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European Journal of Physical and Rehabilitation Medicine 2021 May 27

DOI: 10.23736/S1973-9087.21.06639-9


lingua: Inglese

Effects of position-triggered electrical stimulation on post-stroke hemiparetic shoulder subluxation

Jun T. HONG 1, 2, Tae M. JUNG 3, Ae R. KIM 4, Hyo S. CHOI 5, Sun M. LEE 2, Deog Y. KIM 1, 2

1 Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; 2 Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; 3 Yonsei ROI Rehabilitation Clinic, Seoul, Republic of Korea; 4 Department of Physical Medicine and Rehabilitation, Kyungpook National University, Daegu, Republic of Korea; 5 Department of Physical Medicine and Rehabilitation, Eulji University College of Medicine, Daejeon, Republic of Korea


BACKGROUND: Shoulder subluxation is a frequent complication after stroke causing joint instability, shoulder pain, decreased activities of daily living, and impedance to rehabilitation progress. Electrical stimulation (ES) is considered an effective modality to reduce shoulder subluxation in acute stroke. However, few studies have investigated the effect of position-triggered ES, which induces active muscle contraction though accurate motion detection.
AIM: To investigate whether position-triggered ES was more effective in reducing acute hemiplegic shoulder subluxation after stroke than passive ES.
DESIGN: Single-blind, randomized controlled trial.
SETTING: University hospital rehabilitation center.
POPULATION: Fifty post-stroke subacute hemiparetic patients with shoulder subluxation.
METHODS: Patients were randomly assigned into two groups. The position-triggered ES group received 30-minute ES sessions, 5 days per week for 3 weeks with specially modified Novastim® CU-FS1 for motion triggering. The passive ES group received the same protocol without motion triggering. The vertical distance (VD) and the joint distance (JD), relative VD and JD (rVD, rJD), upper extremity component of Fugl-Meyer Motor Assessment (FMAupper), Motricity Index (MI), Manual Function Test (MFT), and peak torque of affected shoulder abductor (PT) were assessed at baseline (T0), end of electrical stimulation session (T1), and 3 weeks (T2) after treatment.
RESULTS: Repeated-measures analysis of variance revealed significant interaction between TIME and INTERVENTION on JD and rJD, indicating that shoulder subluxation was significantly more reduced in position-triggered ES than in passive ES (p<0.05). However, FMAupper, MI, MFT, and PT did not show this significance. The change of (Δ)JD , ΔrVD, and ΔrJD in the motion-triggered ES group improved significantly more at T1 than in the passive ES group (p<0.05). This significant improvement was not seen at T2.
CONCLUSIONS: Position-triggered ES may be more effective than passive ES in improving post-stroke shoulder subluxation; however, this effect was not maintained after the withdrawal of stimulation.
CLINICAL REHABILITATION IMPACT: Position-triggered ES may be useful to reducing post-stroke shoulder subluxation.

KEY WORDS: Stroke; Electrical stimulation; Shoulder subluxation; Position-triggered

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