient than passive exercise in this regard. Rehabilitation with the Monkey Chair and Band system may represent an efficient and important tool in upper limb training and comprehensive modern rehabilitation therapy.
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Affiliation(s)
- Hyun-Ju Jeon
- Department of Dance, Hanyang University, Republic of Korea
| | - Sangjoon An
- Korea Institute of Industrial Technology, Republic of Korea
| | - Jinwoo Yoo
- Department of Mechanical and Aerospace Engineering, Seoul National University, Republic of Korea
| | - No-Hyun Park
- The Graduate School of Industry, Sejong University, Republic of Korea
| | - Kyu Hoon Lee
- Department of Physical Medicine and Rehabilitation, College of Medical School, Hanyang University, Republic of Korea
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9
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Kim YW, Kim Y, Kim JM, Hong JS, Lim HS, Kim HS. Is poststroke complex regional pain syndrome the combination of shoulder pain and soft tissue injury of the wrist?: A prospective observational study: STROBE of ultrasonographic findings in complex regional pain syndrome. Medicine (Baltimore) 2016; 95:e4388. [PMID: 27495051 PMCID: PMC4979805 DOI: 10.1097/md.0000000000004388] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients with poststroke complex regional pain syndrome (CRPS) show different symptoms compared to other types of CRPS, as they usually complain of shoulder and wrist pain with the elbow relatively spared. It is thus also known by the term "shoulder-hand syndrome."The aim of this study is to present a possible pathophysiology of poststroke CRPS through ultrasonographic observation of the affected wrist before and after steroid injection at the extensor digitorum communis (EDC) tendon in patients suspected with poststroke CRPS.Prospective evaluation and observation, the STROBE guideline checklist was used.Twenty-three patients diagnosed as poststroke CRPS in accordance to clinical criteria were enrolled. They had a Three Phase Bone Scan (TPBS) done and the cross-sectional area (CSA) of EDC tendon was measured by using ultrasonography. They were then injected with steroid at the EDC tendon. The CSA of EDC tendon, visual analogue scale (VAS), and degree of swelling of the wrist were followed up 1 week after the injection.TPBS was interpreted as normal for 4 patients, suspected CRPS for 10 patients, and CRPS for 9 patients. Ultrasonographic findings of the affected wrist included swelling of the EDC tendon. After the injection of steroid to the wrist, CSA and swelling of the affected wrist compared to that before the treatment was significantly decreased (P < 0.001). The VAS score declined significantly after the injection (P < 0.001).Our results suggest that the pathophysiology of poststroke CRPS might be the combination of frozen shoulder or rotator cuff tear of shoulder and soft tissue injury of the wrist caused by the hemiplegic nature of patients with stroke.
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Affiliation(s)
- Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Severance Hospital
| | - Yoon Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital
| | - Jong Moon Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital
| | - Ji Seong Hong
- Departments of Physical Medicine and Rehabilitation, Hando Hospital
| | - Hyun Sun Lim
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital
- Correspondence: Hyoung Seop Kim, National Health Insurance Service Ilsan Hospital, Ilsan-ro 100, ilsan-donggu, Goyang, Korea, 10444 (e-mail: )
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10
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Affiliation(s)
- Christopher W Roy
- Senior Registrar, Rehabilitation Studies Unit, University of Edinburgh
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11
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Partridge CJ, Edwards SM, Mee R, van Langenberghe H. Hemiplegic shoulder pain: a study of two methods of physiotherapy treatment. Clin Rehabil 2016. [DOI: 10.1177/026921559000400108] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A study was undertaken to examine the effectiveness of two methods of physiotherapy treatment for hemiplegic shoulder pain. Sixty-five patients were randomly allocated to receive either cryotherapy or the Bobath approach. Patients were assessed before and after a four-week period of treatment. The differences between the scores of the two groups on exit were not found to reach statistically significant levels for severity of pain at rest, on movement, or for reported distress; however the proportion of patients who reported no pain after the four weeks' treatment was greater in those who received the Bobath approach. The differences in reported frequency of occurrence of pain reached a significant level (p < .05), those in the Bobath group reporting less frequent pain. It is suggested that reasons forthe lack of expected differences in outcome between the two groups may be in part due to the diversity of underlying pathology, and to further trauma which occurred in the study period. The difference between before and after ratings for all pain variables was significant; for reported severity and frequency p < .05, and for reported distress p < .001. These findings suggest that physiotherapy may have a role to play in the treatment and management of hemiplegic shoulder pain, but further investigations are needed. It may be appropriate to set up and monitor programmes of careful handling to see if shoulder pain can be avoided, and it is also suggested that those with severe pain at rest and on movement may be considered as a separate group for study.
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Affiliation(s)
- CJ Partridge
- Centre for Physiotherapy Research, King's College, London
| | - SM Edwards
- Centre for Physiotherapy Research, King's College, London
| | - R. Mee
- Centre for Physiotherapy Research, King's College, London
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Küçükdeveci AA, Tennant A, Hardo P, Chamberlain MA. Sleep problems in stroke patients: relationship with shoulder pain. Clin Rehabil 2016. [DOI: 10.1177/026921559601000214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was designed to document the occurrence and the type of sleep problems in stroke patients and to examine the importance of shoulder pain in stroke in relation to sleep disturbances. Forty-six stroke patients were evaluated for the presence of sleep disturbances, general health problems (Nottingham Health Profile) and anxiety-depression (Hospital Anxiety Depression Scale) and compared with 47 age- and sex-matched subjects who had not had strokes. A four-item sleep questionnaire was used to assess different components of insomnia disorders through the previous month. The results showed that stroke patients had significantly more problems in initiating sleep than controls (p < 0.01). Other components of insomnia, difficulty in maintaining sleep or nonrestorative sleep did not differ between the two groups (p < 0.05). Factors found to be associated with poor sleep such as pain (p < 0.01), anxiety (p < 0.01) and depression (p < 0.01) were more common in the patient group but these did not otherwise result in a significant increase in all components of insomnia, probably because of the high level of benzodiazepine and tricyclic antidepressant intake amongst patients. Stroke patients with shoulder pain showed significantly more sleep disturbances (p < 0.01 ) and less general well-being ( p < 0.05) than patients without shoulder pain. It is concluded that attention must be paid to shoulder pain and to ensuing sleep disturbances among stroke patients.
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Affiliation(s)
- Ayse A Küçükdeveci
- Department of Physical Medicine and Rehabilitation, University of Ankara, Ankara, Turkey
| | - Alan Tennant
- Rheumatology and Rehabilitation Research Unit, University of Leeds Leeds
| | - Philip Hardo
- Rheumatology and Rehabilitation Research Unit, University of Leeds Leeds
| | - M Anne Chamberlain
- Rheumatology and Rehabilitation Research Unit, University of Leeds Leeds
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Tao W, Fu Y, Hai-Xin S, Yan D, Jian-Hua L. The application of sonography in shoulder pain evaluation and injection treatment after stroke: a systematic review. J Phys Ther Sci 2015; 27:3007-10. [PMID: 26504346 PMCID: PMC4616147 DOI: 10.1589/jpts.27.3007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/25/2015] [Indexed: 01/12/2023] Open
Abstract
[Purpose] This review article is designed to expose the application of sonography in
shoulder pain after stroke. [Methods] A range of databases was searched to identify
articles that address sonography examination, with or without ultrasound guided
corticosteroid injection for hemiplegic shoulder pain (HSP). The electronic databases of
PubMed, CENTRAL, CINAHL, Cochrane Library, Medline were searched. [Results] According to
the articles identified in our databases research, sonographic technique has potential to
provide objective measurements in patients with HSP. The main sonography finding of HSP
included subacromial subdeltoid (SASD) bursal effusion, tendinosis of the supraspinatus
and subscapularis tendon, long head of biceps tendon sheath effusion, and shoulder
subluxation. Our analysis also revealed significantly decreased pain score (VAS) and
increased passive external rotation degree in the steroid injection group than control
group. [Conclusion] The sonography examination is useful for HSP assessment and ultrasound
guided technique is recommended for HSP injection treatment.
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Affiliation(s)
- Wu Tao
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
| | - Yu Fu
- Department of Rehabilitation Medicine, Alxa League Central Hospital, China
| | - Song Hai-Xin
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
| | - Dong Yan
- Department of Rehabilitation Medicine, Hangzhou Hospital of Zhejiang CAPF, China
| | - Li Jian-Hua
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
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14
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Shepherd RB, Carr JH. The Shoulder following Stroke: Preserving Musculoskeletal Integrity for Function. Top Stroke Rehabil 2015. [DOI: 10.1310/u7qr-a17d-16xr-5gbt] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Zeliha Karaahmet O, Eksioglu E, Gurcay E, Bora Karsli P, Tamkan U, Bal A, Cakcı A. Hemiplegic Shoulder Pain: Associated Factors and Rehabilitation Outcomes of Hemiplegic Patients With and Without Shoulder Pain. Top Stroke Rehabil 2014; 21:237-45. [DOI: 10.1310/tsr2103-237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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17
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Effect of Interferential Current Stimulation in Management of Hemiplegic Shoulder Pain. Arch Phys Med Rehabil 2014; 95:1441-6. [DOI: 10.1016/j.apmr.2014.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/18/2014] [Accepted: 04/04/2014] [Indexed: 11/15/2022]
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18
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Jeon WH, Park GW, Jeong HJ, Sim YJ. The Comparison of Effects of Suprascapular Nerve Block, Intra-articular Steroid Injection, and a Combination Therapy on Hemiplegic Shoulder Pain: Pilot Study. Ann Rehabil Med 2014; 38:167-73. [PMID: 24855610 PMCID: PMC4026602 DOI: 10.5535/arm.2014.38.2.167] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/21/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the relative effectiveness of three injections methods suprascapular nerve block (SSNB) alone, intra-articular steroid injection (IAI) alone, or both-on relief of hemiplegic shoulder pain. METHODS We recruited 30 patients with hemiplegic shoulder pain after stroke. SSNB was performed in 10 patients, IAI in 10 patients, and a combination of two injections in 10 patients. All were ultrasonography guided. Each patient's maximum passive range of motion (ROM) in the shoulder was measured, and the pain intensity level was assessed with a visual analogue scale (VAS). Repeated measures were performed on pre-injection, and after injection at 1 hour, 1 week, and 1 month. Data were analyzed by Kruskal-Wallis and Friedman tests. RESULTS All variables that were repeatedly measured showed significant differences in shoulder ROM with time (p<0.05), but there was no difference according injection method. In addition, VAS was statistically significantly different with time, but there was no difference by injection method. Pain significantly decreased until a week after injection, but pain after a month was relatively increased. However, pain was decreased compared to pre-injection. CONCLUSION The three injection methods significantly improved shoulder ROM and pain with time, but no statistically significant difference was found between them.
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Affiliation(s)
- Woo Hyun Jeon
- Department of Rehabilitation Medicine, Dong-Eui Medical Center, Busan, Korea
| | - Gun Woong Park
- Department of Rehabilitation Medicine, Dong-Eui Medical Center, Busan, Korea
| | - Ho Joong Jeong
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Young Joo Sim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
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Peripheral nerve stimulation compared with usual care for pain relief of hemiplegic shoulder pain: a randomized controlled trial. Am J Phys Med Rehabil 2014; 93:17-28. [PMID: 24355994 DOI: 10.1097/phm.0000000000000011] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study sought to establish the efficacy of single-lead, 3-wk peripheral nerve stimulation (PNS) therapy for pain reduction in stroke survivors with chronic hemiplegic shoulder pain. DESIGN This study is a single-site, pilot, randomized controlled trial of adults with chronic shoulder pain after stroke. Participants were randomized to receive a 3-wk treatment of single-lead PNS or usual care. The primary outcome was the worst pain in the last week (Brief Pain Inventory, Short Form, question 3) measured at baseline and weeks 1, 4, 12, and 16. The secondary outcomes included pain interference (Brief Pain Inventory, Short Form, question 9), pain measured by the ShoulderQ Visual Graphic Rating Scales, and health-related quality-of-life (Short-Form 36 version 2). RESULTS Twenty-five participants were recruited, 13 to PNS and 12 to usual care. There was a significantly greater reduction in pain for the PNS group compared with the controls, with significant differences at 6 and 12 wks after treatment. Both PNS and usual care were associated with significant improvements in pain interference and physical health-related quality-of-life. CONCLUSIONS Short-term PNS is a safe and efficacious treatment of shoulder pain. Pain reduction is greater compared with usual care and is maintained for at least 12 wks after treatment.
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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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Abstract
OBJECTIVE This study aimed to examine the association of hemiplegic shoulder pain (HSP) with central hypersensitivity through pressure-pain thresholds (PPTs) in healthy, distant tissues. DESIGN This study is a cross-sectional study. A total of 40 patients (n = 20, HSP; n = 20, stroke without HSP) were enrolled in this study. PPTs were measured at the affected deltoid and the contralateral deltoid and the tibialis anterior using a handheld algometer. Differences in PPTs were analyzed by Wilcoxon's rank-sum test and with linear regression analysis, controlling for sex, a known confounder of PPTs. RESULTS The subjects with HSP had lower local PPTs than did the control subjects who have had a stroke when comparing the painful shoulders with the dominant shoulders of the controls and comparing the nonpainful shoulder and the tibialis anterior with the nondominant side of the controls. Similarly, those with HSP had lower PPTs compared with the controls in contralesional-to-contralesional comparisons as well as ipsilesional-to-ipsilesional comparisons. CONCLUSIONS The subjects with HSP have lower local and distal PPTs than the subjects without HSP. This study suggests that chronic shoulder pain may be associated with widespread central hypersensitivity, which has been previously found to be associated with other chronic pain syndromes. This further understanding can then help develop better treatment options for those with this HSP.
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Lee JA, Park SW, Hwang PW, Lim SM, Kook S, Choi KI, Kang KS. Acupuncture for shoulder pain after stroke: a systematic review. J Altern Complement Med 2012; 18:818-23. [PMID: 22924414 DOI: 10.1089/acm.2011.0457] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Shoulder pain, for which acupuncture has been used, is a common complication after a stroke that interferes with the function of the upper extremities. The aim of this systematic review is to summarize and evaluate the effects of acupuncture for shoulder pain after stroke. METHODS Randomized controlled trials (RCTs) involving the effects of acupuncture for shoulder pain, published between January 1990 and August 2009, were obtained from the National Libraries of Medicine, MEDLINE(®), CINAHL, AMED, Embase, Cochrane Controlled Trials Register 2009, Korean Medical Database (Korea Institute of Science Technology Information, DBPIA, KoreaMed, and Research Information Service System), and the Chinese Database (China Academic Journal). RESULTS Among the 453 studies that were obtained (300 written in English, 137 in Chinese, and 16 in Korean), 7 studies met the inclusion criteria for this review. All of them were RCTs published in China and reported positive effects of the treatment. The quality of the studies was assessed by the Modified Jadad Scores (MJS) and the Cochrane Back Review Group Criteria List for Methodologic Quality Assessment of RCTs (CBRG); the studies scored between 2 and 3 points on MJS, and between 4 and 7 points on CBRG. CONCLUSIONS It is concluded from this systematic review that acupuncture combined with exercise is effective for shoulder pain after stroke. It is recommended that future trials be carefully conducted on this topic.
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Affiliation(s)
- Jung Ah Lee
- Department of Motor & Cognitive Rehabilitation, Korea National Rehabilitation Research Institute, Seoul, Republic of Korea
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Rah UW, Yoon SH, Moon DJ, Kwack KS, Hong JY, Lim YC, Joen B. Subacromial Corticosteroid Injection on Poststroke Hemiplegic Shoulder Pain: A Randomized, Triple-Blind, Placebo-Controlled Trial. Arch Phys Med Rehabil 2012; 93:949-56. [DOI: 10.1016/j.apmr.2012.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 01/24/2012] [Accepted: 02/03/2012] [Indexed: 11/30/2022]
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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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Yasar E, Vural D, Safaz I, Balaban B, Yilmaz B, Goktepe AS, Alaca R. Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial. Clin Rehabil 2010; 25:60-8. [DOI: 10.1177/0269215510380827] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine which injection technique was effective for patients with hemiplegic shoulder pain. Design: Randomized prospective double-blind study. Setting: Brain Injury Rehabilitation Unit. Intervention: Patients with hemiplegic shoulder pain were recruited over a 12-month period and all were hospitalized in our clinic. Intra-articular steroid injection or suprascapular nerve block was performed on all patients. Main measures: Range of motion values at the moment that pain started (range of motion A) and passive maximum range of motion values (range of motion B) were recorded. Pain intensity levels (visual analogue scale) at these two range of motion values (pain A and pain B) were also taken. Evaluations were made before the injection, and 1 hour, one week and one month after the injection. Results: Twenty-six patients were enrolled in the study, the mean age was 61.53 ± 10.30 years. The mean time since injury was 8.69 ± 15.71 months. The aetiology was ischaemic in 16 (61%) patients. Intra-articular steroid injection was performed in 11 (42 %) patients, and suprascapular nerve block in 15 (57%) patients. Range of motion A and range of motion B were changed statistically in repeated measures. There were important differences in repeated measures of pain intensity levels at these two range of motion values ( P < 0.05). However, no significant differences were determined in all measurements between intra-articular steroid injection and suprascapular nerve block groups ( P > 0.05). Conclusions: Our results showed that neither injection technique was superior to the other. Both injection procedures are safe and have a similar effect in stroke patients with hemiplegic shoulder pain.
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Affiliation(s)
- Evren Yasar
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Dilek Vural
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Ismail Safaz
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Birol Balaban
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Bilge Yilmaz
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Ahmet Salim Goktepe
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Ridvan Alaca
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
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The effect of arm sling on balance in patients with hemiplegia. Gait Posture 2010; 32:641-4. [PMID: 20888770 DOI: 10.1016/j.gaitpost.2010.09.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Revised: 08/09/2010] [Accepted: 09/08/2010] [Indexed: 02/02/2023]
Abstract
The aim of this study was to investigate the effect of an arm sling on balance in patients with, hemiplegia following a stroke. Twenty-six patients with hemiplegia (11 men, 15 women) who had, shoulder subluxation were enrolled in the study. Balance was evaluated by the Berg Balance Scale, the, Functional Reach test, and a static balance index which was measured by the Kinesthetic Ability, Trainer 3000. Balance tests were performed twice, with arm sling and without arm sling use. Results of, this study show that the Berg Balance Scores and static balance index ameliorated with arm sling use (p=0.005 and p=0.004, respectively). Likewise, the Functional Reach test was better when performed with an arm sling (p=0.039). In conclusion, arm slings have a beneficial effect on balance in patients, with hemiplegia. An arm sling may be applied for its possible beneficial effect on balance especially in, the early phases of stroke rehabilitation while the upper extremity is still flaccid and arm swing is, reduced.
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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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The Effect of Local Injections in Hemiplegic Shoulder Pain. Am J Phys Med Rehabil 2009; 88:805-11; quiz 812-4, 851. [DOI: 10.1097/phm.0b013e3181b71c65] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pong YP, Wang LY, Wang L, Leong CP, Huang YC, Chen YK. Sonography of the shoulder in hemiplegic patients undergoing rehabilitation after a recent stroke. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:199-205. [PMID: 19253350 DOI: 10.1002/jcu.20573] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To examine the hemiplegic shoulders for soft-tissue injury by musculoskeletal sonography and to determine the relationship between the motor functions of the upper extremity and these injuries, which play an important role in hemiplegic shoulder pain and may impede rehabilitation. METHODS The following characteristics of 34 acute stroke patients were recorded: age, gender, height, body weight, side of hemiplegia, type and duration of stroke, Brunnstrom stage, subluxation, and degree of spasticity of the upper extremity. On the basis of the Brunnstrom stage, the patients were divided into 2 groups. Patients with stages I, II, or III were categorized under the lower Brunnstrom stage (LBS) group (n = 21), and those with stages IV, V, or VI were allocated to the higher Brunnstrom stage (HBS) group (n = 13). Both shoulders of each patient were examined by musculoskeletal sonography with a 5-10-MHz linear transducer on 2 separate occasions (i.e., at admission and 2 weeks after rehabilitation). RESULTS With the exception of age, there were no significant differences in the demographic and clinical characteristics of the patients in the 2 groups. Shoulder musculoskeletal sonography revealed soft-tissue injury in 7 patients (33%) and 15 patients (71%) in the LBS group at admission and 2 weeks after rehabilitation, respectively (p < 0.05), and in 4 patients (31%) in the HBS group both at admission and 2 weeks after rehabilitation. CONCLUSIONS Acute stroke patients with poor upper limb motor functions are more prone to soft-tissue injury of the shoulder during rehabilitation.
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Affiliation(s)
- Ya-Ping Pong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao Sung Hsiang, Kaohsiung County, Taiwan
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Viel E, Pellas F, Ripart J, Pélissier J, Eledjam JJ. [Peripheral nerve blocks and spasticity. Why and how should we use regional blocks?]. Presse Med 2008; 37:1793-801. [PMID: 18775634 DOI: 10.1016/j.lpm.2008.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 07/08/2008] [Accepted: 07/15/2008] [Indexed: 11/16/2022] Open
Abstract
Muscle spasticity causes pain, disability, and difficulties in the rehabilitation of patients with cerebrovascular lesions, head, brain or spine trauma, coma, or neurologic diseases such as multiple sclerosis, amyotrophic lateral sclerosis, or cerebral palsy. Regional blocks have a threefold use in patients with painful spasticity: diagnostic, prognostic, and therapeutic. Blocks are feasible on an outpatient or day-hospital basis. Blocks are applied most often to 4 peripheral sites: the pectoral nerve loop, median, obturator, and tibial nerves. The main indication is debilitating or painful spasticity. Peripheral blocks with local anesthetics are used as tests, to mimic the effects of motor blocks and determine their potential adverse effects, transiently and reversibly. Peripheral neurolytic blocks are easy to perform, effective, and inexpensive.
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Affiliation(s)
- Eric Viel
- Centre d'évaluation et de traitement de la douleur, pôle anesthésie-réanimations-douleur-urgences, groupe hospitalo-universitaire Caremeau, faculté de médecine de Montpellier-Nîmes, 30029 Nîmes Cedex 9, France.
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Wang RY. Neuromodulation of effects of upper limb motor function and shoulder range of motion by functional electric stimulation (FES). ACTA NEUROCHIRURGICA. SUPPLEMENT 2007; 97:381-5. [PMID: 17691400 DOI: 10.1007/978-3-211-33079-1_50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Upper extremity motor impairment is a major contributing factor to functional disability of stroke patients. Functional electric stimulation (FES) is one of the therapeutic regimens for the management of upper extremity dysfunction after stroke. This review shows that therapeutic FES intervention on supraspinatus and posterior deltoid muscles for 6 weeks is effective to speed up upper limb motor recovery in hemiplegia of short-duration after stroke or less severely affected symptoms. The positive effect of FES could be attributable to neural mechanisms including: an enhanced information flow from the joint and muscle afferents, a better visual perception of the movement produced, and a stronger muscle contraction due to direct stimulation of the motor neuron. However, FES was demonstrated as not being effective in reducing the shoulder range of motion of external rotation in patients with either short- or long-duration hemiplegia. In order to offer better management in maintaining or improving limited shoulder range of motion, other types of electrical stimulation should be considered.
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Affiliation(s)
- R Y Wang
- Institute and Faculty of Physical Therapy, National Yang-Ming University, Shih-Pai, Taipei, Republic of China.
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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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Appelros P. Prevalence and predictors of pain and fatigue after stroke: a population-based study. Int J Rehabil Res 2006; 29:329-33. [PMID: 17106351 DOI: 10.1097/mrr.0b013e328010c7b8] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pain and fatigue are two often overlooked symptoms after stroke. Their prevalence and determinants are not well understood. In this study patients with first-ever stroke (n=377) were examined at baseline and after 1 year. General characteristics of the patients, as well as stroke type, stroke severity and risk factors were registered at baseline. After 1 year survivors (n=253) were examined with respect to residual impairment, disability, cognition and depression. They were asked whether they had experienced pain and/or fatigue which had started after the stroke, and which the patient felt to be stroke related. Twenty-eight patients (11%) had stroke-associated pain and 135 (53%) had stroke-associated fatigue. Pain was associated with depression and different manifestations of stroke severity, especially degree of paresis at baseline. Fatigue was more associated with physical disability. In univariate analysis, fatigue was also associated with sleep disturbances. In conclusion, it is important to be aware of the occurrence of pain and fatigue after stroke, because these symptoms are common, they impair quality of life and they are potentially treatable. Post-stroke depression may coexist with pain and fatigue. The detection of one symptom should lead to consideration of the others. Follow-up and individual assessment of stroke patients is crucial.
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Affiliation(s)
- Peter Appelros
- Department of Neurology, Orebro University Hospital, Orebro and Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
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Abstract
Poor recovery of arm function after stroke can often have a negative impact on the patient and his/her family. These patients often need assistance from the society and may need to rely on government resources. Numerous therapeutic treatments are currently available for stroke rehabilitation. Traditional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, and motor relearning) have been used for many years. However, few of these interventions have been tested in clinical trials and are thus practiced on an empirical basis. Various evidence-based therapies (electric stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotic aided system, and virtual reality) have been added to classic rehabilitation approaches and seem to improve function. Recently, we demonstrated that a novel intervention, thermal stimulation, facilitated upper-limb functional recovery after acute stroke. In this review, we describe detailed thermal stimulation procedures and outcomes in stroke patients. We found that thermal stimulation in combination with other physiotherapies or chemotherapies was of great benefit to stroke patients. Development of a better rehabilitation paradigm that maximizes rapid recovery of arm function is a priority to help stroke patients and society.
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Affiliation(s)
- Jia-Ching Chen
- Department of Rehabilitation, Tzu Chi Buddhist General Hospital, Hualien, Taiwan
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Viel E, Pellas F, Ripart J, Pélissier J, Eledjam JJ. Spasticité : intérêt du testing par anesthésie locorégionale et blocs thérapeutiques. ACTA ACUST UNITED AC 2005; 24:667-72. [PMID: 15950114 DOI: 10.1016/j.annfar.2005.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Peripheral nerve blockade is one of the therapeutic possibilities to treat spasticity of various muscles. Percutaneous nerve stimulation allows accurate location of nerves and neurolysis can be performed using intraneural injection of 65% ethanol or 5 to 12% phenol. Spastic contraction of various muscle groups is a common source of pain and disability which prevents from having efficient rehabilitation. Test-blocks as well as neurolytic blocks are possible in most of motor nerves of the upper and lower limbs and main indications are spastic sequelae of stroke and spinal trauma but also of multiple sclerosis, cerebral palsy and chronic coma. The use of percutaneous nerve stimulation allows accurate location and four nerves are more frequently treated: pectoral nerve loop, median, obturator and tibial nerves. In patients with spasticity of the adductor thigh muscles, nerve blocks are performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. No complications occurred and minor side effects are transient painful phenomena during injection. These approaches proved to be accurate, fast, simple, highly successful and reproducible. Percutaneous neurolytic procedures should be done as early as possible, as soon as spasticity becomes painful and disabling in patients with neurological sequelae of stroke, head trauma or any lesion of the motor neuron.
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Affiliation(s)
- E Viel
- Département d'anesthésie et centre de la douleur, hôpital Caremeau, CHU, 30029 Nîmes, France.
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Ada L, Goddard E, McCully J, Stavrinos T, Bampton J. Thirty minutes of positioning reduces the development of shoulder external rotation contracture after stroke: A randomized controlled trial. Arch Phys Med Rehabil 2005; 86:230-4. [PMID: 15706548 DOI: 10.1016/j.apmr.2004.02.031] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the efficacy of positioning the affected shoulder in flexion and external rotation to prevent contracture shortly after stroke. DESIGN Prospective, parallel-group, randomized controlled trial. SETTING Four metropolitan mixed rehabilitation units. PARTICIPANTS A volunteer sample of 36 subjects (minus 5 dropouts), whose mean age was 68 years and had had their first stroke within the past 20 days. INTERVENTIONS The experimental group received two 30-minute sessions a day, 5 days a week, for 4 weeks, during which the affected upper limb was placed in maximum comfortable external rotation and 90 degrees of flexion. Both the experimental and control groups received up to 10 minutes of shoulder exercises and standard upper-limb care. MAIN OUTCOME MEASURES Contracture was measured as the maximum passive shoulder external rotation and flexion of the affected side as compared with the intact side. Measures were taken at 2 and 6 weeks after stroke by an assessor blinded to group allocation. RESULTS The 30-minute program of positioning the shoulder in maximum external rotation significantly reduced the development of contractures in the experimental group, compared with the control group ( P =.03). The 30-minute program of positioning the shoulder in 90 degrees of flexion did not prevent contractures in the experimental group as compared with the control group ( P =.88). CONCLUSIONS At least 30 minutes a day of positioning the affected shoulder in external rotation should be started as soon as possible for stroke patients who have little activity in the upper arm.
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Affiliation(s)
- Louise Ada
- School of Physiotherapy, University of Sydney, Australia.
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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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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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41
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Kong KH, Woon VC, Yang SY. Prevalence of chronic pain and its impact on health-related quality of life in stroke survivors11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2004; 85:35-40. [PMID: 14970965 DOI: 10.1016/s0003-9993(03)00369-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To document the prevalence of chronic pain and to evaluate the effect of pain on quality of life (QOL) in patients 6 months or more after a stroke. DESIGN Cross-sectional survey. SETTING Outpatient clinic of a rehabilitation center. PARTICIPANTS One hundred seven stroke patients (68 men, 39 women; mean age, 60.9 y) attending the outpatient clinic of a rehabilitation center. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patients were interviewed on pain, QOL, mood, and functional status by using the short form of the Brief Pain Inventory (BPI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Beck Depression Inventory, and Modified Barthel Index (MBI), respectively. RESULTS Self-reported chronic pain was present in 45 patients (42%), with 32 having musculoskeletal pain and 13 central poststroke pain. It was significantly more common in patients with a shorter poststroke duration (P=.025), but was not related to the nature of stroke (infarct or bleed), age, gender, presence of depression, and MBI score. There was no difference in the SF-36 scores between patients with and without pain except for the domain of bodily pain. When compared with patients with musculoskeletal pain, patients with central poststroke pain were more likely to have sensory impairments (P=.009), higher pain scores on the question "least pain in the past 24 hours" of the BPI (P=.036), and lower scores on the vitality domain of the SF-36 (P=.042). CONCLUSION Pain is common in chronic stroke patients, and it does not appear to have a significant effect on patients' QOL.
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Affiliation(s)
- Keng-He Kong
- Tan Tock Seng Hospital Rehabilitation Centre, Singapore.
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Gustafsson L, McKenna K. Treatment approaches for clients with a stroke-affected upper limb: Are we following evidence-based practice? Aust Occup Ther J 2003. [DOI: 10.1046/j.1440-1630.2003.00395.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gamble GE, Barberan E, Laasch HU, Bowsher D, Tyrrell PJ, Jones AKP. Poststroke shoulder pain: a prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke. Eur J Pain 2003; 6:467-74. [PMID: 12413435 DOI: 10.1016/s1090-3801(02)00055-1] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Shoulder pain is known to retard rehabilitation after stroke. Its causes and prognosis are uncertain. This study describes the incidence of poststroke shoulder pain prospectively, in an unselected stroke population in the first 6 months after stroke and identifies risk factors for developing pain. METHODS 297 patients with possible stroke were screened and stroke diagnosed in 205 cases. The 152 patients entered the study of which 123 patients were assessed up to 6 months. This cohort, with a mean age of 70.6 years, was examined at 2 weeks, 2, 4, and 6 months. A history of shoulder pain, Barthel score, anxiety and depression score were recorded. Full neurological and rheumatological examination was undertaken, using the contralateral side as a control. Pain outcome and stroke outcome was recorded at subsequent visits. RESULTS 52 (40%) patients developed shoulder pain on the same side of their stroke. There was a strong association between pain and abnormal shoulder joint examination, ipsilateral sensory abnormalities and arm weakness. Shoulder pain had resolved or improved at 6 months in 41 (80%) of the patients with standard current treatment. CONCLUSIONS Shoulder pain after stroke occurred in 40% of 123 patients surviving, consenting and not too unwell to participate. This included 52 patients of an original cohort of 205 patients presenting with stroke. Eighty percent of patients made a good recovery with standard treatment Patients with sensory and or motor deficits represent at risk sub-groups.
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Affiliation(s)
- Giles E Gamble
- Elderly Care Department, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK.
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Lindfield H. Chronic shoulder pain in stroke. Are we missing the acupoint? PHYSIOTHERAPY RESEARCH INTERNATIONAL 2002; 7:44-50. [PMID: 11992984 DOI: 10.1002/pri.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Snels IA, Beckerman H, ten Kate JJ, Lankhorst GJ, Bouter LM. Measuring subluxation of the hemiplegic shoulder: reliability of a method. Neurorehabil Neural Repair 2002; 15:249-54. [PMID: 11944748 DOI: 10.1177/154596830101500314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Subluxation of the shoulder after stroke can be measured according to the method described by Van Langenberghe and Hogan. METHODS To evaluate the reliability of this method, the shoulder radiographs of 25 patients were available for this study. Two independent raters each assessed these radiographs twice. RESULTS The intrarater reliability was good: percentage of agreement was 88 and 84%, weighted kappa, 0.69 [95% confidence interval (CI), 0.38-1.0] and 0.78 (95% CI, 0.60-0.95) for raters 1 and 2, respectively. The interrater reliability was poor: percentage of agreement was 36 and 28%, kappa, 0.11 (95% CI, 0.0-0.31) and 0.09 (95% CI, 0.0-0.23) in sessions 1 and 2, respectively. Subsequently the original method was adjusted by combining two categories (no subluxation and beginning subluxation) into one ("no clinically important subluxation"). CONCLUSIONS After this adjustment of the categories, the interrater reliability improved [percentage of agreement, 72%, and kappa, 0.49 (95% CI, 0.18-0.80)], but did not reach acceptable values.
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Affiliation(s)
- I A Snels
- Department of Rehabilitation Medicine, University Hospital, and Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands
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Turner-Stokes L, Jackson D. Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil 2002; 16:276-98. [PMID: 12017515 DOI: 10.1191/0269215502cr491oa] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Shoulder pain is a common complication of stroke. It can impede rehabilitation and has been associated with poorer outcomes and prolonged hospital stay. This systematic review was undertaken to inform the development of an evidence-based integrated care pathway (ICP) for the management of hemiplegic shoulder pain (HSP). AIMS AND OBJECTIVES 1) To provide a background understanding of the functional anatomy of the shoulder and its changes following stroke. 2) To review the literature describing incidence and causation of HSP and the evidence for factors contributing to its development. 3) To appraise the evidence for effectiveness of different interventions for HSP. METHODS Data sources comprised a computer-aided search of published studies on shoulder pain in stroke or hemiplegia and references to literature used in reviews (total references = 121). MAIN FINDINGS Although a complex variety of physical changes are associated with HSP, these broadly divide into 'flaccid' and 'spastic' presentations. Management should vary accordingly; each presentation requiring different approaches to handling, support and intervention. (1) In the flaccid stage, the shoulder is prone to inferior subluxation and vulnerable to soft-tissue damage. The arm should be supported at all times and functional electrical stimulation may reduce subluxation and enhance return of muscle activity. (2) In the spastic stage, movement is often severely limited. Relieving spasticity and maintaining range requires expert handling; overhead exercise pulleys should never be used. Local steroid injections should be avoided unless there is clear evidence of an inflammatory lesion. CONCLUSIONS HSP requires co-ordinated multidisciplinary management to minimize interference with rehabilitation and optimize outcome. Further research is needed to determine effective prophylaxis and document the therapeutic effect of different modalities in the various presentations. Development of an integrated care pathway provides a reasoned approach to management of this complex condition, thus providing a sound basis for prospective evaluation of different interventions in the future.
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Affiliation(s)
- Lynne Turner-Stokes
- Regional Rehabilitation Unit, Northwick Park and St Mark's Hospital Trust, Harrow, Middlesex, UK.
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Wang RY, Yang YR, Tsai MW, Wang WTJ, Chan RC. Effects of functional electric stimulation on upper limb motor function and shoulder range of motion in hemiplegic patients. Am J Phys Med Rehabil 2002; 81:283-90. [PMID: 11953546 DOI: 10.1097/00002060-200204000-00007] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The present study examines functional electric stimulation (FES) applied on patients with hemiplegia of short and long duration for the purpose of upper limb motor recovery and increasing shoulder range of motion. DESIGN Patients with hemiplegia with subluxation participating in the study were placed into a short-duration group or a long-duration group. Subjects in each group were then randomly assigned to either the control or the experimental subgroup. The experimental groups of both short- and long-duration groups received FES therapy in which the supraspinatus and posterior deltoid muscles were induced to contract repetitively up to 6 hr a day for 6 wk. Duration of FES session and muscle contraction/relaxation ratio were progressively increased as performance improved. The experimental groups also received a second 6-wk FES therapy 6 wk after completing the first FES therapy. RESULTS After the first 6-wk FES therapy, the experimental group of short-duration hemiplegia showed significant improvements in motor recovery as indicated by Fugl-Meyer scores compared with the control group. Such significant improvement did not occur for the experimental group of long-duration hemiplegia. The changes in the second FES treatment program were insignificant. CONCLUSIONS This study suggests that patients with hemiplegia of short duration are effectively trained by FES for motor recovery.
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Affiliation(s)
- Ray-Yau Wang
- Faculty of Physical Therapy, National Yang-Ming University, Taipei, Taiwan, Republic of China
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48
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Tyson SF, Chissim C. The immediate effect of handling technique on range of movement in the hemiplegic shoulder. Clin Rehabil 2002; 16:137-40. [PMID: 11911511 DOI: 10.1191/0269215502cr480oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE To assess the immediate effect of two different handling. techniques on range of flexion in the hemiplegic shoulder. METHOD A randomized controlled design with within-subject comparison was used. Range of shoulder flexion was measured using a bubble goniometer. Range of passive movement was compared as the weak arm was lifted using an 'axilla hold' (when the gleno-humeral joint is supported and held in external rotation) and a 'distal hold' (when the arm is lifted at the forearm without shoulder support). Twenty-two people with arm weakness following stroke were recruited. They were inpatients or attending a day hospital in two NHS trusts, with no previous limitation of range or function of their arm. A paired t-test was used for analysis. RESULTS Mean shoulder flexion for the axilla hold was 115.2 degrees (SD 38.45), and 97.7 degrees (SD 44.7) for the distal hold. This difference was significant at p < 0.001 (95% confidence interval (95% CI) 7.96, 26.88). CONCLUSIONS Lifting the hemiplegic arm by holding the humerus under the axilla and maintaining external rotation produces greater range of flexion at the hemiplegic shoulder than a 'distal hold'.
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Affiliation(s)
- S F Tyson
- Department of Health Studies, Brunel University, Middlesex, UK.
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49
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Snels IAK, Dekker JHM, van der Lee JH, Lankhorst GJ, Beckerman H, Bouter LM. Treating patients with hemiplegic shoulder pain. Am J Phys Med Rehabil 2002; 81:150-60. [PMID: 11807352 DOI: 10.1097/00002060-200202000-00013] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies on the efficacy of available methods of treatment for hemiplegic shoulder pain are reviewed in an attempt to identify the most effective treatment for this problem. Because of the poor quality of the 14 selected studies, no definite conclusion can be drawn about the most effective method of treatment. However, functional electrical stimulation and intra-articular triamcinolone acetonide injections seem to be the most promising treatment options.
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Affiliation(s)
- Ingrid A K Snels
- Department of Rehabilitation Medicine, University Hospital, Vrije Universiteit, Amsterdam, The Netherlands
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50
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Kondo I, Hosokawa K, Soma M, Iwata M, Maltais D. Protocol to prevent shoulder-hand syndrome after stroke. Arch Phys Med Rehabil 2001; 82:1619-23. [PMID: 11689984 DOI: 10.1053/apmr.2001.25975] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the effectiveness of a protocol designed to restrict passive movement of affected upper extremity on the incidence of shoulder-hand syndrome (SHS) after stroke. DESIGN Before-and-after trial: follow-up duration of subject group and historical control group 231.6 and 257.2 days, respectively. SETTING Rehabilitation medicine department in a hospital in Japan. PARTICIPANTS SUBJECTS 81 stroke patients treated with the protocol from 1994 to 1996 who were followed for at least 4 months from the onset of stroke; controls: 71 stroke patients treated without the protocol from 1991 to 1994 who were followed for same length of time. INTERVENTION Use of a set protocol for controlled passive movement by trained therapists and restriction of passive movement by the patients for 4 months after stroke. The SHS criterion used to detect early signs of SHS has not yet been validated. Corticosteroids were given to all subjects diagnosed with SHS. MAIN OUTCOME MEASURES Swelling index, SHS diagnostic criteria applied in physical exam, Brunnstrom stage, and sensory disturbance evaluations. RESULT The incidence of SHS in the subject group was 18.5% (n = 15), whereas the incidence of SHS in the control group was 32.4% (n = 23). The difference between the 2 groups was statistically significant (chi(2) = 3.885, p < .05). CONCLUSION The protocol helped to prevent development of SHS.
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Affiliation(s)
- I Kondo
- Department of Rehabilitation Medicine, Institute of Brain Science, Hirosaki University, Japan.
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