ABSTRACT
Objective:To compare the immediate effectiveness of elbow forearm support with that of a traditional shoulder sling in reducing glenohumeral subluxation (GHS) after a stroke.Methods:Eight stroke survivors with GHS were randomized to receive either 30 minutes of intervention of an elbow forearm support treatment or a traditional shoulder sling treatment twice within 24 hours. Their healthy and affected shoulders were X-rayed before and right after the treatment is ongoing as well as after the end of the 30 min of treatment. The vertical (VD) and horizontal (HD) distances from the lower edge of the acromion to the center of the humeral head were measured. The satisfaction of the patients and their relatives was surveyed.Results:The average VD and HD improved significantly more after wearing the elbow forearm support. Moreover, the patients and their relatives expressed greater satisfaction with the elbow forearm support.Conclusion:Either an elbow forearm support or a traditional shoulder sling will have an immediate effect in reducing shoulder subluxation, but the elbow forearm support is more effective and gives greater satisfaction.
ABSTRACT
Background: Shoulder subluxation in stroke is one of the most common and challenging squeals. Shoulder subluxation limits the patient’s daily activities, and it may lead to permanent disability. NMES (NeuroMuscular Electrical Stimulation) had been studied widely on shoulder subluxation with controversial results, but no evidence is reported of its effectiveness in shoulder subluxation. As NMES helps in producing strong contraction and thereby helps in improving the strength of the muscles and as it also helps in learning to contract appropriate muscles, this study was made to examine the Effectiveness of Electrical Stimulations in reducing Subluxation of the Shoulder after Stroke. Method: Study design, A Randomized control experimental design of 30 subjects. Subjects were randomly assigned into two groups, experimental (NMES group) and control (Non-NMES group) with 15 subjects in each group. Outcome measures were taken before and after the intervention on both the groups by using ‘Pain Estimation Scale’ (PES), 'Subluxation Grading’ by X-rays (AP view) and upper arm section of ‘Motor Assessment Scale’(MAS). Experimental group electrodes were placed over posterior deltoid and supraspinatus. Treatment time was 30 mints two times a day for five days in a week and six weeks. Results: Comparison of electrical stimulation with non-electrical stimulation was done by considering the differences of pre and post treatments in both groups and significance is observed by using independent sample t-test. Statistical analysis proved that there was significant (p<0.05) improvement using NMES compared to NON-NMES in all the three parameters. Conclusion: Electrical stimulation has shown significant improvement in reducing shoulder subluxation, pain and increased motor recovery of the arm in stroke patients compared to the patient's given non-electrical stimulation training.
ABSTRACT
@#Objective To observe the effect of athletic taping on shoulder subluxation in stroke patients with hemiplegia. Methods From March, 2017 to March, 2018, 40 stroke patients with hemiplegia were randomly divided into control group (n = 20) and experiment group (n = 20). They all accepted routine rehabilitation training, and the experiment group accepted athletic taping before the training. They were measured acromio-humeral distance (AHD) before and after four weeks of treatment. Meanwhile, the were assessed with Visual Analogue Scale (VAS) of pain, simplified Fugl-Meyer Assessment-upper extremity (FMA-UE) and Functional Comprehensive Assessment (FCA). Results AHD, and scores of VAS, FMA-UE and FCA improved in both the groups after treatment (Z > 3.508, t > 4.544, P < 0.001), and improved more in the scores of VAS, FMA-UE and FCA in the experiment group than in the control group (Z = -3.151, t > 2.843, P < 0.01). Conclusion Athletic taping can alleviate shoulder pain, promote upper limb functional recovery and improve the ability of daily living for stroke patients with hemiplegia.
ABSTRACT
Objective To explore the effects of the neotype hand-arm sling on shoulder subluxation and transferring movement in hemiplegic stroke patients.Methods Thirty hemiplegic stroke survivors with shoulder subluxation and poor elbow flexor muscle tone (＜2 on the Modified Ashworth Scale).were selected and randomly divided into three groups.Group 1 was trained in static upright standing,plus 10 min of sit-to-stand training and 20 min of walking training with no support for the hemiplegic,subluxed shoulder.Group 2 did the same training using a bagtype shoulder sling,and group 3 used the neotype hand-arm sling.Index finger palpation was used to evaluate the degree of shoulder subluxation,and the Five Times Sit-to-Stand (FTSST) and Timed Up-and-Go (TUG) times for the three groups were compared.Results In the static standing training,both the bag-type sling and the neotype hand-arm sling could effectively reduce shoulder subluxation.However,after 10 min of sit-to-stand training the neotype hand-arm sling was found to be significantly superior to the bag-type shoulder sling in improving shoulder subluxation,with the latter having no effect on shoulder subluxation.In the 20 rin of walking training,the neotype hand-arm sling provided significantly more effective support than the bag-type shoulder sling,although both could support the shoulders.Those using the neotype sling had shorter FTSST times,though there were no significant differences in the average TUG times.Conclusions The neotype slings can more effectively counter shoulder subluxation in upright stance,especially during sit-to-stand maneuvers and walking.It might have positive effects on transferring ability.
ABSTRACT
@#Objective To observe the effect of Arm Spasticity Inhibitor worn in rehabilitation training on patients with upper extremities spasticity and shoulder subluxation after stroke. Methods 80 stroke patients with flexor spasm in upper extremities complicated with subluxation of shoulder were divided into treatment group and control group equally. Both groups accepted routine medicine and rehabilitation, and the treatment group wore the Arm Spasticity Inhibitor developed ourselves during the rehabilitation training. Their acromio-humeral interval (AHI) was measured with the X- ray; and they were assessed with modified Ashworth Scale (MAS), range of motion of shoulder (ROM) and elbow before and 2 months after treatment. Results It improved more in the AHI, score of MAS and ROM in the treatment group than in the control group after treatment (P<0.001). Conclusion Wearing Arm Spasticity Inhibitor during rehabilitation training may release the spasticity of upper extremities and shoulder subluxation, and improve shoulder function in patients after stroke.
ABSTRACT
Objective To observe the effect of Arm Spasticity Inhibitor worn in rehabilitation training on patients with upper extremities spasticity and shoulder subluxation after stroke. Methods 80 stroke patients with flexor spasm in upper extremities complicated with sublux-ation of shoulder were divided into treatment group and control group equally. Both groups accepted routine medicine and rehabilitation, and the treatment group wore the Arm Spasticity Inhibitor developed ourselves during the rehabilitation training. Their acromio-humeral in-terval (AHI) was measured with the X-ray; and they were assessed with modified Ashworth Scale (MAS), range of motion of shoulder (ROM) and elbow before and 2 months after treatment. Results It improved more in the AHI, score of MAS and ROM in the treatment group than in the control group after treatment (P<0.001). Conclusion Wearing Arm Spasticity Inhibitor during rehabilitation training may release the spasticity of upper extremities and shoulder subluxation, and improve shoulder function in patients after stroke.
ABSTRACT
@#Objective To observe the therapeutical effect of inflatable shoulder harness on hemiplegia subluxation of shoulder joint.Methods 68 stroke patients with hemiplegia subluxation of shoulder joint were divided into two groups: the experiment group (n=34) and the control group (n=34). All the patients accepted routine rehabilitation for subluxation of shoulder joint, meanwhile, the experiment group wore inflatable shoulder harness. The interval between acromion and caput humeralis were measured according to the X-ray before and after treatment, as well as the Fugl-Meyer Assessment and Visual Analogue Scale (VAS) of shoulder pain. Results After 8 week of treatment, the rate of diaplasis or improvement was not different significantly between these groups (P<0.05). Compared to the control group, the incidence and VAS score of shoulder pain, and the score of Fugl-Meyer Assessment improved significantly after the treatment (P<0.05). Conclusion On the basis of routine rehabilitation, inflatable shoulder harness may reduce the incidence and grade of shoulder pain, improve motor function of hemiplegic upper limb further in hemiplegia subluxation of shoulder.
ABSTRACT
OBJECTIVE: To test the effectiveness of the METS (modified extension-type sling) in reducing subluxation in patients with hemiplegic shoulders, and to assess the functional support of METS as the angle of the elbow changes. METHOD: Sixteen flaccid hemiplegics were assessed by the anteroposterior shoulder radiographs. Three parameters, vertical distance (VD), horizontal distance (HD) and joint distance (JD), were measured on both affected and unaffected sides before and after the fitting of the METS and the Bobath sling. Three parameters were also measured in each elbow flexion angle (0degrees, 30degrees, 60degrees, 90degrees) after the fitting of the METS and extension-type sling with a forearm cuff to evaluate the effectiveness in the dynamic condition. RESULTS: In the Bobath sling, the mean values of VD and JD reduced significantly (p0.05). In the Bobath sling, VD, HD and JD were different from the unaffected side (p0.05). As the elbow flexion angle increased with the METS, three parameters were not different from the unaffected side (p>0.05), but with the extension-type sling with a forearm cuff, VD and JD were different from the unaffected side (p<0.05). CONCLUSION: The METS was more effective not only in the reduction of the hemiplegic shoulder subluxation, but also in the maintenance of reduction as the elbow flexion angle changes within various activities.
Subject(s)
Humans , Elbow , Forearm , Hemiplegia , Joints , Orthotic Devices , ShoulderABSTRACT
Objective To investigate the curative effects of selected proprioceptive neuromuscular facilitation (PNF) patterns and techniques on shoulder subluxation soon after strokd. Methods Forty-one stroke patients with shoulder subluxation were randomly divided into a treatment group(n=22) and a control group (n=19). The patients in the treatment group receiveed the selected PNF techniques daily for 4 weeks, while the patients in the control group were treated with their previous therapeutic protocol. The shortest distance from the lower border of the acromion to the nearest point of the humeral head(AHH) was measured. Brunnstron grading was used to evaluate motor function in the affected upper linb, and a visual analogue scale (VAS) to assess subLuxation. Shoulder pain before and after treatment was also assessd. Results There was no significant difference in general condition between the patients in the two groups before treatment. In the treatment group, a significant improvement in AHH distance of the affected shoulder was observed after 4 weeks. Shoulder subluxation waw cured in 13 patients, with AHH distance ＜0.75 cm after 4 weeks of treatment. Conclusion The PNF technique applied was effective for the early treatment of subluxation after stroke. Motor function in the affected upper limb could be improved significantly and pain alleviated.
ABSTRACT
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.
ABSTRACT
OBJECTIVE: To evaluate the effects of functional magnetic stimulation (FMS) on shoulder subluxation following hemiplegia due to stroke or traumatic brain injury. METHOD: Twenty-four hemiplegic patients were participated in this study as FMS group (12 subjects) and FES (functional electric stimulation) group (12 subjects). FMS or FES were applied on the supraspinatus and posterior deltoid muscle area for 20 minutes, 5 days a week for 3 weeks. The effect of treatment was evaluated by assessment of the degree of shoulder subluxation using radiologic measurements, pain threshold and pain tolerance pressure, range of motion of the shoulder, muscle power and spasticity. RESULTS: The degree of shoulder subluxation was signifi-cantly decreased after 3 weeks in both groups, and the FMS group improved more than the FES group. However there were no differences between two groups significantly. There was no significant effect of disease duration on change of shoulder subluxation. The ranges of motion of shoulder were increased in FMS group significantly. Pain threshold and pain tolerance pressure were increased in pectoralis major and infraspinatus muscles shortly after FMS application. CONCLUSION: This study suggests that the FMS could be applied effectively in preventing and reducing the shoulder subluxation in patient with hemplegia irrespective of disease duration.
Subject(s)
Humans , Brain Injuries , Deltoid Muscle , Hemiplegia , Muscle Spasticity , Muscles , Pain Measurement , Pain Threshold , Range of Motion, Articular , Shoulder , StrokeABSTRACT
OBJECTIVE: To compare the radiological corrective effect for shoulder subluxation among GivMohr & other slings in hemiplegic patients. METHOD: Fifteen hemiplegic patients with flaccid upper limb were included. The vertical distance (VD), horizontal distance (HD) & joint distance (JD) on the plain AP views of the shoulders were measured. GivMohr sling was compared with 2 conventional slings, which were forearm cuff type extension sling and Bobath sling, in the effects of correction. RESULTS: The mean values of VD and JD of hemiplegic shoulder increased compared to unaffected side, but those of HD was not different between them. In Bobath sling, VD was significantly reduced and HD was not changed. However, JD was increased as other studies. GivMohr sling and forearm cuff type extension sling showed corrective effect in VD and JD (p<0.05). When compared with these two slings, there were no significant differences in VD and JD. CONCLUSION: The results show that GivMohr sling reduces shoulder subluxation as other slings. This new sling is helpful for patients with flaccid upper limbs to reduce shoulder subluxation.
Subject(s)
Humans , Forearm , Hemiplegia , Joints , Radiography , Shoulder , Upper ExtremityABSTRACT
OBJECTIVE: To identify the etiology of hemiplegic shoulder pain by ultrasonographic and clinical examinations and to determine the correlation between ultrasonographic findings and clinical factors in patients with hemiplegic shoulder. METHOD: Seventy hemiplegic patients with shoulder pain or without shoulder pain were enrolled. All of patients were evaluated by ultrasonography. We analyzed clinical factors including visual analogue scale (VAS) of hemiplegic shoulder pain, shoulder subluxation measured by plain X-ray, shoulder manual muscle test (MMT), passive range of motion (PROM) of the shoulder joint and complex regional pain syndrome (CRPS). RESULTS: 51.0% of patients with shoulder pain showed abnormal ultrasonographic findings, while 9.5% of patients without shoulder pain. Those with abnormal ultrasonographic findings had significantly decreased shoulder PROM in flexion, abduction, external rotation and internal rotation and more severe subluxation of hemiplegic shoulder (p<0.05). CONCLUSION: After investigating the hemiplegic shoulder through ultrasonography, painful hemiplegic shouder had high incidence of abnormal ultrasonographic characteristics. Ultrasonography is more worthwhile and useful as an primary diagnostic method, especially when there is severe shoulder subluxation and the limitation of PROM of shoulder in hemiplegic patients.
Subject(s)
Humans , Hemiplegia , Incidence , Range of Motion, Articular , Shoulder Joint , Shoulder Pain , Shoulder , UltrasonographyABSTRACT
@#ObjectiveTo observe the effect of comprehensive rehabilitation on shoulder subluxation of patients with stroke hemiplegia.MethodsComprehensive rehabilitation was practiced on 20 hemiplegic post-stroke patients with shoulder subluxation, including putting injured limb at correct position, keeping the range of passive motion, resistance exercise of scapula muscle group, and shoulder sting. The therapeutic effect was evaluated after 6 weeks treatment.ResultsThere was a significant difference in the shoulder subluxation and movement function of the upper extremities between pre-therapy and after therapy ( P<0.05～0.01).ConclusionComprehensive rehabilitation has obvious therapeutic effect on shoulder subluxation and motor dysfunction of patients with stroke hemiplegia.
ABSTRACT
We reported three types of newly designed arm slings (the "V" strap pouch arm sling, the Modified hemisling, the Tripod arm sling). The three slings and the conventional hemisling were all tested by a single stroke patient for the correction of shoulder subluxation. Sling effectiveness was evaluated by simple shoulder AP X-rays, quantitative electromyography (root mean square; RMS), strap tension, and preference of the patient. Of the four types, the "V" strap pouch arm sling reduced the vertical displacement the most. RMS values of the supraspinatus muscle tended decrease and strap tension was also lower after using the "V" strap pouch arm sling compared with others. The patient also preferred the "V" strap pouch arm sling to the other slings. We suggested that "V" strap pouch arm sling was the most effective among four types of arm slings (including conventional hemisling) for the correction of shoulder subluxation, and patient's preference.
Subject(s)
Humans , Arm , Electromyography , Shoulder , StrokeABSTRACT
OBJECTIVE: The purpose of this study was to compare the reduction of shoulder subluxation radiologically using two types of extension arm sling. METHOD: Fifteen patients with a hemiplegic shoulder subluxation were studied. Two types of extension sling (forearm cuff type and humeral cuff type) were applied for the shoulder subluxation. On the shoulder X-ray, three parameters were measured: vertical distance (VD), horizontal distance (HD), and joint distance (JD). RESULTS: The mean values of the VD, HD, and JD of hemiplegic shoulder without a sling were 2.00+/-0.69 cm, 2.69+/-0.45 cm, and 1.53+/-0.56 cm, respectively, which were reduced to 1.00+/-0.43 cm, 2.61+/-0.46 cm, and 0.80+/-0.37cm by a forearm cuff type and to 1.80+/-0.83 cm, 2.60+/-0.45 cm, and 1.33+/-0.66 cm by a humeral cuff type. A forearm cuff type showed corrective effect in VD and JD, but a humeral cuff type did not in any of three parameters. When compared with nonhemiplegic side, there was no significant difference in VD and JD with a forearm cuff. But a humeral cuff showed significant difference in all parameters. So a forearm cuff type showed corrective effect this time. CONCLUSION: A forearm cuff type extension arm sling was a more effective orthosis for the reduction of the hemiplegic shoulder subluxation than a humeral cuff type extension arm sling.
Subject(s)
Humans , Arm , Forearm , Hemiplegia , Joints , Orthotic Devices , ShoulderABSTRACT
OBJECTIVE: To introduce a Modified triangular Bobath sling (MTBS) and a MTBS with distal support (MTBSDS) as a new slings and to compare with previous slings in the therapeutic effects of shoulder subluxation in stroke patient. METHOD: Using a simple X-ray with and without slings, the vertical and horizontal distances were measured for 17 stroke patients. MTBS and MTBSDS were compared with 3 conventional slings, which were hemisling, Bobath sling and Extension-type sling, in the effects of correction. The questionaire was used to evaluate preference of patients. RESULTS: In two developed slings, inferior subluxation showed significant correction and lateral displace was less increased than a Bobath sling although it was not statistically significant (p<0.05). MTBS had the preference during non-walking because of comfort and easiness for donning and doffing, whereas MTBSDS had the preference during walking because of reciprocal arm swing and protecting the hemiplegic upper extremity from trauma. CONCLUSION: The results indicated MTBS and MTBSDS were more effective on shoulder subluxation in stroke patients. Further study on the development of slings for decrement of lateral displacement is recommended.
Subject(s)
Humans , Arm , Shoulder , Stroke , Upper Extremity , WalkingABSTRACT
OBJECTIVE: To introduce a newly designed arm sling and to compare the effects on a shoulder subluxation. METHOD: Sixteen hemiplegic patients with shoulder subluxation were evaluated by a simple X-ray with and without the slings and the vertical and horizontal distances on the plain AP views were measured. The newly designed arm sling was compared in terms of the effects of correction with a pouch sling and a Bobath sling. The arm sling designed for this study was developed for the purpose of maintaining patients' hands in a functional position and performing ROM exercise of the shoulder easily. The mean values of the vertical and horizontal distance were compared to determine if there was significant difference of function between the new sling and the conventional slings. Variables such as comfort, choice, and easiness for donning and doffing of the arm slings were evaluated by questions. RESULTS: The new sling provided the patients with good vertical correction of the subluxation (p<0.05) but did not increase the horizontal distance significantly. According to the responses to the questions, the new sling was more comfortable than the conventional slings. CONCLUSION: These results support the effectiveness and the comfort of a new sling to decrease subluxation in hemiplegia. Further study on the long term effects or complication of the new sling is recommended.
Subject(s)
Humans , Arm , Hand , Hemiplegia , Pilot Projects , ShoulderABSTRACT
OBJECTIVE: To evaluate the frequency of complex regional pain syndrome (CRPS) and to determine the risk of CRPS after stroke according to the degree of shoulder subluxation by quantitative radiographic analysis. METHOD: Sixty-four stroke patients (40 male; 24 female, mean age: 59.2 10.4) were included in the study. All subjects underwent a clinical examination that included spasticity and Brunnstrom stage; and a radiologic examination. The diagnosis of CRPS was based on clinical criteria and three-phase scintigraphies. The degree of shoulder subluxation was assessed by the distance between inferomedial point of acromion and the center of humeral head and glenoid fossa. RESULTS: CRPS after stroke occurred in 34 patients (53%). There were significant differences in Brunnstrom stage and shoulder subluxation between the CRPS groups and the non CRPS groups. Among radiographic measurements, vertical distance ratio (involved/uninvolved) and oblique distance ratio indicated a strong correlation with CRPS (p<0.01). Among clinical variables and radiographic measurements, oblique ratio was the most valuable determinant of the risk for CRPS. CONCLUSION: Shoulder subluxation shows a significant correlation with CRPS after stroke. We suggest oblique ratio as a useful measurement of shoulder subluxation to estimate the risk of CRPS.
Subject(s)
Female , Humans , Male , Acromion , Diagnosis , Humeral Head , Muscle Spasticity , Shoulder , StrokeABSTRACT
OBJECTIVE: This study was designed to investigate the correlation between the lateral scapular slide test (LSST) and shoulder subluxation, scapular position, pain on movement, Brunnstrom stage in hemiplegic patients. METHOD: 20 hemiplegic patients (right: 10, left: 10) were evaluated LSST in resting position at three different points (T2-Superior Angle, T3-Scapular Spine, T7-Inferior Angle) in three times of the both shoulder. Muscle power of shoulder, Brunnstrom stages, spasticity, subluxation degrees using X-ray studies and ROM pain degrees using Visual Analog Scale (VAS) were also evaluated to examine the clinical correlation RESULTS: This study showed the evidence of positive correlation with LSST and shoulder subluxation, ROM pain degrees using VAS at T7-inferior angle (p<0.05), and negative correlations with LSST with shoulder abduction muscle power and Brunnstrom stage. But, there were no correlations with shoulder spasticity and hemiplegic side. CONCLUSION: This study provided LSST can be a useful predictor of shoulder subluxation and it supposed that the glenoid fossa on the affected side was upward rotated compared to the unaffected side.