Bilateral training guided by contralaterally controlled functional electrical stimulation for shoulder pain and subluxation in subacute stroke: A randomized controlled trial

Abstract

Background

Shoulder pain, subluxation, and motor dysfunction are common issues in hemiplegic patients, which hinder the recovery of upper limb function and have a negative impact on patients’ daily life abilities and quality of life. Current rehabilitation interventions alone can not purposefully address the aforementioned problems, while bilateral training (BT) and contralaterally controlled functional electrical stimulation (CCFES) can be synergistically coordinated to provide a simultaneous treatment for hemiplegic shoulders.

Objective

This study attempted to treat hemiplegic patients using bilateral training with contralaterally controlled functional electrical stimulation (BT-CCFES), aiming to observe the changes of shoulder pain, subluxation, and motor function.

Methods

Thirty-eight individuals who had experienced hemiplegia with shoulder pain and subluxation due to stroke were randomly divided into two groups: a control group and an experimental group consisting of nineteen cases both. Patients in the control group underwent neuromuscular electrical stimulation (NMES) therapy, while those in the experimental group received BT-CCFES. Before and after a four-week treatment period, shoulder subluxation distance (SSD) was measured using a flexible ruler, and the pain level was assessed using the visual analogue scale (VAS). Additionally, shoulder joint active range of motion (AROM) and the upper extremity Fugl-Meyer assessment (UE-FMA) were used to evaluate shoulder motor function.

Results

After four weeks of treatment, there were significant improvements in SSD, VAS, UE-FMA, and AROM in the experimental group (p < 0.001), as well as in the control group (p < 0.05). The changes between the experimental group and control group showed significant differences in SSD (−9.74 ± 6.63 vs −3.58 ± 5.51, p = 0.016), flexion (37.37 ± 14.08 vs 21.05 ± 12.65, p = 0.001), and UE-FMA (15.21 ± 4.30 vs 8.84 ± 4.26, p < 0.001), while the difference in VAS (−1.31 ± 1.34 vs −1.10 ± 1.24, p = 0.619) and abduction (15.00 ± 8.82 vs 10.79 ± 7.86, p = 0.111) was not significant.

Conclusion

BT-CCFES can be used to prevent and treat hemiplegic shoulder subluxation after stroke, improve shoulder and upper limb function, and is superior to NMES except in pain relief.