Ultrasonographic assessment of neuromuscular electrical stimulation efficacy on glenohumeral subluxation in patients with hemiplegia: a randomized-controlled study.

OBJECTIVES: This study aims to investigate the short-term effects of neuromuscular electrical stimulation (NMES) on glenohumeral subluxation (GHS) in stroke patients. PATIENTS AND METHODS: This prospective, randomized-controlled study included 24 unilateral hemiplegic patients (10 males, 14 females; mean age 64.1±14.8 years; range 22 to 84 years) with GHS as assessed by ultrasonography between December 2013 and September 2014. The patients were randomly divided into two groups as those in the NMES group (n=12) who were treated with NMES to supraspinatus, upper trapezius, and posterior deltoid muscles combined with conventional physiotherapy and as those in the control group (n=12) who were received conventional physiotherapy alone. Clinical (the Brunnstrom Motor Recovery Stage, Visual Analog Scale [VAS] for Pain and Shoulder Disability Questionnaire [SDQ]) and ultrasonographic (acromion-greater tuberosity distance, thicknesses of supraspinatus, upper trapezius, and posterior deltoid muscles) variables were evaluated before and after treatment in both groups. RESULTS: The SDQ index, acromion-greater tuberosity distance, and supraspinatus muscle thickness were improved in the NMES group, compared to the control group (for all p<0.05). The VAS-pain scores decreased in both groups. There was no statistically significant alterations in the other measurements in both groups (for all p>0.05). The percentage change (%) of the VAS-pain scores was not significantly different between two groups (p=0.03). CONCLUSION: Our study results showed that GHS decreased after 20 sessions of NMES treatment. Based on these findings, ultrasonography appears to be a proper imaging tool for the evaluation of GHS in stroke patients.

Ultrasonographic evaluation of the median and sciatic nerves in hemiplegic patients after stroke.

OBJECTIVE: The aim of this study was to evaluate morphologically and electrophysiologically the peripheral nerves of hemiplegic patients. DESIGN: Thirty-three (18 women and 15 men) stroke patients were recruited. The mean (SD) age was 55.6 (11.3) yrs, and the mean (SD) disease duration was 14.2 (16.0) mos. Motor nerve conduction study of the median, ulnar, fibular, and tibial nerves as well as sensory nerve conduction study of the median, ulnar, and sural nerves were performed. Diameters and cross-sectional area (CSA) measurements of the median (wrist/midarm levels) and sciatic nerves (midthigh level) were acquired using a 7- to 12-MHz linear probe. The values of the nonparetic limbs were taken as controls. RESULTS: Prolonged distal latency and slowed motor conduction velocity of the tibial nerve as well as reduced amplitudes of the median and ulnar nerves were observed on the paretic sides when compared with those of the nonparetic sides (all P < 0.05). The median and sciatic nerve cross-sectional area values were found to be smaller on the paretic sides when compared with the nonparetic sides (all P < 0.05). The median and ulnar nerve compound muscle action potential amplitudes (paretic side) were positively correlated with arm/hand Brunnstrom Motor Recovery Stage, disease duration, motor Functional Independence Measure score, and Functional Ambulation Category. CONCLUSIONS: The peripheral nerves of stroke patients seem to be affected--morphologically and electrophysiologically--on the paretic side.

Doppler ultrasonographic evaluation of the radial and ulnar arteries in hemiparetic patients after stroke.

BACKGROUND: To evaluate blood flow of hand arteries (using Doppler ultrasonography) and sympathetic skin response (SSR) in patients with hemiparesis. METHODS: Fifty-six stroke patients (30 M, 26 F) with unilateral hemiparesis (age 53.5 ± 10.8 years, mean disease duration 12.0 ± 19.1 months) were included. The patients' arm and hand motor functions were assessed according to Brunnstrom's stages. SSR was evaluated bilaterally from median nerves at the wrist level. Radial and ulnar artery blood flow was measured at the wrist in the neutral position. RESULTS: Both radial and ulnar artery volume flow and end diastolic velocity, and radial artery diameter were smaller on the paretic side (all p < 0.0125). Radial artery resistance and pulsatility index were greater on the paretic side (both p < 0.0125). SSR amplitude was lower on the paretic side of patients with right-sided hemiparesis patients (p = 0.009). Hand Brunnstrom's stage was negatively correlated with nonparetic-paretic difference in radial artery volume flow and SSR amplitudes (all p < 0.025). CONCLUSIONS: Hand blood flow was lower on the paretic side and was accompanied by a similar decrease in SSR amplitudes in patients with right-sided hemiparesis.