TY - JOUR
T1 - Passive accessory joint mobilization in the multimodal management of chronic dysesthesia following thalamic stroke
AU - Griffin, Kristina
AU - O’Hearn, Michael
AU - Franck, Carla C.
AU - Courtney, Carol A.
PY - 2018/3/16
Y1 - 2018/3/16
N2 - Study design: Case Report. Purpose: Stroke is the most common cause of long-term disability. Dysesthesia, an unpleasant sensory disturbance, is common following thalamic stroke and evidence-based interventions for this impairment are limited. The purpose of this case report was to describe a decrease in dysesthesia following manual therapy intervention in a patient with history of right lacunar thalamic stroke. Case description: A 66-year-old female presented with tingling and dysesthesia in left hemisensory distribution including left trunk and upper/lower extremities, limiting function. Decreased left shoulder active range of motion, positive sensory symptoms but no sensory loss in light touch was found. She denied pain and moderate shoulder muscular weakness was demonstrated. Laterality testing revealed right/left limb discrimination deficits and neglect-like symptoms were reported. Passive accessory joint motion assessment of glenohumeral and thoracic spine revealed hypomobility and provoked dysesthesia. Interventions included passive oscillatory joint mobilization of glenohumeral joint, thoracic spine, ribs and shoulder strengthening. Results: After six sessions, shoulder function, active range of motion, strength improved and dysesthesia decreased. Global Rating of Change Scale was +5 and QuickDASH score decreased from 45% to 22% disability. Laterality testing was unchanged. Conclusion: Manual therapy may be a beneficial intervention in management of thalamic stroke-related dysesthesia.Implications for RehabilitationWhile pain is common following thalamic stroke, patients may present with chronic paresthesia or dysesthesia, often in a hemisensory distribution.Passive movement may promote inhibition of hyperexcitable cortical pathways, which may diminish aberrant sensations.Passive oscillatory manual therapy may be an effective way to treat sensory disturbances such as paresthesias or dysesthesia.
AB - Study design: Case Report. Purpose: Stroke is the most common cause of long-term disability. Dysesthesia, an unpleasant sensory disturbance, is common following thalamic stroke and evidence-based interventions for this impairment are limited. The purpose of this case report was to describe a decrease in dysesthesia following manual therapy intervention in a patient with history of right lacunar thalamic stroke. Case description: A 66-year-old female presented with tingling and dysesthesia in left hemisensory distribution including left trunk and upper/lower extremities, limiting function. Decreased left shoulder active range of motion, positive sensory symptoms but no sensory loss in light touch was found. She denied pain and moderate shoulder muscular weakness was demonstrated. Laterality testing revealed right/left limb discrimination deficits and neglect-like symptoms were reported. Passive accessory joint motion assessment of glenohumeral and thoracic spine revealed hypomobility and provoked dysesthesia. Interventions included passive oscillatory joint mobilization of glenohumeral joint, thoracic spine, ribs and shoulder strengthening. Results: After six sessions, shoulder function, active range of motion, strength improved and dysesthesia decreased. Global Rating of Change Scale was +5 and QuickDASH score decreased from 45% to 22% disability. Laterality testing was unchanged. Conclusion: Manual therapy may be a beneficial intervention in management of thalamic stroke-related dysesthesia.Implications for RehabilitationWhile pain is common following thalamic stroke, patients may present with chronic paresthesia or dysesthesia, often in a hemisensory distribution.Passive movement may promote inhibition of hyperexcitable cortical pathways, which may diminish aberrant sensations.Passive oscillatory manual therapy may be an effective way to treat sensory disturbances such as paresthesias or dysesthesia.
KW - Manual therapy
KW - central post-stroke pain
KW - quantitative sensory testing
KW - somatosensation
KW - stroke rehabilitation
KW - thalamic pain syndrome
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U2 - 10.1080/09638288.2018.1450453
DO - 10.1080/09638288.2018.1450453
M3 - Article
C2 - 29557687
AN - SCOPUS:85044199655
SP - 1
EP - 6
JO - International Rehabilitation Medicine
JF - International Rehabilitation Medicine
SN - 0963-8288
ER -