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ORIJINAL ARAŞTIRMA

İnme Sonrası Omuz Subluksasyonunda İki Farklı Askı Tipinin Etkinliğinin Karşılaştırılması
Comparison of the Effectiveness of Two Different Types of Slings in Shoulder Subluxation After Stroke
Received Date : 27 Oct 2021
Accepted Date : 31 Jan 2022
Available Online : 02 Feb 2022
Doi: 10.31609/jpmrs.2021-86796 - Makale Dili: EN
J PMR Sci. 2022;25(2):233-39
ÖZET
Amaç: Bu çalışmanın amacı, akut dönem hemiplejik hastalarda omuz subluksasyonunda omuz askısının ağrı, motor fonksiyon, günlük yaşam ve denge üzerindeki etkinliğinin ve farklı tipte kullanılan askıların birbirine üstünlüğünün olup olmamasının araştırılmasıdır. Gereç ve Yöntemler: Akut inmeye bağlı hemiplejik omuz subluksasyonu olan 32 hasta, omuz destekli askı (Grup 1, n=20) ve önkol destekli askı (Grup 2, n=20) kullanılan 2 gruba ayrıldı. Tüm hastalara, hemipleji rehabilitasyonu pasif ve aktif-yardımlı eklem hareket açıklığı, germe ve nörofizyolojik egzersizler 8 hafta boyunca her gün yapıldı. Ağrı değerlendirmesi Vizüel Analog Skala ile sensorimotor değerlendirme Fugl Meyer değerlendirmesiyle, günlük yaşam aktivitesi Barthel İndeksi ve denge Berg Balance Skalası ile değerlendirildi. Bulgular: Omuz ağrı şiddetinde, 8 haftalık tedavi sonunda hem Grup 1 hem de Grup 2’de anlamlı azalma elde edilememiştir. Barthel İndeksi skorlarında ve Berg Balance Skalası skorlarında her iki grupta da istatistiksel bir artış var iken, 2 grup arasında fark yoktu. Fugl Meyer skorunda, tedavi sonrası Grup 1’de (3,0±3,1; p=0,007) istatistiksel olarak anlamlı bir artma meydana gelirken, Grup 2’de (2,2±5,9; p=0,063) yoktu. Gruplar karşılaştırıldığında, Grup 1’de Grup 2’ye göre Fugl Meyer skorları anlamlı olarak daha fazlaydı (p=0,048). Sonuç: Akut inmeli hastalarda, omuz subluksasyonu gelişiminden sonra omuz veya önkol destekli askıların denge ve günlük yaşam aktivitelerini olumlu etkilediği ve ek olarak; omuz destekli askı kullanımının motor fonksiyonları geliştirmede daha etkin olduğu gözlemlendi.
ABSTRACT
Objective:The purpose of this study is to investigate the effectiveness of shoulder slings on pain, motor function, daily life and balance in acute hemiplegic patients with shoulder subluxation and to investigate whether different types of slings are superior to each other. Material and Methods:Thirty-two patients with hemiplegic shoulder subluxation due to acute stroke were divided into 2 groups: shoulder supported slings (Group1, n=20) and forearm supported slings (Group2, n=20). Results: At the end of treatment, no significant decrease was achieved in the severity of shoulder pain in 2 groups. There was a statistical increase in BI scores and Berg Balance scores in both groups, while there was no difference between the 2 groups. There was a statistically significant increase in the Fugl Meyer score in Group 1 following treatment (3.0±3.1; p=0.007), while there was none in Group 2 (2.2±5.9; p=0.063). In the comparison of the groups, Fugl Meyer scores were significantly higher in Group 1 compared to Group 2 (p=0.048). Conclusion: It was determined that after the development of shoulder subluxation in patients with acute stroke, slings with shoulder or forearm support positively affect the balance and daily life activities of patients, and in addition, slings with shoulder were more effective in improving motor functions.
REFERENCES
  1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146-603. [Crossref]  [PubMed]  [PMC] 
  2. Kalichman L, Ratmansky M. Underlying pathology and associated factors of hemiplegic shoulder pain. Am J Phys Med Rehabil. 2011; 90(9):768-80. [Crossref]  [PubMed] 
  3. Zorowitz RD. Recovery patterns of shoulder subluxation after stroke: a six-month follow-up study. Top Stroke Rehabil. 2001;8(2):1-9. [Crossref]  [PubMed] 
  4. 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(3):276-98. [Crossref]  [PubMed] 
  5. Bender L, McKenna K. Hemiplegic shoulder pain: defining the problem and its management. Disabil Rehabil. 2001;23(16):698-705. [Crossref]  [PubMed] 
  6. Brooke MM, de Lateur BJ, Diana-Rigby GC, et al. Shoulder subluxation in hemiplegia: effects of three different supports. Arch Phys Med Rehabil. 1991;72(8):582-6. [PubMed] 
  7. Williams R, Taffs L, Minuk T. Evaluation of two support methods for the subluxated shoulder of hemiplegic patients. Phys Ther. 1988;68(8):1209-14. [PubMed] 
  8. Yoon YS, Kim JH, Lee KA, et al. [The effect of modified triangular bobath slings on shoulder subluxation in stroke patients]. J Korean Acad Rehabil Med. 2004;28(5):494-500. [Link] 
  9. Turner-Stokes L, Jackson D. Assessment of shoulder pain in hemiplegia: sensitivity of the ShoulderQ. Dis Rehabil. 2006;28(6):389-95. [Crossref]  [PubMed] 
  10. Küçükdeveci AA, Yavuzer G, Tennant A, et al. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med. 2000;32(2):87-92. [Crossref]  [PubMed] 
  11. Sanford J, Moreland J, Swanson LR, et al. Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Phys Ther. 1993;73(7):447-54. [Crossref]  [PubMed] 
  12. Steffen TM, Hacker TA, Mollinger L. Age-and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002;82(2):128-37. [Crossref]  [PubMed] 
  13. Gilmore PE, Spaulding SJ, Vandervoort AA. Hemiplegic shoulder pain: implications for occupational therapy treatment. Can J Occup Ther. 2004;71(1):36-46. [Crossref]  [PubMed] 
  14. Nadler M, Pauls M. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review. Clin Rehabil. 2017;31(4):444-53. [Crossref]  [PubMed] 
  15. Ada L, Foongchomcheay A, Canning C. Supportive devices for preventing and treating subluxation of the shoulder after stroke. Cochrane Database Syst Rev. 2005;2005(1):CD003863. [Crossref]  [PubMed]  [PMC] 
  16. Van Bladel A, Lambrecht G, Oostra KM, et al. A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients. Eur J Phys Rehabil Med. 2017;53(3):400-9. [Crossref]  [PubMed] 
  17. Hesse S, Herrmann C, Bardeleben A, et al. A new orthosis for subluxed, flaccid shoulder after stroke facilitates gait symmetry: a preliminary study. J Rehabil Med. 2013;45(7):623-9. [Crossref]  [PubMed] 
  18. Hartwig M, Gelbrich G, Griewing B. Functional orthosis in shoulder joint subluxation after ischaemic brain stroke to avoid post-hemiplegic shoulder-hand syndrome: a randomized trial. Clin Rehabil. 2012;26(9):807-16. [Crossref]  [PubMed] 
  19. Ashburn A, Hyndman D, Pickering R, et al. Predicting people with stroke at risk of falls. Age Ageing. 2008;37(3):270-6. [Crossref]  [PubMed] 
  20. Yavuzer G, Ergin S. Effect of an arm sling on gait pattern in patients with hemiplegia. Arch Phys Med Rehabil. 2002;83(7):960-3. [Crossref]  [PubMed] 
  21. Acar M, Karatas GK. The effect of arm sling on balance in patients with hemiplegia. Gait Posture. 2010;32(4):641-4. [Crossref]  [PubMed] 
  22. Şahin E, Baydar M, El Ö, et al. Effect of shoulder strap on static balance in patients with stroke. Neurol Sci. 2012;29(3):458-66. [Link] 
  23. Paci M, Nannetti L, Rinaldi LA. Glenohumeral subluxation in hemiplegia: an overview. J Rehabil Res Dev. 2005;42(4):557-68. [Crossref]  [PubMed] 
  24. Pop T. Subluxation of the shoulder joint in stroke patients and the influence of selected factors on the incidence of instability. Ortop Traumatol Rehabil. 2013;15(3):259-67. [Crossref]  [PubMed] 
  25. Ada L, Foongchomcheay A, Langhammer B, et al. Lapt-ray and triangular sling are no more effective than a hemi-sling in preventing shoulder subluxation in those at risk early after stroke: a randomised trial. Eur J Phys Rehabil Med. 2017;53(1):41-8. [Crossref]  [PubMed]