A new orthosis for subluxed, flaccid shoulder after stroke facilitates gait symmetry: a preliminary study.

OBJECTIVE: The aims of this study were: (i) to evaluate the immediate effects on subluxation and gait pattern of a new shoulder orthosis, developed for treatment of painful shoulder syndrome in subacute stroke patients; and (ii) to evaluate patients' and therapists' opinions about its fit and benefits after 4 weeks. METHODS: A total of 40 subacute in-rehabilitation stroke patients with non-functional arm and painful shoulder were included in the study. Of these, 12 subjects underwent shoulder radiography and gait analysis with and without the orthosis to determine the immediate effects of the orthosis. All 40 patients wore the orthosis during the daytime for 4 weeks before completing a survey. Outcome measures were: repositioning of the humeral head, gait cycle parameters, and qualitative lower limb muscle activation patterns. Patients and therapists rated wearing comfort, odour nuisance, effect on pain and performing gait and mobility-related activities. RESULTS: When using the shoulder orthosis the humeral head was repositioned in 10 of 12 patients, patients walked more symmetrically due to a prolonged hemiparetic stance phase (p < 0.01), and the paretic quadriceps muscle activity was higher and more appropriately timed. The majority of patients and therapists rated the wearing comfort positive, the odour nuisance minimal, and that the orthosis helped with performing activities. However, less than half of patients and therapists reported improvement in pain. CONCLUSION: The well-tolerated shoulder orthosis improved gait quality and repositioned the subluxated humeral head, offered a good fit, and eased performing activities, but did not reduce pain. This preliminary study does not warrant any definite conclusions on the effectiveness of the orthosis; more studies are needed to compare its effect with other models.

A new electromechanical trainer for sensorimotor rehabilitation of paralysed fingers: a case series in chronic and acute stroke patients.

BACKGROUND: The functional outcome after stroke is improved by more intensive or sustained therapy. When the affected hand has no functional movement, therapy is mainly passive movements. A novel device for repeating controlled passive movements of paralysed fingers has been developed, which will allow therapists to concentrate on more complicated tasks. A powered cam shaft moves the four fingers in a physiological range of movement. METHODS: After refining the training protocol in 2 chronic patients, 8 sub-acute stroke patients were randomised to receive additional therapy with the Finger Trainer for 20 min every work day for four weeks, or the same duration of bimanual group therapy, in addition to their usual rehabilitation. RESULTS: In the chronic patients, there was a sustained reduction in finger and wrist spasticity, but there was no improvement in active movements. In the subacute patients, mean distal Fugl-Meyer score (0-30) increased in the control group from 1.25 to 2.75 (ns) and 0.75 to 6.75 in the treatment group (p < .05). Median Modified Ashworth score increased 0/5 to 2/5 in the control group, but not in the treatment group, 0 to 0. Only one patient, in the treatment group, regained function of the affected hand. No side effects occurred. CONCLUSION: Treatment with the Finger Trainer was well tolerated in sub-acute & chronic stroke patients, whose abnormal muscle tone improved. In sub-acute stroke patients, the Finger Trainer group showed small improvements in active movement and avoided the increase in tone seen in the control group. This series was too small to demonstrate any effect on functional outcome however.