Authors (including presenting author) :
Fan MK(1), Lau M(1), Yue SY(1), Ip WM(1), Choy PC(1), Chen PW(1), Cheung KY(1), Ho HH(1), Ip CS(1), Tse KY(1), Yip CH(1)
Affiliation :
(1) Occupational therapy Department, Shatin Hospital
Introduction :
Shoulder subluxation and pain are frequent complications in post-stroke hemiparesis, affecting 17%-81% and 22-47% of patients respectively (Paci, Nannetti, & Rinaldi, 2005; Anwer & Alghadir, 2020). These complications often result from the prolonged gravitational pull on the arm against hypotonic muscles (Lee, Baker, Johnson, & Tilson, 2017), substantially impede functional recovery (Kumar, Saunders, Ellis, & Whitlam, 2013). Despite extensive research, recent systematic reviews indicate a lack of consensus on effective interventions for alleviating shoulder subluxation and pain (Arya, Pandian, Vikas, & Puri, 2018; Dyer, Mordaunt, & Adey-Wakeling, 2020), emphasizing the need for preventive strategies in rehabilitation.
Advancements in robotic-assistive technologies have presented marked improvements in post-stroke upper limb motor recovery (Zhang, Li-Tsang, & Au, 2017), their potential therapeutic benefits in managing shoulder subluxation and pain were beginning to gain attention.
Objectives :
This retrospective, matched-pair study examined the efficacy of a standardized robotic-assistive hemiplegic shoulder management protocol developed at Shatin hospital in July 2023.
Methodology :
Patients with Functional Test of Hemiplegic Upper Extremities level 1-5 were recruited for robotic-assistive training, alongside standardized hemiplegic shoulder management that included support for hemiplegic upper extremity, proper shoulder positioning, and conventional mobilization techniques.
Total of 164 patients were screened, exclusions were applied to 25 patients based on two criteria: (1) past medical history or comorbidity related to shoulder conditions. The remaining patients were allocated into two groups after matched-pair in terms of diagnosis, sex, and occupational therapy attendances: robotic training group (n = 86) and non-robotic training group (n = 53). Statistical analysis was conducted to compare the incidence of shoulder subluxation and pain between two groups.
Result & Outcome :
Throughout the rehabilitation phase, 22.6% of patients in the non-robotic training group experienced shoulder subluxation, compared to 4.7% in the robotic training group, indicated robotic-assistive training significantly reduced the likelihood of shoulder subluxation (Chi-square: 10.419, p = 0.001). After rehabilitation commenced, shoulder subluxation developed in 15% of patients in the non-robotic training group, compared to 2.3% in the robotic training group. Furthermore, the robotic training group exhibited notably lower incidence of shoulder subluxation after rehabilitation began (Chi-square 8.007, p = 0.005). A significant correlation was identified between the type of training received and the incidence of shoulder subluxation both during (Spearman's who: -0.274, p = 0.001) and after the rehabilitation (Spearman's who: -0.240, p = 0.004).
Regarding shoulder pain, 18.9% of patients in the non-robotic group developed pain during rehabilitation, compared with 14% in the robotic group. Pain resolution was achieved by 10% of patients in the non-robotic group and 25% in the robotic group. Following the initiation of rehabilitation, new-onset shoulder pain was observed in 9.4% of the non-robotic group and 6.9% of the robotic group.
Overall, these findings suggest that robotic-assisted training may confer additional benefits in preventing shoulder subluxation and reducing shoulder pain in post-stroke patients. Further studies are recommended to validate these findings in broader patient populations and to determine the long-term effects of robotic-assistive training on rehabilitation outcome. To conclude, integrating hemiplegic shoulder prevention strategies with robotic-assistive training represented a promising advancement in the management of hemiplegic shoulder subluxation and pain.
