Efficacy of a Newly Designed Custom-Fitted Shoulder Subluxation Orthosis for Stroke Patients: A Single-Blinded Crossover Randomized Controlled Trial
Keywords:shoulder subluxation, radiograph, orthosis, stroke, rehabilitation
Objectives: To compare the efficacy of a newly designed custom-fitted shoulder subluxation orthosis (SSO) with a commercial Bobath sling for shoulder subluxation in stroke patients.
Study design: A single-blinded crossover randomized controlled trial.
Setting: Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Subjects: Sixteen post-stroke patients with hemiplegia/hemiparesis
Methods: A radiologist measured the acromiohumeral (AH) distance in anterior-posterior view radiographs of normal and affected shoulders of patients in a sitting position when not using any orthosis, when wearing a Bobath sling which supports the proximal humerus only, and when wearing an SSO. Comparison of the AH distance was conducted using the paired t-test.
Results: Without any orthosis, the mean (SD) of the affected and normal shoulders were 47.9 (7.5) and 36.2 (4.6) mm, respectively. The AH distance of the affected shoulder while wearing SSO was reduced to 36.8 (4.7) mm which is not statistically significant different from the normal shoulder distance (p = 0.49), whereas the mean AH distance wearing a Bobath sling was only reduced to 44.9 (7.7) mm., statistically significantly greater than the normal shoulders (p < 0.01).
Conclusions: The newly designed custom-fitted proximal-distal type shoulder subluxation orthosis for hemiplegia/hemiparesis patients, can reduce the AH distance significantly closer to that of a normal shoulder than a Bobath sling.
Keywords: shoulder subluxation, radiograph, orthosis, stroke, rehabilitation
Suwanwela NC. Stroke epidemiology in Thailand. J Stroke. 2014; 16:1-7.
Turner-Stokes L, Jackson D. Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil. 2002;16:276-98.
Allison R, Shenton L, Bamforth K, Kilbride C, Richards D. Incidence, time course and predictors of impairments relating to caring for the profoundly affected arm after stroke: a systematic review. Physiother Res Int. 2016;21:210-27.
Paci M, Nannetti L, Taiti P, Baccini M, Pasquini J, Rinaldi L. Shoulder subluxation after stroke: relationships with pain and motor recovery. Physiother Res Int. 2007;12:95-104.
Kumar P, Saunders A, Ellis E, Whitlam S. Association between glenohumeral subluxation and hemiplegic shoulder pain in patients with stroke. Phys Ther Rev. 2013;18:90-100.
Adey-Wakeling Z, Arima H, Crotty M, Leyden J, Kleinig T, Anderson CS, et al. Incidence and associations of hemiplegic shoulder pain poststroke: prospective population-based study. Arch Phys Med Rehabil. 2015;96:241-7.
Kuptniratsaikul V, Kovindha A, Suethanapornkul S, Manimmanakorn N, Archongka Y. Long-term morbidities in stroke survivors: a prospective multicenter study of Thai stroke rehabilitation registry. BMC Geriatr. 2013;15:13-33.
Dursun E, Dursun N, Ural CE, Cakci A. Glenohumeral joint subluxation and reflex sympathetic dystrophy in hemiplegic patients. Arch Phys Med Rehabil. 2000;81:944-6.
Roy CW, Sands MR, Hill LD: Shoulder pain in acutely admitted hemiplegics. Clin Rehabil. 1994;8:334-40.
Kalichman L, Ratmansky M. Underlying pathology and associated factors of hemiplegic shoulder pain. Am J Phys Med Rehabil. 2011;90:768–80.
Nadler M, Pauls MMH. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review. Clin Rehabil. 2017;31:444–53.
Paci M, Nannetti L, Rinaldi LA. Glenohumeral subluxation in hemiplegia: an overview. J Rehabil Res Dev. 2005;42:557-68.
Dajpratham P, Sura P, Lektrakul N, Chanchairujira G. Efficacy of shoulder slings in shoulder subluxation of stroke patients. J Med Assoc Thai. 2006;89:2050-5.
Moodie NB. Subluxation of the glenohumeral joint in hemiplegia: evaluation of supportive devices. Physiother Can. 1986;38:151-7.
Hesse S, Herrmann C, Bardeleben A, Holzgraefe M, Werner C, Wingendorf I, et al. A new orthosis for subluxed, flaccid shoulder after stroke facilitates gait symmetry: a preliminary study. J Rehabil Med. 2013;45:623-9.
Brooke MM, de Lateur BJ, Diana-Rigby GC, Questad KA. Shoulder subluxation in hemiplegia: Effects of three different supports. Arch Phys Med Rehabil. 1991;72:582–6.
Arya KN, Pandian S, Puri V. Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: a systematic review. Top Stroke Rehabil. 2018;25:68-81.
Dieruf K, Poole JL, Gregory C, Rodriguez EJ, Spizman C. Comparative effectiveness of the GivMohr sling in subjects with flaccid. Arch Phys Med Rehabil. 2005;86:2324-9.
Yavuzer G, Ergin S. Effect of an arm sling on gait pattern in patients with hemiplegia. Arch Phys Med Rehabil. 2002;83:960-3.
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