Analgesic Effects of Low Frequency Transcutaneous Electrical Stimulation and Therapeutic Ultrasounds on Functional Disability in Post-stroke Shoulder Pain

Cerebral vascular accidents (CVAs) are the second most common cause of death in developed nations, according to the World Health Organization.It is a significant factor in disability because it causes paralysis and cognitive impairments in the population that survives. According to data from the literature, 25% of stroke patients pass away within a few weeks.Shoulder pain is exasperating complication after stroke and responsible for the longer stay in the rehabilitation department. The incidence varies from 9%-40.Post-Stroke shoulder pain decreased functional outcome, and quality of life.Post-stroke muscle weakness and spasticity lead to shoulder instability and immobility. The etiology of shoulder pain after stroke is multifactorial complex regional pain syndrome, shoulder joint subluxation, adhesive capsulitis, spasticity, and shoulder muscles weakness.Etiological intricacy makes it necessary to use a stroke-specific approach rather than always expanding the musculoskeletal knowledge base.

Presence of hemiplegic shoulder pain is strongly associated poor recovery of arm function in the first 12 weeks after stroke.It may be a sign of brachial plexus damage if there are aberrant motor recovery patterns, spasticity or particularly severe localized atrophy. A pre-existing ailment like osteoarthritis may worsen as a result of improper management of a hemiplegic limb. Therefore, hemiplegic shoulder pain may be caused by pre-morbid shoulder illness.Physical therapy has been shown to be very effective in treating post-stroke shoulder pain. A variety of techniques and treatment modalities are use around the world to alleviate the post-stroke shoulder pain. Of particular interest to this research are two electrotherapy modalities low frequency transcutaneous electrical stimulation and Therapeutic Ultrasound will be treatment option.

TENS therapy together with conventional rehabilitation could be used as a good alternative therapy in patients with hemiplegic shoulder pain.There is wide spread use of TENS throughout health care and it is a common treatment modality for musculoskeletal pain. The TENS settings are based on the gate control theory of pain. TENS is agree to produce a significant reduction in pain. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, noninvasive, self-administered technique that is use as an adjunct to medication. TENS treatment is rarely associated with negative side effects and has been reported to be effective in patients with neuropathic pain. Most studies evaluated the effect of high-frequency or low-frequency TENS (LF-TENS).The study aim is to investigate the effect of LF-TENS on the treatment of neuropathic pain in patients with post-stroke shoulder pain.

Therapeutic Ultrasound a physical therapy agent commonly used to increase temperature in deep tissue. The biologic effects observed when mammalian tissues are expose to ultrasound include changes in blood flow rates, tissue metabolism, the extensibility of connective tissue, and tissue regeneration. Thermal effects of therapeutic ultrasound reduces pain, swelling and improve ROM. When treating knee, shoulder, and hip pain, therapeutic ultrasound is routinely utilize in conjunction with other physiotherapeutic methods. The body of research on knee arthritis is very strong, and there is some evidence that therapeutic ultrasound is effective although there is debate about whether ultrasound should be delivered continuously or in pulses. Although ultrasound therapy alone may not have much of an effect on functional improvement, it can be a fair adjunct to take into account when combined with other widely used modalities.

The current study aims to evaluate and generalize the comparative effects of low frequency transcutaneous electrical stimulation combined with therapeutic ultrasound and therapeutic ultrasound and low frequency TENS alone in our settings. It is suggested that low frequency TENS with therapeutic ultrasound would provide a clinically and statistically significant benefit over a therapeutic ultrasound and low frequency TENS alone for patients with functional disability in post stroke shoulder pain. The purpose of the study is to determine an appropriate and cost-effective rehabilitation protocol for patients with functional disability in post-stroke shoulder pain.