Hemiplejik omuzda bantlama ile nöromüsküler elektrik stimülasyon sonuçlarının karşılaştırılması: randomize kontrollü çalışma

Year 2020, Volume: 7 Issue: 2, 99 - 108, 31.08.2020

Gül Öznur Karabıçak , Burcu Talu

Abstract

Amaç: Omuz fonksiyonu, inme sonrası hayatta kalanların bağımsızlık kazanmaları için önemli bir rol oynar. Bu çalışmanın
amacı, inme geçiren hastalarda omuz bantlama (Tp) ve nöromüsküler elektrik stimülasyonunun (NMES) omuz fonksiyonu, motor
aktivite ve ağrı üzerindeki etkilerini karşılaştırmaktır.

Yöntem: Çalışmaya üst ekstremite tutulumu olan inme hastaları alındı. Altmış hasta, inmeden 1-3 ay sonra bantlama grubu
(TpG), NMES veya kontrol gruplarına (CG) rasgele ayrıldı. Tedavi süresi 4 hafta idi. Omuz fonksiyonel değerlendirmede Fugl–
Meyer Duyu Motor Değerlendirme Ölçeği (FMDDÖ) ve Motor Aktivite Log-28 (MAL) kullanıldı. Omuz ağrısı değerlendirmesinde
Görsel Analog Skala kullanıldı.

Bulgular: Grup içi karşılaştırmalarda FMDDÖ (TpG p≤0,001; NMES p=0,002; CG p≤0,001) ve MAL skorlarında (TpG p≤0,001;
NMES p≤0,001; CG p ≤0,001) istatistiksel açıdan anlamlı gelişmeler bulundu. Grup içi karşılaştırmalar hem istirahatte omuz
ağrısı yoğunluğunda (TpG p=0,007 ve NMES p=0,014) hem de aktivite ile (TpG p≤0,01 ve NMES p=0,016) anlamlı bir azalma
gösterirken, CG’de hem istirahatte hem de aktivite ağrısı ile anlamlı bir azalma saptanmadı (her ikisi için p=0,054). Gruplar
arası karşılaştırmalar, FMDDÖ'lerde TpG lehine önemli bir değişiklik (p=0,0026) gösterdi (p≤0,001). Grup karşılaştırmalarında
MAL'de fark saptanmadı (p>0,05).

Sonuç: İnme hastalarının konservatif tedavisinde, etkilenen omuzda izole motor aktivitesini arttırmak için bantlama ve NMES
kullanılabilir; ancak, fonksiyon için destekleyici bantlama daha etkili olacaktır.

Keywords

Hemipleji, Omuz, Atletik Bant, Elektrik Stimulasyonu, Motor Aktivitesi

A comparison of taping and neuromuscular electric stimulation outcomes in hemiplegic shoulder: a randomized controlled trial

Abstract

Purpose: Aim of this study is to compare the effects of shoulder taping (Tp) and neuromuscular electric stimulation (NMES) on shoulder function, motor activity, and pain in patients with hemiplegia.

Methods: Outpatients with ischemic stroke with upper extremity involvement were enrolled in the study. Sixty patients were randomly assigned to supported taping (TpG), NMES, or control groups (CG) within 1-3 months of stroke. Treatment duration was 4 weeks. The Fugl–Meyer Sensorimotor Assessment Scale (FMSAS) and the Motor Activity Log-28 (MAL) were used for shoulder functional assessment. A Visual Analog Scale was used for shoulder pain assessment.

Results: Statistically significant improvements in the FMSAS (TpG p ≤ 0.001; NMES p=0.002; CG p ≤ 0.001) and MAL scores (TpG p ≤ 0.001; NMES p ≤ 0.001; CG p ≤ 0.001) were found in within-group comparisons. Within-group comparisons showed a significant decrease in shoulder pain intensity both at rest (TpG p = 0.007 and NMES p = 0.014) and with activity (TpG p≤ 0.01 and NMES p= 0.016), whereas no significant decrease was found in the CG either at rest or with activity pain (p = 0.054 for both). Between-group comparisons revealed a significant change (p=0.0026) in the FMSAS in favor of TpG (p ≤ 0.001). No difference was found in the MAL in between-group comparisons (p>0.05).

Conclusion: In the treatment of symptomatic shoulders in patients with hemiplegia, both options could be used to increase isolated motor activity; however, if function is desired, supportive taping would be more effective.

Keywords

Hemiplegia, Shoulder, Athletic Tape, Electric Stimulation, Motor Activity

References

• 1. Griffin C. Management of the hemiplegic shoulder complex. Top Stroke Rehabil. 2014;21:316–318.
• 2. Barreca S, Wolf SL, Fasoli S, Bohannon R. Treatment interventions for the paretic upper limb of stroke survivors: a critical review. Neurorehabil Neural Repair. 2003;17:220–226.
• 3. Pong YP, Wang LY, Huang YC, Leong CP, Liaw MY, Chen HY. Sonography and physical findings in stroke patients with hemiplegic shoulders: A longitudinal study. J Rehabil Med. 2012;44:553–557.
• 4. Távora DGF, Gama RL, Bomfim RC, Nakayama M, Silva CEP. MRI findings in the painful hemiplegic shoulder. Clin Radiol. 2010;65:789–794.
• 5. Grampurohit N, Pradhan S, Kartin D. Efficacy of adhesive taping as an adjunt to physical rehabilitation to influence outcomes post-stroke: a systematic review. Top Stroke Rehabil. 2015;22:72–82.
• 6. Heo, M-Y, Kim, C-Y, Nam C-W. Influence of the application of inelastic taping on shoulder subluxation and pain changes in acute stroke patients. J Phys Ther Sci. 2015;27:3393–3395.
• 7. Griffin A, Bernhardt J. Strapping the hemiplegic shoulder prevents development of pain during rehabilitation: a randomized controlled trial. Clin Rehabil. 2006;20:287–295.
• 8. Huang YC, Chang KH, Liou TH, Cheng CW, Lin LF, Huang SW. Effects of kinesio taping for stroke patients with hemiplegic shoulder pain: A double-blind, randomized, placebo-controlled study. J Rehabil Med. 2017;49:208–215.
• 9. Hazar Kanik Z, Citaker S, Yilmaz Demirtas C, Celik Bukan N, Celik B, Gunaydin G. Effects of Kinesio Taping on the Relief of Delayed Onset Muscle Soreness: A Randomized, Placebo-Controlled Trial. J Sport Rehabil. 2019;00:1–6.
• 10. Huang YC, Leong CP, Wang L, Wang LY, Yang YC, Chuang CY, et al. Effect of kinesiology taping on hemiplegic shoulder pain and functional outcomes in subacute stroke patients: a randomized controlled study. Eur J Phys Rehabil Med. 2016;52:774–781.
• 11. Hochsprung A, Domínguez-Matito A, López-Hervás A, Herrera-Monge P, Moron-Martin S, Ariza-Martínez C, et al. Short- and medium-term effect of kinesio taping or electrical stimulation in hemiplegic shoulder pain prevention: A randomized controlled pilot trial. NeuroRehabilitation. 2017;41:801–810.
• 12. Page T, Lockwood C. Prevention and management of shoulder pain in the hemiplegic patient. JBI Database Syst Rev Implement Reports. 2003;1:149–165.
• 13. Hsu SS, Hu MH, Wang YH, Yip PK, Chiu JW, Hsieh CL. Dose-response relation between neuromuscular electrical stimulation and upper-extremity function in patients with stroke. Stroke. 2010;41:821–824.
• 14. Knutson JS, Harley MY, Hisel TZ, Hogan SD, Maloney MM, Chae J. Contralaterally controlled functional electrical stimulation for upper extremity hemiplegia: An early-phase randomized clinical trial in subacute stroke patients. Neurorehabil Neural Repair. 2012;26:239–246.
• 15. Renzenbrink GJ, IJzerman MJ. Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life. Clin Rehabil. 2004;18:359–365.
• 16. Zhou M, Li F, Lu W, Wu J, Pei S. Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2018;99:1730–1739.
• 17. Sheffler LR, Chae J. Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve. 2007;35:562–590.
• 18. Chuang LL, Chen YL, Chen CC, Li YC, Wong AMK, Hsu AL, et al. Effect of EMG-triggered neuromuscular electrical stimulation with bilateral arm training on hemiplegic shoulder pain and arm function after stroke: A randomized controlled trial. J Neuroeng Rehabil. 2017;14:122.
• 19. Lee JH, Baker LL, Johnson RE, Tilson JK. Effectiveness of neuromuscular electrical stimulation for management of shoulder subluxation post-stroke: A systematic review with meta-analysis. Clinical Rehabilitation. 2017;1431–1444.
• 20. Rong W, Li W, Pang M, Hu J, Wei X, Yang B, et al. A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke. J Neuroeng Rehabil. 2017;14(1):34.
• 21. Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S SS. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7:13–31.
• 22. Lee YY, Lin KC, Cheng HJ, et al. Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: A double-blinded randomized controlled trial. J Neuroeng Rehabil. 2015;12:96.
• 23. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983;63:1606–1610.
• 24. Di Fabio RP, Badke MB. Relationship of sensory organization to balance function in patients with hemiplegia. Phys Ther. 1990;70:542–548.
• 25. Gladstone DJ, Danells CJ, Black SE. The Fugl- Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties. Neurorehabil Neural Repair. 2002;16:232–240.
• 26. Uswatte G, Taub E, Morris D, Vignolo M, McCulloch K. Reliability and validity of the upper-extremity motor activity log-14 for measuring real-world arm use. Stroke. 2005;36:2493–2496.
• 27. Uswatte G, Taub E, Morris D, Light K, Thompson PA. The Motor Activity Log-28: Assessing daily use of the hemiparetic arm after stroke. Neurology. 2006;67:1189–1194.
• 28. Huseyinsinoglu BE, Ozdincler AR, Ogul OE, Krespi Y. Reliability and validity of Turkish version of Motor Activity Log-28. Turk Noroloji Derg. 2011;17:83–89.
• 29. Kalichman L, Ratmansky M. Underlying pathology and associated factors of hemiplegic shoulder pain. Am J Phys Med Rehabil. 2011;90:768–80.
• 30. Jaraczewska E, Long C. Kinesio taping in stroke: improving functional use of the upper extremity in hemiplegia. Top Stroke Rehabil. 2006;13:31–42.
• 31. Kho AY, Liu KPY, Chung RCK, Kho Y. A. Meta-analysis on the effect of mental imagery on motor recovery of the hemiplegic upper extremity function. Aust Occup Ther J. 2014;61:38–48.
• 32. Viehöfer AF, Gerber C, Favre P, Bachmann E, Snedeker JG. A larger critical shoulder angle requires more rotator cuffactivity to preserve joint stability. Journal of Orthopaedic Research. 2016;961-968.
• 33. Bustrén EL, Sunnerhagen KS, Alt Murphy M. Movement Kinematics of the Ipsilesional Upper Extremity in Persons with Moderate or Mild Stroke. Neurorehabil Neural Repair. 2017;31:376–386.
• 34. Teasell R, Foley N, Salter K, et al. Evidence- Based Review of Stroke Rehabilitation: executive summary, 12th edition. Top Stroke Rehabil. 2009;16:463–488.
• 35. Dromerick AW, Edwards DF, Kumar A. Hemiplegic shoulder pain syndrome: Frequency and characteristics during inpatient stroke rehabilitation. Arch Phys Med Rehabil. 2008;89:1589–1593.
• 36. Aytar A, Ozunlu N, Surenkok O, Baltaci G, Oztop P, Karatas M. Initial effects of kinesio® taping in patients with patellofemoral pain syndrome: A randomized, double-blind study. Isokinet Exerc Sci. 2011;19:135–142.
• 37. Kaya E, Zinnuroglu M, Tugcu I. Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome. Clin Rheumatol. 2011;30:201–207.
• 38. Gibson JNA, Smith K, Rennie MJ. Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesis. Lancet. 1988;332:767–770.
• 39. Francisco G, Chae J, Chawla H, Kirshblum S, Zorowitz R, Lewis G, et al. Electromyogram-triggered neuromuscular stimulation for improving the arm function of acute stroke survivors: A randomized pilot study. Arch Phys Med Rehabil. 1998;79:570–575.