Scapular Upward Rotation During Passive Humeral Abduction in Individuals With Hemiplegia Post-stroke

Moment arms of the deltoid, infraspinatus and teres minor muscles for movements with high range of motion: A cadaveric study

BACKGROUND

Moment arms are an indicator of the role of the muscles in joint actuation. An excursion method is often used to calculate them, even though it provides 1D results. As shoulder movement occurs in three dimensions (combination of flexion, abduction and axial rotation), moment arms should be given in 3D. Our objective was to assess the 3D moment arms of the rotator cuff (infraspinatus and teres minor) and deltoid muscles for movements with high arm elevation.

METHODS

The 3D moment arms (components in plane of elevation, elevation and axial rotation) were assessed using a geometric method, enabling to calculate the moment arms in 3D, on five fresh post-mortem human shoulders. Movement with high range of motion were performed (including overhead movement). The humerus was elevated until it reaches its maximal posture in different elevation plane (flexion, scaption, abduction and elevation in a plane 30° posterior to frontal plane).

FINDINGS

We found that the anterior deltoid was a depressor and contributes to move the elevation plane anteriorly. The median deltoid was a great elevator and the posterior deltoid mostly acted in moving the elevation plane posteriorly. The infraspinatus and teres minor were the greatest external rotator of the shoulder. The position of the glenohumeral joint induces changes in the muscular moment arms. The maximal shoulder elevation was 144° (performed in the scapular plane).

INTERPRETATION

The knowledge of 3D moment arms for different arm elevations might help surgeons in planning tendon reconstructive surgery and help validate musculoskeletal models.

Intervention Effect of Rehabilitation Robotic Bed Under Machine Learning Combined With Intensive Motor Training on Stroke Patients With Hemiplegia

It was aimed to discuss the effect of bed-type rehabilitation robots under machine learning combined with intensive motor training on the motor function of lower limbs of stroke patients with hemiplegia. A total of 80 patients with stroke hemiplegia were taken as the subjects, who all had a course of treatment for less than 6 months in the Rehabilitation Medicine Department of Ganzhou Hospital. These patients were divided into the experimental group (40 cases) and the control group (40 cases) by random number method. For patients in the control group, conventional intensive motor training was adopted, whereas the conventional intensive motor training combined with the bed-type rehabilitation robot under machine learning was applied for patients in the experimental group. Fugl-Meyer Assessment of Lower Extremity (FMA-LE), Rivermead Mobility Index (RMI), and Modified Barthel Index (MBI) were used to evaluate the motor function and mobility of patients. The human–machine collaboration experiment system was constructed, and the software and hardware of the control system were designed. Then, the experimental platform for lower limb rehabilitation training robots was built, and the rehabilitation training methods for stroke patients with hemiplegia were determined by completing the contact force experiment. The results showed that the prediction effect of back-propagation neural network (BPNN) was better than that of the radial basis neural network (RBNN). The bed-type rehabilitation robot under machine learning combined with intensive motor training could significantly improve the motor function and mobility of the lower limbs of stroke patients with hemiplegia.

Early multidisciplinary prevention program of post-stroke shoulder pain: A randomized clinical trial

OBJECTIVE

To evaluate if positioning the upper-limb promoting abduction, external rotation and flexion of the shoulder reduces the intensity of post-stroke shoulder pain at day-7 compared to usual clinical practice.

DESIGN & SETTING

Prospective single-center randomized clinical trial using a superiority design comparing two preventive strategies of post-stroke shoulder pain in a stroke unit.

SUBJECTS

Patients were included within 2 days from a first symptomatic ischemic stroke affecting shoulder motor function.

INTERVENTIONS

Intervention group included specific positioning of the shoulder in abduction, external rotation and flexion in bed, chair and during mobilization. Control group referred to usual practice i.e. positioning using a standard support scarf.

MAIN MEASURES

Primary outcome was the intensity of shoulder pain assessed by the visual analog scale (VAS) (0-100) at day-7 post-stroke. Other outcomes measured at day-7 and 2 months post-stroke were the VAS, motor function, spasticity, depression, functional independence and rates of complex regional Pain syndrome (CRPS).

RESULTS

76 patients (49 males; mean age = 68.3) were randomized. The shoulder pain at day-7 was not different between the control group (16.1, SD = 27.4) and the intervention group (10.3, SD = 21.5, p = 0.18) as well as at 2 months (p = 0.12). A lower rate of depression was observed in the intervention group at 2 months 36.7% (CI95% 19.9;56.1) vs 52.9% (CI95% 35.1;70.2). No between-group difference in other outcomes was observed at 2 months.

CONCLUSIONS

This study failed to demonstrate the benefit of a specific positioning tool in reducing the intensity of post-stroke shoulder pain which was lower than previously reported in the literature.