Assessment Of Functional Magnetic Stimulation On The Effect Of Glenohumeral Subluxation In Acute Post-stroke Hemiplegic Patients

Objective:evaluate the efficacy of functional magnetic stimulation(FMS)in the treatment of GHS in acute hemiplegic patients after stroke.Methods:The study used prospective case control study.Acute stroke hemiplegic patients with GHS were recruited and assigned to control group and FMS group.Contrl group received electrode stimulation(ftequency 50HZ,intensity 50mA)at the supraspinatus and deltoid muscles of the hemiplegic side,while FMS group used magnetic stimulator(frequency 5HZ,intensity 100%movement threshold)to stimulate the same locations.The two groups were treated for 20 minutes per day in consecutive 5 days a week for a total of 4 weeks.Before and after treatment respectively by X-ray to measure the vertical distance from the lower lateral margin of acromioclavicular joint to the middle point of humerus(AJHH),and MSUS to measure acromion-greater tuberosity distance(AGT),acromion-lesser tuberosity distance(ALT),acromio humeral distance(AHD),supraspinatus thickness(SST)and deltoid muscle thickness(DMT)in patients'bilateral shoulder joint.Meanwhile,Fugl-Meyer Assessment(FMA)and Shoulder function rating scale was used to evaluate the improvement of upper limb function.Results:34 patients who met the standards were recruited for the study,of which 30 completed the study.In the control group,4 patients failed to adhere due to Dermatitis,pain and numbness.After FMS treatment,there was a significantly decrease in the difference value between ipsilateral side and contralateral side of AJHH[(4.52±3.41)vs(14.08±4.03),t=9.459,P<0.01],AGT[(5.70±1.15)vs(13.75±3.44),t=8.595,P<0.01],ALT[(3.93±1.03)vs(12.30±2.64),t=11.435,P<0.01],AHD[(0.90±0.49)vs(2.78±0.72),t=8.375,P<0.01],SST[(2.44±0.73)vs(6.54±0.73),t=15.394,P<0.01]and DMT[(4.13±0.57)vs(8.45±0.36),t=24.935,P<0.01],FMA score increased[(33.47±2.17)vs(22.00±2.54),t=-13.315,P<0.01]and Shoulder function rating scale score increased[(67.27±11.61)vs(49.47±13.42),t=-9.903,P<0.01].Compared with control group,FMS group decreased more significantly in the difference value between ipsilateral side and contralateral side of AGT[(8.05±2.66)vs(6.35± 1.49),t=2.161,P<0.05],ALT[(8.37±1.78)vs(5.93±2.21),t=3.332,P<0.01],AHD[(1.88±0.29)vs(0.91±0.31),t=8.768,P<0.01],SST[(4.099±0.29)vs(3.24±0.44),t=6.244,P<0.01]and the DMT[(4.32±0.29)vs(3.76±0.60),t=3.238,P<0.01],FMA score and Shoulder function rating scale score increased more significantly in FMS group[(11.47±2.72)vs(5.400±1.80),t=7.194,P<0.01],[(17.80±6.96)vs(9.400±4.32),t=3.97,P<0.01].Conclusion:This study preliminarily shown FMS is more effective and less side effects compared with electric stimulation,it's worthy of further study with large sample.In addition,MSUS can objectively and dynamically evaluate the degree of shoulder subluxation after stroke,and can be used as a means and method for evaluation of treatment effect.