Sonographic Evaluation of the Effect of Shoulder Orthosis on the Subluxation in Stroke Patients
Condition: Stroke Patients
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Shoulder pain is frequently reported as a complication among stroke patients. Muscular
      imbalance disrupts stability of the glenohumeral joint creating a subluxation. Stretching the
      soft tissue can cause shoulder pain which impedes quality of life, length of stay and
      rehabilitation outcome. To align the humeral head in the cavitas glenoïdalis a shoulder
      orthosis is often provided to the patient. Since the use of these orthoses is not always
      considered positive by the patient nor the therapist the question rises if the investigators
      can objectify if the subacromial space is reduced when wearing a sling.

      Sonography is a valid way to asses subluxation of the shoulder joint by measuring the
      subacromial space. To objectify if an orthosis can reduce the enlarged subacromial space the
      investigators will use sonography to measure the distance between acromion and greater
      tuberosity are between acromion and the humeral head. This distance will be measured with and
      without the orthosis and also after a period of at least 4 hours of wearing the orthosis.
      This last measurement might inform us about how long the orthosis can correct the
      glenohumeral position. To validate the sonographic measurement X-rays will be taken by a
      sample of the investigators study population to compare with the ultrasound data.

      Two different orthoses will be compared. First of all the actimove sling, which is standardly
      used in the rehabilitation centre where patients will be recruited. This sling can be adapted
      by the patient itself and is very easy to wear. The disadvantage is that the elbow is
      continuously flexed, which enlarges the risk on contractures of m. biceps and m.
      brachioradialis. Also the negative influence on the interpretation of the body scheme and on
      the quantitative use of the arm can be reasons not to wear this kind of orthosis. The
      shoulderlift on the other hand is a newly developed orthosis which supports the shoulder
      joint with the arm extended. This is a more normal position during the daily living and
      stimulates the use of the paretic arm. An extra adaptation can be adjusted to make it
      possible to position the arm flexed in order to reduce oedema of the hand if necessary. The
      control group does not wear any orthosis at all.

      Additional the investigators will evaluate passive range of motion of the shoulder,
      spasticity of the upper limb (modified ashworth scale), active motion of the upper limb (fugl
      meyer assessment) and trunk stability (Trunk Impairment Scale) at starting point and after a
      period of 6 weeks wearing the orthosis minimal 6 hours a day.

      If possible the investigators will do an evaluation of balance on a moving platform and an
      evaluation of gait with and without the orthosis after 6 weeks to assess the impact of on
      balance and gait.
    


Intervention name(s): actimove sling; shoulderlift
Intervention type(s): Device; Device
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care