Shoulder Passive Range of Motion and Positioning Exercise on Hemiplegic Stroke Patients

Completed

Phase N/A Results N/A

Trial Description

Several factors associated with the hemiplegic shoulder pain after stroke includes rotator cuff injury, bicipital tendonitis, impingement, spasticity, limited external rotation of shoulder joint, adhesive capsulitis, shoulder subluxation, shoulder hand syndrome, and brachial/axillary neuropathy. In this study, the investigators aim to usie high frequency ultrasound to evaluate the relationship between stroke patients with poor shoulder motor function and shoulder tendon injury. Also, assumed that performing passive range of motion and positioning training might prevent tendon injury of shoulder and hemiplegic shoulder pain in either acute or chronic stage of stroke.

Detailed Description

Hemiplegic shoulder pain is a common complication. Several factors associated with the hemiplegic shoulder pain includes rotator cuff injury, bicipital tendonitis, impingement, spasticity, limited external rotation of shoulder joint, adhesive capsulitis, shoulder subluxation, shoulder hand syndrome, and brachial/axillary neuropathy. Flaccidity has a positive association with soft tissue injury or tendon injury of the shoulder.
In the preliminary study, base on the sonography results, it is found that the possibility of getting tendon injury or inflammation on the affected shoulder joint is higher in the group of patients who were with worse motor functions during the rehabilitation in hospital.
In this study, one hundred acute stroke patients with hemipelgia will be enrolled. And those participants would be separated into 2 groups: control group (Brunnstrom stage IV-VI) and experimental group (Brunnstrom stage I-III). Clinical characteristics and physical findings will be recorded on the admission date. During the process, the investigators will use high frequency (5-12 MHz) musculoskeletal ultrasound to evaluate those tendons around bilateral shoulder joints on the admission date and at 2 weeks later. In the first year after stroke, half patients in those 2 groups will perform positioning training and passive range of motion for affected shoulder either during hospitalization or after being discharged. Then, the investigators will execute physical examination and use high frequency ultrasound to evaluate those tendons around bilateral shoulder joints of the participants twice after 6 months and 12 months. Then, the investigators will discuss the incidences of shoulder tendon injury after receiving rehabilitation program according to ultra-sonographic findings.

Conditions

Interventions

  • Video-teaching Other
    Intervention Desc: By watching a video specially designed by a rehabilitation team, the participants may learn how to position their affected arm properly (30 minutes per time, twice a day for five days in a week), how to transfer safely with the help from the caregivers, how to execute appropriate passive range of motion exercises regularly (15 minutes per time, twice a day for five days in a week), and be taught to be aware of not doing insecure pulley exercises nor carrying stuffs which are too heavy.
    ARM 1: Kind: Experimental
    Label: video-teaching materials
    Description: regular passive ROM exercise regular rehabilitation programe alternative video-teaching materials
  • Oral-teaching Other
    Intervention Desc: The nurses will teach patients how to position their affected arm properly, how to transfer safely with the help from the caregivers, how to execute appropriate passive range of motion exercises regularly, and be taught to be aware of not doing insecure pulley exercises nor carrying stuffs which are too heavy on the admission date of hospitalization.
    ARM 1: Kind: Experimental
    Label: video-teaching materials
    Description: regular passive ROM exercise regular rehabilitation programe alternative video-teaching materials
    ARM 2: Kind: Experimental
    Label: control group
    Description: regular passive ROM exercise regular rehabilitation programe regular oral-teaching materials
  • Regular rehabilitation program Other
    Intervention Desc: Regular occupational therapy program and regular physical therapy program in the rehabilitation department of the hospital.
    ARM 1: Kind: Experimental
    Label: video-teaching materials
    Description: regular passive ROM exercise regular rehabilitation programe alternative video-teaching materials
    ARM 2: Kind: Experimental
    Label: control group
    Description: regular passive ROM exercise regular rehabilitation programe regular oral-teaching materials

Outcomes

Type Measure Time Frame Safety Issue
Primary the change from baseline on hemiplegic upper extremity sonography baseline (before intervention), changes from baseline sonography results at one week before being discharged and at six month after.
Secondary Brunnstrom motor recovery stage for motor ability baseline (before intervention), changes from baseline Brunnstrom stage at one week before being discharged and at six month after.
Secondary Modified Ashworth scale for level of spasticity of affected arm baseline (before intervention), changes from baseline level of spasticity at one week before being discharged and at six month after.
Secondary Range of motion baseline (before intervention), changes from baseline range of motions at one week before being discharged and at six month after.

Sponsors