Changes in Muscle Tone, Function, and Pain in the Chronic Hemiparetic Shoulder after Dry Needling Within or Outside Trigger Points in Stroke Patients: A Crossover Randomized Clinical Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2939-2947 ◽  
Author(s):  
Alma R Hernández-Ortíz ◽  
Raquel Ponce-Luceño ◽  
Carlos Sáez-Sánchez ◽  
Olga García-Sánchez ◽  
César Fernández-de-las-Peñas ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Shoulder Pain ◽  
Repeated Measures ◽  
Muscle Tone ◽  
Trigger Point ◽  
Treatment Session ◽  
Dry Needling ◽  
Extremity Function ◽  
Upper Extremity Function

Abstract Objectives To investigate the effects of applying dry needling into a trigger point (TrP) or non-TrP area in people who have suffered a stroke and to investigate if the effects of dry needling are maintained at six-week follow-up. Methods A controlled, repeated-measures, crossover, double-blinded randomized trial was conducted. Nineteen patients with hemiparetic shoulder pain after a stroke event were randomly assigned to receive a single multimodal treatment session combined with TrP dry needling or non-TrP dry needling. The neuro-rehabilitation session included modulatory interventions targeting the central nervous system. Spasticity (Modified Ashworth Scale), shoulder pain intensity (numerical pain rate scale, 0–10), and upper extremity function (Motor Evaluation Scale for Upper Extremity in Stroke [MESUPES], Reaching Performance Scale [RPS]) were assessed before (baseline) and one, two, three, four, five, and six weeks after the treatment session by a blinded assessor. All participants received both sessions in a randomized order where they were followed up for six weeks before receiving the opposite treatment and then followed up for another six weeks. Results Changes in muscle tone (all P > 0.266) and upper extremity function (MESUPES: F = 0.544, P  = 0.465; RPS close task: F = 0.820, P = 0.371; RPS far task: 0.830, P  = 0.368) were similar after both interventions at all follow-up periods. The decrease in shoulder pain was higher within the TrP dry needling group as compared with the non-TrP dry needling group, particularly at two and four weeks (P  = 0.01). Conclusions The effect of dry needling on muscle tone (spasticity) and upper extremity function is not related to its application in or outside of a TrP area. The effect of dry needling on shoulder pain was slightly superior when applied over a TrP in poststroke people. These effects were maintained six weeks after treatment.

scholarly journals Long-Term Quality of Life after Free Flap Upper Extremity Reconstruction for Traumatic Injuries

2019 ◽  
Vol 36 (03) ◽  
pp. 213-222 ◽  
Author(s):  
Sara van Bekkum ◽  
Tim de Jong ◽  
Michiel Zuidam ◽  
Marc A. M. Mureau
Keyword(s):  
Upper Extremity ◽  
Free Flap ◽  
Extremity Function ◽  
Sf 36 ◽  
Patient Reported ◽  
Extremity Reconstruction ◽  
Upper Extremity Function

Abstract Background Microsurgical reconstruction of upper extremity injuries is often challenging, and the resulting impact on the quality of life (QoL) may be significant. However, there is a lack of knowledge on long-term patient-reported QoL. Methods In a retrospective long-term follow-up study, all consecutive patients with an upper extremity injury who had undergone a free flap reconstruction were identified and categorized into three groups based on the type of injury. Patient-reported upper extremity function and QoL were assessed using three validated questionnaires: the 36-item Short Form Health Survey (SF-36), the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Michigan Hand Outcomes Questionnaire (MHQ). Results A total of 61 patients were identified, of whom 10% had undergone a free flap reconstruction for soft tissue loss only, 62% for an injury accompanied by a fracture, and 28% for a (sub) total amputation. Twenty-one (44%) patients responded to the questionnaires, with a mean follow-up time of 9.7 ± 6.2 years. Patients, on average, reported poorer SF-36 “physical component score” and “role limitations due to physical health” scores compared with Dutch norms. Also, they reported poorer mean DASH scores compared with the general population, indicating worse upper extremity function. Mean MQH scores were lower for the injured side compared with the noninjured side. Pain correlated negatively with the total scores of DASH, MHQ, and SF-36. Conclusion Free flap upper extremity reconstruction is challenging. At 10 years of follow-up, the injury and its treatment continued to have a significant impact on the upper extremity function and daily QoL, with chronic pain being an important factor negatively affecting these outcomes.

Postoperative Analysis of Patients Who Received the Universal 2 Total Wrist Implant System

2012 ◽  
Vol 28 (4) ◽  
pp. 466-472 ◽  
Author(s):  
Matthew B.A. McCullough ◽  
Brian D. Adams ◽  
Nicole M. Grosland
Keyword(s):  
Upper Extremity ◽  
Patient Perception ◽  
Joint Stability ◽  
Perceived Disability ◽  
Extremity Function ◽  
Total Wrist Arthroplasty ◽  
Severe Arthritis ◽  
Upper Extremity Function ◽  
Implant System

Third-generation total wrist arthroplasty devices have provided joint stability, relief from pain and increased wrist motion for patients suffering from severe arthritis. While reports of clinical follow-up appointments describe improved wrist function, the improvement in overall upper extremity function and patient perception remains a question. Therefore, the purpose of this study was to assess the upper extremity function in patients that received the Universal 2 total implant system. Eight patients participated in the complete protocol, which included testing activities of daily living as well as surveys to assess patient perception. The findings of the current study suggest that although patients exhibit motion that exceeds the needed amount, many still have a perceived disability.

scholarly journals Combined Effect Of Botulinum Toxin And Splinting On Motor Components And Function Of People With Stroke

2017 ◽  
pp. 18 ◽  
Author(s):  
Aryan Shamili ◽  
Bijan Forogh ◽  
Marzieh Pashmdarfard
Keyword(s):  
Botulinum Toxin ◽  
Range Of Motion ◽  
Upper Extremity ◽  
Muscle Tone ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Injection ◽  
Extremity Function ◽  
Combined Use ◽  
Upper Extremity Function ◽  
The Difference

Background and objective: Spasticity is one of the problems following stroke. Due to this increase in muscle tone, patients are confronted to problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of Simultaneous use of both splint and botulinum toxin-A (BTX-A) injection on spasticity, range of motion and upper extremity function in a 3-month period.Methods: The design of this study was a comparison between 3 groups of interventions, conducted in rehabilitation clinics in Tehran. Sixty people with chronic stroke were recruited. Based on the inclusion criteria, a total of 39 stroke patients after completing the consent forms were entered to intervention groups; splint or botulinum toxin injection or combined splint/botulinum toxin injection. They were followed up about 3 months and the evaluations were done monthly. Goniometry was the method to measure range of motion, and Modified Ashworth scale was used to examine the spasticity and the upper extremity function was scored based on Fugl-Meyer assessment.   Statistical analysis was done using SPSS 17. And ANOVAs was used for comparison between groups and times.  Significance was set at 0.05.Results: All outcome measures improved within each group but the differences between splint group and BTX-A group and the BTX-A-splint group was not significant in most outcomes during 3 periods (first evaluation until end of the first month, the end of first month until the end of second month, the end of second month until the end of the third month) (p> 0 / 05). The results also showed that the changes in elbow`s spasticity {p= 0.05} and wrist`s spasticity {p= 0.007} and upper extremity function { p = 0.04} were obvious between the three groups over the 3-months and the difference in the group of combined use of botulinum toxin and splint was more than other groups.Conclusion: In this study, the effects of botulinum toxin injection and Volar-Dorsal Wrist/Hand Immobilization splint and the combined use of botulinum injection and splint were obvious in all groups but was not significantly different between the interventions in a 3-month follow-up.  

scholarly journals Effectiveness of Percutaneous Electrolysis in Supraspinatus Tendinopathy: A Single-Blinded Randomized Controlled Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1837 ◽  
Author(s):  
Manuel Rodríguez-Huguet ◽  
Jorge Góngora-Rodríguez ◽  
Pablo Rodríguez-Huguet ◽  
Alfonso Javier Ibañez-Vera ◽  
Daniel Rodríguez-Almagro ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Rating Scale ◽  
Trigger Point ◽  
Controlled Trial ◽  
Pressure Pain Threshold ◽  
Dry Needling ◽  
Invasive Approach ◽  
Shoulder Range Of Motion ◽  
One Year

Supraspinatus tendinopathy is one of the most common causes of shoulder pain. Many studies support conservative treatments such as exercise, trigger point dry needling or corticosteroid injections. Otherwise, a minimally invasive approach with percutaneous electrolysis (PE) has also been used successfully in shoulder pain, although evidence about its long-term effects is scarce. The aim of this trial was to determine the effects of PE on supraspinatus tendinopathy compared with trigger point dry needling (TDN). Thirty-six patients with supraspinatus tendinopathy were randomly assigned to either a PE group (n = 18) or a TDN group (n = 18). Both groups also performed eccentric exercises. The main outcome to be measured was the Numerical Pain Rating Scale (NPRS), but the shoulder range of motion (ROM) and trigger point pressure pain threshold (PPT) were also considered. A one-year follow-up was conducted. Significant differences favoring the PE group were found regarding pain at one-year follow-up (p = 0.002). The improvement achieved in the PE group was greater in the NPRS (p < 0.001), proximal PPT, middle PPT, distal PPT (all p < 0.001) and ranges of movement. PE seems to be more effective than TDN in relieving pain and improving ROM and PPT supraspinatus values in patients with supraspinatus tendinopathy, both right after treatment and at one-year follow-up.

scholarly journals Personalised inpatient multidisciplinary rehabilitation elicits clinically relevant improvements in physical function in patients with multiple sclerosis – The Danish MS Hospitals Rehabilitation Study

2021 ◽  
Vol 7 (1) ◽  
pp. 205521732198938
Author(s):  
Lars G Hvid ◽  
Tobias Gaemelke ◽  
Ulrik Dalgas ◽  
Mette K Slipsager ◽  
Peter V Rasmussen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Physical Function ◽  
Upper Extremity ◽  
Step Test ◽  
Multidisciplinary Rehabilitation ◽  
Extremity Function ◽  
Walking Capacity ◽  
Upper Extremity Function ◽  
Dynamic Gait Index

Purpose Evidence of the effects of inpatient multidisciplinary rehabilitation (MDR) on physical function in patients with multiple sclerosis (MS) is limited, particularly whether clinically relevant improvements can be achieved. The aim of this study, therefore, was to investigate the effects of personalised inpatient MDR on the physical function of MS patients. Methods Embedded in the Danish MS Hospitals Rehabilitation Study, a pragmatic study was performed in MS patients undergoing four weeks of inpatient MDR specifically targeting physical function. Outcomes were assessed at baseline (n = 142), at discharge (n = 137) and at six months follow-up (n = 126) using the six-minute walk test (6MWT), six-spot step test (SSST), five times sit to stand test (5STS), nine-hole peg test (NHPT), dynamic gait index (DGI) and 12-item MS walking scale (MSWS). Results From Baseline-to-Discharge, significant and clinically relevant improvements were found in all measures of walking capacity (6MWT, SSST, 5STS, DGI and MSWS; p < 0.05) along with significant (but not clinically relevant) improvements in upper extremity function (NHPT; p < 0.05). Whilst comparable improvements were observed within subgroups of MS phenotype (relapsing-remitting [RR] vs. secondary + primary progressive [SP + PP]), disease severity (moderate [EDSS2.5–5.5] vs. severe [EDSS6.0–7.5]) and age (young/middle-aged [Age24–59] vs. old [Age60–65]), an attenuated adaptation was nevertheless observed for 6MWT in the most affected and vulnerable subgroups (i.e. SP + PP, EDSS6.0–7.5 and Age60–65). The significant improvements in walking capacity and upper extremity function persisted at six months follow-up but did not exceed anymore the thresholds regarded as clinically relevant. Conclusion The results provide novel evidence that personalised inpatient MDR targeting physical function in MS patients elicits significant and clinically relevant improvements in physical function.

scholarly journals Playing Piano Can Improve Upper Extremity Function after Stroke: Case Studies

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Myriam Villeneuve ◽  
Anouk Lamontagne
Keyword(s):  
Training Program ◽  
Upper Extremity ◽  
Chronic Stroke ◽  
Manual Dexterity ◽  
Stroke Survivors ◽  
Home Practice ◽  
Long Term Effects ◽  
Extremity Function ◽  
Upper Extremity Function

Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken at baseline (week0, week3), prior to (week6) and after the intervention (week9), and at 3-week follow-up (week12). Three persons with stroke participated in the 3-week piano training program that combined structured piano lessons to home practice program. The songs, played on an electronic keyboard, involved all 5 digits of the affected hand and were displayed using a user-friendly MIDI program. After intervention, all the three participants showed improvements in their fine (nine hole peg test) and gross (box and block test) manual dexterity, as well as in the functional use of the upper extremity (Jebsen hand function test). Improvements were maintained at follow-up. These preliminary results support the feasibility of using an MST approach that combines structured lessons to home practice to improve upper extremity function in chronic stroke.

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