Purpose

To establish the acute changes that occur in the upper limb post stroke regarding shoulder subluxation, shoulder pain, upper limb motor function and muscle tone.

Relevance

In order for one to provide optimum treatment to a patient post stroke, one needs accurate ideas of what problems the patient potentially faces. There is differing literature with regards to the acute changes that occur in the upper limb post stroke and the frequency. By determining this, prevention and treatment within the rehabilitation setting can be influenced and consequently impact on the quality of life of patients with stroke.

Participants

This study recruited 51 participants within two weeks of stroke presenting with upper involvement (hemiplegia). They were excluded if they had receptive aphasia and/or were medically unstable. Informed consent was sought from patients admitted to Helen Joseph and Charlotte Maxeke Johannesburg  Academic Hospitals in Johannesburg, South Africa.

Method

A longitudinal study design was used for this study. Each participant was assessed at baseline, week 1, week 2 and week 6 post baseline assessment. The participants were assessed for shoulder subluxation (measured using the finger width measurement system), shoulder pain (measured using the Ritchie Articular Index), upper limb motor function (measured using the upper limb subscales 6, 7 and 8 of the Motor Assessment Scale) and muscle tone (measured using the Modified Ashworth Scale). In the event of discharge, the patients were followed up and assessed as out-patients at the relevant hospital. Ethical approval was granted by the Human Research Ethics Committee (Medical) at the University of the Witwatersrand.

Analysis

Descriptive statistics were used to analyse the data. Data were presented in tables using frequencies and percentages for the following variables: age, gender, side of stroke, shoulder subluxation, shoulder pain, upper limb motor function and muscle tone.

Results

The study participants were generally young with a mean age of 49.2 ± 12.6 years. There more females (56.9%) than males and the majority of the study sample (58.8%) had right cerebrovascular accident. The number of patients presenting with shoulder subluxation increased from 35.3% at baseline to 40.0% at the six week follow up time. The same trend was observed for shoulder pain (47.1% at baseline to 56.7% at six weeks) and muscle tone increase which affected 21.6% of the patients at baseline and 30.6% at the two week follow up. Motor function was poor throughout the study period agreeing with the observed number of patients with shoulder subluxation, pain and muscle tone problems.

Implication and Conclusion

This study confirmed the presence of the commonly known upper limb problems post stroke. The fact that the proportion of patients with these problems increased over the study period confirms that upper limb rehabilitation is a real challenge for physiotherapists and other healthcare providers. It is imperative that one find ways of addressing these common problems if one is to improve the quality of life post stroke.

Keywords

Stroke; upper limb function; upper limb complications

Funding Source

University of the Witwatersrand