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Neuro? Logical! Forum for all neuro-things => from neuron to brain...

View Poll Results: Can electrical stimulation can avoid risk of shoulder subluxation in Hemiplegia?
YES 2 33.33%
NO 4 66.67%
Voters: 6. You may not vote on this poll

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Old 13-05-2005, 07:53 PM   #1
emad
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of course "NO" at all

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Old 14-05-2005, 01:44 PM   #2
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Emad,

I would like to know how u justify ES will not be useful in this regard. This idea i got only after reading that ES can help, but if u r sure enough that it is not at all useful, it better to explain ur idea. So others can get an idea about this topic.

if u don't mind, I request u to place ur explanation with ur own experience.
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Old 14-05-2005, 08:54 PM   #3
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Hi :

It is better to tell me what i call u !


ES ( Passive therapy ) CAN NOT Increase the Active control of the glenohumeral J ( Muscles ) and even the passive controlers of the J (ligaments ) .

I think ES is time- consuming .
What I can not understand , i have the imperssion that you are working in Neural Mobilis project , how and you believe in ES ??

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Old 16-05-2005, 07:39 AM   #4
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I haven't the experience of preventing shoulder subluxation via e-stim however I have been using it for subluxation problems, especially pain. Invariably, it helps to reduce pain even with old strokes. There has been enough positive results (about 80%) that I include it in POC whenever subluxation is present. There have been times when the patient didn't recognize the low intensity pain of his/her shoulder. I was skeptable about this in training, but my first patient, 6 months post injury, regained voluntary movement, was able to achieve about 80 degrees shoulder movement and ultimately hand grasp. So why not?

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Old 16-05-2005, 03:28 PM   #5
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Default Stimulation for subluxation

Dear emad,

U can call me as Gopi,

Since I have not gone through this practically, I can't tell that I am believing this. The main thing that made me to think like this is, if the stimulation is able to tone up muscles and sometimes used to improve power of muscles from 0, 1, or +1 why this can't be concentrated on shoulder muscles by addressing individually.

The main thing I would like to clarify about this information is: whether ES can avoid suluxation.(I am not asking that after subluxation it can help or not). I am meaning the way of "prevention is better than cure" in subluxation caused by hemiplegia.

It's please to have good response and explanations from experienced persons like u.

with smiles,

Gopi
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Old 16-05-2005, 09:39 PM   #6
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Hi Gopi :

On the forum there are more experienced therapist :idea:

As for prevention of subluxation , 2 ways , first using of sling to suppot the limb weight , particularly if it is flaccid .

Second , enhancing muscles /recuritement of muscles arund the shoulder, as well advising /education of the family members ,the cares how to hamdle the patient from that upper imb and avoiding its tractioning .

Regards
Emad
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Old 17-05-2005, 06:35 AM   #7
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http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15609840

Clin Rehabil. 2004 Dec;18( 8 ):833-62.
The impact of physical therapy on functional outcomes after stroke: what's the evidence?

Van Peppen RP, Kwakkel G, Wood-Dauphinee S, Hendriks HJ, Van der Wees PJ, Dekker J.

Department of Physical Therapy, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.

OBJECTIVE: To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke. METHODS: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, PEDro, EMBASE and DocOnline were searched for controlled studies. Physical therapy was divided into 10 intervention categories, which were analysed separately. If statistical pooling (weighted summary effect sizes) was not possible due to lack of comparability between interventions, patient characteristics and measures of outcome, a best-research synthesis was performed. This best-research synthesis was based on methodological quality (PEDro score). RESULTS: In total, 151 studies were included in this systematic review; 123 were randomized controlled trials (RCTs) and 28 controlled clinical trials (CCTs). Methodological quality of all RCTs had a median of 5 points on the 10-point PEDro scale (range 2-8 points). Based on high-quality RCTs strong evidence was found in favour of task-oriented exercise training to restore balance and gait, and for strengthening the lower paretic limb. Summary effect sizes (SES) for functional outcomes ranged from 0.13 (95% Cl 0.03-0.23) for effects of high intensity of exercise training to 0.92 (95% Cl 0.54-1.29) for improving symmetry when moving from sitting to standing. Strong evidence was also found for therapies that were focused on functional training of the upper limb such as constraint-induced movement therapy (SES 0.46; 95% Cl 0.07-0.91), treadmill training with or without body weight support, respectively 0.70 (95% Cl 0.29-1.10) and 1.09 (95% Cl 0.56-1.61), aerobics (SES 0.39; 95% Cl 0.05-0.74), external auditory rhythms during gait (SES 0.91; 95% Cl 0.40-1.42) and neuromuscular stimulation for glenohumeral subluxation (SES 1.41; 95% Cl 0.76-2.06). No or insufficient evidence in terms of functional outcome was found for: traditional neurological treatment approaches; exercises for the upper limb; biofeedback; functional and neuromuscular electrical stimulation aimed at improving dexterity or gait performance; orthotics and assistive devices; and physical therapy interventions for reducing hemiplegic shoulder pain and hand oedema. CONCLUSIONS: This review showed small to large effect sizes for task-oriented exercise training, in particular when applied intensively and early after stroke onset. In almost all high-quality RCTs, effects were mainly restricted to tasks directly trained in the exercise programme.

Publication Types:

* Review


PMID: 15609840 [PubMed - indexed for MEDLINE]
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Old 22-08-2005, 01:53 PM   #8
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Hi there, .... in my clinical pratice ES is one of the good tool to minimise the rate of subluxation and ofcourse it has been proved that it has reduce subluxation with my clients.ASAP after the stroke if ES given to supraspinatus and post deltoid will be helpful. Here are some articles may be of your inntrest........http://www.ncbi.nlm.nih.gov/entrez/q...fft&query_hl=3
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Old 22-08-2005, 01:58 PM   #9
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Default Sling not enough?

Quote:
Originally Posted by emad
Hi Gopi :

On the forum there are more experienced therapist :idea:

As for prevention of subluxation , 2 ways , first using of sling to suppot the limb weight , particularly if it is flaccid .

Second , enhancing muscles /recuritement of muscles arund the shoulder, as well advising /education of the family members ,the cares how to hamdle the patient from that upper imb and avoiding its tractioning .

Regards
Emad
hi , i think shoulder sling alone and of course education is not enough to support shoulder subluxation, i guess recruiting ES also helps along with the education of family members as well the client will be helpful in reducing subluxation.
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Old 23-08-2005, 09:56 AM   #10
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Hello neuron and welcome.

I like the name you chose.

I do understand that ES is helpful to recruit muscle support, however, I still feel that a sling can undo all the good that ES may do. Immobility in a flexed postion plus the risk of loss of external rotation of the shoulder, I think is not worth the risk, it has been proved that a sling does not alter subluxation. I feel the risk of promoting loss of recovery is greater than not using a sling at all. Of course, if there is no sign of recovery of tone in the upper limb, and neglect is dominant, then a sling may help to protect damage from others.

If I used a sling at all, I used collar and cuff with two loops at either end; two to support the wrist and hand to prevent sustained wrist drop, and two loops at the other end to keep a direct line of support from elbow to shoulder where it is needed. If there is no support directly at the elbow, then nothing is achieved.
I felt an ordinary sling (triangular) was tough on the neck and also hid the arm from view (promoting disability and damage)

Only my thoughts.


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Old 25-08-2005, 12:03 PM   #11
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Hi Neuron and Welcome,

If there is some muscular activity over/on the shoulder then I try to develop it. It works finer than ES anyway. I agree however with Nari about neglect and flacidity.

BTW, ES is made brutal by the means used. The current is far from the one neurons need. Square waves are not natural neither physiological. It is not necessary to create a reactive zone, with electricity.
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Old 25-08-2005, 08:55 PM   #12
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Hi :

Easy , Easy , I did not know that i had to write .

Well,I support using of sling in flaccid stage particularly in walking , ifd it is possible .

Nari :
As i understand from your post , you justify your view against sling , by saying we need supports for neck , elbow ......, I will say , do you think , or have you seen before an elbow of hemiplegia in pain /subluxation , at all i do not think so , on the other hand , there is always referred consistant pain along the whole upper limb , of course you will find ULTTs positive ....
Another point , you stated before that the Shoulder subluxation is NOT a porblem in itself , but i feel it is great problem , Do NOT you see that this subluxation and weight of the limb could put tension on the Perpheral N S along the whole upper limb , resulting in pain ,,, ,and complaints .

I know very well that Topic Stroke Workshop contained that issue in our discussion , but in do not know if we move there or contuine here .

I can NOT imagine at all allowing the stroke victim to walk with that upper limb downing like pandloum , resulting in pain and walk training balance disturbed , in the first month .

Regards

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Old 25-08-2005, 10:55 PM   #13
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emad

It has been shown with studies that subluxation of the humerus is quite unrelated to pain.

I don't understand what you are saying about the elbow. Think biomechanics-

1) patient has pain, flaccidity in the arm, subluxation and has no sign of movment.
2) IF we are going to put a sling on (for the above reasons) it makes sense to support the elbow++ to ease stress on the brachial plexus. Try it yourself. You have a hanging (L) arm, and you have pain++. Place your (R) hand UNDER the (L) olecranon, and ease slightly upwards. Feel the difference. The collar and cuff sling with the double twist (one loop above the elbow, the other below) does not reduce subluxation (that has been demonstrated for 10 years) but it does reduce pain, by giving direct support to the head of the humerus and thus the plexus. This can be achieved with a cotton triangular sling, but that locks in the arm and permits NO vision of the arm and promotes disability.

That's my theory. An standard collar and cuff does NOT support the shoulder complex adequately.

Hope that is clearer

Nari
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