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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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 review summarizes the recent advances in glenohumeral subluxation (GHS) in hemiplegic patients and analyzes the reliability and validity of clinical evaluation and the effectiveness of different treatment approaches. GHS, a common complication of stroke, can be considered an important risk factor for shoulder pain and other problems. GHS is a complex phenomenon, and its pathomechanics are not yet fully understood. Radiographic measurements are considered the best method of quantifying GHS. Clinical evaluation can be useful as screening assessment. Functional electrical stimulation and strapping are effective in an acute stage of hemiplegia; some types of slings have been shown to be effective and may be used together with other strategies.
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PMID:Glenohumeral subluxation in hemiplegia: An overview. 1632 Jan 50

Precise muscle co-ordination is required to maintain normal shoulder function and alterations in synchrony between shoulder muscles can result in loss of full range of movement and pain. Although shoulder pain in kayakers is high with 53% of elite international paddlers reporting shoulder injuries, little information is available regarding the pattern of shoulder muscle recruitment during paddling. The aim of this study was to investigate the normal recruitment pattern of shoulder muscles during the kayak stroke. Nine recreational paddlers without shoulder pain were examined. EMG data from eight shoulder muscles of the dominant arm were collected simultaneously with video data during simulated paddling on an ergometer. EMG data was normalized to time and peak amplitude. Intersubject consistency was evaluated using Pearson correlation analysis. The results of this study indicated a fair to high correlation in at least one phase of the kayak stroke in five of the muscles examined: upper trapezius, supraspinatus, latissimus dorsi, serratus anterior and rhomboid major. This normative data will enable comparisons with the shoulder muscle recruitment patterns in kayakers with shoulder pain in order to determine the role of altered motor control in the painful kayaking shoulder.
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PMID:Shoulder muscle recruitment patterns during a kayak stroke performed on a paddling ergometer. 1651 67

Shoulder joint pain occupies the second place among muscle-skeletal disorders in frequency categories. A main reason of this problem are overload, trauma, osteoartchritis or spascity after stroke. An aim of this study was to determinate an influence of crotherapy and warm radiation on effectivness of kinesitherapy in shoulder pain treatment. A group of thirty patients (20 women and 10 men in the age between 30 and 65 years old) was examined in categories of free-range movement and a strength of muscles lying near the joint. It was done before and after a treatment, which was, consists of kinesitherapy and physical procedures. Results show that a both methods are useful but cryotherapy acting a little stronger. Physiotherapy should be recommended in shoulder pain as a treatment of choice.
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PMID:[Aspects of physiotherapy in treatment of shoulder joint pain]. 1652 32

The purpose of this paper is to look at the different motions swimmers produce while practicing their sport and how these different motions cause problems with glenohumeral joint impingement, or "swimmer's shoulder." All four competitive strokes were analyzed to determine their effect on shoulder pain. Reasons for swimmers' impingement problems include long and demanding training seasons, lack of strength and flexibility, hypovascularity in the rotator cuff tendons, and different bony configurations that may predispose athletes to shoulder pain. Current methods of prevention of glenohumeral joint impingement syndrome include strengthening and flexibility exercises and supervision of proper stroke mechanics. Treatment includes the use of modalities, such as ice, ultrasound, electrical muscle stimulation, NSAIDs, and pain-free exercises.
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PMID:1995 student writing contest winner: glenohumeral joint impingement in swimmers. 1655 58

No pain scale is available for stroke patients due to the presence of language or cognitive disorders. However, the Faces Pain Scale (FPS), which was initially developed for children, has been used with success in adults with cognitive impairments. The aim of this study is to test whether the FPS could be used in left or right hemispheric stroke patients (LHSP, RHSP). One hundred twenty-seven stoke patients and 21 controls were recruited in 2 rehabilitation units. Construct validity of FPS was assessed by rating and ranking facial expressions. FPS was correlated to a Visual Analog Scale (VAS) and to a Verbal Rating Scale (VRS) for the assessment of shoulder pain. Reliability was determined by test-retest procedures. Performances of RHSP in the ranking and rating procedures were very poor compared to LHSP and to controls. However, in the assessment of patients' shoulder pain, FPS scores were highly correlated with VAS and VRS in both stroke groups (r=0.65-0.82, p<10(-3)). FPS was more reliable in LHSP than in RHSP. It was preferred to VAS and VRS in LHSP, while in RHSP VAS was the preferred scale. The present study provides preliminary support for the validity and the reliability of FPS in LHSP. However, we do not recommend its sole use in stroke patients. Further studies are needed to determine whether FPS can be used in stroke patients for assessing changes in severity of pain over time.
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PMID:Use of the Faces Pain Scale by left and right hemispheric stroke patients. 1751 62

This review provides a comprehensive overview of the clinical uses of neuromuscular electrical stimulation (NMES) for functional and therapeutic applications in subjects with spinal cord injury or stroke. Functional applications refer to the use of NMES to activate paralyzed muscles in precise sequence and magnitude to directly accomplish functional tasks. In therapeutic applications, NMES may lead to a specific effect that enhances function, but does not directly provide function. The specific neuroprosthetic or "functional" applications reviewed in this article include upper- and lower-limb motor movement for self-care tasks and mobility, respectively, bladder function, and respiratory control. Specific therapeutic applications include motor relearning, reduction of hemiplegic shoulder pain, muscle strengthening, prevention of muscle atrophy, prophylaxis of deep venous thrombosis, improvement of tissue oxygenation and peripheral hemodynamic functioning, and cardiopulmonary conditioning. Perspectives on future developments and clinical applications of NMES are presented.
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PMID:Neuromuscular electrical stimulation in neurorehabilitation. 1729 44

The purposes of this report were to: 1) determine the amount of upper extremity use in people with hemiparesis post stroke during their inpatient rehabilitation stay, and 2) to examine the relationships between upper extremity use and impairments and activity limitations at this early time point after stroke. We studied 34 subjects with mild-to-moderate acute hemiparesis (mean time since stroke = 9.3 days) and 10 healthy control subjects. Upper extremity use was measured over 24 hours using bilateral wrist accelerometers. Upper extremity impairments and activity limitations were measured using standard clinical techniques and tests. We found that healthy control subjects use their dominant and nondominant upper extremities 8-9 hours per day. Hemiparetic subjects used their affected and unaffected upper extremities substantially less than control subjects, 3.3 and 6.0 hours per day, respectively. Seven of ten impairment level measures and each of the activity level measures were related to affected upper extremity use. The impairment measures that were related to upper extremity use were those measures that assessed the ability to activate muscles (ie active range of motion and force production) and the measurement of shoulder pain. Our data show that affected upper extremity use is minimal during the inpatient rehabilitation stay, especially given that patients in this setting are required to have 3 hours of therapy per day. We speculate that accelerometer measurements of upper extremity use could be used in a variety of settings and that the objective information they provide would be of great value to clinicians as they select treatments and evaluate progress.
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PMID:Upper extremity use in people with hemiparesis in the first few weeks after stroke. 1755 58

Pain following stroke is a common but often neglected problem. Headache is present in about one fourth of patients in the acute phase. Later, chronic musculoskeletal pain including shoulder pain may be present, partly due to muscle weakness, posture and stiffness. Central neuropathic pain is a chronic pain, often described as burning or shooting and in some cases associated with pain evoked by light touch or cold. Central pain usually develops within months after the stroke and is located within the area of sensory abnormality corresponding to the CNS region damaged by the stroke.
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PMID:[Poststroke pain]. 1795 64

Botulinum toxin type A (BTX-A) has been used to treat several neurological conditions such as sialorrhea, hyperhydrosis, dystonia, hemifacial spasm, spasticity and pain. Although spasticity has been successfully treated with BTX-A, few are the authors studying the use of BTX-A to treat shoulder pain secondary to stroke. In order to study if BTX-A is effective to treat post-stroke shoulder pain, we followed up during 4 months 16 patients with sustained shoulder pain. Patients received BTX-A according to previous discussion with the rehabilitation group to determine the muscles and dose to be injected and were evaluated by the join range of motion and analogic pain scale. There was decrease of pain during shoulder motion, mainly during the movements of extension and rotation. We conclude that BTX-A is a safe and efficacious therapy.
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PMID:Botulinum toxin type A for refractory post-stroke shoulder pain. 1854 85


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