| Hemiplegic shoulder pain(HSP) is commonly seen in post-stroke patients.HSP does harm to patient’s physical rehabilitation and social competence,even causes emotional problems, such as anxiety and depression. Many previous studies reported that hemiplegic shoulder pain was correlated with shoulder functional assessment,but have not reported the correlation between hemiplegic shoulder pain in early stroke recovery stage with shoulder functional assessment. This study is conducted to investigate the functional problems of HSP patients in early recovery stage by examing the correlations between HSP and shoulder functional assessment,including passive range of motion(PROM) of shoulder in flexion, extension, abduction, external rotation and internal rotation, shoulder spasticity, motor function level of upper limb as well as shoulder subluxation.And then,we conducted another research to clarify the effectiveness of Maitland mobilization on treating patients with HSP in early stroke recovery stage.Part one:The correlation between shoulder function assessment andhemiplegic shoulder pain in early stroke recovery stage:a clinical studyObjective:To investigate the correlations between hemiplegic shoulder pain(HSP) and passive range of motion(PROM) of shoulder in flexion, extension, abduction, external rotation and internal rotation, shoulder spasticity, motor function level of upper limb and shoulder subluxation of post-stroke patients in early stage(in 3 months).Methods:105 patients after the first stroke in the last 3 months participated in this study.There were 66 males and 39 females.The average age of them is 62.00 ± 8.26 year-old.The average duration of them is 49.90 ± 20.12 days.At the beginning,the severity of HSP was measured by the patient himself/herself with visual analogue scale(VAS).The physical therapist measured shoulder PROM for the patients.The motor function level was graded according to the Brunnstrom motor recovery(BMR) stage.Modified Ashworth scale(MAS) was conducted to evaluate the spasticity of the shoulder joint.Glenohumeral subluxation was identified by palpation and X-ray examination if it was necessary.The reseacher analysed the correlation between HSP and all the evaluation results above.Results:(1) The mean value of VAS is 3.26±2.39.(2) The mean PROM of shoulder:flexion 124.14±25.70°,extension 36.91±7.90°,abduction 102.80±29.19°,external rotation 41.77±15.05°,internal rotation 57.46±7.53°.(3) Hemiplegic shoulder pain is significantly correlated with shoulder PROM in flexion(r=- 0.515,P<0.01),extension(r=- 0.466,P<0.01),abduction(r=- 0.579, P<0.01),external rotation(r=-0.656,P<0.01) and internal rotation(r=-0.344,P<0.01).(4) BMR stage correlated with VAS(r=-0.406,P<0.01).(5) Spasticity of shoulder showed little coherence with VAS(r=0.232,P>0.05)。(6) It showed negative association between glenohumeral subluxation and VAS(r=0.207,P>0.05).Conclusion:(1) Shoulder PROM in flexion,extension,abduction,external rotation and internal rotation all showed strong, positive associations with HSP.(2) BMR stage was also correlated with HSP.(3) Little correlation could be seen between HSP and shoulder spasticity or glenohumeral subluxation. Part two: The effectiveness of Maitland mobilization on the treatment of patients with hemiplegic shoulder pain after recent stroke:a clinical study0bjective: To observe the different effectiveness of Maitland mobilization with different graded oscillation techniques in the treatment of patients with hemiplegic shoulder pain(HSP) after stroke in early stage.Methods: 72 patients with HSP were randomly divided into rehabilitation group 1(n=24),rehabilitation group 2(n=24) and control group(n=24).The patients in rehabilitation group 1 and 2 received Maitland mobilization treatment,once per day,6 days per week.I or II graded oscillation techniques for group 1, III or IV graded oscillation techniques for group 2,and the control group accepted routine therapy. After 4 weeks, the visual analogue scale(VAS) and the upper extremities of the Fugl-Meyer Movement Assessment(U-FMA)were compared between three groups before and after the rehabilitation.Results: After 4 weeks, the scores of VAS were significant lower and the U-FMA were much higher in all the three groups. The scores of VAS in rehabilitation group 1 and 2 were both lower than that of control group, and the scores of U-FMA in rehabilitation group 1 and 2 were both higher than that of control group. Furthermore, the scores of VAS in rehabilitation group 2 were lower than that of rehabilitation group 1,and there were statistically differences.(P<0.05).Conclusion: Maitland mobilization is effective on HSP patients with stroke in early stage, especially mobilization with III or IV graded oscillation techniques. |
