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Meng X, Sun J, Liu Q, Huang Y, Qiu X, Seto DJ, Li Y, Wang L, Li C, Gao S, Yu H, Zhao J, Zhao B. Efficacy and Safety of a Novel Plum Blossom Needling with Mild Moxibustion Device for Upper Limb Pain Disorder and Motor Dysfunction in Patients with Stage 1 Post-Stroke Shoulder-Hand Syndrome: Study Protocol for a Multi-Center, Single-Blind, Randomized Sham-Controlled Trial. J Pain Res 2023; 16:407-420. [PMID: 36817867 PMCID: PMC9936879 DOI: 10.2147/jpr.s396195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023] Open
Abstract
Background Post-stroke shoulder-hand syndrome (PS-SHS), a common neurological comorbidity after stroke episodes, poses a grave threat on patients' functional recovery. Preliminary trials have demonstrated that the acupuncture and moxibustion treatment, including a dermal acupuncture tapping method known as plum blossom needling (PBN) can improve pain and motor dysfunctions in patients with PS-SHS. However, there are few reports describing simultaneous moxibustion treatment in combination with PBN. Hence, a novel plum blossom needle device with mild moxibustion (PBNMM) was developed to evaluate its potential efficacy and safety in patients with stage 1 PS-SHS. Materials and Methods This multicenter, sham-controlled, randomized controlled trial (RCT) will recruit 102 eligible patients with stage 1 PS-SHS from three clinical centers, randomly allocated in a ratio of 1:1:1 to the PBNMM group, PBNMM with no moxa smoke (PBNMM-NMS) group and sham control group. Patients in each group will receive a 30-minute treatment once per day for 4 weeks, with 5 consecutive sessions per week, for a total of 20 sessions. The primary outcome measure will be defined as the decreased scores from baseline in the visual analog scale (VAS) assessment at week 4. Secondary outcome measures will include scores on the Fugl-Meyer Assessment of the Upper Extremity Scale (FMA-UE), the Modified Barthel Index (MBI), and the somatosensory evoked potential (SEP) records. All outcomes will be evaluated at baseline and weeks 4, 5, 6 and 10, and the intention-to-treat analysis will be applied. Conclusion This study aims to provide robust evidence for the efficacy and safety of the PBNMM for PS-SHS treatment, as well as the specific impact of moxibustion smoke itself in dealing with PS-SHS. Clinical Trial Registration Chinese Clinical Trial Registry No. ChiCTR2200062441. Registered on 7 August 2022.
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Affiliation(s)
- Xiaonan Meng
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China,Department of Acupuncture and Moxibustion, Beijing Huguosi TCM Hospital, Affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Jie Sun
- Department of Integrated Chinese and Western Medicine Rehabilitation, Beijing Xiaotangshan Hospital, Beijing, People’s Republic of China
| | - Qi Liu
- Department of General Internal Medicine, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Yueping Huang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Xianwen Qiu
- Department of Acupuncture and Moxibustion, Beijing Shichahai Community Healthcare Center, Beijing, People’s Republic of China
| | - David Jung Seto
- Division of Integrative Medicine, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ying Li
- Department of Integrated Chinese and Western Medicine Rehabilitation, Beijing Xiaotangshan Hospital, Beijing, People’s Republic of China
| | - Liping Wang
- Department of Acupuncture and Moxibustion, Beijing Huguosi TCM Hospital, Affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Chunying Li
- Department of Acupuncture and Moxibustion, Beijing Huguosi TCM Hospital, Affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Sen Gao
- Department of Rehabilitation, Beijing Huguosi TCM Hospital, affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Haikuo Yu
- Rehabilitation Department, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Jiping Zhao
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China,Correspondence: Jiping Zhao; Baixiao Zhao, Email ;
| | - Baixiao Zhao
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
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Feng S, Tang M, Huang G, Wang J, He S, Liu D, Gu L. EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with the post-stroke shoulder-hand syndrome: A Bayesian network meta-analysis. Front Neurol 2023; 13:1056156. [PMID: 36703623 PMCID: PMC9873378 DOI: 10.3389/fneur.2022.1056156] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
Background Post-stroke shoulder-hand syndrome (SHS), although not a life-threatening condition, may be the most distressing and disabling problem for stroke survivors. Thus, it is essential to identify effective treatment strategies. Physical therapy is used as a first-line option for treating SHS; however, it is unclear which treatment option is preferred, which creates confusion in guiding clinical practice. Our study aims to guide clinical treatment by identifying the most effective physical therapy interventions for improving clinical symptoms in patients with post-stroke SHS using Bayesian network meta-analysis. Methods We conducted a systematic and comprehensive search of data from randomized controlled trials using physical therapy in patients with SHS from database inception to 1 July 2022. Fugl-Meyer Upper Extremity Motor Function Scale (FMA-UE) and pain visual analog score (VAS) were used as primary and secondary outcome indicators. R (version 4.1.3) and STATA (version 16.0) software were used to analyze the data. Results A total of 45 RCTs with 3,379 subjects were included, and the intervention efficacy of 7 physical factor therapies (PFT) combined with rehabilitation training (RT) was explored. Compared with the control group, all the PFT + RT included were of statistical benefit in improving limb motor function and pain relief. Also, our study indicated that EMG biofeedback combined with RT (BFT + RT) [the surface under the cumulative ranking curve (SUCRA) = 96.8%] might be the best choice for patients with post-stroke SHS. Conclusion EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with post-stroke SHS according to our Bayesian network meta-analysis results. However, the above conclusions need further analysis and validation by more high-quality RCTs. Systematic review registration www.crd.york.ac.uk/prospero/, identifier: CRD42022348743.
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Affiliation(s)
- Sisi Feng
- Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Mingzhi Tang
- Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Gan Huang
- Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - JuMei Wang
- Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Sijin He
- Department of Rehabilitation, Kunming Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China
| | - Duo Liu
- Department of Rehabilitation, Kunming Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China
| | - LiHua Gu
- Department of Rehabilitation, Kunming Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China,*Correspondence: LiHua Gu ✉
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Meng X, Wang L, Li C, Gao S, Yu H, Zhang L, Sun J. Efficacy of Moxibustion Smoke for Stage 1 Post-Stroke Shoulder-Hand Syndrome: Protocol for a Multi-Center, Single-Blind Randomized Sham-Controlled Trial. J Pain Res 2022; 15:643-653. [PMID: 35264882 PMCID: PMC8901261 DOI: 10.2147/jpr.s351576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/17/2022] [Indexed: 01/01/2023] Open
Abstract
Objective Materials and Methods Trial Registration Number
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Affiliation(s)
- Xiaonan Meng
- Acupuncture Department, Beijing Huguosi TCM Hospital, affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Liping Wang
- Acupuncture Department, Beijing Huguosi TCM Hospital, affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Chunying Li
- Acupuncture Department, Beijing Huguosi TCM Hospital, affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Sen Gao
- Rehablitation Department, Beijing Huguosi TCM Hospital, affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Haikuo Yu
- Rehabilitation Department, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Lufen Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Jie Sun
- Rehabilitation Department of Integrated Chinese and Western Medicine, Beijing Xiaotangshan Hospital, Beijing, People’s Republic of China
- Correspondence: Jie Sun, Rehabilitation Department of Integrated Chinese and Western Medicine, Beijing Xiaotangshan Hospital, No. 390 Spring Road, Changping District, Beijing, 102211, People’s Republic of China, Email
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Taketomi M, Shimizu Y, Kadone H, Hada Y, Yamazaki M. Hybrid Assistive Limb Intervention for Hemiplegic Shoulder Dysfunction Due to Stroke. Cureus 2021; 13:e19827. [PMID: 34963844 PMCID: PMC8702387 DOI: 10.7759/cureus.19827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
Abstract
Upper limb dysfunction after stroke is one of the most serious functional disorders, and adequate functional recovery is often not expected. Although various studies have been conducted on effective rehabilitation for upper limb dysfunction, active rehabilitation such as repetitive training of upper limb elevation has not been sufficiently conducted yet because the shoulder joint is highly unstable and the appearance of pain is easily observed. In this study, we performed right shoulder joint elevation training in a seated position using a single-joint hybrid assistive limb (HAL) in a 54-year-old female with right hemiplegia after a stroke. Her right upper limb function improved as follows: passive and active range of motion (ROM) of shoulder flexion, from 105° to 115° and from 65° to 105°, respectively; manual muscle test (MMT), from 2 to 4; box and block test of the right hand, from 1 to 8; right grip strength, from less than 5 to 7.4 kg; and action research arm test (ARAT) total scores, from 10 to 20. No adverse events including shoulder pain were seen. According to the result of the pilot study, HAL may be an effective rehabilitation tool for upper limb dysfunction after stroke.
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Affiliation(s)
- Masakazu Taketomi
- Doctoral Program in Clinical Science Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, JPN
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, JPN
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
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A Meta-Analysis and Meta-Regression of Frequency and Risk Factors for Poststroke Complex Regional Pain Syndrome. Medicina (B Aires) 2021; 57:medicina57111232. [PMID: 34833449 PMCID: PMC8622266 DOI: 10.3390/medicina57111232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: This article aimed to investigate the risk factors for poststroke complex regional pain syndrome (CRPS). Materials and Methods: We searched electronic databases including PubMed, Medline, Web of Science, Cochrane Library, and Embase up to 27 October 2021. We enrolled analytical epidemiological studies comprising cohort, case-control, and cross-sectional studies. A quality assessment was performed using the Newcastle–Ottawa Quality Assessment Scale for cohort and case-control studies and the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Binary outcomes were reported as odds ratios (ORs), and continuous outcomes were described as standardized mean differences (SMDs) with 95% confidence intervals. For the meta-regression, beta coefficient and p value were adopted. Results: We included 21 articles comprising 2225 participants. Individuals with shoulder subluxation and spasticity were found to have higher risks for poststroke CRPS. Spasticity with higher modified Ashworth scale score, lower Brunnstrom hand stage, and inferior Barthel index scores were observed in patients with poststroke CRPS. The pooled incidence proportion in nine articles was 31.7%, and a correlation was found between effect sizes and the ratio of women and the proportion of left hemiparesis. The summarized prevalence in nine cross-sectional studies was 33.1%, and a correlation was observed between prevalence and the subluxation ratio and Brunnstrom stage. Conclusions: Based on our meta-analysis, being female, left hemiparesis, shoulder subluxation, spasticity, a lower Brunnstrom stage of distal upper limb, and an inferior Barthel index are all features for poststroke CRPS. Larger studies with greater statistical power may confirm our findings and clarify some other unknown risk factors for poststroke CRPS.
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Do JG, Choi JH, Park CH, Yoon KJ, Lee YT. Prevalence and Related Factors for Poststroke Complex Regional Pain Syndrome: A Retrospective Cross-Sectional Cohort Study. Arch Phys Med Rehabil 2021; 103:274-281. [PMID: 34480888 DOI: 10.1016/j.apmr.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/19/2021] [Accepted: 08/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the prevalence of poststroke complex regional pain syndrome (CRPS) to estimate related factors for poststroke CRPS in patients with first-ever stroke. DESIGN This was a retrospective cross-sectional cohort study of adult patients (age >18y) with stroke who were admitted to rehabilitation unit from December 2014 to May 2018 in Korea. SETTING Single acute rehabilitation unit of university hospital. PARTICIPANTS Participants (N=313) diagnosed with first-ever stroke were identified from the stroke rehabilitation registry of our institute. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Prevalence of poststroke CRPS based on clinical features and 3-phase bone scintigraphy and the related factors of poststroke CRPS. RESULTS A total of 313 records were analyzed, including demographic, clinical characteristics, and functional variables. Poststroke CRPS was found in 8.94% (28 of 313) patients with first-ever stroke. Logistic regression analysis showed that Fugl Meyer Assessment of Upper Extremity (FMA-UE) score was a significant associated factor for the presence of CRPS (odds ratio, 0.96; 95% confidence interval, 0.94-0.98; P=.003). The cutoff value of 76 points for FMA-UE score yielded moderate accuracy in identifying of poststroke CRPS (92.6% sensitivity, 65.8% specificity, and 0.85 area under the curve). CONCLUSIONS The prevalence of poststroke CRPS was 8.94% in patients with first-ever stroke. The FMA-UE score was associated with the poststroke CRPS. Therefore, in patients with low FMA-UE score, prevention and high suspicion of post-stroke CRPS is necessary.
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Affiliation(s)
- Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Jae Hyeong Choi
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul-Hyun Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Jae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Wang TS, Wang SF, Song WD, Tang ZC, Zhao Y, Lee K. Effectiveness of extracorporeal shock wave for post-stroke shoulder-hand syndrome: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e20664. [PMID: 32629638 PMCID: PMC7337467 DOI: 10.1097/md.0000000000020664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Post-stroke shoulder-hand syndrome (PSSHS) is one of the most common sequelae in patients with stroke. Previous studies have reported that extracorporeal shock wave (EPSW) has been used to treat this condition effectively. However, its conclusions are still inconsistent. Therefore, this study will provide evidence to systematically assess the effectiveness and safety of EPSW for the treatment of PSSHS. METHODS We will comprehensively search relevant randomized controlled trials (RCTs) assessing the effectiveness and safety of EPSW for the treatment of PSSHS in the following databases from their start to February 1, 2020 without language and publication date limitations: Cochrane Library, MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. For trials that meet all inclusion criteria, 2 researchers will independently extract the data from them and appraise study quality by Cochrane risk of bias. Any differences will be solved by discussion with the help of another researcher. All data will be performed and analyzed using RevMan 5.3 software. RESULTS We will summarize up-to-date high quality RCTs to evaluate the effectiveness and safety of EPSW for the treatment of PSSHS. CONCLUSIONS This study will provide a comprehensive evidence summary to determine whether EPSW is effective and safety for the treatment of PSSHS or not. PROSPERO REGISTRATION NUMBER PROSPERO CRD42020175630.
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Affiliation(s)
| | - Shou-feng Wang
- First Ward of Orthopedics Department, First Affiliated Hospital of Jiamusi University
| | - Wei-dong Song
- Department of Orthopedics, Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang
| | - Zhao-chen Tang
- School of Clinical Medicine, Jiamusi University, Jiamusi
| | - Yu Zhao
- Department of Orthopedics, Huludao Central Hospital, Huludao, China
| | - Ken Lee
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Zheng J, Wu Q, Wang L, Guo T. A clinical study on acupuncture in combination with routine rehabilitation therapy for early pain recovery of post-stroke shoulder-hand syndrome. Exp Ther Med 2018; 15:2049-2053. [PMID: 29434804 PMCID: PMC5776623 DOI: 10.3892/etm.2017.5659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/12/2017] [Indexed: 11/15/2022] Open
Abstract
The clinical effect of acupuncture in combination with rehabilitation therapy for post-stroke shoulder-hand syndrome (SHS) was explored. Patients (178) with post-stroke SHS who received treatment in the Dalian Second Hospital from March 2012 to March 2016 were included in this study. The patients were divided into experimental group (89 cases) and control group (89 cases). Patients in the control group received rehabilitation therapy, while those in the treatment group received acupuncture treatment in addition to rehabilitation therapy. Visual analogue scale (VAS) was applied to assess the pain degree of patients. Fugl-Meyer assessment (FMA), functional comprehensive assessment (FCA) and assessment of quality of life (QoL) were used to evaluate rehabilitation condition of the patients. Early pain relief, rehabilitation of upper extremity motor function and improvement of QoL after treatment were compared between the two groups. The scores of VAS, FMA, FCA and QoL showed obvious differences between the two groups after treatment (P<0.05). The scores of the experimental group were significantly better than those of the control group, and the improvement in upper extremity motor function of the patients in the experimental group was better than that of the patients in the control group. The total effective rate of the patients in the experimental group was higher than that of control group (P<0.05). The effect in improving the upper extremity motor function of the patients in the experimental group was better than that of control group. The scores of QoL of the patients in the experimental group were better than that of the patients in the control group (P<0.05). In conclusion, acupuncture in combination with rehabilitation therapy can improve early pain and rehabilitation significantly and enhance QoL for patients with post-stroke SHS, which is worthy of being widely used in clinical practice.
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Affiliation(s)
- Jinling Zheng
- Department of Traditional Chinese Medical Rehabilitation, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Qinglian Wu
- Department of Traditional Chinese Medical Rehabilitation, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Lu Wang
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116031, P.R. China
| | - Ting Guo
- Cancer Clinic, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
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Wattchow KA, McDonnell MN, Hillier SL. Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence. Arch Phys Med Rehabil 2017; 99:367-382. [PMID: 28734936 DOI: 10.1016/j.apmr.2017.06.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/10/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the therapeutic interventions reported in the research literature and synthesize their effectiveness in improving upper limb (UL) function in the first 4 weeks poststroke. DATA SOURCES Electronic databases and trial registries were searched from inception until June 2016, in addition to searching systematic reviews by hand. STUDY SELECTION Randomized controlled trials (RCTs), controlled trials, and interventional studies with pre/posttest design were included for adults within 4 weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared with usual care, sham, or another technique. DATA EXTRACTION Two reviewers independently assessed eligibility of full texts, and methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool. DATA SYNTHESIS A total of 104 trials (83 RCTs, 21 nonrandomized studies) were included (N=5225 participants). Meta-analyses of RCTs only (20 comparisons) and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardized mean difference [SMD]=1.09; 95% confidence interval [CI], .21-1.97) and task-specific training (SMD=.37; 95% CI, .05-.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported. CONCLUSIONS Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase poststroke. Further high-quality studies into the initial 4 weeks poststroke are needed to determine therapies for targeted functional UL outcomes.
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Affiliation(s)
- Kimberley A Wattchow
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Michelle N McDonnell
- Stroke and Rehabilitation Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.
| | - Susan L Hillier
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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Kim YW, Kim Y, Kim JM, Hong JS, Lim HS, Kim HS. Is poststroke complex regional pain syndrome the combination of shoulder pain and soft tissue injury of the wrist?: A prospective observational study: STROBE of ultrasonographic findings in complex regional pain syndrome. Medicine (Baltimore) 2016; 95:e4388. [PMID: 27495051 PMCID: PMC4979805 DOI: 10.1097/md.0000000000004388] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients with poststroke complex regional pain syndrome (CRPS) show different symptoms compared to other types of CRPS, as they usually complain of shoulder and wrist pain with the elbow relatively spared. It is thus also known by the term "shoulder-hand syndrome."The aim of this study is to present a possible pathophysiology of poststroke CRPS through ultrasonographic observation of the affected wrist before and after steroid injection at the extensor digitorum communis (EDC) tendon in patients suspected with poststroke CRPS.Prospective evaluation and observation, the STROBE guideline checklist was used.Twenty-three patients diagnosed as poststroke CRPS in accordance to clinical criteria were enrolled. They had a Three Phase Bone Scan (TPBS) done and the cross-sectional area (CSA) of EDC tendon was measured by using ultrasonography. They were then injected with steroid at the EDC tendon. The CSA of EDC tendon, visual analogue scale (VAS), and degree of swelling of the wrist were followed up 1 week after the injection.TPBS was interpreted as normal for 4 patients, suspected CRPS for 10 patients, and CRPS for 9 patients. Ultrasonographic findings of the affected wrist included swelling of the EDC tendon. After the injection of steroid to the wrist, CSA and swelling of the affected wrist compared to that before the treatment was significantly decreased (P < 0.001). The VAS score declined significantly after the injection (P < 0.001).Our results suggest that the pathophysiology of poststroke CRPS might be the combination of frozen shoulder or rotator cuff tear of shoulder and soft tissue injury of the wrist caused by the hemiplegic nature of patients with stroke.
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Affiliation(s)
- Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Severance Hospital
| | - Yoon Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital
| | - Jong Moon Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital
| | - Ji Seong Hong
- Departments of Physical Medicine and Rehabilitation, Hando Hospital
| | - Hyun Sun Lim
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital
- Correspondence: Hyoung Seop Kim, National Health Insurance Service Ilsan Hospital, Ilsan-ro 100, ilsan-donggu, Goyang, Korea, 10444 (e-mail: )
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Barreca S, Wolf SL, Fasoli S, Bohannon R. Treatment Interventions for the Paretic Upper Limb of Stroke Survivors: A Critical Review. Neurorehabil Neural Repair 2016; 17:220-6. [PMID: 14677218 DOI: 10.1177/0888439003259415] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite a threefold increase in treatment interventions studies during the past 10 years, “best practice” for the rehabilitation of the paretic upper limb is still unclear. This review aims to lessen uncertainty in the management of the poststroke upper limb. Two separate searches of the scientific literature from 1966-2001 yielded 333 articles. Three referees, using strict inclusion and exclusion criteria, selected 68 relevant references. Cohort studies, randomized control trials, and systematic reviews were critically appraised. Mean randomized control trial quality (n = 33) was 17.1/27 (SD = 5.2, 95% CI = 15.2–19.0, range = 6–26). Mean quality of cohort studies (n = 29) was 11.8/27 (SD = 3.8, 95% CI = 10.4–13.2, range = 4–19). Quantitative syntheses were done using theZ -statistic. This systematic review indicated that sensorimotor training; motor learning training that includes the use of imagery, electrical stimulation alone, or combined with biofeedback; and engaging the client in repetitive, novel tasks can be effective in reducing motor impairment after stroke. Furthermore, careful handling, electrical stimulation, movement with elevation, strapping, and the avoidance of overhead pulleys could effectively reduce or prevent pain in the paretic upper limb. Rehabilitation specialists can use this research synthesis to guide their selection of effective treatment techniques for persons with impairments after stroke.
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Affiliation(s)
- Susan Barreca
- Hamilton Health Sciences, School of Rehabilitation Science, McMaster University, Rehabilitation and Orthopedic Services, Holbrook 1, Chedoke, Hamilton, Ontario, Canada, L8M 3Z5.
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Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis 2015; 39:190-201. [PMID: 25766121 DOI: 10.1159/000375397] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/20/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pain is a common complication after stroke and is associated with the presence of depression, cognitive dysfunction, and impaired quality of life. It remains underdiagnosed and undertreated, despite evidence that effective treatment of pain may improve function and quality of life. SUMMARY We provide an overview of the means for clinical assessment and risk factors for the development of post-stroke pain, then review the newest available literature regarding the commonest post-stroke pain syndromes, including central post-stroke pain, complex regional pain syndrome, musculoskeletal pain including shoulder subluxation, spasticity-related pain, and post-stroke headache, as well as the available epidemiology and current treatment options. Key Messages: In the best interests of optimizing quality of life and function after stroke, clinicians should be aware of pain as a common complication after stroke, identify those patients at highest risk, directly inquire as to the presence and characteristics of pain, and should be aware of the options for treatment for the various pain syndromes.
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Affiliation(s)
- Rebecca A Harrison
- Division of Neurology, University of British Columbia, Vancouver, B.C., Canada
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Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation. Top Stroke Rehabil 2015; 13:1-269. [PMID: 16939981 DOI: 10.1310/3tkx-7xec-2dtg-xqkh] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.
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Abstract
The prevalence of hemiplegic shoulder pain is approximately 22%-23% in the general population of stroke survivors and approximately 54%-55% among stroke patients in rehabilitation settings. Hemiplegic shoulder pain causes a reduced quality-of-life, poor functional recovery, depression, disturbed sleep, and prolonged hospitalization. Herein, we attempted to understand, based on a literature review and experts' opinion, the pathologic processes underlying hemiplegic shoulder pain and the major associated factors contributing to its development. The systematization of underlying pathologies was proposed, which might eventually enable a more constructive clinical approach in evaluating and treating patients with hemiplegic shoulder pain.
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Falsetti P, Acciai C, Carpinteri F, Palilla R, Lenzi L. Bedside ultrasonography of musculoskeletal complications in brain injured patients. J Ultrasound 2010; 13:134-41. [PMID: 23396883 DOI: 10.1016/j.jus.2010.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the role of bedside ultrasonography (US) in early diagnosis of musculoskeletal complications (MSC) of acquired brain injuries, to describe its incidence and US features in a neurorehabilitation setting. MATERIALS AND METHODS All 163 patients admitted in tertiary-level neurorehabilitation unit with diagnosis of stroke or severe brain injury (SBI), with symptoms or signs of musculoskeletal pathology, underwent bedside US. RESULTS MSC were diagnosed in 51.5%. In 86.9% US clarified diagnosis and/or modified therapeutic approach. Shoulder pain was observed in 27.6%. US showed a shoulder subluxation in 73.3% and a frozen shoulder in 8.8% of painful shoulders. In all the cases rotator cuff abnormalities were noted. Wrist-hand syndrome was observed in 29.4%. US showed mild effusion in wrist joints and tendon sheaths and subcutaneous edema without significant vascularity. Neurogenic heterotopic ossification was observed in 1.8%. US demonstrated the "zone phenomenon" or heterogeneously hypoechoic mass with low resistance vessels within the lesions. Contractures and spasticity were observed in 18.4%. US allowed reliable guidance for Botulinum toxin A injection. Relapsing osteoarthritis and acute arthritis were diagnosed in 15.3% and 7.3% respectively. Patients with MSC had lower Functional Independence Measurement (FIM) and Katz index scores in discharge (p < 0.04 and p < 0.0294 respectively) and more length of hospital stay (p = 0.0024). DISCUSSION Musculoskeletal pathology frequently complicates the course of acquired brain injuries and it delays functional recovery. Bedside US is a cheap and sensitive diagnostic tool and it can aid clinicians to define diagnosis and to choose therapeutic approach.
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Affiliation(s)
- P Falsetti
- Neurorehabilitation Unit, Department of Rehabilitation, Local Health Unit (AUSL) 8, S. Donato Hospital, Arezzo, Italy
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Matayoshi S, Shimodozono M, Hirata Y, Ueda T, Horio S, Kawahira K. Use of calcitonin to prevent complex regional pain syndrome type I in severe hemiplegic patients after stroke. Disabil Rehabil 2010; 31:1773-9. [PMID: 19479511 DOI: 10.1080/09638280902795573] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the effects of calcitonin in preventing complex regional pain syndrome type I (CRPS) in patients with severe hemiplegia following stroke. METHODS In this observer-blinded, controlled study comparison with historical controls between April 2003 and May 2004, subjects comprised consecutive patients with post-stroke hemiplegia admitted between June 2004 and September 2005, with any upper limb or finger graded as Brunnstrom stage (BrST) III or below. One group was administered intramuscular injection of 20 units of elcatonin (EL) (Asu(1-7) eel calcitonin) weekly from immediately after admission to discharge, together with rehabilitation therapy. The control group received rehabilitation therapy alone. Patients were observed during the in-hospital rehabilitation period. The main outcome measure was onset of CRPS. RESULTS Incidence of CRPS in all patients with post-stroke hemiplegia during the control period was about 8.2%, similar to recent studies. Limited to serious hemiplegic patients graded as BrST III or below, incidence of CRPS was significantly lower in the EL group (12.5%) than in controls (57.1%). No significant differences in patient background were seen between groups. CRPS was completely prevented when EL injection was started <or=4 weeks after stroke, but prophylactic effects were weak when EL was started >6 weeks after stroke. CONCLUSION Intramuscular calcitonin appears to suppress onset of CRPS after stroke, particularly when started early after stroke.
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Affiliation(s)
- Satoru Matayoshi
- Department of Rehabilitation and Physical Medicine, Faculty of Medicine, Kagoshima University, Makizono-cho, Kagoshima, Japan
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Rosewilliam SB, BüCher C, Roffe C, Pandyan AD. An approach to standardize, quantify and record progress of routine upper limb therapy for stroke subjects: The Action Medical Research Upper Limb Therapy protocol. HAND THERAPY 2009. [DOI: 10.1258/ht.2009.009017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction. Explicitly describing therapy for research purposes, in terms of content and quantity, improves the validity of research and facilitates evidence-based clinical practice. However, such descriptions are not common in therapy research. The aim was to develop an upper limb therapy protocol which reflected local clinical practice in the stroke unit, and a recording form to document the content, quantity and progression of therapy. Methods. This was a multi-method study. A list of interventions commonly used for the rehabilitation of the stroke upper limb was compiled following a systematic literature search. This was then refined into the Action Medical Research Upper Limb Therapy (AMRULT) protocol in a two-stage process involving a survey and a group discussion. Six physical therapists and three occupational therapists supported its development. The AMRULT protocol was then piloted in a two-arm randomized controlled trial with 90 stroke patients for therapy and recording purposes. Results. The protocol classified therapies based on therapy input as passive, active assisted, active/strengthening and functional. Using this form it was possible to not only summarize the content of therapy but also objectively document progression (e.g. 14% of the participants progressed to functional exercises between the 5th and 8th weeks after stroke onset). Discussion. The AMRULT protocol and associated recording form were useful in both standardizing the delivery and quantification (content and progression) of therapy. While the AMRULT protocol was devised for a specific purpose, the method used can be adapted to develop protocols to support other research studies.
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Affiliation(s)
| | - Catherine BüCher
- School of Health and Rehabilitation & Research Institute for Life Course Studies, Keele University, Keele
| | - Christine Roffe
- University Hospitals of North Staffordshire, Stoke-on-Trent, UK
| | - Anand D Pandyan
- School of Health and Rehabilitation & Research Institute for Life Course Studies, Keele University, Keele
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Abstract
There is a high incidence of reflex sympathetic dystrophy of the upper limbs in patients with hemiplegia, and its painful and functional consequences present a problem to specialists in physical medicine and rehabilitation. This study was designed to assess the role of several factors in the occurrence of reflex sympathetic dystrophy in patients with hemiplegia. Ninety-five consecutive stroke patients (63 male and 32 female, mean age 59+/-12 years) admitted to our hospital were evaluated. Of the study group, 29 patients (30.5%) were found to develop reflex sympathetic dystrophy. There were no significant differences between the hemiplegic patient groups with or without reflex sympathetic dystrophy regarding age, gender, etiology, side of involvement, disease duration and the presence of comorbidities. The recovery stages of hemiplegia, as shown by Brunnstrom functional classification, were significantly different between the two groups; patients in lower recovery stages tended to develop reflex sympathetic dystrophy more frequently (P<0.01). Additionally, the presence of flaccidity was also a significant factor in the development of reflex sympathetic dystrophy. Glenohumeral subluxation was present in 37 patients (38.9%) in our study group and the presence of this complication was related to the occurrence of reflex sympathetic dystrophy. The presence of glenohumeral subluxation was significantly higher in patients with reflex sympathetic dystrophy (21/29, 72.4%) when compared to the patients without reflex sympathetic dystrophy (16/66, 24.2%) (P<0.001). Also, hemiplegic patients with more severe shoulder subluxation were significantly more likely to develop reflex sympathetic dystrophy. These results suggest that lower recovery stages, reduced tonus and glenohumeral subluxation significantly contribute to the occurrence of reflex sympathetic dystrophy in the hemiplegic patient. We believe that preventive and treatment measures should consider these factors as they seem to have in common a higher risk of traumatizing the paralyzed upper limb and causing reflex sympathetic dystrophy.
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Okudan B, Celik C. Determination of inflammation of reflex sympathetic dystrophy at early stages with Tc-99m HIG scintigraphy: preliminary results. Rheumatol Int 2005; 26:404-8. [PMID: 16025330 DOI: 10.1007/s00296-005-0009-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 05/07/2005] [Indexed: 11/25/2022]
Abstract
The pathogenesis of reflex sympathetic dystrophy (RSD) is not completely understood. However, an excessive regional inflammation, sensitization of primary somatosensory afferents, and sensitization of spinal neurons are considered to have a role in the pathogenesis of RSD. The underlying pathophysiology relating the clinical picture may help to determine the pharmacotherapeutic approach for an individual patient. Scintigraphy using radiolabelled human polyclonal non-specific immunoglobulin (HIG) has been recognized as a useful tool for the localization of inflammatory disorders. Thirty-six consecutive RSD patients associated with hemiplegia were included in this study. All the patients in this study had three phases bone scan and Tc-99m HIG scintigraphy. On admission, of 36 patients with positive bone scan, 30 had positive Tc-99m HIG scan. All the patients were symptomatic at the time of bone scanning. On the contrary, 24 out of 36 patients subsequently became asymptomatic at an 8-month re-evaluation period. Tc-99m HIG scintigraphy is a non-invasive complementary method for the determination of ongoing inflammatory reactions which also aids the clinicians to predict the response to anti-inflammatory therapy at the very early phase of RSD associated with hemiplegia. This preliminary study may be a source of inspiration for further studies with larger series and longer follow-up .
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Affiliation(s)
- Berna Okudan
- Department of Nuclear Medicine, Ankara Numune Research and Training Hospital, Ankara, Turkey.
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Wang JS, Chen SY, Lan C, Wong MK, Lai JS. Neuromuscular electric stimulation enhances endothelial vascular control and hemodynamic function in paretic upper extremities of patients with stroke. Arch Phys Med Rehabil 2004; 85:1112-6. [PMID: 15241759 DOI: 10.1016/j.apmr.2003.11.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the effects of neuromuscular electric stimulation (NMES) on endothelial vascular control and hemodynamic function in patients in rehabilitation after acute stroke. DESIGN Before-after trial. SETTING Inpatients in a tertiary hospital. PARTICIPANTS Sixteen stroke patients (11 women, 5 men) with a mean age of 60.6+/-19.5 years. INTERVENTIONS All patients received NMES for paretic wrist extensor and flexor muscles 30 minutes daily, 5 days a week, for 4 weeks. The nonparetic upper extremities, which served as controls, did not receive NMES. MAIN OUTCOME MEASURES Laser Doppler perfusion testing was conducted to measure cutaneous microcirculatory responses to transdermal iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), as specific endothelium-dependent and -independent vasodilators, respectively. Arterial and venous hemodynamic function was also measured by impedance plethysmography. RESULTS Before NMES treatment, the venous capacity and compliance of the paretic extremities did not differ significantly from those of the nonparetic extremities. However, hyperemic arterial inflow, ACh-induced cutaneous perfusion, and the ratio of ACh- to SNP-induced cutaneous perfusion were lower in the paretic than in the nonparetic extremities. After NMES treatment, hyperemic arterial inflow and venous outflow increased by 21.5% and 57.2%, respectively, in the paretic extremities (P<.05). ACh-induced cutaneous perfusion and the ratio of ACh- to SNP-induced cutaneous perfusion were also significantly enhanced in the paretic extremities. In contrast, hyperemic arterial inflow decreased by 39.6% in the nonparetic extremities (P<.05), and endothelium-dependent cutaneous vasodilation also decreased significantly. CONCLUSIONS NMES therapy may enhance the hyperemic arterial response and endothelium-dependent dilation in skin vasculature in the paretic upper extremities of patients with stroke.
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Affiliation(s)
- Jong-Shyan Wang
- Graduate Institute of Rehabilitation Sciences and Center for Gerontological Research, Chang-Gung University, Tao-Yuan, Taipei, Taiwan 10016
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