Comparison the Impact on TENS and Conventional Physiotherapy in Stroke Patients with Upper Limb Dysfunctions: A Research Protocol

Background: Stroke is a sudden neurological explosion resulting from poor blood flow perfusion to the brain. Stroke prevalence rates in India are expected to range from eighty-four to two hundred sixty-two strokes every 100,000 persons in remote regions and from three hundred thirty-four to four hundred twenty-four strokes every 100,000 persons in metropolitan areas. It causes brain cells to die abruptly due to inadequate oxygen and is a neurological condition characterized by blood flow blockage. Aim & Objective: to examine the impact of TENS (Transcutaneous Electrical Nerve Stimulation), EMS (Electrical Muscle Stimulation), and ROM (Range of Motion) exercises on upper-limb functioning in hemi paretic stroke victims. Methods: The current study subjects (n=39) would be stroke survivors. Patients will be divided into three groups: group A will receive TENS, group B will receive EMS, and group C will get ROM exercises. The protocol will cover 2 weeks of treatment. We will assess upper limb functioning, activities of everyday living (ADLs), and mental condition at frequent intervals. By using the MHQ (Michigan Hand Outcomes Questionnaire), Hand Grip Strength (HGS), Brunnstrom Hand Function Recovery stages. Results: The successful completion of this study will provide evidence on the best treatment strategy for stroke patients to improve their upper extremity motor function using individual TENS, EMS, or ROM exercises. Conclusion: This study will be beneficial to treat Stroke patients with upper limb dysfunction by treating by TENS modality which might be an option for EMS treatment.

Brachial plexus injury after clavicle fracture operation: a case report and literature review

Background Open reduction and internal fixation (ORIF) is the preferred choice for treating clavicle fractures. The brachial plexus injury caused by ORIF of a clavicle fracture is very rare. If it is not treated in time, the function of the brachial plexus will be challenging to recover, which will eventually lead to upper limb dysfunction and seriously affect the patient’s quality of life. Our team recently used ORIF to treat a patient with a clavicle fracture, who developed brachial plexus injury symptoms after surgery. Case presentation A 34-year-old female patient was admitted to the hospital for 13 h due to the right shoulder movement restriction after a fall. Due to the significant displacement of the fracture, we used ORIF to treat the fracture. The surgery went well. When the anaesthesia effect subsided 12 h after the operation, the patient developed right brachial plexus injury symptoms, decreased right upper limb muscle strength, dysfunction, and hypoesthesia. Symptomatic treatments, such as nourishing nerve and electrical stimulation, were given immediately. Sixty days after the operation, the patient’s brachial plexus injury symptoms disappeared, and the function of the right upper limb returned to the preoperative state. Conclusions Patients with clavicle fractures usually need to undergo a careful physical examination before surgery to determine whether symptoms of brachial plexus injury have occurred. Anaesthesia puncture requires ultrasound guidance to avoid direct damage to the brachial plexus. When the fracture end is sharp, reset should be careful to prevent nerve stump stabbed. When using an electric drill to drill holes, a depth limiter should be installed in advance to prevent the drill from damaging the subclavian nerve and blood vessels. When measuring the screw depth, the measuring instrument should be close to the bone surface and sink slowly to avoid intense hooks and damage to the brachial plexus. Try to avoid unipolar electrosurgical units to prevent heat conduction from damaging nerves, and bipolar electrocoagulation should be used instead. If symptoms of brachial plexus injury occur after surgery, initial symptomatic treatment is drugs and functional exercise, and if necessary, perform surgical exploration.

Application of MET Technique after Upper Limb Dysfunction after Breast Cancer Surgery

Object: Explore the application and actual effect of MET (Muscle Energy) technology after breast cancer surgery with upper limb dysfunction. Methods: Taking 40 female breast cancer patients who underwent surgical treatment in our hospital from September 2017 to June 2019 as the research objects, all of them successfully completed modified radical mastectomy for breast cancer. According to different nursing methods, the patients were randomly divided into two groups. The experiment There were 20 cases in each group and the control group. The control group was given routine functional recovery exercise intervention after the operation, and the experimental group added MET technology to the base of the control group. One month after the operation, the functional recovery of the affected limbs of the two groups of patients was effectively assessed. The upper limb dysfunction of the two groups was compared by statistical methods, and the shoulder joint range of motion (ROM) was used for performance. Results: Through early functional recovery training and MET technology, 19 cases of ROM in the experimental group showed compliance (95%), compared with only 14 cases (70%) in the control group. The difference in upper limb dysfunction between the two groups is very obvious with statistical significance (P<0.05). Conclusions: Early functional recovery training combined with muscle energy technology can promote the recovery of upper limb dysfunction after breast cancer surgery faster and better, which is conducive to the recovery of patients as soon as possible and improve the quality of life.

Objective Assessment of Postoperative Morbidity After Breast Cancer Treatments with Wearable Activity Monitors: The “BRACELET” Study

Background Current validated tools to measure upper limb dysfunction after breast cancer treatment, such as questionnaires, are prone to recall bias and do not enable comparisons between patients. This study aimed to test the feasibility of wearable activity monitors (WAMs) for achieving a continuous, objective assessment of functional recovery by measuring peri-operative physical activity (PA). Methods A prospective, single-center, non-randomized, observational study was conducted. Patients undergoing breast and axillary surgery were invited to wear WAMs on both wrists in the peri-operative period and then complete upper limb function (DASH) and quality-of-life (EQ-5D-5L) questionnaires. Statistical analyses were performed to determine the construct validity and concurrent validity of WAMs. Results The analysis included 39 patients with a mean age of 55 ± 13.2 years. Regain of function on the surgically treated side was observed to be an increase of arm activity as a percentage of preoperative levels, with the greatest increase observed between the postoperative days 1 and 2. The PA was significantly greater on the side not treated by surgery than on the surgically treated side after week 1 (mean PA, 75.8% vs. 62.3%; p < 0.0005) and week 2 (mean PA, 91.6% vs. 77.4%; p < 0.005). Subgroup analyses showed differences in recovery trends between different surgical procedures. Concurrent validity was demonstrated by a significant negative moderate correlation between the PA and DASH questionnaires (R = −0.506; p < 0.05). Conclusion This study demonstrated the feasibility and validity of WAMs to objectively measure postoperative recovery of upper limb function after breast surgery, providing a starting point for personalized rehabilitation through early detection of upper limb physical morbidity.

Clinical Utility of an Exoskeleton Robot Using 3-Dimensional Scanner Modeling in Burn Patient: A Case Report

Hands are the part of the body that are most commonly involved in burns, and the main complications are finger joint contractures and nerve injuries. Hypertrophic scarring cannot be avoided despite early management of acute hand burn injuries, and some patients may need application of an exoskeleton robot to restore hand function. To do this, it is essential to individualize the customization of the robot for each patient. Three-dimensional (3D) technology, which is widely used in the field of implants, anatomical models, and tissue fabrication, makes this goal achievable. Therefore, this report is a study on the usefulness of an exoskeleton robot using 3D technology for patients who lost bilateral hand function due to burn injury. Our subject was a 45-year-old man with upper limb dysfunction of 560 days after a flame and chemical burn injury, with resultant impairment of manual physical abilities. After wearing an exoskeleton robot made using 3D printing technology, he could handle objects effectively and satisfactorily. This innovative approach provided considerable advantages in terms of customization of size and reduction in manufacturing time and costs, thereby showing great potential for use in patients with hand dysfunction after burn injury.

Upper Limb Dysfunction Increases Fear of Falling in People With Stroke

Objective: Our study was planned to investigate the effect of upper limb function on fear of falling in stroke patients. Materials and methods: A total of 61 patients, 33 women with chronic hemiplegia or hemiparesis, were included in the study. Patients’ upper limb motor condition was obtained using the Fugl-Meyer Upper Extremity Rating Scale (FMA), upper limb function Arm Motor Ability Test (AMAT) and fear of falling International Fall Efficacy Scale (FES-I). Standard Mini-Mental Examination scale was used to exclude patients with mental disorders. Results and Discussion: There was a highly significant negative correlation between FES-I and AMAT and FMA scores (p <0.001, r = -0.926 and r = -0.888, respectively). There was also a significant positive correlation between FMA and stroke time (p <0.05). It was observed that the fear of falling with the level of upper limb dysfunction increased in parallel. Conclusion: It suggests situation that this is due to the fact that they experience balance problems as a result of upper limb dysfunction and when they fail to reveal protective reflexes in a quality way Bangladesh Journal of Medical Science Vol.20(3) 2021 p.539-542