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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Etiologies of shoulder pain in the hemiplegic population, such as glenohumeral subluxation, frozen shoulder, and reflex sympathetic dystrophy (RSD), have been described extensively. We present an 89-year-old woman with right hemiparesis secondary to ischemic lacunar infarction who developed sudden onset of right shoulder pain on the fifth day of inpatient rehabilitation. The pain was severe, limiting range of motion (ROM) and participation in therapy. Extensive investigations to rule out subluxation, fracture, connective tissue disease, RSD, and pulmonary embolism were negative. Ultimately, her shoulder pain and decreased ROM completely resolved with antibiotic treatment for right lower lobe pneumonia. We conclude that her symptoms were possibly referred pain from diaphragmatic irritation transmitted via right C4 sensory axons in the phrenic nerve, which shares the same dermatome as the right acromion area. This case was an unusual presentation of pneumonia in an elderly woman with hemiplegia. We recommend that pneumonia be considered in the differential diagnoses of shoulder pain.
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PMID:Shoulder pain as an unusual presentation of pneumonia in a stroke patient: a case report. 1098 75

This case report describes the first survivor with chronic stroke who was treated with percutaneous, intramuscular neuromuscular electrical stimulation (NMES) for shoulder subluxation and pain. The patient developed shoulder subluxation and pain within 2 mo of his stroke. After discharge from acute inpatient rehabilitation, he developed shoulder and hand pain, which was treated with subacromial bursa steroid injection and ibuprofen with eventual resolution. The patient remained clinically stable until approximately 15 mo after his stroke-when he developed severe shoulder pain associated with shoulder abduction, external rotation, and downward traction. The patient could not tolerate transcutaneous NMES because of the pain of stimulation. At approximately 17 mo post-stroke, the patient's posterior deltoid, middle deltoid, and supraspinatus muscles were percutaneously implanted with intramuscular electrodes. After 6 wk of percutaneous, intramuscular NMES treatment, marked improvements in shoulder subluxation and pain, and modest improvements in activities of daily living and motor function were noted. One year after the onset of treatment, the patient remained pain free, but subluxation had recurred. However, the patient was able to volitionally reduce the subluxation by abducting his shoulder. The patient remained pain free for up to 40 mo after the initiation of percutaneous, intramuscular NMES treatment. This case report demonstrates the feasibility of using percutaneous, intramuscular NMES for treating shoulder subluxation and pain in hemiplegia.
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PMID:Percutaneous, intramuscular neuromuscular electrical stimulation for the treatment of shoulder subluxation and pain in chronic hemiplegia: a case report. 1127 37

A 37 year old male presented with left hemiplegia, left below knee amputation, right partial foot amputation and claudication pain. The limitations in the rehabilitation management in such a high-risk patient are multiplied. The appreciable benefits from supervised rehabilitation and judicious goal setting can help in improving the functional status and retard the disease progression in such patients. This study highlights that coexisting cerebrovascular, coronary and peripheral vascular diseases can pose a real challenge and can result in multiple disabilities.
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PMID:Multiple vasculogenic disabilities : a challenge in rehabilitation. 1130 50

Neurolytic blockade is one of the therapeutic possibilities to treat spasticity of various muscles. In patients with spasticity of the adductor thigh muscles, a percutaneous approach to the obturator nerve is often difficult. We describe a new approach to the obturator nerve and we examine its feasibility. The second objective was to assess the efficacy of obturator neurolysis for the management of adductor thigh muscle pain and spasticity associated with hemiplegia or paraplegia. Nerve blocks were performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. Neurolysis was performed by injection of 65% ethanol. We performed 27 blocks in 23 patients. Technical evaluation was achieved in terms of number of attempted needle insertions, time to accurate location of the nerve and success rate. The efficacy of the block was assessed using four scores: degree of alleviation of muscle spasm and triple flexion of the lower limb, improvement of gait and facilitation of hygienic care. Success rate of the technique was 100% with a time to accurate nerve location of 130+/-35 s. Compared with scores measured immediately before the block, all studied parameters were significantly improved. Efficiency was significant on adductor muscle spasticity (p<0.001 at 1 day and p<0.01 at 60 and 120 months). Triple flexion was also significantly improved (p<0.05 from 1 to 120 days), as well as gait (p<0.02) and hygiene (p<0.01) scores. No complications occurred. The combined approach of the obturator nerve represents a new technique which proved to be accurate, fast, simple, highly successful and reproducible. Obturator neurolysis was confirmed as an efficient and cost-effective technique to reduce adductor muscle spasm and related pain and to improve gait and hygienic care in patients with neurological sequelae of stroke, head trauma or any lesion of the motor neurone.
Eur J Pain 2002
PMID:Neurolytic blockade of the obturator nerve for intractable spasticity of adductor thigh muscles. 1190 Apr 70

Botulinum toxin A has been reported to reduce spasticity and increase the comfort of hemiplegic patients. The aim of this study was to assess the efficacy of the treatment on disability, especially in manual activities, and to attempt to identify predictive factors of improvement. Twenty patients (mean age: 54.4 years; M: 14; right hemiplegia: 12) were included, with a delay of at least three months after unilateral hemispheric stroke. Botulinum toxin A (BOTOX) was injected into the arm adductors (8 cases), forearm flexors (17 cases), pronators, wrist and finger flexors (20 cases),with a total dose of 200 to 300 U. Examination (day 1 and 15, month 2 and 5) consisted of spasticity assessment (modified Ashworth scale), muscle strength, passive range of motion (goniometry), and pain, followed by functional tests, especially the Rivermead Motor Assessment (RMA) and Nine-hole Peg Test (NHPT). Performance in daily living was assessed with the Functional Independence Measure (FIM), and an original analysis of hand grasp, grip and pinches used in domestic activities (9 items), and of comfort of patients and caregivers. Significant reduction in spasticity was observed on the elbow flexors, pronators, wrist and fingers flexors, especially at day 15 (mean 0.90 to 1 point), with wide variations in effect. Muscle strength was increased in wrist and fingers extensors, with concomitant increase in the opening of the thumb to index finger space. There was no effect on the NHPT requiring distal manipulation, but the RMA, which especially concerned picking up and releasing a tennis ball, showed significant improvement. Furthermore, use of the upper limb in daily living increased, particularly for internal grasping of objects, and for grasping by the top, transporting and releasing of objects. Patients and caregivers re ported facilitation in dressing, and in proximal and distal care of the upper limb. The global flexor position of the limb improved. Ad verse reactions were rare and mostly consisted of transitory pain during injection. The improvement in the RMA was better explained by the quality of the initial motor command on distal prehension (positive correlation with motor strength), and that in hand using in domestic activities by a lower level of spasticity on pronators and wrist flexors (negative correlations with spasticity). Conversely, the severity of the motor deficit (negative correlations with motor strength) and a high level of spasticity before injection (positive correlations with spasticity) mostly explained the improvement in comfort. In conclusion, botulinum toxin A is efficient in improving hand use in patients with relatively preserved distal motricity, and in increasing comfort in patients with severe global disorders.
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PMID:Efficacy of botulinum toxin A in upper limb function of hemiplegic patients. 1195 72

We describe a case of a brain-damaged patient who had a peculiar bodily illusion which could not be labelled an hallucination but seemed somatognosically and phenomenologically similar to the phantom limb without amputation. The patient, who showed left hemiplegia, felt a third upper limb (without seeing it) which he himself defined as "spare." The spare limb was not deformed; it could be moved and controlled by the patient, and there was no sensation of pain. The patient did not show psychopathological or cognitive disorders. A possible interpretation of the phenomenon is as a "phantom movement" of the paralysed limb: the mental representation of the movement of the limb was dissociated from the bodily representation of his own limb and so was still present in his consciousness despite the paralysis.
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PMID:On the syndrome of the "spare limb": one case. 1460 17

The body scheme is a complex of memory patterns secured in the structures of the brain, where the parietal lobes play the most important role. Basic principles are given by the genetic programming of the structure and function along with the synthesis of information brought by means of sensory activity. The unitary perception of the body scheme is a dynamic image, enabling conscious and unconscious representation of our body, its parts, their functions, position, shape and/or movements. The recognition of the body scheme in humans is named somatognosia. Disorders of somatognosia include visceral and somatic phantom, phantom pain and other disorders related to the capability of communication by means of language: autotopoagnosia, hemiasomatognosia, pain asymboly, anosognosia of hemiplegia, anosognosia of blindness, deafness, neglect and other defects appearing at the neurologist's and psychiatrist's borderline of interest. Interest in the visceral phantom is usually much smaller than that in the phantom limb. The aim of this paper was to draw the to phantom phenomena in patients following rectum amputation and colostomy. A survey of contemporary knowledge about the body scheme and its disorders, cortical plasticity and the problem of cortical maladaptation are presented.
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PMID:[Somatognosis, body schema and the phenomena of somatic and visceral phantoms and phantom pain]. 1292 31

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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PMID:Shoulder pain in hemiplegia. 1521 95

Approximately 84% of all stroke patients with hemiplegia will experience shoulder injury and pain. The importance of maintaining proper posture while positioning and transferring a stroke patient is key to decreasing risk for shoulder injury. Shoulder subluxation injury post-stroke is a consequence of sustained hemiplegia and spasticity. Current research evidence suggests that using therapies such as gentle range of motion and functional electrical stimulation may reduce and prevent shoulder subluxation and hemiplegic shoulder pain. However, physiotherapists are currently the only professionals who can implement such therapies. Considering that stroke care provided by neuroscience nurses includes transferring, positioning and assisting in activities of daily living, it is clear that nurses are an important part of the therapy process. Therefore, the question is: "What is the role of the neuroscience nurse in the reduction and prevention of shoulder pain post-stroke?" The purposes of this paper are to i) discuss the causes of shoulder subluxation and related pain post-stroke, ii) review current best practice in prevention and treatment of shoulder subluxation, and iii) explore ways in which the acute neuroscience nurse can prevent or reduce shoulder subluxation in the hemiplegic stroke patient.
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PMID:Post-stroke shoulder subluxation: a concern for neuroscience nurses. 1625 32

This study presents the result of the studies explaining the effects of acupuncture on various systems and symptoms. It has been determined that endomorphin-1, beta endorphin, encephalin, and serotonin levels increase in plasma and brain tissue through acupuncture application. It has been observed that the increases of endomorphin-1, beta endorphin, encephalin, serotonin, and dopamine cause analgesia, sedation, and recovery in motor functions. They also have immunomodulator effects on the immune system and lipolithic effects on metabolism. Because of these effects, acupuncture is used in the treatment of pain syndrome illnesses such as migraine, fibromyalgia, osteoarthritis, and trigeminal neuralgia; of gastrointestinal disorders such as disturbance at gastrointestinal motility and gastritis; of psychological illnesses such as depression, anxiety, and panic attack; and in rehabilitation from hemiplegia and obesity.
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PMID:The mechanism of acupuncture and clinical applications. 1639 78


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