Association between Patients with Spatial Neglect after Stroke and Their Shoulder Pain - Assignment Example

Reliability of an Association between patients with Spatial Neglect after Stroke and their Shoulder Pain Introduction The research aims to find out an association between patients with spatial neglect after stroke and their shoulder pain. It will determine the reliability of an association between patients with spatial neglect after stroke and their shoulder pain. It would try to establish that left shoulder pain is the result of neglect after the stroke and focus on the importance of looking at both the sides of the body after a stroke in order to avoid complications. However, in order to undertake this research, it is also important to understand the previous studies conducted on this subject matter. Further, it is also imperative to comprehend the meaning of the shoulder pain and its association in post-stroke patients. Literature Review Pain is considered to be a frequently occurring medical complication that takes place after a stroke (Langhorne et al., 2000). Pain can not only affect the well being of a person and his or her quality of life (Kong et al., 2004), but can also impact the rehabilitation program (Roy et al., 1994). However, it is difficult to measure the severity of pain and therefore, treating pain becomes problematic as well. This is due to the fact that pain also includes cognitive disorders. Stroke is also a very common condition and has very serious implications, but there is still no definite preventive treatment for this condition. Further, a post-stroke patient needs utmost care and should be given proper attention and professional care. However, it has been found that due to the absences of qualified professionals and technological advancements, most post-stroke patients only have rely on the rehabilitation programs (Langhorne et al., 2000). However, the rehabilitation after the stroke may get prolonged because of shoulder pain in such patients (English, Hillier, Stiller, & Warden-Flood, 2007). Thus, it is essential to understand the occurrence of shoulder pain in post-stroke patients and need to evaluate the relationship between stroke and shoulder pain carefully. Further, it can be said that shoulder pain in post-stroke patients might be the result of spatial neglect. However, not much research has been conducted in this area. Although, many experts have tried to establish a correlation between shoulder pain and stroke, not many literatures have focused on the issue of spatial neglect as a reason for shoulder pain in post-stroke patients. Nonetheless, it is important to study about shoulder pain in such patients as negligence in these cases may result into spasticity or paralysis (Lindgren, 2007). Shoulder pain in post-stroke patients It has been found that shoulder pain is a common phenomenon in post-stroke patients. However, such shoulder pain in post-stroke patients differs in their characteristics. Experts believe that around one-third post-stroke patients complain about shoulder pain within the first four months of suffering a stroke attack (Lindgren, Jonsson, Norrving and Lindgren, 2007). Bohannon et al (1986) and Van Langerberghe & Hogan (1988) found that 72 per cent of the stroke patients suffered from shoulder pain within the first month of the stroke itself. Bohannon et al reviewed the records of 50 consecutive hemiplegic patients, out of which 36 were found suffering from shoulder pain. The study was conducted to find out the relationship between shoulder pain in hemiplegic patients and variables such as age of the patient, occurrence of hemiplegia, spasticity etc. The study found that shoulder pain and shoulder motion have significant relation with each other. However, the onset of hemiplegia did not have much significance on the shoulder pain. Thus, the study concluded that shoulder pain in hemiplegia patient might be due to adhesive capsulitis. This study provides an alternative view about shoulder pain, which can be applied in the current research, especially focusing on the use of adhesive capsulitis. As per Andersen et al (1995), around 8 per cent of post-stroke patients suffered from chronic shoulder pain. However, it should also be kept in mind that most of these post-stroke patients were old people who were already suffering from age-related diseases such as arthritis and other such musculoskeletal ailments (Kehayia et al, 1997). However, the irony of the issue is that researchers are still struggling to find out the reasons behind shoulder pain in post-stroke patients. Most researchers have given differing viewpoints about this issue. Some such as Turner-Stokes & Jackson (2002) and Lo et al. (2003) believe that shoulder pain occur due to severe motor impairments, while others such as Roy, Sands, & Hill (1994) think that shoulder pain is the result of long-term hospitalisation of the patient. Some of the other common probable causes of shoulder pain in post stroke patients are inappropriate recovery of the upper limb movement (Roy, Sands, & Hill, 1994), depression (Gamble et al., 2000) and sleep deprivation (Kucukdeveci, Tennant, Hardo, & Chamberlain, 1996). Turner-Stokes & Jackson (2002) for their research compiled data from various published sources that focused on shoulder pain in post-stroke patients with hemiplegia. A total of 121 references were used for this study. This study focused on the shoulder anatomy after a stroke attack. Further, literature on the subject of hemiplegic shoulder pain were analysed to find out the causes and development of shoulder pain in such patients. It is found that in order to manage hemiplegic shoulder pain, coordination is required among various disciples, which would reduce the interference in rehabilitation programs. As this study provided an integrated view about shoulder pain in post-stroke patients, the researcher was able to understand different point-of-views and opinions on the subject in a single paper itself. Most of the past literature has focused on finding the correlation between shoulder pain and post-stroke patients with aphasia or hemiplegia. It has not considered finding the relationship between shoulder pain and post-stroke patients with spatial neglect. In the below sections, some of the past literature on shoulder pain and aphasia and hemiplegia are being considered. This literature review finds that although, correlation between shoulder pain and post-stroke patients with spatial neglect has not been conducted, similar research has been undertaken to establish the seriousness of the condition. Shoulder pain and aphasia Shoulder pain may occur for a variety of reasons in post-stroke patients. Some of these may be directly related to stroke-specific reasons, while others are premorbid conditions. Although, it is difficult to measure the intensity of pain in the patients, the work might become much more problematic if the patient is also suffering from aphasia. Aphasia would make the patient unable to state that he or she is under pain. Various studies are conducted to find out the correlation between aphasia and shoulder pain in post-stroke patients. Kehayia et al (1997) conducted a study to find out whether there is a correlation between the pain medication and severity of aphasia. It can be said that most people can manage the pain on their own by communicating with the caregivers about the severity of the pain. They can tell the caregivers about the degree of pain they are suffering from and help in assessing the level of pain and thereby in getting proper medication. However, there is also a group of people who are not able to express the pain they are undergoing as they are not able to communicate effectively due to various disabilities. Aphasia is one of them, wherein the patient is not able to express his or her needs and pain due to impaired ability to communicate. In this study 207 charts of the patients who suffered from stroke were studied by Kehayia et al. (1997). These patients were admitted at the Jewish Rehabilitation Hospital (JRH), Laval, Canada. The study intended to find out the relationship between pain medication usage and severity of aphasia in post-stroke patients. It was found that post-stroke patients with aphasia were given lesser dosage of pain medication than those without aphasia. This shows that patients with aphasia have not been able to express pain and thus were not treated for it. In the current research as well, patients with spatial neglect are not able to express pain to their physician and may not receive adequate treatment like patients with aphasia. Similarly, Wee & Hopman (2008) also conducted a study to state that left and right unilateral neglect usually takes place after a stroke and it can also be found in the patient who is suffering from aphasia. In this cohort study, hemipersonal and hemispatial neglect is being observed in around 309 post-stroke patients over a period of 28 months. The study focuses on the left and right unilateral neglect in patients rehabilitating from stroke attack. It also discusses complications regarding shoulder pain, various safety issues, hospitalisation of patients as well as post-discharge information. It has been found that left and right unilateral neglect can occur in post-stroke patients with aphasia. Further, safety risks also increases manifold in patients with hemispatial and hemipersonal neglect. This paper by Wee & Hopman is closer to the research problem undertaken by the researcher, as the researcher is considering undertaking the study of left hand side shoulder pain in post-stroke patients with spatial neglect. These papers are also closer to the subject matter of spatial neglect, as like patients with aphasia, spatial neglect patients can not as well express pain to their physicians. However, in case of spatial neglect, it is difficult to detect it as it is a behavioural disorder rather than a physical one. In case of aphasia, it is easier to be detected as the condition is more physical and relates to communication disability. Therefore, the physicians are able to undertake various other methods to find out if the patient is suffering from pain in such patients. However, the situation is much complex in patients with spatial neglect, and therefore, the researcher has decided to undertake this as the research topic. Shoulder pain and hemiplegia It has been witnessed that shoulder pain in post-stroke patients is also very common with those who are suffering from hemiplegia. In fact, it has been estimated that around 16 to 84 per cent of post-stroke patients with hemiplegia suffers from shoulder pain (Gamble et al., 2000; Langhorne et al., 2000). Such shoulder pain and body stiffness due to stroke also affect the rehabilitation program of the patients, especially those who are suffering from hemiplegia. Although, it is still not known what causes this complication, it can be said that hemiplegia is related to various neurological problems, injuries of soft tissues, subluxation, or even shoulder-hand syndrome. Further, shoulder pain in post-stroke patients with hemiplegia further impedes their rehabilitation and affects their quality of life. Thus, various researchers have conducted studies to find out the correlation between shoulder pain and post-stroke patients with hemiplegia. Niessen et al (2008) conducted a study to find out the causes for post-stroke shoulder pain in hemiplegia patients. The study tried to establish a kinematical shoulder trend in post-stroke patients suffering from shoulder pain. Studies have also indicated that post-stroke shoulder pain is the most common complication is patients who suffered from hemiplegia as well. This also affected the rehabilitation of their movements and creating a balance in their psychological well-being as well. In a study by Vuagnat & Chantraine (2003), they suggested that the shoulder needs to be kept in a proper position and the movement of the shoulder should be done under supervision and with utmost care in post-stroke patients with hemiplegia. For this study, 256 hemiplegic patients who suffered from stroke were studied. This study wanted to find out the strategies to prevent and treat post-stroke patients with hemiplegia who are undergoing rehabilitation. In order to prevent shoulder pain in such patients, efforts much be made to keep the shoulder in such a position that minimal movement should take place. Further, physicians should encourage the patients to undertake various motion exercises as well. The study provides various recommendation to prevent and treat shoulder pain in post-stroke patients and these can also be applied in the present study as well and help in providing better rehabilitation to such patients. Although, it is difficult to measure shoulder pain, it can be managed through various pain management programs if the pain is identified and treated properly. The efficacy of the treatment would depend on the earlier detection of the pain and the starting of the treatment right at the onset of the symptoms. However, still more clinical research is required in order to find out the cause of shoulder pain in hemiplegic patients so that appropriate treatments could be given in a timely manner (Griffin, 1986). Shoulder pain and spatial neglect Shoulder pain in post-stroke patients undoubtedly prolongs the rehabilitation time taken by a patient. Further, this situation may get more complicated if the patient suffers from spatial neglect as well, as a patient with spatial neglect may not be able to express his or her problem in a proper manner. Thus, it becomes imperative to find out the relation between shoulder pains in post-stroke patients with spatial neglect. It is difficult and time consuming to find out the cause of shoulder pain in post-stroke patients as research has still not able to provide a solid foundation for the occurrence of shoulder pain in post-stroke patients. Thus, it has been commonly seen that most of the patients are being referred to physiotherapists to help them move their shoulders in a proper manner. However, people with spatial neglect might not be able to describe the situation or pain in a proper manner which would result in further complications. This result in physicians not able to identify spatial neglect in patients and thus, the proper treatment of the shoulder pain could not be undertaken (Turner-Stokes & Jackson, 2002). Thus, the situation would get complex as the physician might have to undertake a lot of guesswork to diagnose the cause for the shoulder pain and provide appropriate treatment. Although, the situation is particularly grave for patients suffering from spatial neglect, it is ironic to find that not much study has been conducted in this field. The prior studies conducted in this subject matter only attempted to find out the correlation between shoulder pain and post-stroke patients or were very subjective in their approach. Very few studies attempted to actually find any real correlation between shoulder pain and post-stroke patients. For instance, de Courval (1990) conducted a study to find out the role of hemi neglect in shoulder pain. However, he was unable to find any association between pain and hemi neglect. Studies by Ikai, Tei, Yoshida, Miyano and Yonemoto (1998) stated that subluxation and pain do not have any correlation between them. They however found that the occurrence of shoulder pain is much higher in the left hemiplegia than the right one. Further, he also said that adhesive capsulitis were the major reason for the occurrence of the pain. Some such as Barra, Oujamaa, Chauvineau, Rougier and Pérennou (2009) had other ideas about shoulder pain and said that the body’s orientation is the major cause for shoulder pain. They also said that behavioural neglect also causes shoulder pain in post-stroke patients. As not much research has been carried out in this field, it is imperative that this research should be undertaken which focuses on the correlation between post-stroke patients with shoulder pain and spatial neglect. Further, the paper also focuses on the left hand side shoulder pain as it has been found that post a stroke, most caregivers and patients often ignore the left-hand side pain. Therefore, through this study, the researcher would attempt to identify spatial neglect in post-stroke patients. The results from this study would help future physicians to prevent and manage shoulder pain in post-stroke patients with spatial neglect. Although, healthcare, surgical and medical treatments have improved considerably over the last few years, it is still not possible to treat pain. A pain reliever only helps in obstructing the pain message to reach the brain. However, the pain is still present in the body and though the mind may not feel it, the physical body does undergo the discomfort. This situation can get aggravated in patients with spatial neglect as such patients are not able to communicate about their needs or pain to the physicians properly. And if the patient has just suffered from a stroke, such a situation can be much serious. Therefore, it is important to understand the relation between post-stroke shoulder pain and patients with spatial neglect, so that better rehabilitation and improved quality of life could be provided to such patients. However, only a handful of studies find a link between shoulder pain and neglect, and in fact, not even a single study focuses on the direct relationship between post-stroke patients with shoulder pain and spatial neglect. As the past literatures indicate that shoulder pain in post-stroke patients may result in various complications, which gets aggravated in case the patient is suffering from spatial neglect, therefore, the researcher has decided to undertake this subject line for the study. Further, the researcher has also found that the past literature did not focus on the left hand side pain much, which might also become fatal. Thus, the researcher would especially focus on the left hand side shoulder pain in post-stroke patients with spatial neglect. Reference: Andersen, G, Vestergaard, K, Ingeman-Nielsen, M, Jensen, T.S. (1995). Incidence of central post-stroke pain. Pain, 61, 187-193. Bohannon, R.W., Larkin, P.A., & Smith, M.B. (1986). Shoulder pain in hemiplegia; statistical relationship with five variables. Arch Phys Med Rehabil, 67, 514-516. English, C., Hillier, S., Stiller, K., & Warden-Flood A. (2007). Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation. A controlled trial. Archives of Physical Medicine and Rehabilitation 88, 955-963. Gamble, G., Barberan, E., Bowsher, D., Tyrrell, P., & Jones, A. (2000). Post stroke shoulder pain: more common than previously realized. European Journal of Pain, 4, 313-315. Griffin, Judy W. (1986). Hemiplegic Shoulder Pain. Phys Ther, 66(12), 1884-1893. Ikai, T., Tei, K., Yoshida, K., Miyano, S., & Yonemoto, K. 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