taping in post-stroke subluxation

Hi,
Anyone tried using 'taping techniques' in post stroke clients with shoulder subluxation. Kindly let me know if you know your views on taping
1. will it be effective?
2. what's the outcome?
3. Any criteria to select the client's?

thank you

Sorry to be terse in my comments. The answers are
1. No effective
2. none
3. Not necessary

I am wondering if Jowales has any experience with taping or has ever looked into research. As far as I know only taping and collar and cuff are effective (research 2004, cannot remember which magazine but seemed sound) so all the fancy collars one can buy are, according to that research, a waiste of time. jowales could also and would have given you an idea what you might do in stead of taping if... he or she (I expect a he), he knew what he was talking about. Look into tresearch first before you believe what I write here But.... taping should be done oblique from caudal to cranial and both from dorsal as well as ventral over the deltoid over the sides you can add some strips of paralel taping. Before taping,The shoulder joint should be put in an 30dgrs abduction with some flexion in an none sublucated position.
How it could work? well ask Mc Connell because he does the theory behind taping. When taping? Asap and change the tape every week until you get some muscle tone but abbandon when you get allergic reactions or no effect after some months. For whom? Painful shoulders. Advantage? patient and nursing staff are not puzzled by the complexity of 'collar and cuff' and for shure not by the ones you can buy over the counter which allways give a lot of fun by the different ways these can be used. (in general they have a strapp under the other shoulder which irritates most patients after some time.

Anatomically the superior genohumeral ligament unwinds/become more lax in internal rotation of the arm. It would follow then that a flaccid arm, left in internal rotation would tend towards subluxation.

I have used various cuffs over the years and have even experimented with a few thermoplastic creations of my own. I must say that none have been fantastic and none are useful in isolation.

I have also tried muscle stimulation for supination of the forarm combined with external rotation of the shoulder girdle to facilitate a better boney alignment. OT and PT exercises that place objects and tasks to the side and behind the effected side would also encourage this.

Anyway that's a few ideas from me, best of luck 8o

hi,
Thank you very much for your suggestions well i will try those in my clients.:rollin

The physical therapist can provide splints and braces to support joints and limbs, to treat and prevent complications (eg, shoulder-hand syndrome, spasticity), and to assist the patient in walking.

Early after stroke, patients often have flaccid paralysis that can potentiate further complications such as contractures, joint subluxation, and nerve pressure palsies. For instance, common upper extremity examples are shoulder subluxation, ulnar neuropathy, and elbow flexion contractures. Physical therapy should focus on appropriate positioning and avoidance of traction, which can harm joints previously stabilized by muscular tone. Range of motion (ROM) should be preserved during this phase. Later efforts can be pursed to reeducate weak musculature through modalities that provide sensory feedback.


Neuromuscular electrical stimulation

Since no sling design definitively prevents or treats shoulder subluxation, an effective alternative available is NMES. It was reported that the aim of NMES is to reduce subluxation of the hemiplegic shoulder without the use of restrictive splints. NMES may even elicit strong sedative effects on pain by acting on sensory nerves. It is believed that it also could be used prophylactically as a temporary means of splinting the shoulder until recovery of motor function is sufficient enough to support the glenohumeral joint. Numerous other studies have suggested that it also improves spasticity and enhances muscle strength of the hemiparetic limb.
A study found that patients with hemiplegia and subluxation who received 5 weeks of NMES had significantly more improvement in pain relief, reduced subluxation, quicker motor recovery, and possibly facilitated recovery of shoulder function. These results were maintained for up to 2 years. However, it was recommended that patients continue exercising to maintain control of their pain. In chronic hemiplegic stroke and TBI patients, there was used percutaneous NMES (perc-NMES) in the posterior deltoid and supraspinatus muscles 6 hours per day for 6 weeks. This resulted in reduced subluxation and improvements in pain and disability. These results were maintained during 3 months of follow-up. It was subsequently followed this up with a study comparing transcutaneous-NMES with perc-NMES. It was found that perc-NMES is less painful, has a much easier application, and has potential for long-term use.
This study also found a reduction of shoulder subluxation, with possible enhancement of recovery and improvement in shoulder pain. At this point, the optimal muscles and number to stimulate has not been established. Using muscles with strong superior and medially directed forces, as well as those stabilizing the scapula, may significantly enhance the efficacy of this intervention.

Even after 6 months poststroke, forced active repetitive movements of the paretic limb through the use of NMES appears to enhance motor and functional recovery. This has been clinically proven to occur as a result of neuroplasticity, in which active repetitive training of the hemiparetic limb causes functional reorganization in the adjacent intact cortex, subsequently allowing for maximum motor recovery. There was treatment of the extensor digitorum communis (EDC) and extensor carpi radialis (ECR) by combining neuromuscular stimulation with active repetitive wrist and finger extension exercises for one hour per day for a total of 15 sessions, subsequently producing significantly enhanced motor recovery that was maintained for up to 12 weeks. However, no significant functional effect was proven.

See Biofeedback and electrical Stimulation for Stroke Recovery

See Functional Electrical Stimulation and Upper Extremity Motor Relearning

Active Repetition

The use of active repetition has been shown to maximize motor relearning when used in the appropriate candidate. It is found that stroke patients who were less severely impaired (ie, possessed some early volitional arm movement) prior to treatment benefited from the use of early additional therapies that involved repetitive movements and functional tasks. However, patients with severe arm impairment showed very little improvement in function irrespective of receiving additional therapies. This data supports previous clinical trials that suggest there is no current physical therapy approach that results in sustained improvements of upper limb function in patients who are severely impaired. In patients who are severely impaired, the use of adaptive techniques and equipment may be an appropriate rehabilitation strategy.
Following basic concepts be used during muscle reeducation:

Patient should visualize (ie, mirror) specific movements.
Verbally reinforce intended movements and encourage the feel of specific motions.
Copy similar motions performed simultaneously by the contralateral arm.
Position the UE to decrease scapular depression and retraction.
Apply sensory stimulation simultaneously to movements.
Use prone exercises to stimulate righting reflexes that tend to imitate primitive motor function.
Start seated and standing stimulation exercises to help decrease subluxation and modify synergy patterns.
Attempt to increase passive range of motion (PROM) with gentle slow motion, rhythmic stabilization, or voluntary contraction followed by relaxation or gentle stretching.
Avoid vigorous traction on the arm when stretching connective tissue around the spastic joint.
Use of electric stimulation can enhance muscle relaxation.
Use the functional arm to simultaneously train the paretic arm to improve ROM and proprioceptive stimulation.
Use modalities (eg, ice, transcutaneous electrical nerve stimulation [TENS], vibration) to diminish spasticity.
Surgical Intervention: In the past, surgical release of tendons and muscle was commonly performed on patients experiencing prolonged spasticity and synergy. For patients experiencing a painful spastic shoulder, surgical transection of the subscapularis and pectoralis tendons was performed to eliminate internal rotation and adduction forces. Hecht et al reported that following treatment, up to 88% of these patients had improved pain and increased ROM, with some developing active abduction. Today, this form of treatment rarely is used.

Stroke syndromes present with various alterations in motor, sensory, and cognitive function, each unique in clinical presentation and prognosis. Although there are general principles of stroke recovery, no two patients share the same experience. Understanding the correlated physiologic and anatomic changes in the brain helps identify which syndrome is present and how best to institute comprehensive rehabilitation to meet the individual needs of the patient.

Share your own views and thoughts about that.

hi neurospast,
do u have any reference to tapping techniques either as a form of book or web address please give me.....
iam interested to learn about taping techniques to hemiplegics and sport injuries.

Hi,:) (sports injuries)

You could go thru this website and find some of the taping techniques in sports injuries.









Regards,

Charlize29:D

Here are some of the Mulligan taping techniques: (Sports injuries)

1. Ankle sprain

Mulligan Taping Techniques :: Inversion Ankle Sprain




2. Tennis elbow

Mulligan Taping Techniques :: Tennis Elbow



Regards,
Charlize29:D :)

hi,
can u tell me tht what r the causes of shoulder subluxation in hemiplegics and how can we prove it clinically?
ganga.

yes we have tried taping the hemiplegic shoulder.
the only thing is to be done is deltoid and supraspinatus muscle should be reeducated bt the help of a tape. The taping should be of a long leverage to cover the deltoid muscle.
the pull of the tape should be in the direction of deltoid muscle that is from lateral portion of the arm right upto the shoulder joint.

Hi guys i wanted to know the treatment for hyperextension of knee in Hemiplegia. We have tried with strengthening of Hamstrings and Quadricpes but anything apart from that and orthosis also.