The Changes of The Shoulder Function and Quantitative Radiographic Measurements in Hemiplegic Patients by Sling Exercise

슬링운동에 의한 편마비 환자의 견관절 기능 및 정량적 방사선 계측 값 변화

  • Lee, Dong-Rour (Department of Physical Therapy, Good Samsun Hospital) ;
  • Kim, Jong-Soon (Departtment of Physical Therapy, Busan Cathiloic University) ;
  • Song, Min-Young (Physical Therapy, Department of Rehabilitation Science, Graduate School of Daegu University)
  • Published : 2009.11.30

Abstract

Purpose:The aim of this study was to determine the effect of active sling exercise on shoulder subluxation in hemiplegic patients. Methods:Twenty persons with shoulder subluxation were randomly divided into two groups; the experimental group(10 persons) and the control group(10 persons). Usual physical therapy and occupational therapy were applied in all groups in a day for 4 weeks. Additionally the experimental group was received 30 minutes sling active exercise (flexion, extention, adduction, abduction, intenal rotation, external rotation, horizontal adduction, horizontal abduction) for shoulder joint in a day for 4 weeks. I investigated the therapeutic effect of sling exercise through the Wolf motor function test (WMFT), Quantitative radiographic measurements and range of motion test at pre and post intervention period. Results:The passive range of motion was significantly increased in the experimental group compare with the control group. However, the active range of motion was no statistically significantly difference in both of the experimental and the control group. The level of WMFT was significantly decreased in the experimental group compared with control group. Although, there was no significantly difference the degree of the shoulder subluxation was more decreased in experimental group than control group. Conclusion:Taken together, these results suggest that sling exercise could be beneficial therapeutic method for hemiplegic shoulder. But to generalize it, more study and exercise program might be needed to confirm its availability.

Keywords

References

  1. 강욱, 서원희, 유종윤 등. 견관절 아탈구 교정을 위하여 새로이 고안된 조끼형 팔걸이 대한재활의학회지. 1996;20(3);787-93.
  2. 김선엽, 김택연, 박성진. 슬링운동에서 Hanging point의 원리와 임상적 적용. 대한정형도수치료학회지. 2003;9(2):25-45.
  3. 김영신. 뇌졸중으로 인한 편마비 환자의 프로그램화 된 견관절 자가 운동이 자기효능감과 상지기능에 미치는 효과. 원광대학교 대학원. 석사학위청구논문. 2005.
  4. 김태구, 이석민, 이재구. 뇌졸중 편마비환자들의 견 관절 운동가동범위, 통증 및 통증요인들에 대한 연구. 한국스포츠리서치. 2005;16(6):137-48.
  5. 라기용. 복와위 자세에서 전박지지 운동이 뇌졸중 환자의 견관절 동통 및 관절가동범위에 미치는 영향. 대구대학교 재활과학대학원. 석사학위논문. 1999.
  6. 신승철, 권영달, 송용선. 중풍 후유증으로 인한 편마 비환자 견관절 아탈구의 방사선학적 임상고찰. 한방재활의학회지. 1998;8:283-5.
  7. 이주상. 편마비환자에서 견갑골의 위치 안정성이 팔 뻗기 및 견관절 기능에 미치는 영향. 한국스포츠리서치. 2007;18(4):589-98.
  8. 임재영, 조현우, 이규범 등. 견관절 아탈구와 뇌졸중 후 복합부위통증증후군 발생과의 관계. 대한재활의학회지. 2003;27(1):21-6.
  9. 한경희, 박태환, 장기언. 편마비 환자에서 견관절 아탈구의 방사선학적 평가방법. 대한재활의학회지. 1993;17(2):226-34.
  10. 통계청. 2006년 사망원인별 통계 보고서. http://www. nso.go.kr. 2007.
  11. Baker LL, Parker K. Neuromuscular electrical stimulation of muscle surrounding the shoulder. Phys Ther. 1986;6(12):1930-7.
  12. Basmajian TV, Bazant FJ. Factors prevention downward dislocation of adducted shoulder joint: electrographic and morphological study. J Bone Joint Surg. 1959;41A:1182-6.
  13. Brooke MM, Lateur BJ, Diana-Rigby GC et al. Shoulder subluxation in hemiplegia: effects of three different supports. Arch Phys Med Rehabil. 1995;72(8):582-6.
  14. Feys HM, De Weerdt WG. Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke. Stroke. 1998;29(4): 785-92. https://doi.org/10.1161/01.STR.29.4.785
  15. Gialanella B, Benvenuti P, Santoro R. The painful hemiplegic shoulder: Effects of exercises program according to bobath. Clin Ter. 2004;155(11): 491-7.
  16. Gustafsson L, Mckenna K. A programme of static positional stretches does not reduce hemiplegic shoulder pain or maintain shoulder range of motion. Clin Rehabil. 2006;20(4):277-89. https://doi.org/10.1191/0269215506cr944oa
  17. Hummelshim H, Maier-Loth ML, Eickhof C. The functional value of electrical muscle stimulation for the rehabilitation of the hand in stroke patients. Scan J Rehabil Med. 1997;29(1):3-10.
  18. Ikai T, Tei K, Yoshida K, Yonemoto K. Evaluation and treatment of shoulder subluxation in hemiplegia: relationship between subluxation and pain. Am J Phys Med Rehabil. 1998;77(5):421-6. https://doi.org/10.1097/00002060-199809000-00012
  19. Kirkesola G. Sling exercise therapy(S-E-T): a total concept for exercise and active treatment of musculoskeletal disorders. J Kor Orthop Manu Phys Ther. 2001;7(1): 87-106.
  20. Langhammer B, Stanghelle JK. Bobath or motor relearning programme: A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Clin Rehabil. 2000;14(4):361-9. https://doi.org/10.1191/0269215500cr338oa
  21. Moodie NB, Brisbin JB, Margan AMG. Subluxation of the glenohumeral joint in hemiplegia: Evaluation of supportive device. Physiother Can. 1986;38: 151-7.
  22. Morris DM, Uswatte G, Crago JE. The reliability of the wolf motor function test for assessing upper extremity function after stroke. Arch Phy Med Rehabil. 2001:82(6):750-5. https://doi.org/10.1053/apmr.2001.23183
  23. Nelles G, Jentzen W, Jueptner S. Arm training induced brain plasticity in stroke studied with serial position emission tomograph. Neuroimage. 2001;13(6):1146-54.
  24. Olsen TS. Arm and leg paresis as outcome predictors in stroke rehabilitation. Stroke. 1990;21(2):247-51. https://doi.org/10.1161/01.STR.21.2.247
  25. Roy CW, Sands MR, Hill LD et al. The effect of shoulder pain on outcome of acute hemiplegia. Clin Rehabil. 1995;9(1):21-7. https://doi.org/10.1177/026921559500900103
  26. Sabari JS. Occupational therapy after stroke: are we providing the right services at the right time? Am J Occup Ther. 1998;52(4):299-302. https://doi.org/10.5014/ajot.52.4.299
  27. Shai G, Ring H, Costeff H , Solzi P. Glenohumeral malalignment in the hemiplegic shoulder. Scand J Rehabil Med. 1984;16(3):133-6.
  28. Smith RG, Cruikshank JG, Dunbar S, et al. Malalignment of shoulder after stroke. Br Med J.1982;84(6324):1224-6.
  29. Snels IAK, Beckerman H. Measuring subluxation of the hemiplegic shoulder: reliability of a method. Neurorehabil Neural Repair. 2001;15(3):249-54. https://doi.org/10.1177/154596830101500314
  30. Van der Lee, Wagenaar RC. Forced use of the upper extremity in chronic stroke patient. Stroke. 1999;30(11):2369-75. https://doi.org/10.1161/01.STR.30.11.2369
  31. Wang RY, Chan RC, Tsai MW. Functional Electrical Stimulation on Chronic and Acute Hemiplegic Shoulder Subluxation. Am J Phys Med Rehabil, 2000;79(4):385-90. https://doi.org/10.1097/00002060-200007000-00011
  32. Wolf SL, Lecraw DE, Barton LA. Forced use of hemiplegic upper extremities to reverse the effects of learned nonuse among chronic stroke and head-injuried patients. Exp Neurol. 1989;104: 125-32. https://doi.org/10.1016/S0014-4886(89)80005-6
  33. Trombly Occupational therapy for physical dysfunction 4th ed. baltimore. Williams & Wilkins. 1300-2.