Evaluation of Pain and Ultrasonography on Shoulder in Poliomyelitis Wheelchair Basketball Players / 대한스포츠의학회지

The purpose of this study was to determine shoulder pain and shoulder ultrasonographic findings in poliomyelitis Wheelchair Basketball (WB) players. Three physicians performed physical examinations and interviewed WB players about their shoulder pain by using Wheelchair User's Shoulder Pain Index (WUSPI), Performance-Corrected WUSPI (PC-WUSPI), and Shoulder Pain and Disability Index (SPADI). One physician performed shoulder ultrasonography on WB players. All confirmed their International Wheelchair Basketball Federation (IWBF) classifications through Korean Wheelchair Basketball Federation (KWBF). Seventeen men and 6 women players were enrolled in the study, with 46 shoulders evaluated. Nine players had unilateral lower extremity weakness and 14 players were bilateral weakness. Six players used wheelchair for daily living, and 17 players used wheelchair only when playing WB. They were 44.35+/-5.42 years old on average. They had played WB for 11.09+/-9.49 years and trained 8.69+/-3.83 hours a week. PC-WUSPI was significantly correlated with age (p=0.014). There were no significant differences between time spent playing WB, training time for WB, types of poliomyelitis involvement, their use of wheelchair, and WUSPI, PC-WUSPI and SPADI. Tendon tear prevalence was significantly different with training time for WB (p=0.021). Most common abnormal shoulder ultrasonographic findings were subscapularis and supraspinatus tendinopathy. Tendinopathy and tendon tear prevalence did not differ significantly with age, time spent playing WB, types of poliomyelitis, and the use of wheelchair. High prevalence of shoulder pain and rotator cuff pathology were found by physical and ultrasonographic examination in the poliomyelitis wheelchair basketball players. Rotator cuff injury prevention program are needed for prevent shoulder pain and rotator cuff pathology.

Comparison of Cardiopulmonary Endurance among Positions in Middle School Soccer Players and Their Sports Injuries / 대한스포츠의학회지

The purpose of this study was to investigate the difference in cardiopulmonary endurance among positions in middle school soccer, and to identify the incidence of sports injuries in association with soccer matches and training. Ninety-six (32 forwards, 27 defenders, 29 midfielders, and eight goalkeeper [GK]) middle school soccer players (12.77+/-0.53 years) participated in this study. They had no medical problems. Their height, weight and body mass index (BMI) were measured, and they also went through tests for maximal oxygen consumption (VO2max). We interviewed middle school soccer players about their soccer careers and their history of sports-related injuries. Physical fitness was compared among players in different playing positions. VO2max was significantly higher in forward and defender groups than GK group. There was no significant relationship in cardiopulmonary endurance among outfield players. GK were taller and heavier than outfield players. BMI was significantly higher in GK group than midfielder group. They had played soccer for 39.08+/-20.28 months on average. During matches and training, forwards suffered 13 injuries (36.1%); defenders suffered 10 injuries (27.8%); midfielders suffered 12 injuries (33.3%); and only one GK came down with an injury (2.8%). The most common types of injuries were to knees (36.1%) and ankles (33.3%).

Strapping on Subluxation of the Hemiplegic Shoulder: Effects of Elasticity Difference Strapped

OBJECTIVE: To investigate the effects of elasticity difference in strapping therapy for 4 weeks in the patients with hemiplegic shoulder. METHOD: Total sixty-two patients with hemiplegic shoulder were randomly enrolled to three groups. In group I, two parts of a Y shaped first tape, were attached from humeral insertion of deltoid muscle to clavicle midline, following anterior and mid deltoid line, respectively, with 125% elasticity. And two parts of a Y shaped second tape were attached horizontally from head of greater tubercle to medial end of scapular spinous process, following supraspinatus and infraspinatus muscles, respectively, with 125% elasticity. Group II patients were applied by the tape with 100% elasticity. Group III was control. The effects of strapping therapy were evaluated by using visual analogue scale (VAS), range of motion (ROM), vertical distance (VD), horizontal distance and joint distance on radiologic findings of plain anteroposterior view and lateral distance on shoulder ultrasonography which was examined between lateral border of acromion and greater tuberosity of humeral head, at entry, 14 and 28 days later. RESULTS: Repeated measured ANOVA indicated that the all groups of the VD showed corrective effect (p<0.05). And for early 14 days, reductions of VAS between the study group I and the other groups were meaningful at this study (p<0.05). CONCLUSION: The strapping therapy is a useful therapeutic tool to decrease the degree of shoulder subluxation and to reduce pain in early rehabilitation therapy of patients with post-stroke hemiplegic subluxation.

Electrophysiological Characteristics of Autonomic Nervous System Function in Post-Stroke Patients

OBJECTIVE: To evaluate the autonomic nervous function in post-stroke patients. METHOD: A total of 58 subjects, 34 post-stroke patients (mean age of 61.35 years) and 24 healthy subjects (mean age of 34.42 years) were included. The sympathetic skin response (SSR), the R-R interval variation (RRIV) and orthostatic hypotension (OH) were evaluated. Bilateral sympathetic skin responses were recorded on the palm and sole with stimulation of both median and tibial nerves. The obtained SSRs were divided into normal response and abnormal response including no response. The R-R interval variations were estimated during rest, deep breathing and Valsalva maneuver respectively. RESULTS: In all healthy subjects, obtained SSRs were of normal response. Although the rate of abnormal SSR was 75.4% (205 of 272 waves) in stroke patients, the rate of abnormal SSR on affected side (81.6%, 111 of 136 waves) was significantly higher than unaffected side (69.1%, 94 of 136 waves) (p0.05). The RRIV of stroke patients with OH (1.09+/-0.06) was significantly lower than in control (1.14+/-0.05) during rest (p<0.01), and in stroke patients without OH, the RRIV (1.13+/-0.06) was also significantly lower than in control (1.27+/-0.22) during Valsalva maneuver (p<0.01). CONCLUSION: Evaluation of SSR and RRIV could be helpful in detecting dysfunction of autonomic nervous system in post-stroke patients.

The Effect of Strapping on Hemiplegic Shoulder Subluxation: A Pilot Study

OBJECTIVE: To investigate the effect of taping therapy on hemiplegic shoulder subluxation. METHOD: Sixty patients were randomly assigned to three groups. In study group, two parts of the first tape was shaped as letter Y and were attached from humeral insertion of deltoid muscle to extension line of the clavicle midline, following anterior and middle deltoid line, respectively, with 125% elasticity. And two parts of the second tape as same as the first tape were attached horizontally from head of greater tubercle to medial border of scapular, following supraspinatus and infraspinatus muscles, respectively, with 125% elasticity. The placebo group was applied by the tape with 100% and 150% elasticity and control group was not applied. The effects of strapping were evaluated by using visual analogue scale (VAS), passive range of movement (ROM), vertical distance (VD) and horizontal distance (HD) on radiologic findings of plain anteroposterior (AP) view and lateral distance (LD) on shoulder ultrasonography at entry (day 0), 1 and 2 days later. RESULTS: Repeated measured analysis of variances indicated that the study group showed corrective effect in the VAS (p<0.05). The control and placebo groups showed no significant change in any parameters of distance measurements and clinical findings. In every group, spasticity, MMT and Brunnstrom stage were not changed during study. CONCLUSION: The taping therapy with 125% elasticity may be helpful for patients with hemiplegic shoulder to reduce pain.

Magnetic Resonance Arthrographic Findings of the Painful Hemiplegic Shoulder

OBJECTIVE: To identify the etiology of hemiplegic shoulder pain by magnetic resonance (MR) arthrography. METHOD: The study included seventy-four hemiplegic patients with shoulder pain. After several physical examinations, all patients had fluoroscopically guided injection by a physiatrist with a maximum of 12~15 ml of contrast agent. Then T1-weighted, T2-weighted and fat-suppressed T1-weighted images were taken at the oblique coronal plane. In addition, fat-suppressed T1-weighted images were obtained at the oblique sagittal and oblique coronal plane. RESULTS: Except for the 9 patients who did not finish the study, the mean age of the participants was 61.5+/-8.9 years and mean duration of the cerebrovascular accident (CVA) was 15.7+/-9.7 weeks. The findings were as follows: 40% supraspinatus tendinitis, 30.8% superior labrum anterior to posterior (SLAP) lesion, 29.2% adhesive capsulitis, 24.6% supraspinatus partial tear, 23.1% biceps tendinitis, 13.8% supraspinatus full thickness tear, 7.7% infraspinatus partial tear. The SLAP lesion had significant statistic relationship with biceps tendinitis (p<0.05) but not with rotator cuff lesion. CONCLUSION: We found that causes of hemiplegic shoulder pain were various. The prevalence of the SLAP lesion was high (30.8%). We recommend the MR arthrography when the hemiplegic shoulder pain does not improve by conventional therapy or the cause of the pain is uncertain.

Comparison of Activity Patterns between Rehabilitation Stroke Unit and Mixed Rehabilitation Ward for Stroke Patients

OBJECTIVE: To determine if the physical design and organizational structure of rehabilitation stroke unit (RSU) is related to the amount of patients' activity pattern. METHOD: An observational study was conducted using behavioral mapping method. Time samples of the motor activity of patients following stroke were taken at 10-minute interval, between 7 AM and 7 PM both on weekdays and weekends. At each observation, physical activity patterns, location in which the patients spent their time, and other person present were recorded. RESULTS: RSU patient spent less time in non-therapeutic activity and more time in therapeutic activity (p<0.05). There were significant differences in the locations of patient's position between the two types of ward (p<0.05). RSU patients had significantly more interaction with formal carerand less time disengaged (p<0.05). The proportion of time in therapeutic activity was low in all location, with patients spending many hours in bed and doing nothing. There was no significant differences in total Functional Independence Measure (FIM) scores at admission and on discharge, FIM gain, and FIM efficiency between RSU and mixed rehabilitation ward (p<0.05). CONCLUSION: In spite of quantitative difference, the two wards had similar patterns of treatment activity and deployment of staff. These maybe resulted in similar treatment experiences for patient and no functional differences between two wards. It appears that strategies are required so that patients can be practicing at an more appropriate level.