The effect of electrical stimulation in combination with Bobath techniques in the prevention of shoulder subluxation in acute stroke patients: An Experimental study

INTRODUCTION: Stroke is a disease of developed nations. Worldwide it is increasing along with modernization. In India stroke is one of the leading cause of serious, long term disability. It is the acute severe manifestation of cerebro-vascular disease. WHO defined stroke as “rapidly developed clinical signs of focal disturbance of cerebral function, lasting more than 24 hrs or leading to death, with no apparent cause other than vascular origin”. A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. The disturbance of cerebral function is caused by 3 morphological abnormalities, i.e. stenosis, occlusion or rupture of the arteries. Dysfunction of the brain (neurological deficit) manifests itself by various neurological signs and symptoms that are related to the extent and site of the area involved and to the underlying causes. Warning signs of stroke can be numbness, weakness or paralysis of face, arm, and leg especially on one side of the body sudden severe head ache, loss of balance and many factor contribute to delay in seeking medical treatment for stroke. OBJECTIVES: 1. To find out the efficacy of Bobath techniques in the prevention of inferior and anterior shoulder subluxation in acute stroke patients. 2. To find out the efficacy of electrical stimulation in combination with Bobath techniques in the prevention of inferior and anterior shoulder subluxation in acute stroke patients. MATERIALS AND METHODOLOGY: The purpose of the study is to record "The effect of electrical stimulation in combination with Bobath techniques in the prevention of shoulder subluxation in acute stroke patients." The research design was selected so that it may serve as a guideline for planning and implementing a study in a way that is more likely to achieve a goal. MATERIALS: Electrical stimulator, Couch, Pillows, Chair, A large firm exercise mat, Shoulder brace. METHODOLOGY: Study Setting: The study was carried out on stroke patients. The patients were referred to the department of physiotherapy and department of neurology, Sri Ramakrishna Hospital Coimbatore, under the supervision of staff, College of Physiotherapy, Sri Ramakrishna College of paramedical Sciences Coimbatore. 13 Sample size A total of 50 patients were selected for the study, 20 of them were excluded for various reasons. Out of 30 patients 15 were assigned to each group. Study Duration: The study was conducted for a period of six months. Sampling: The patients were selected on the basis of convenient sampling and were divided into Group A and Group B of 15 each. Group A: (Control Group) Subjects were treated in accordance with the Bobath concept. Group B: (Experimental Group) In addition to Bobath techniques, electrical stimulation was also applied to the supraspinatus muscle, mid and posterior portions of the deltoid muscle of subjects in this group. The study was conducted as an experimental pre-test and post-test study design. SELECTION CRITERIA: Inclusion criteria: Age limit 40-65 years, Both Sexes, Patients willing to participate on a voluntary basis, Patients with acute stage of stroke during early hospitalization. Exclusion criteria: Age below 40 and above 65 years, Post traumatic head injury, Unbearable pain, Medical instability, Unreliable patients. DATA PRESENTATION ANALYSIS & INTERPRETATION: The study was conducted with the two groups, control group and experimental group Control group- treated with Bobath techniques Experimental group- treated with Bobath techniques combined with electrical stimulation Pre-test and post-test values were taken and assessed using the following parameters: Visual analogue scale, Upper limb- motor assessment scale. CONCLUSION: In an effort to find out the effect of electrical stimulation in combination with Bobath techniques in the prevention of shoulder subluxation in acute stroke patients, 30 subjects were selected using convenient sampling technique and assigned in to two groups with 15 subjects each. Control group was treated with Bobath techniques and Experimental group was treated with Electrical stimulation and Bobath techniques with for a period of 6 months. Pre-test and Post-test scores are noted and analysis was done using independent ‘t’ test which favored the alternate hypothesis. Statistical analysis shows there is significant improvement in group B (Electrical stimulation and Bobath techniques) than in group A (Bobath techniques). It can be concluded that combination of Electrical stimulation and Bobath techniques were found to have fast recovery in of stroke patients than giving Bobath techniques alone. Hence the alternate hypothesis is accepted” There is significant difference between the groups with the electrical stimulation in combination with Bobath techniques in the prevention of inferior and anterior shoulder subluxation in acute stroke patients”