kennisclip post-stroke english

Knowledge clip, Post - strong

Hemiplegic shoulder pain (HSP)

different type of pain

  • muscle-skeletal pain, central pain

  • patients experience phase often in the acute phase

  • around 40% of stroke patients develop HSP in the acute and early rehab phase

Pathophysiology

changes associated with or resulting from stroke

  • muscle weakness

  • change in muscle tone

  • pathological muscle synergies

  • spasticity (affected side) → can be painful

  • shortened muscles (due to not using the arm)

  • altered muscle activity hampering scapular control (shoulder girdle)

Causes HSP (multifactorial!)

  • glenohumeral subluxation (due to loss of muscle strength, tone and wrong positioning, it happens especially due the decrease of activity of the supraspinatus and deltoid muscles,

  • capsulitis → inflammation due to the muscles that don’t support the joint

  • neuritis scapularis nerve

  • subdeltoid bursitis

  • tendovaginitis of biceps tendon

  • neuropathy of the brachial plexus

  • arthritis

  • spasticity

  • thalamic pain

  • shoulder-hand syndrome (sympathische reflexdystrphy)

  • edema → hands hanging down for prolonged period of time

Assessment

1) inspection, arm positioning, functional inspection

2) AROM/PROM

3) MAS

4) MI of Upper extremity

5) Frenchay arm test or Action research arm test → to assess functional movement

6) FM (upper extremity) → motor synergies and motor selectivity

clinical scapular control-not for exam

Prevention

  • A sling, orthoses or taping provides mechanical support for glenohumeral subluxation

Taping:

  • to correct reduces LR of scapula

  • To support the head of the humerus in the glenoid fossa

  • To alleviate the m. supraspinatus → allow more freedom of movement

It improves the arm positioning

Exercise therapy

  • arm positioning

  • weight bearing

  • stretching

  • building up normal tone/ moving out of the spastic pattern

  • strengthening the rotator cuff muscles

  • coaching the patient to avoid unnecessary strain on the shoulder

Robot assisted training for paretic arm

  • reduce atypical pain in the paretic arm (shoulder+ elbow)

Medical treatment options for spasticity

  • + steroid injections for inflamed area’

Patient education

  • involve the family

  • teach them to work with a mirror (self - awareness)

  • explain impairments of shoulder and how the patient can improve them

  • help to understand the movements of the shoulder and how to avoid inappropriate movements

  • explain and teach appropriate positioning and handling of hemiplegic shoulder

  • explain and teach appropriate exercises