Abstract
BackgroundShoulder subluxation is a frequent complication of motor impairment after stroke, leading to soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain, thus limiting use of the affected extremity beyond weakness. In this pilot study, we determined whether robotic treatment of chronic shoulder subluxation can lead to functional improvement and whether any improvement was robust.Methods18 patients with chronic stroke (3.9 ± 2.9 years from acute stroke), completed 6 weeks of robotic training using the linear shoulder robot. Training was performed 3 times per week on alternate days. Each session consisted of 3 sets of 320 repetitions of the affected arm, and the robotic protocol alternated between training vertical arm movements, shoulder flexion and extension, in an anti-gravity plane, and training horizontal arm movements, scapular protraction and retraction, in a gravity eliminated plane.ResultsTraining with the linear robot improved shoulder stability, motor power, and resulted in improved functional outcomes that were robust 3 months after training.ConclusionIn this uncontrolled pilot study, the robotic protocol effectively treated shoulder subluxation in chronic stroke patients. Treatment of subluxation can lead to improved functional use of the affected arm, likely by increasing motor power in the trained muscles.
Highlights
Glenohumeral subluxation (GHS) occurs commonly in 17- 81% of those with a paralyzed or plegic upper limb after stroke [1,2,3,4,5], in part because the shoulder is stabilized only by surrounding muscles, the joint capsules and ligamentous structures
Assessment of shoulder subluxation showed that subluxation decreased significantly from admission to discharge (56.7±0.3 mm on admission to 26.7±0.2 mm on discharge; p
Pain was not a significant problem in our patient population (22.9±2.9, n= 18, with a score of 24 indicating no pain at all in one limb), and was not included as an outcome measure in our analysis. In this pilot study, the data demonstrate that the treatment protocol with the anti-gravity robot significantly reduced shoulder instability in chronic stroke patients, and the therapeutic effect lasted beyond the duration of treatment
Summary
Glenohumeral subluxation (GHS) occurs commonly in 17- 81% of those with a paralyzed or plegic upper limb after stroke [1,2,3,4,5], in part because the shoulder is stabilized only by surrounding muscles, the joint capsules and ligamentous structures. The subluxation that occurs after stroke, during the early flaccid phase, is in the inferior direction This is likely due to the effects of gravity and the basic structure that allows increased laxity in the inferior capsule to afford adequate joint freedom [2]. Shoulder subluxation is a frequent complication of motor impairment after stroke, leading to soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain, limiting use of the affected extremity beyond weakness. In this pilot study, we determined whether robotic treatment of chronic shoulder subluxation can lead to functional improvement and whether any improvement was robust
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