Arya Kamal Narayan, Pandian Shanta, Puri Vinod
a Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities , New Delhi , India.
b Department of Neurology , GB Pant Post Graduate Institute of Medical Education and Research , New Delhi , India.
Top Stroke Rehabil. 2018 Jan;25(1):68-81. doi: 10.1080/10749357.2017.1383712. Epub 2017 Oct 11.
Background Shoulder subluxation is a common post-stroke complication affecting up to 80% of the stroke subjects. The pathomechanics at the skeletal level does not provide the structural base for the neural-motor recovery. The management of subluxed shoulder has always been a challenge, complicating the motor and functional recovery. Objective To review the available studies of rehabilitation interventions for reduction of subluxed shoulder and to explore the evidence for impact of subluxation on motor recovery. Method PubMed, the Cochrane Central Register of Controlled Trials, DORIS, PEDro, and OTseeker databases were searched using the keywords: Stroke and Shoulder and Subluxation. The experimental, quasi-experimental, and single group studies investigated the rehabilitation methods to reduce the subluxation were selected. A narrative synthesis of the findings from the selected studies was carried out. Result 2717 studies were identified and 22 studies (14 RCTs or controlled trials and 8 pre-post-single group studies) were finally selected for the review. The rehabilitation intervention: Functional electrical stimulation (FES)/electrical stimulation (11), orthosis/support (07), taping (02), and robotic training and other methods (02) were reviewed. FES is effective in reducing subluxation in acute stage. Shoulder support or orthosis while in situ may reduce the subluxation temporarily. X-ray was the most commonly used assessment tool for the subluxation. Implication of the rehabilitation technique on motor recovery has not been investigated. Conclusion No technique could effectively reduce the subluxation and facilitate the upper limb recovery. Further studies integrating the usual motor training and the subluxation rehabilitation are warranted. Future trials using more precise and valid tool such as ultrasonography are also needed.
肩关节半脱位是常见的中风后并发症，影响多达80%的中风患者。骨骼层面的病理力学并未为神经运动恢复提供结构基础。半脱位肩关节的管理一直是一项挑战，使运动和功能恢复复杂化。目的：回顾关于减少半脱位肩关节的康复干预的现有研究，并探讨半脱位对运动恢复影响的证据。方法：使用关键词“中风、肩部和半脱位”检索PubMed、Cochrane对照试验中央注册库、DORIS、PEDro和OTseeker数据库。选择研究减少半脱位康复方法的实验性、半实验性和单组研究。对所选研究的结果进行叙述性综合分析。结果：共识别出2717项研究，最终选择22项研究（14项随机对照试验或对照试验以及8项前后单组研究）进行综述。对康复干预措施：功能性电刺激（FES）/电刺激（11项）、矫形器/支撑（7项）、贴扎（2项）以及机器人训练和其他方法（2项）进行了综述。FES在急性期有效减少半脱位。原位时使用肩部支撑或矫形器可暂时减少半脱位。X线是最常用于评估半脱位的工具。尚未研究康复技术对运动恢复的影响。结论：没有技术能够有效减少半脱位并促进上肢恢复。有必要进行进一步研究，将常规运动训练与半脱位康复相结合。未来还需要使用更精确有效的工具（如超声检查）进行试验。
