Shoulder Passive Range of Motion and Positioning Exercise on Hemiplegic Stroke Patients
Condition: Shoulder Pain; Hemiplegia; Stroke; Rotator Cuff Injury
MeSH terms: Shoulder Pain; Stroke; Hemiplegia; Rotator Cuff Injuries
Study type: Interventional

Summary: 
      Several factors associated with the hemiplegic shoulder pain after stroke includes rotator
      cuff injury, bicipital tendonitis, impingement, spasticity, limited external rotation of
      shoulder joint, adhesive capsulitis, shoulder subluxation, shoulder hand syndrome, and
      brachial/axillary neuropathy. In this study, the investigators aim to usie high frequency
      ultrasound to evaluate the relationship between stroke patients with poor shoulder motor
      function and shoulder tendon injury. Also, assumed that performing passive range of motion
      and positioning training might prevent tendon injury of shoulder and hemiplegic shoulder pain
      in either acute or chronic stage of stroke.
    

Detailed description: 
      Hemiplegic shoulder pain is a common complication. Several factors associated with the
      hemiplegic shoulder pain includes rotator cuff injury, bicipital tendonitis, impingement,
      spasticity, limited external rotation of shoulder joint, adhesive capsulitis, shoulder
      subluxation, shoulder hand syndrome, and brachial/axillary neuropathy. Flaccidity has a
      positive association with soft tissue injury or tendon injury of the shoulder.

      In the preliminary study, base on the sonography results, it is found that the possibility of
      getting tendon injury or inflammation on the affected shoulder joint is higher in the group
      of patients who were with worse motor functions during the rehabilitation in hospital.

      In this study, one hundred acute stroke patients with hemipelgia will be enrolled. And those
      participants would be separated into 2 groups: control group (Brunnstrom stage IV-VI) and
      experimental group (Brunnstrom stage I-III). Clinical characteristics and physical findings
      will be recorded on the admission date. During the process, the investigators will use high
      frequency (5-12 MHz) musculoskeletal ultrasound to evaluate those tendons around bilateral
      shoulder joints on the admission date and at 2 weeks later. In the first year after stroke,
      half patients in those 2 groups will perform positioning training and passive range of motion
      for affected shoulder either during hospitalization or after being discharged. Then, the
      investigators will execute physical examination and use high frequency ultrasound to evaluate
      those tendons around bilateral shoulder joints of the participants twice after 6 months and
      12 months. Then, the investigators will discuss the incidences of shoulder tendon injury
      after receiving rehabilitation program according to ultra-sonographic findings.
    

Intervention name(s): video-teaching; oral-teaching; regular rehabilitation program
Intervention type(s): Other; Other; Other
Intervention description(s): By watching a video specially designed by a rehabilitation team, the participants may learn how to position their affected arm properly (30 minutes per time, twice a day for five days in a week), how to transfer safely with the help from the caregivers, how to execute appropriate passive range of motion exercises regularly (15 minutes per time, twice a day for five days in a week), and be taught to be aware of not doing insecure pulley exercises nor carrying stuffs which are too heavy.; The nurses will teach patients how to position their affected arm properly, how to transfer safely with the help from the caregivers, how to execute appropriate passive range of motion exercises regularly, and be taught to be aware of not doing insecure pulley exercises nor carrying stuffs which are too heavy on the admission date of hospitalization.; Regular occupational therapy program and regular physical therapy program in the rehabilitation department of the hospital.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Stroke; Hemiplegia; Rotator Cuff Injury