Hatton Nichola J, Stockley Rachel C
Tameside General Hospital, Ashton-u-Lyne, Greater Manchester, OL6 9RW UK.
Department of Health Professions, Birley Campus, Manchester Metropolitan University, Manchester, M15 6GX UK.
Arch Physiother. 2015 Aug 11;5:7. doi: 10.1186/s40945-015-0006-9. eCollection 2015.
Glenohumeral subluxation (GHS) is a common symptom following stroke. Many therapists postulate that GHS may be reduced if the base of support (BOS) is reduced and the centre of mass (COM) is raised as this requires greater postural muscle activity. However, there is little empirical evidence to support this practice.
The aim of this preliminary study was to investigate if the amount of GHS alters from sitting to standing.
A cross sectional, within-subject design in a convenience sample of 15 stroke patients with GHS was utilised.
A prospective design was used with a single blinded tester who assessed GHS using the calliper method in sitting, standing and on return to sitting. Friedman and post hoc Wilcoxon tests showed that GHS was significantly reduced in standing compared to sitting ( <0.05) but this reduction was not maintained on return to sitting ( = 0.25).
The results of this study are limited by its small size. However, these results indicate that reducing BOS during rehabilitation may improve GHS after stroke. Whilst the maintenance of benefit is not established, these findings suggest that reducing BOS as part of treatment may help patients with GHS. Further research is now required to replicate these results in a larger sample and to directly examine shoulder muscle activity to investigate which muscles may influence GHS in response to changing BOS. Future work could also aim to determine whether the reduction in GHS was directly attributable to a reduced BOS or the effort associated with moving from sitting to standing.
肩肱关节半脱位（GHS）是中风后的常见症状。许多治疗师推测，如果支撑面（BOS）减小且重心（COM）升高，GHS可能会减轻，因为这需要更大的姿势肌肉活动。然而，几乎没有实证证据支持这种做法。
这项初步研究的目的是调查GHS的程度从坐位到站立位是否会改变。
采用横断面、受试者内设计，对15例患有GHS的中风患者的便利样本进行研究。
采用前瞻性设计，由一名单盲测试者使用卡尺法在坐位、站立位以及恢复坐位时评估GHS。Friedman检验和事后Wilcoxon检验表明，与坐位相比，站立位时GHS显著减轻（<0.05），但恢复坐位时这种减轻未持续（=0.25）。
本研究结果受样本量小的限制。然而，这些结果表明，康复过程中减小BOS可能会改善中风后的GHS。虽然益处的维持情况尚未确定，但这些发现表明，将减小BOS作为治疗的一部分可能有助于患有GHS的患者。现在需要进一步的研究在更大的样本中重复这些结果，并直接检查肩部肌肉活动，以调查哪些肌肉可能会因BOS的变化而影响GHS。未来的工作还可以旨在确定GHS的减轻是否直接归因于BOS的减小或从坐位到站立位移动所涉及的努力。
