Upper Limb Functions and Complications of Hemiplegic Side in Patients with Chronic Stroke in the Community
Keywords:
stroke; upper limb; communityAbstract
Background and objective: Upper limb dysfunctions and complications of hemiplegic side are most common problems after stroke. However, currently no studies have been undertaken to investigate these problems in community-dwellers with stroke in Thailand. This study aimed to evaluate upper limb functions and complications of hemiplegic side in individuals with chronic stroke in a community.
Methods: Participants were stroke survivors with at least 6 months post-stroke who were able to sit independently for at least 50 minutes and understand commands to perform various tests. Upper limb functions of hemiplegic side of the patients were evaluated by the Short form Fugl-Meyer Assessment Scale (S-FM) and the Streamlined Wolf Motor Function Test for chronic stroke (SWMFT-C), which each of 6 activities. Complications of the hemiplegic upper limb were identified by interviews, observations and basic physical therapy evaluations. Data were analyzed by using descriptive statistics.
Results: Ninety-seven patients who were on average of 62.9±12.2 years old and 37.2±56.3 months post-stroke were recruited. Evaluations of the hemiplegic upper limb functions of the patients revealed that average scores of each activity of the S-FM and SWMFT-C ranged from 1.14 to 1.31 points (full score = 2 points) and 1.99 to 2.40 points (full score = 5 points), respectively. Additionally, the average timescale of the SWMFT-C activities ranged from 44.74 to 55.98 seconds. The two most common hemiplegic upper limb complications were shoulder pain and shoulder subluxation, following by wrist pain, muscle atrophy and hand edema.
Conclusions: Community-dwellers with chronic stroke had a decrease in upper limb functions of hemiplegic side. Most of them had complications of the upper limb, particularly the shoulder joint problems. So, continuing rehabilitation after hospital discharge is necessary to enhance the recovery of upper limb in hemiplegic side.
References
2. กระทรวงสาธารณสุข. อัตราการป่วยตายด้วยโรคหลอดเลือดสมอง 2560. [ออนไลน์]. [สืบค้นเมื่อ 10 เมษายน 2560]. เข้าถึงได้จาก http://hdcservice.moph.go.th/hdc/reports/report.php? source=formated%2Fncd_death_age.php&cat_id=6a1fdf282fd28180eed7d1cfe0155e11&id=9bf46fa15f85178a05b665ae986bd467
3. Sadler E, Wolfe CD, Jones F, McKevitt C. Exploring stroke survivors’ and physiotherapists’ views of self-management after stroke: a qualitative study in the UK. BMJ 2017; 7: e011631.
4. Nijland RH, van Wegen EE, Harmeling-van der Wel BC, Kwakkel G, Investigators E. Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: early prediction of functional outcome after stroke, the EPOS cohort study. Stroke 2010; 41: 745-50.
5. Kong KH, Chua KS, Lee J. Recovery of upper limb dexterity in patients more than 1 year after stroke: frequency, clinical correlates and predictors. NeuroRehabilitation 2011; 28: 105-11.
6. Lang CE, Beebe JA. Relating movement control at 9 upper extremity segments to loss of hand function in people with chronic hemiparesis. Neurorehabil Neural Repair 2007; 21: 279-91.
7. Likhi M, Jidesh VV, Kanagaraj R, George JK. Does trunk, arm, or leg control correlate best with overall function in stroke subjects? Top Stroke Rehabil 2013; 20: 62-7.
8. Levin MF, Kleim JA, Wolf SL. What do motor “recovery” and “compensation” mean in patients following stroke? Neurorehabil Neural Repair 2009; 23: 313-9.
9. Au-Yeung SS, Hui-Chan CW. Predicting recovery of dextrous hand function in acute stroke. Disabil Rehabil 2009; 31: 394-401.
10. Kwah LK, Harvey LA, Diong J, Herbert RD. Models containing age and NIHSS predict recovery of ambulation and upper limb function six months after stroke: an observational study. J Physiother 2013; 59: 189-97.
11. Kwah LK, Harvey LA, Diong JH, Herbert RD. Half of the adults who present to hospital with stroke develop at least one contracture within six months: an observational study. J Physiother 2012; 58: 41-7.
12. จิรวรรณ โปรดบำรุง. ภาวะแทรกซ้อนหลังเกิดอัมพาตครึ่งซีกในผู้ป่วยหลอดเลือดสมอง. พุทธชินราชเวชสาร 2557; 31: 376-84.
13. กรมการแพทย์ กระทรวงสาธารณสุข. คู่มือการคัดกรอง/ประเมินผู้สูงอายุ. กรุงเทพมหานคร: สำนักงานกิจการโรงพิมพ์สงเคราะห์องค์การทหารผ่านศึก, 2557.
14. Daniel WW. Biostatistics: a foundation for analysis in the health sciences. 4th ed. Hoboken: John Wiley & Sons, 2005.
15. Srisoparb W. Prediction of upper limb recovery post-stroke using wrist motor impairments [Doctor of Philosophy Thesis]. Southampton: University of Southampton, 2016.
16. Hsieh YW, Hsueh IP, Chou YT, Sheu CF, Hsieh CL, Kwakkel G. Development and validation of a short form of the Fugl-Meyer motor scale in patients with stroke. Stroke 2007; 38: 3052-4.
17. Tretriluxana J, Poungvarin N, Emsakul J, Juntrkaew T, Srirugsa P, Thongkaew S. The reliability and validity of Wolf Motor Function Test (WMFT) for assessing paretic limb of individuals with acute stroke. J Neurol Sci 2009; 285(Suppl 1): S176.
18. Hsueh IP, Hsu MJ, Sheu CF, Lee S, Hsieh CL, Lin JH. Psychometric comparisons of 2 versions of the Fugl-Meyer Motor Scale and 2 versions of the Stroke Rehabilitation Assessment of Movement. Neurorehabil Neural Repair 2008; 22: 737-44.
19. Morris DM, Uswatte G, Crago JE, Cook EW III, Taub E. The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke. Arch Phys Med Rehabil 2001; 82: 750-5.
20. Taub E, Morris DM, Uswatte G, Crago J. Wolf Motor Function Test (WMFT) manual. 2011. [ออนไลน์]. [สืบค้นเมื่อ 8 พฤษภาคม 2560]. เข้าถึงได้จาก https://www.uab.edu>images>pdf_files
21. Wee S. Relationship between trunk control and recovery of upper extremity function in stroke patients [Doctoral of Philosophy Thesis]. Southampton: University of Southampton, 2015: pp.159.
22. Kuptniratsaikul V, Kovindha A, Suethanapornkul S, Manimmanakorn N, Archongka Y. Complications during the rehabilitation period in Thai patients with stroke: a multicenter prospective study. Am J Phys Med Rehabil 2009; 88: 92-9.
23. Pinedo S, de la Villa FM. Complications in the hemiplegic patients in the first year after the stroke. Revista de Neurologia 2001; 32: 206-9.
24. Chen CM, Hsu HC, Chang CH, Lin CH, Chen KH, Hsieh WC, et al. Age-based prediction of incidence of complications during inpatient stroke rehabilitation: a retrospective longitudinal cohort study. BMC Geriatrics 2014; 14: 41.
25. น้อมจิตต์ นวลเนตร์. การเคลื่อนย้ายผู้ป่วยอัมพาตครึ่งซีก. ใน: สุกัลยา อมตฉายา, วรวรรณ คำฤาชา (บรรณาธิการ). การเดิน การเคลื่อนย้ายตัว และอุปกรณ์ช่วย. ขอนแก่น: โรงพิมพ์มหาวิทยาลัย ขอนแก่น, 2552: 97-106.
26. น้อมจิตต์ นวลเนตร์. การจัดท่าทางสำหรับผู้ป่วยอัมพาตครึ่งซีก. ใน: สุกัลยา อมตฉายา, วรวรรณ คำฤาชา (บรรณาธิการ). การเดิน การเคลื่อนย้ายตัว และอุปกรณ์ช่วย. ขอนแก่น: โรงพิมพ์มหาวิทยาลัยขอนแก่น, 2552: 127-32.
27. Murie-Fernández M, Iragui MC, Gnanakumar V, Meyer M, Foley N, Teasell R. Painful hemiplegic shoulder in stroke patients: causes and management. Neurología 2012; 27: 234-44.
28. กิ่งแก้ว ปาจรีย์. การฟื้นฟูสมรรถภาพผู้ป่วยโรคหลอดเลือดสมอง. กรุงเทพมหานคร: งานตำราวารสารและสิ่งพิมพ์ สถานเทคโนโลยีการศึกษาแพทยศาสตร์ คณะแพทยศาสตร์ศิริราชพยาบาล มหาวิทยาลัยมหิดล, 2547.
29. Stinear CM, Barber PA, Petoe M, Anwar S, Byblow WD. The PREP algorithm predicts potential for upper limb recovery after stroke. Brain 2012; 135: 2527-35.
30. Taub E, Uswatte G, Mark VW, Morris DM. The learned nonuse phenomenon: implications for rehabilitation. Eura Medicophys 2006; 42: 241-56.
