Management of hemiplegic shoulder pain: A UK wide online survey of physiotherapy and occupational therapy practice

Introduction:Hemiplegic shoulder pain (HSP) is a common complication of stroke that can lead to reduced quality of life. The primary aim of the present study was to identify how HSP is assessed, diagnosed and managed in routine clinical practice by physiotherapists (PTs) and occupational therapists (OTs) in the UK. A secondary aim was to identify the challenges to services in the management of HSP. MethodsA questionnaire was developed from similar surveys of musculoskeletal/neurological practice, a review of the literature and consultation with researchers and clinicians. The survey was distributed online to PT’s and OT’s working in stroke rehabilitation via professional bodies’ interest groups. Results: Sixty seven responses were received from PTs (60%) and OTs (40%). The respondents gained knowledge in HSP management through in-service training, clinical supervision and reading (80%). HSP was routinely checked (89%) and the mean time spent on assessment was 10 minutes. Commonly used assessments were glenohumeral subluxation (94%), strength (76%), range of movement (67%), spasticity (79%) and palpation (63%). Interventions included education, exercise and self-management. Patients were discharged when treatment options were exhausted (80%). Time constraints (62%); lack of diagnosis (54%) and training (60%) were the major challenges in providing appropriate care for HSP. Conclusion: The results suggest that a wide range of approaches are utilised by clinicians and that patients are potentially receiving treatment irrespective of the underlying problem due to lack of accurate diagnosis of the cause of HSP. A comprehensive assessment tool and additional training specific to HSP are required to improve the patients’ outcome

Exploring altered body perception and comfort after stroke: An interpretive phenomenological analysis

Background: After stroke, changes to body perception are common. However, little is known about what these disturbed perceptions feel like to the stroke survivor. This study took a phenomenological approach to explore experiences ofaltered body perception, whether these perceptions were uncomfortable, and whether participants indicated a need for clinical interventions.Method: A purposive sample of 16 stroke survivors were predominantly recruited from community support groups for stroke. All participants were at least six months post-stroke, experiencing motor and sensory impairments and able to communicate verbally. In-depth, semi-structured interviews were conducted in participants’ homes. Interviews were audio-recorded, transcribed verbatim, and analysed alongside reflexive notes using an interpretativephenomenological approach. Ethical approval was obtained from University of the West of England.Results/Findings: Four themes emerged. Participants described a body which did not exist; a body hindered by strange sensations and distorted perceptions; an uncontrollable body; and a body isolated from health professionals and clinical interventions. Participants expressed discomfort and feelings of conflict towards the body. They found their experiences difficult to understandand hard to describe.Discussion: Altered body perceptions left survivors feeling disembodied: their bodies perceived as strange, uncooperative, uncomfortable, and isolated from support. This is the first study to look at altered body perceptions in terms of patient comfort.Conclusion: These findings highlight the need for health professionals to recognize and support the communication of stroke survivors’ experiences of altered body perceptions and discomfort. Further research is needed to determine new ways to communicate about altered body perception and develop interventions to improve body comfort

The feasibility of using sonoelastography to identify the effect of joint hypermobility syndrome on elasticity of gastrocnemius muscle

Background: Joint hypermobility syndrome (JHS) is a heritable connective tissue disorder in which multiple synovial joints demonstrate a painful and extraordinary range of motion. Genetically there are abnormal changes in the connective tissue matrix in people with JHS, and that may alter the viscoelasticity of their muscular tissue. Sonoelastography (SEG) is a new technology in musculoskeletal practice for assessing tissue elasticity. This study aimed to determine the feasibility of using SEG to distinguish between those with and without a diagnosis of JHS. Gastrocnemius muscle (GM) elasticity was examined, as it is essential for balance and walking.Methods: Twenty participants were examined in a cross-sectional feasibility study: 10 participants diagnosed with JHS and 10 age- and gender-matched healthy controls. The dominant GM was scanned three times using SEG. The colours of the SEG images indicate soft (red), intermediate (green) and hard (blue) tissues. ImageJ software was used to analyse the images by identifying the mean percentage of pixels of each colour.Results: For the JHS group, nine females and one male were examined, with a mean age of 38.9 years (S.D. 15.53). Similarly, for the non-JHS group, nine females and one male were examined, with a mean age of 38.9 years (S.D. 12.37). The groups were comparable in terms of age, gender and BMI (P = 1.00, 1.00, and 0.77, respectively).The JHS group had a significantly higher percentage of blue (hard tissue) pixels when compared with the control group (P = 0.035). No significant differences were found in the mean percentage of green (intermediate) and red (soft) pixels (P = 0.55 and P = 0.051, respectively).SEG required a reasonable amount of training for clinicians with sufficient background in musculoskeletal anatomy, 4 h of observation and practical training. The examination was completed in < 5 min, so it may be reasonable for use in clinical practice, and it was well tolerated by patients. The SEG image was analysed in < 5 minutes.Conclusion: The results indicate that the GM in people with JHS had more areas of hard tissue when compared with the control group, contradicting the expected results. However, GM hyperactivity has been identified during walking in people with JHS, and increased muscle tone might therefore explain the findings. The findings need to be verified in a much larger future study. The SEG seems a feasible tool for quantifying muscular tissue elasticity in JHS

Selected static foot assessments do not predict medial longitudinal arch motion during running

Background: Static assessments of the foot are commonly advocated within the running community to classify the foot with a view to recommending the appropriate type of running shoe. The aim of this work was to determine whether selected static foot assessment could predict medial longitudinal arch (MLA) motion during running. Methods: Fifteen physically active males (27 ± 5 years, 1.77 ± 0.04 m, 80 ± 10 kg) participated in the study. Foot Posture Index (FPI-6), MLA angle and rearfoot angle were measured in a relaxed standing position. MLA motion was calculated using the position of retro-reflective markers tracked by a VICON motion analysis system, while participants ran barefoot on a treadmill at a self-selected pace (2.8 ± 0.5 m.s−1). Bivariate linear regression was used to determine whether the static measures predicted MLA deformation and MLA angles at initial contact, midsupport and toe off. Results: All three foot classification measures were significant predictors of MLA angle at initial contact, midsupport and toe off (p < .05) explaining 41–90 % of the variance. None of the static foot classification measures were significant predictors of MLA deformation during the stance phase of running. Conclusion: Selected static foot measures did not predict dynamic MLA deformation during running. Given that MLA deformation has theoretically been linked to running injuries, the clinical relevance of predicting MLA angle at discrete time points during the stance phase of running is questioned. These findings also question the validity of the selected static foot classification measures when looking to characterise the foot during running. This indicates that alternative means of assessing the foot to inform footwear selection are required

Evaluation of multi-segmental kinematic modelling in the paediatric foot using three concurrent foot models

Background: Various foot models are used in the analysis of foot motion during gait and selection of the appropriate model can be difficult. The clinical utility of a model is dependent on the repeatability of the data as well as an understanding of the expected error in the process of data collection. Kinematic assessment of the paediatric foot is challenging and little is reported about multi-segment foot models in this population. The aim of this study was to examine three foot models and establish their concurrent test-retest repeatability in evaluation of paediatric foot motion during gait. Methods: 3DFoot, Kinfoot and the Oxford Foot Model (OFM) were applied concurrently to the right foot and lower limb of 14 children on two testing sessions. Angular data for foot segments were extracted at gait cycle events and peaks and compared between sessions by intraclass correlation coefficient (ICC) with 95% confidence intervals (95% CI) and standard error of measurement (SEM). Results: All foot models demonstrated moderate repeatability: OFM (ICC 0.55, 95% CI 0.16 to 0.77), 3DFoot (ICC 0.47, 95% CI 0.15 to 0.64) and Kinfoot (ICC 0.43, 95% CI −0.03 to 0.59). On the basis of a cut-off of 5°, acceptable mean error over repeated sessions was observed for OFM (SEM 4.61° ± 2.86°) and 3DFoot (SEM 3.88° ± 2.18°) but not for Kinfoot (SEM 5.08° ± 1.53°). Reliability of segmental kinematics varied, with low repeatability (ICC < 0.4) found for 14.3% of OFM angles, 22.7% of 3DFoot angles and 37.6% of Kinfoot angles. SEM greater than 5° was found in 26.2% of OFM, 15.2% of 3DFoot, and 43.8% of Kinfoot segmental angles. Conclusion: Findings from this work have demonstrated that segmental foot kinematics are repeatable in the paediatric foot but the level of repeatability and error varies across the segments of the different models. Information on repeatability and test-retest errors of three-dimensional foot models can better inform clinical assessment and advance understanding of foot motion during gait

Evaluation of multi-segmental kinematic modelling in the paediatric foot using three concurrent foot models

Background: Various foot models are used in the analysis of foot motion during gait and selection of the appropriate model can be difficult. The clinical utility of a model is dependent on the repeatability of the data as well as an understanding of the expected error in the process of data collection. Kinematic assessment of the paediatric foot is challenging and little is reported about multi-segment foot models in this population. The aim of this study was to examine three foot models and establish their concurrent test-retest repeatability in evaluation of paediatric foot motion during gait. Methods: 3 DFoot, Kinfoot and the Oxford Foot Model (OFM) were applied concurrently to the right foot and lower limb of 14 children on two testing sessions. Angular data for foot segments were extracted at gait cycle events and peaks and compared between sessions by intraclass correlation coefficient (ICC) with 95% confidence intervals (95% CI) and standard error of measurement (SEM). Results: All foot models demonstrated moderate repeatability: OFM (ICC 0.55, 95% CI 0.16 to 0.77), 3DFoot (ICC 0.47, 95% CI 0.15 to 0.64) and Kinfoot (ICC 0.43, 95% CI − 0.03 to 0.59). On the basis of a cut-off of 5°, acceptable mean error over repeated sessions was observed for OFM (SEM 4.61° ± 2.86°) and 3DFoot (SEM 3.88° ± 2.18°) but not for Kinfoot (SEM 5.08° ± 1.53°). Reliability of segmental kinematics varied, with low repeatability (ICC < 0.4) found for 14.3% of OFM angles, 22.7% of 3DFoot angles and 37.6% of Kinfoot angles. SEM greater than 5° was found in 26.2% of OFM, 15.2% of 3DFoot, and 43.8% of Kinfoot segmental angles. Conclusion: Findings from this work have demonstrated that segmental foot kinematics are repeatable in the paediatric foot but the level of repeatability and error varies across the segments of the different models. Information on repeatability and test-retest errors of three-dimensional foot models can better inform clinical assessment and advance understanding of foot motion during gai

‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke

Objective: This study explored stroke survivors’ experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. Design: A qualitative phenomenological study. Setting: Participants’ homes. Participants: A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. Interventions: Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. Results: Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. Conclusion: Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke

Reliability of Kinematic Waveforms during Gait Analysis with Total Hip Arthroplasty Patients

Purpose: The aim of the study was to determine the test-retest reliability of lower limb kinematic waveforms derived from 3D gait analysis (3DGA) in patients following total hip arthroplasty (THA). Methods: Eight (7M:1F; age: 70 ± 7 years; height: 1.68 ± 0.11m; mass: 85 ± 20kg) adults with a unilateral THA attended test and retest sessions. 3DGA was undertaken with participants walking at a self-selected pace along a 7m walkway within each session. The standard error or the measurement (SEM) was calculated for hip, knee and ankle joint angles in all three planes, over the walking gait cycle. Results: The SEM ranged from 2.9 – 4.1°, 2.7 – 3.7° and 1.9 – 3.9°, in the sagittal, frontal and traverse planes at the hip. At the knee the SEM ranged from 1.6 – 4.2°, 1.0 – 1.9° and 1.3 – 2.9° in the sagittal, frontal and transverse planes, respectively. While the SEM ranged from 0.7 – 2.0°, 1.2 – 2.3° and 2.9 – 4.0° in the sagittal, frontal and transverse planes at the ankle. Conclusions: The findings demonstrate that 3DGA provides a reliable means of quantifying lower limb kinematics over the walking gait cycle in patients following THA, with all SEM values below the 5° threshold previously suggested to identify clinically meaningful differences. The SEM values reported may aid in the interpretation of changes in lower limb kinematics in patients following THA