van Bladel Anke, Cools Ann, Michielsen Marc, Oostra Kristine, Cambier Dirk
Department of Rehabilitation Sciences, Faculty of Medicine and Health, Ghent University, Ghent, Belgium.
Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.
S Afr J Physiother. 2022 Feb 21;78(1):1589. doi: 10.4102/sajp.v78i1.1589. eCollection 2022.
Performing a careful but effective mobilisation of the hemiplegic shoulder is essential for optimal muscle activation and to preserve the passive range of motion (PROM) needed to perform functional tasks. Studies concerning passive mobilisation of the post-stroke shoulder are scarce.
A randomised multiple treatment trial was conducted to compare the effects of different mobilisation techniques on shoulder PROM.
Eleven participants with upper limb paresis in the subacute phase after stroke underwent three different mobilisation techniques (3 × 4 weeks):(1) combined soft-tissue mobilisation in the scapular plane, (2) scapular mobilisation without glenohumeral movement, (3) angular glenohumeral mobilisation in the frontal plane. Depending on the randomisation, the order of the techniques changed. Differences in outcome measures (PROM shoulder, shoulder pain, spasticity of shoulder muscles and biceps, trunk impairment scale and Fugl-Meyer assessment) were calculated between the beginning and end of each intervention period.
Using combined soft-tissue mobilisation in patients in the subacute phase after stroke with persistent arm paresis resulted in an increased passive shoulder external rotation ( = 0.006). An average increase of 6.82° (± 9.20°) for shoulder external rotation was noted, whilst after the two other techniques, passive external rotation decreased (scapular mobilisation -7.27° ± 10.81°; angular mobilisation -5.45° ± 11.72°).
These preliminary findings, suggest that combined soft-tissue mobilisation technique might improve the PROM for external shoulder rotation in subacute stroke patients with persistent arm paresis.
Performing a specific mobilisation technique might have positive effects on shoulder PROM. Research including larger sample sizes is necessary to confirm these findings and define the underlying mechanisms.
对偏瘫肩进行仔细而有效的活动对于实现最佳肌肉激活以及保持执行功能任务所需的被动活动范围（PROM）至关重要。关于中风后肩部被动活动的研究很少。
进行一项随机多治疗试验，以比较不同活动技术对肩部PROM的影响。
11名中风后亚急性期上肢轻瘫的参与者接受了三种不同的活动技术（3×4周）：（1）肩胛平面联合软组织活动；（2）无盂肱关节活动的肩胛活动；（3）额面内的盂肱关节角度活动。根据随机分组，技术顺序会发生变化。计算每个干预期开始和结束之间结局指标（肩部PROM、肩部疼痛、肩部肌肉和肱二头肌痉挛、躯干损伤量表和Fugl-Meyer评估）的差异。
对中风后亚急性期且存在持续性手臂轻瘫的患者使用联合软组织活动，可使肩部被动外旋增加（ = 0.006）。观察到肩部外旋平均增加6.82°（±9.20°），而在其他两种技术之后，被动外旋减少（肩胛活动-7.27°±10.81°；角度活动-5.45°±11.72°）。
这些初步研究结果表明，联合软组织活动技术可能会改善亚急性中风且存在持续性手臂轻瘫患者的肩部外旋PROM。
采用特定的活动技术可能对肩部PROM有积极影响。需要纳入更大样本量的研究来证实这些发现并确定潜在机制。
