Sensori-motor Recovery In Post-stroke Shoulder Subluxation: A Non Invasive Correlation Study

Background: Stroke is the most common neurological condition causing long term disabilities in various ways.Post-stroke shoulder subluxation, mainly the Gleno-humeral Subluxation (GHS) of the affected side is oftendetected as a complication. Numerous theories exist to explain the pathomechanics of developing GHS,butstudies regarding its relationship with the sensori-motor recovery of the affected limb is still controversial.Aim of Study: To ascertain the correlation between Gleno-humeral subluxation with sensori-motor recovery ofthe affected upper limb following stroke.Method: This correlation study was conducted on 30 patients of both sexes within the age group of 45-65 yearswith post-stroke (duration < 6weeks) Gleno-humeral subluxation( GHS). Screening of GHS was done by palpationand degree of GHS was quantified by High resolution USG by measuring the Acromion - Greater TuberosityDistance difference (AGTDD) between two shoulders. Sensorimotor recovey of the affected limb was assessed byFugl - Meyer Assessment Scale of Upper Extremity (FMA-UE). Data collected at the baseline (visit1), at 6 weeks(visit 2), 12 weeks (visit 3) and at the end of the study i.e 24 weeks (visit 4).Results: Pearson Correlation (r) in all visits (V1: r=-0.926, p=0.000. V2: r=- 0.947, p=0.000. V3: r=- 0.912, p=0.000.V4: r=- 0.924, p=0.000) established a statistically significant negative correlation between degree of shouldersubluxation and sensory-motor recovery.Conclusion: Post-stroke GHS is a significant complication which undoubtedly plays a cardinal negative roleduring sensori-motor recovery of the affected upper limb.KEY WORDS: Gleno-humeral subluxation (GHS), Acromion-Greater Tuberosity Distance difference (AGTDD),

A comparative study between total contact casting and conventional dressings in the non-surgical management of diabetic plantar foot ulcers.

Of all non-traumatic amputations 50% occur in Diabetics, mostly as a final outcome of foot ulcers. A major biomechanical factor in the causation of foot ulcers in persons with diabetes mellitus is elevated peak plantar pressure. Offloading the ulcer area in the form of equalisation of pressure across the plantar surface can accelerate healing of the ulcer. Total contact casting is one such method of offloading, and this study attempts to investigate the advantages of the above method as compared to conventional dressings in the physiatric management of the depth--ischaemia grades 1A, 1B, 2A, 2B neuropathic plantar ulcers in a diabetic patient. The outcome measure was the time taken for complete resolution of the ulcers. Of the 29 patients in Category A treated with total contact casting involving a total of 39 foot ulcers, 36 healed, which was statistically significant (p < 0.05) as compared to 25 out of the 33 ulcers healing in Category B consisting of 26 patients treated by conventional dressings alone. Total contact casting is an effective, rapid, economical, ambulatory and outpatient--based method for the treatment of diabetic foot ulcers.