Effect of electroacupuncture treatment combined with rehabilitation care on serum sirt3 level and motor function in elderly patients with stroke hemiparesis

Medicine, Journal Year: 2023, Volume and Issue: 102(15), P. e33403 - e33403

Published: April 14, 2023

Objective: Acupuncture treatment helps to improve neurological and motor function in elderly patients with stroke hemiplegia. However, the exact mechanism by which electroacupuncture improves hemiparesis is uncertain. The aim of this study was determine effect care on sirt3 levels hemiparesis. Methods: One hundred ten hemiplegia after first were divided into an experimental group a control (n = 55 each group). given conventional rehabilitation therapist. In group, basis care, performed once day for 28 days. Results: Fugl-Meyer assessment (FMA) barthel index (BI) scores significantly higher, while neurologic deficit scale (NDS) physiological state lower both groups 14 days intervention compared preintervention. Generalized estimating equation (GEE) model also showed that more favorable improvements all outcomes at postintervention time points group. After intervention, serum increased preintervention, increase pronounced Consistently, GEE higher points. Correlation analysis revealed negatively correlated FMA BI pre- postintervention, showing significant positive correlation NDS scores. Conclusion: Electroacupuncture led function, activities daily living hemiplegia, may be associate levels.

Language: Английский

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Robotic-Assisted Rehabilitation for Post-Stroke Shoulder Pain: A Systematic Review

Sensors, Journal Year: 2023, Volume and Issue: 23(19), P. 8239 - 8239

Published: Oct. 3, 2023

Post-stroke shoulder pain (PSSP) is a debilitating consequence of hemiplegia, often hindering rehabilitation efforts and further limiting motor recovery. With the advent robotic-assisted therapies in neurorehabilitation, there potential for innovative interventions PSSP. This study systematically reviewed current literature to determine effectiveness addressing PSSP stroke patients. A comprehensive search databases was conducted, targeting articles published up August 2023. Studies were included if they investigated impact on The outcome interest reduction. risk bias assessed using Cochrane database. Of 187 initially identified articles, 3 studies met inclusion criteria, encompassing 174 indicated benefit reducing PSSP, with some also noting improvements range motion overall function. However, results varied across studies, showing more significant benefits than others, because these use different protocols robotic equipment.

Language: Английский

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Risk factors for shoulder pain after stroke: A clinical study

Pakistan Journal of Medical Sciences, Journal Year: 2021, Volume and Issue: 38(1)

Published: Nov. 12, 2021

To investigate the risk factors for shoulder pain after stroke, and prevent its occurrence effectively.The patients with stroke treated in our hospital between September 2016 October 2020 were reviewed retrospectively. The medical records of included including age, gender, lesion side, duration, stay, diabetes, hypertension, heart disease, limitation joint activity, alcohol abuse, smoking, type Ashworth scale, Brunnstrom stage, sensory disorders, motor arm score National Institutes Health Stroke Scale (NIHSS) collected analyzed to determine stroke.A total 1390 based on inclusion exclusion criteria, consisting 162 prevalence was 11.6%. divided into group non-shoulder group. There significant differences NIHSS two groups (P < 0.05). Based multivariate regression analysis, independent limited grade I-III period, 3-4 grade, points, disturbance.Great emphasis should be placed or disturbance, as these have higher risks stroke.

Language: Английский

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The trajectory of pain and pain intensity in the upper extremity after stroke over time: a prospective study in a rehabilitation population

Disability and Rehabilitation, Journal Year: 2023, Volume and Issue: 46(3), P. 503 - 508

Published: Jan. 10, 2023

Purpose To assess the presence of upper extremity pain after stroke over time and course its intensity in patients with persistent pain.Materials methods Patients completed a question on (yes/no) rated visual analogue scale (0–10) at 3, 18, 30 months starting multidisciplinary rehabilitation. The were analysed Generalized Estimating Equations models Linear Mixed Models, respectively.Results 678 included. proportions reporting 41.8, 36.0, 32.7% months, respectively, decline reaching statistical significance (odds ratio 0.82, 95% confidence interval 0.74–0.92, p < 0.001). At all points, those median was 5.0 (interquartile ranges (IQR) 4.0–7.0 3 3.0–6.0 18 months). In 73 pain, there no significant change time.Conclusions proportion considerable, despite decrease 2.5 years. did not time.

Language: Английский

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High frequency neuronavigated repetitive transcranial magnetic stimulation in post-stroke shoulder pain: A double-blinded, randomized controlled study

Journal of Stroke and Cerebrovascular Diseases, Journal Year: 2024, Volume and Issue: 33(3), P. 107562 - 107562

Published: Jan. 7, 2024

Language: Английский

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Rehabilitation von Menschen mit einem Schlaganfall

Neurorehabilitation, Journal Year: 2024, Volume and Issue: unknown, P. 441 - 479

Published: Jan. 1, 2024

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ХРОНІЧНИЙ БІЛЬ ПІСЛЯ ІНСУЛЬТУ. ПАЛІАТИВНА ДОПОМОГА

ГРААЛЬ НАУКИ, Journal Year: 2024, Volume and Issue: 41, P. 328 - 341

Published: July 26, 2024

Основною причиною інвалідності та другою смерті у світі є інсульт. Хворі, які перенесли інсульт, мають тягар симптомів, найбільш обтяжливим з яких хронічний біль. Післяінсультний біль (ПІБ) проявляється в різних варіантах – центральним післяінсультним болем, комплексним регіональним больовим синдром, скелетно-м’язовим пов’язаним зі спастичною хворобою, головним або може бути як поєднання варіантів. Для полегшення симптомів і покращення якості життя при післяінсультних станах потрібна паліативна допомога, одним із основних напрямків якої позбавлення зменшення болю. Знеболююча терапія ПІБ, незважаючи на загальні спільні підходи, має особливості, що залежать від конкретного виду Диференціація ПІБ адекватне фармакологічне й нефармакологічне лікування його варіантів значно покращити якість хворих, сприяти реабілітації фізичному відновленню.

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Poststroke shoulder pain

Singapore Medical Journal, Journal Year: 2024, Volume and Issue: 65(8), P. 449 - 453

Published: Aug. 1, 2024

Opening Vignette Michael usually comes alone to see you in the clinic for management of his diabetes mellitus and hypertension. Today, were surprised him a wheelchair, accompanied by daughter. had recently been discharged from hospital after left pure motor stroke that happened 2 months ago. He asked painkillers, as there was increasing pain shoulder over past 1 week. described it persistent ache, which worsens on movement arm. denied any falls or trauma shoulder.WHAT IS POSTSTROKE SHOULDER PAIN? Poststroke (PSSP), also known hemiplegic pain, is common debilitating condition occurs stroke. The onset PSSP can occur early weeks poststroke, but typically within 2–3 months.[1] Patients generally report gradual at rest certain posture, side ipsilateral neurological impairment. On clinical examination, are often signs subluxation rotator cuff impingement. predisposing factors include inappropriate positioning during upright position traction force joint transfers, flaccid paresis, spasticity, poor function reduced range motion.[2] HOW RELEVANT THIS TO MY PRACTICE? interferes with retraining recovery It causes physical distress patients affects performance activities daily living, resulting poorer functional recovery, depression quality life.[3] has associated withdrawal rehabilitation programmes, prolonged stay arm first 12 stroke.[3] COMMON IN Studies have shown annual incidence be high 2.5%, lifetime prevalence up 67% population.[4] Annually, about 1% adults consult their primary care doctor new pain.[5] most aetiologies pathologies (e.g. tendinopathy heavy lifting repetitive movements) glenohumeral capsulitis frozen shoulder).[5] For doctors who patients, 22%–47%.[6] Among patient population, significant predictors age, female gender, increased tone, sensory impairment, left-sided hemiparesis, haemorrhagic stroke, hemispatial neglect severity.[6] Given PSSP, family should aware possible consider potential interventions. In this way, treatment approach may tailored each PSSP. divided into three main categories: (a) impaired control tone changes, (b) soft tissue lesions, (c) altered peripheral central nervous activity [Box 1].[7] Often, cause multifactorial.Box 1: Pathologies underlying poststroke pain.[ 7 ]Glenohumeral results weakness muscles surrounding joint. immediately when affected muscle vulnerable instability. does not always result immediately. becomes more apparent spasticity develops.[8] practice, commonly measured number fingerbreadths between acromion humeral head, having seated his/her dependent position, allows weight limb distract head glenoid fossa[7] [Figure 1].Figure Clinical assessment subluxation.Spasticity defined "a disorder characterised velocity-dependent increase tonic stretch reflexes (muscle tone) exaggerated tendon jerks, hyperexcitability reflex, one component upper neuron syndrome".[9] Flexor predominates extremity scapular retraction well internal rotation adduction shoulder. two contribute abnormal subscapularis pectoralis major.[1] local mechanical destabilising effects due lead such tendinopathy, impingement tears, adhesive capsulitis, subacromial/subdeltoid bursitis biceps tendinopathy. Central (CPSP), formerly thalamic syndrome Déjerine Roussy, form neuropathic occurring involving spinothalamocortical pathway.[10] 8%–14% cases, develops 6 its decreases thereafter.[10] constant intermittent abnormalities, particularly thermal sensation.[10] Complex regional (CRPS) severe continuous nondermatomal distribution, affecting sensory, motor, vasomotor sudomotor trophic abnormalities. Diagnosis challenging, no confirmatory test. diagnosis made using International Association Study Pain (IASP) diagnostic criteria 2].[11]Box 2: criteria.[ 11 ]WHAT CAN I DO While likely multifactorial nature, careful delineate major aetiology pain. This includes complete history taking thorough before comprehensive plan customised recommended. A multifaceted useful, especially counselling caregiver appropriate use analgesia other medications, motion exercises. Important outcomes reduction relief, improved passive active motion, return limb. Management strategies listed below based evidence-based review rehabilitation[1] systematic reviews.[12,13] Preventive following: protection methods supporting rest, mobility — regular sling thumb loop 2] taping used prevent injury stage muscles; educate patient, healthcare professionals correctly handle instance, never pull transfers bed put sleeve body dressing; avoid overhead exercises arm, unless adequate support scapula instructions provided; (d) stretching shoulder, abduction–adduction, flexion–extension external–internal rotation, help reduce [Figures 3 & 4].Figure Arm loop.Figure 3: Passive (abduction).Figure 4: (flexion).Physical modalities address lesions exercises, massage, acupuncture, electrical stimulation, strapping, slings supports minimise subluxation. an analysis seven reviews, Dyer et al. reported benefits terms interventions, including orthoses, botulinum toxin injection stimulation.[13] However, authors advised practitioners interventions tailor individual presentation, guided circumstances, expert opinion growing literature base.[12,13] therapeutic (within limits pain) abovementioned preventive still first-line Oral analgesia, nonsteroidal anti-inflammatory drugs (NSAIDs), necessary discomfort Besides well-known risk serious gastrointestinal complications related NSAIDs, ischaemic NSAID appears higher previous transient attack, younger male patients.[14] Concomitant aspirin, anticoagulants platelet aggregation inhibitors mitigate risk.[14] Nonetheless, NSAIDs prescribed judiciously. syndrome, intra-articular injection, subacromial corticosteroid suprascapular nerve block considered.[1] Pharmacological options oral medications (such baclofen, tizanidine, benzodiazepines), intramuscular injections (botulinum toxin), blocks (using alcohol) intrathecal baclofen.[1,12,13] Baclofen, γ-aminobutyric acid agonist, widely spasticity. usual starting dose baclofen ranges 5 mg every evening times day. per days response tolerability. Maximum 80 day doses.[15] Dosage adjustment needed renal depending estimated creatinine clearance Cockcroft–Gault formula.[15] Common sedation, constipation, nausea hypotonia. Baclofen caution existing seizure loss treated baclofen.[15] Antidepressants amitriptyline nortriptyline, antiepileptics lamotrigine gabapentinoids (gabapentin, pregabalin) treatments CPSP,[10,16] while corticosteroids considered only proven effectiveness early/acute phase CRPS.[16] (30–60 mg) prednisolone variable tapering regimen duration (2–12 weeks).[17] WHEN SHOULD REFER SPECIALIST? Indications referral specialist marked despite trial pharmacological agents limited leads impairment hygiene posturing, complex psychosocial perpetuating Referral medicine physician specialised toxin, serial casting. addition, collaboration multidisciplinary team, consisting physiotherapists occupational therapists, prescribe additional splints (resting hand splint, ankle–foot orthoses) transcutaneous stimulation. refractory cases where contracture tears tendons resulted hygiene, orthopaedic surgeon option consideration release, surgical repair mobilisation. conclusion, optimal combination cost-effective essential provide favourable TAKE HOME MESSAGES problem present Increasing severity handling predispose development Apart subluxation, caused neurogenic causes, e.g. Treatment targeted, useful. if non-responsive treatment, perpetuate expect further investigations management, indicated. Closing You assessed noted he mild abductors, elbow wrist flexors. explained gave daughter advice proper taught them do daily. 1-week course ketoprofen 50 TDS Anarex tablets TDS. Before leaving room, agreed weeks.Financial sponsorship Nil. Conflicts interest There conflicts interest. SMC CATEGORY 3B CME PROGRAMME Online Quiz: https://www.sma.org.sg/cme-programme Deadline submission: pm, 05 September 2024

Language: Английский

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Post-stroke pain syndrome: clinical, pathophysiological characteristics and modern rehabilitation management

Medical alphabet, Journal Year: 2024, Volume and Issue: 12, P. 7 - 14

Published: Aug. 12, 2024

Background. Pain is a common complication after stroke and associated with the presence of depression, cognitive dysfunction, impaired quality life. It remains underdiagnosed undertreated, despite evidence that effective treatment pain may improve function The article highlights issues epidemiology, pathogenesis, methods clinical assessment risk factors for development post-stroke pain. A review literature on most syndromes including central pain, complex regional syndrome, musculoskeletal shoulder spasticity headache presented. Modern management analyzed. Conclusion. In best interests optimizing rehabilitation patient, improving his life stroke, clinicians should be aware as identify those patients at highest risk, detail characteristics also options correcting syndromes.

Language: Английский

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Retrospective Cohort Study on the Incidence and Management of Hemiplegic Shoulder Pain in Stroke Inpatients

Cureus, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 19, 2024

Painful hemiplegic shoulder (PHS) is a prevalent and challenging complication following stroke can significantly impair patient's engagement in rehabilitation, leading to poorer functional outcomes extended hospital stays. This retrospective cohort study aims investigate the incidence, etiology, management of PHS inpatients, focusing on effectiveness various therapeutic interventions. We conducted analysis subacute inpatients who developed during rehabilitation at single center. Medical records were reviewed assess incidence PHS, underlying causes, treatment modalities. Primary outcome measures included prevalence distribution identified etiologies, associated with different strategies. Our findings revealed significant among consistent existing literature. The multifactorial etiology spasticity, adhesive capsulitis, glenohumeral subluxation, central post-stroke pain, complex regional pain syndrome, advanced age, low scores, motor sensory impairments, comorbidities such as diabetes mellitus key risk factors. Management strategies ranged from conservative approaches, physical modalities slings, interventions, including intra-articular corticosteroid injections, botulinum toxin type A applications, nerve blocks, radiofrequency neuromodulation. Corticosteroid injections electrical stimulation particularly effective alleviating improving outcomes. Notably, pulsed modulation targeting suprascapular axillary nerves showed superior efficacy enhancing passive range motion compared conventional although was inconsistent. emphasizes multifaceted nature underlining importance individualized comprehensive While several radiofrequency, demonstrated effectiveness, variability highlights need for further investigation. Future research should focus larger patient cohorts follow-up periods better elucidate progression refine approaches. Despite limitations, design short period, these provide valuable insights into prevalence, progression, rehabilitation.

Language: Английский

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