Prevalence of Hemiplegic Shoulder Pain in Post-stroke Patients – A Hospital Based Study

Abstract Objectives To study the prevalence of hemiplegic shoulder pain (HSP) and its association with other factors like age, sex, side of paralysis, type of brain lesion, muscle tone, degree of functional recovery in upper limb and glenohumeral subluxation (GHS). Methodology Prospective study based on all the hemiplegic 140 patients admitted in the physical medicine and rehabilitation ward in two consecutive years. Tools Assessment of HSP was done by using a structured questionnaire known as “Shoulder Q”. Modified Ashworth scale (MAS) was used for spasticity assessment and functional independence measure (FIM) to document the severity of disability. Follow-up at intervals of 1, 3 and 6 months from the date of discharge for all cases were attempted and even cases with at least one follow-up around 3 months were also included in the study. Analysis was done on 109 patients as 31 patients lost to follow-up. Results Out of the 109 patients, 61.5% were males with a mean age of 58.9 ± 10.9 years. Cerebral infarct represents 53.2% of patients. HSP was present in 47.7% (n= 52) of patients. The prevalence of HSP on left and right sides was comparable though involvement was more on the left side (58.8%). Glenohumeral subluxation was present in 32.7% (n=17) of 52 cases with HSP and 33.3% (n=19) of 57 cases without HSP. Mean FIM score at admission for patients with HSP was 54.5 ± 17.6 and 56.6 ± 19.5 among cases without HSP. Again, mean FIM scores at last follow-up were 80.0 ± 16.4 and 79.9 ± 18.9 respectively for both cases with HSP and without it. Among the compliers, patients with tone more than MAS=1 were more likely to develop HSP. Conclusion Prevalence rate of HSP among post-stroke hemiplegic patients admitted during two years was 47.7%. There was no association of HSP with factors like age, sex, side of paralysis, type of lesion and GHS. Correlation between HSP and muscle tone or degree of functional recovery was significant.

Download Full-text

Functional recovery in post-stroke patients on hemodialysis during the convalescent phase: a comparison with those not undergoing hemodialysis

Renal Replacement Therapy ◽

10.1186/s41100-021-00347-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Takeki Ishida ◽

Kenichi Kono ◽

Yuusuke Nishida ◽

Masahiro Yoshida

Keyword(s):

Functional Recovery ◽

Functional Independence Measure ◽

Functional Independence ◽

Hemodialysis Patients ◽

Stroke Patients ◽

Post Stroke ◽

Rehabilitation Hospital ◽

Convalescent Phase ◽

The Difference ◽

Impaired Motor Function

Abstract Background Low physical fitness is often found in patients undergoing hemodialysis. It may be possible that the recovery of impaired motor function with rehabilitative training might be affected when the patient is on hemodialysis. So far, however, no researcher has clinically investigated this issue in post-stroke patients. The purpose of this study is to clarify the difference of functional recovery during the convalescent phase between post-stroke patients with and without hemodialysis. Methods A cohort of 82 post-stroke hemiparetic patients who were admitted to our rehabilitation hospital, were subjected. On the day of admission and discharge, some clinical parameters including Functional Independence Measure (FIM) and Functional Ambulation Category (FAC) were evaluated for each patient. The changes during the hospitalization and the values at the discharge in these parameters were statistically compared between the patients with and without hemodialysis. Results The FIM motor score at the discharge was significantly lower in hemodialysis patients than non-hemodialysis patients (64.7 ± 21.2 points in hemodialysis patients and 81.8 ± 28.0 points in non-hemodialysis patients, p < 0.05). In addition, the frequency of FAC at the discharge of ≥ 3 was significantly lower in hemodialysis patients than non-hemodialysis patients (40.0% in hemodialysis patients and 72.2% in non-hemodialysis patients, p < 0.05). Conclusion In patients undergoing hemodialysis seem to experience a worse functional recovery during the convalescent phase compared to those not undergoing hemodialysis. We might have to modify the rehabilitative program during the convalescent phase after stroke if the patient was on hemodialysis.

Download Full-text

Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients

Current Neurovascular Research ◽

10.2174/1567202617666200603150901 ◽

2020 ◽

Vol 17 (4) ◽

pp. 437-445

Author(s):

Irene Ciancarelli ◽

Giovanni Morone ◽

Marco Iosa ◽

Stefano Paolucci ◽

Loris Pignolo ◽

...

Keyword(s):

Outcome Measures ◽

Functional Recovery ◽

Functional Independence Measure ◽

Functional Independence ◽

Enzyme Linked Immunosorbent Assay ◽

Stroke Patients ◽

Rehabilitation Outcomes ◽

Before And After ◽

Forward Stepwise ◽

Clinical Measures

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

Download Full-text

Postural Assessment Scale for Stroke Patients in Acute, Subacute and Chronic Stage: A Construct Validity Study

Diagnostics ◽

10.3390/diagnostics11020365 ◽

2021 ◽

Vol 11 (2) ◽

pp. 365

Author(s):

Cecilia Estrada-Barranco ◽

Roberto Cano-de-la-Cuerda ◽

Vanesa Abuín-Porras ◽

Francisco Molina-Rueda

Keyword(s):

Construct Validity ◽

Functional Independence Measure ◽

Functional Independence ◽

Assessment Scale ◽

Validity Study ◽

Stroke Patients ◽

Chronic Stage ◽

Post Stroke ◽

Valid Instrument ◽

Postural Assessment

(1) Background: Observational scales are the most common methodology used to assess postural control and balance in people with stroke. The aim of this paper was to analyse the construct validity of the Postural Assessment Scale for Stroke Patients (PASS) scale in post-stroke patients in the acute, subacute, and chronic stroke phases. (2) Methods: Sixty-one post-stroke participants were enrolled. To analyze the construct validity of the PASS, the following scales were used: the Functional Ambulatory Category (FAC), the Wisconsin Gait Scale (WGS), the Barthel Index (BI) and the Functional Independence Measure (FIM). (3) Results: The construct validity of the PASS scale in patients with stroke at acute phase was moderate with the FAC (r = −0.791), WGS (r = −0.646) and FIM (r = −0.678) and excellent with the BI (r = 0.801). At subacute stage, the construct validity of the PASS scale was excellent with the FAC (r = 0.897), WGS (r = −0.847), FIM (r = −0.810) and BI (r = −0.888). At 6 and 12 months, the construct validity of the PASS with the FAC, WGS, FIM and BI was also excellent. (4) Conclusions: The PASS scale is a valid instrument to assess balance in post-stroke individuals especially, in the subacute and chronic phases (at 6 and 12 months).

Download Full-text

Development and Validation of Crosswalks Between FIM® and SCIM III for Voluntary Musculoskeletal Movement Functions

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211033854 ◽

2021 ◽

pp. 154596832110338

Author(s):

Linda A. T. Jones ◽

Chih-Ying Li ◽

David Weitzenkamp ◽

John Steeves ◽

Susie Charlifue ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Functional Recovery ◽

Systems Of Care ◽

Functional Independence Measure ◽

Correlation Coefficients ◽

Functional Independence ◽

Cord Injury ◽

Parametric Analyses ◽

Development And Validation

Background. In spinal cord injury, there are multiple databases containing information on functional recovery, but data cannot be pooled or compared due to differences in how function is measured. A crosswalk is needed to link or convert scores between instruments. Objectives. To create a crosswalk between the voluntary musculoskeletal movement items in the Functional Independence Measure (FIM®) and the Spinal Cord Independence Measure III (SCIM III) for spinal cord injury. Methods. Retrospective datasets with FIM® and SCIM III on the same people were used to develop (Swiss dataset, n = 662) and validate (US, n = 119, and Canadian datasets, n = 133) the crosswalks. Three different crosswalk methods (expert panel, equipercentile, and Rasch analysis) were employed. We used the correlation between observed scores on FIM® and SCIM III to crosswalked scores as the primary criterion to assess the strength of the crosswalk. Secondary criteria such as score distributions, Cohen’s effect size, point differences, and subgroup invariance were also evaluated. Results. All three methods resulted in strong correlation coefficients, exceeding the primary criterion value of r = .866 (.897–.972). Assessment of secondary criteria suggests the equipercentile and Rasch methods produced the strongest crosswalks. Conclusions. The Rasch FIM®/SCIM III crosswalk is recommended because it is based on co-calibration of linearized measures, allowing for more sophisticated parametric analyses. The crosswalk will allow comparisons of voluntary musculoskeletal functional recovery across international databases using different functional measures, as well as different systems of care and rehabilitation approaches.

Download Full-text

Evaluation of Functional Recovery by Motor Functional Independence Measure Test of Elderly After Hip Fracture in Serbia

Acta Médica Portuguesa ◽

10.20344/amp.4267 ◽

2014 ◽

Vol 27 (1) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Natasa Radosavljevic ◽

Dejan Nikolic ◽

Milica Lazovic ◽

Zoran Radosavljevic ◽

Aleksandar Jeremic

Keyword(s):

Hip Fracture ◽

Functional Recovery ◽

Age Groups ◽

Functional Independence Measure ◽

Severity Index ◽

Functional Independence ◽

Post Discharge ◽

Third Age ◽

Period 2 ◽

Group 2

Introduction: The aim of the study was to evaluate motor functional status measured by motor Functional Independence Measure (mFIM) test in population above 65 years of age after the hip fracture. Material and Methods: We evaluated 203 patients after hip fracture by mFIM test on 3 occasions: at admission (Period-1), at discharge (Period-2) and 3 months after discharge (Period-3); 3 age groups: Group65-74, Group75-84 and Group85-up and 2 groups concerning Severity Index (SI): group 0-1.99 (SI1) and group ≥ 2 (SI2). Results: In same SI group there is significant increase in mFIM values for Period-2 and Period-3 for both genders and in first two age groups, while for those above 85 years of age with higher SI we found non-significant change in mFIM values between discharge and 3 months post discharge period. Discussion: The most significant improvement is obtained for women in first and third age groups and with higher SI. Conclusion: Gender is not significant predictor for motor functional recovery measured by mFIM test in patients with hip fracture, although the admittance mFIM is a good indicator for mFIM capacity recovery in women of certain age groups (first and third age groups).

Download Full-text

Association of frailty in hospitalized and institutionalized elderly in the community-dwelling

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167.2016690411i ◽

2016 ◽

Vol 69 (4) ◽

pp. 691-696 ◽

Cited By ~ 4

Author(s):

Suzele Cristina Coelho Fabrício-Wehbe ◽

Rosalina Aparecida Partezani Rodrigues ◽

Vanderlei Jose Haas ◽

Jack Roberto Silva Fhon ◽

Marina Aleixo Diniz

Keyword(s):

Demographic Data ◽

Functional Independence Measure ◽

Functional Independence ◽

Sampling Procedure ◽

Community Dwelling ◽

Specific Data ◽

Follow Up Study ◽

Dual Stage ◽

The Subject

ABSTRACT Objective: to investigate the association between frailty with hospitalization and institutionalization in a follow-up study of elderly residents. Method: the follow-up study was performed in 2008 and 2013 with elderly of both genders, aged 65 years and older who were living in the community-dwelling. The sampling procedure performed was probabilistic, with dual-stage clustering. In 2008, 515 elderly people were interviewed and, in 2013, 262. We used the socioeconomic and demographic data, self-reported morbidity, specific data of hospitalization and institutionalization. Frailty was measured by the Edmonton Frail Scale (EFS), and functional capacity through the Functional Independence Measure. Results: we found the mean gross EFS score was higher among resident elderly who were hospitalized and institutionalized and was statistically significant in both investigated years. Conclusion: the confirmation of association between frailty and hospitalization and institutionalization reinforces the importance of the subject, and highlights frailty as an important tool for risk estimates for these adverse events.

Download Full-text

Influence of New Technologies on Post-Stroke Rehabilitation: A Comparison of Armeo Spring to the Kinect System

Medicina ◽

10.3390/medicina55040098 ◽

2019 ◽

Vol 55 (4) ◽

pp. 98 ◽

Cited By ~ 3

Author(s):

Adomavičienė ◽

Daunoravičienė ◽

Kubilius ◽

Varžaitytė ◽

Raistenskis

Keyword(s):

Virtual Reality ◽

Grip Strength ◽

Functional Recovery ◽

Stroke Rehabilitation ◽

New Technologies ◽

Functional Independence ◽

Upper Limbs ◽

Post Stroke ◽

Visuospatial Abilities ◽

Attention Memory

Background: New technologies to improve post-stroke rehabilitation outcomes are of great interest and have a positive impact on functional, motor, and cognitive recovery. Identifying the most effective rehabilitation intervention is a recognized priority for stroke research and provides an opportunity to achieve a more desirable effect. Objective: The objective is to verify the effect of new technologies on motor outcomes of the upper limbs, functional state, and cognitive functions in post-stroke rehabilitation. Methods: Forty two post-stroke patients (8.69 ± 4.27 weeks after stroke onset) were involved in the experimental study during inpatient rehabilitation. Patients were randomly divided into two groups: conventional programs were combined with the Armeo Spring robot-assisted trainer (Armeo group; n = 17) and the Kinect-based system (Kinect group; n = 25). The duration of sessions with the new technological devices was 45 min/day (10 sessions in total). Functional recovery was compared among groups using the Functional Independence Measure (FIM), and upper limbs’ motor function recovery was compared using the Fugl–Meyer Assessment Upper Extremity (FMA-UE), Modified Ashworth Scale (MAS), Hand grip strength (dynamometry), Hand Tapping test (HTT), Box and Block Test (BBT), and kinematic measures (active Range Of Motion (ROM)), while cognitive functions were assessed by the MMSE (Mini-Mental State Examination), ACE-R (Addenbrooke’s Cognitive Examination-Revised), and HAD (Hospital Anxiety and Depression Scale) scores. Results: Functional independence did not show meaningful differences in scores between technologies (p > 0.05), though abilities of self-care were significantly higher after Kinect-based training (p < 0.05). The upper limbs’ kinematics demonstrated higher functional recovery after robot training: decreased muscle tone, improved shoulder and elbow ROMs, hand dexterity, and grip strength (p < 0.05). Besides, virtual reality games involve more arm rotation and performing wider movements. Both new technologies caused an increase in overall global cognitive changes, but visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) were statistically higher after robotic therapy. Furthermore, decreased anxiety level was observed after virtual reality therapy (p < 0.05). Conclusions: Our study displays that even a short-term, two-week training program with new technologies had a positive effect and significantly recovered post-strokes functional level in self-care, upper limb motor ability (dexterity and movements, grip strength, kinematic data), visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) and decreased anxiety level.

Download Full-text

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 ◽

10.1093/pm/pnaa132 ◽

2020 ◽

Vol 21 (11) ◽

pp. 2939-2947 ◽

Cited By ~ 2

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.

Download Full-text

Long-Term Follow-up of Patients with Spinal Cord Injury

Neurorehabilitation and Neural Repair ◽

10.1177/1545968305280210 ◽

2005 ◽

Vol 19 (4) ◽

pp. 332-337 ◽

Cited By ~ 8

Author(s):

Figen Yilmaz ◽

Fusun Sahin ◽

Semra Aktug ◽

Banu Kuran ◽

Adem Yilmaz

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Functional Independence Measure ◽

Functional Independence ◽

American Spinal Injury Association ◽

Cord Injury ◽

Long Term Follow Up

Objective. The aim of this study was to evaluate the motor, sensory, and functional recovery in patients with spinal cord injury (SCI). Methods. Forty-one patients with SCI participated in this study. Twenty patients were evaluated after discharge. Each patient was evaluated by the American Spinal Injury Association (ASIA) impairment scale and the Functional Independence Measure (FIM) at admission, before discharge, and at least at 6 months after discharge. Friedman, Dunn, and Mann-Whitney U tests were used for statistical analysis. Results. There were 17 male and 3 female patients. Seven patients had complete SCI, and 13 patients had incomplete SCI. The evaluation of motor, sensory, and FIM scores at admission showed significant improvement in all of the patients during the follow-up period (P < 0.0001). Five incompletely injured cases improved with regard to ASIA staging. Motor and FIM scores significantly increased at follow-up for converted and unconverted patients. All parameters increased at follow-up in patients who were complete and incomplete. Motor scores significantly increased at discharge and at follow-up. FIM scores also increased significantly at follow-up in incomplete patients. Conclusion. Motor, sensory, and FIM scores increased in patients with SCI after a follow-up period of 18 months. Improvement to a higher ASIA stage could be accomplished by 25% of the patients. Although both complete and incomplete patients recovered significantly at the follow-up period, only incompletely injured cases could convert to a higher ASIA stage.

Download Full-text

A Literature Synthesis Indicates Very Low Quality, but Consistent Evidence of Improvements in Function after Surgical Interventions for Primary Osteoarthritis of the Elbow

Arthritis ◽

10.1155/2013/487615 ◽

2013 ◽

Vol 2013 ◽

pp. 1-11 ◽

Cited By ~ 8

Author(s):

Joshua I. Vincent ◽

Anthony A. Vandervoort ◽

Joy C. MacDermid

Keyword(s):

Functional Recovery ◽

Joint Destruction ◽

Surgical Techniques ◽

Functional Independence ◽

Surgical Interventions ◽

Primary Osteoarthritis ◽

Literature Synthesis ◽

Long Term Follow Up ◽

Loss Of Motion

Background. Primary osteoarthritis of the elbow is a debilitating disease with an overall incidence of about 2%. Pain and reduced motion (ROM) lead to disability and loss of functional independence. Purpose. To critically review the literature on patient-related important functional outcomes (pain, ROMs and functional recovery) after surgery for primary OA of the elbow, utilizing the 2011 OCEBM levels of evidence. Design. A literature synthesis. Results. Twenty-six articles satisfied the inclusion and exclusion criteria; 25 of the studies were at level IV evidence, and 1 at level III. All three surgical techniques led to improvement in pain, ROM, and functional recovery in the short- and medium-term follow-up. Long-term follow-up results, available only for open joint debridement, showed recurrence of osteoarthritic signs on X-ray with minimal loss of motion. Recently, there seems to be an increased focus on arthroscopic debridement. Conclusion. The quality of research addressing surgical interventions is very low, including total elbow arthroplasty (TEA). However, the evidence concurs that open and arthroscopic joint debridement can improve function in patients with moderate-to-severe OA of the elbow. TEA is reserved for treating severe joint destruction, mostly for elderly individuals with low physical demands when other intervention options have failed.

Download Full-text