The importance of using forearm slings in patients with hemiplegia

- Dec 24, 2019-

We often see in clinical practice that many patients with hemiplegia have a sling on the forearm of the hemiplegia side, especially in the sitting and standing position of the patient. One of the main purposes of doing this is to prevent the patient from having a subluxation of the shoulder joint on the hemiplegia side. Whether a patient has a subluxation of the shoulder joint directly determines the degree of recovery of the patient's upper limb function. Patients with subluxation of the shoulder joint often have pain and limited mobility of the shoulder joint. In severe cases, the pain can spread to the entire upper limb and even form shoulder-hand syndrome. It seriously affects the rehabilitation training of the upper limbs of the patient, which leads to the unsatisfactory recovery of the upper limb function. So for shoulder subluxation, the focus is on prevention. Once subluxation occurs, it is difficult to cure. The main focus of prevention is not to over-stretch the shoulder joint on the hemiplegia side, especially in patients with muscle strength below 3 levels. That's why we see many patients wearing forearm slings clinically.

However, the forearm sling not only serves this purpose but also reduces walking energy consumption for patients with hemiplegia.

Hemiplegia gait in stroke patients can cause decreased walking speed and changes in gait spatiotemporal parameters. Continuous abnormal gait can increase energy expenditure in patients with hemiplegia. Studies have shown that botulinum toxin injection in the upper limbs after stroke can improve the biomechanics of walking.

The forearm sling can restore the position of the scapula, support the forearm inflection, and improve the anatomical force line. Several studies have revealed the relationship between walking ability, balance, gait, and forearm sling, but it is unclear whether supporting upper limbs on the affected side can reduce unnecessary energy consumption when walking in hemiplegia patients.

To clarify the impact of forearm slings on the walking efficiency of patients with stroke and hemiplegia using crutches, Jeong et al. Of the Department of Physical Therapy at Sangshi University in South Korea designed a randomized crossover study. The results were published in the European Journal of Physical and Rehabilitation Medicine in 2017.

A total of 57 patients with hemiplegia after chronic stroke were included in the study. Patients were evaluated before the study began, including age, gender, height, weight, stroke duration, stroke type, hemiplegia, spasticity (modified Ashworth scale), shoulder pain, and upper limb function (unarmed function test). The patients were then divided into two groups: one-legged crutches and four-legged crutches according to the assistive devices used by the patients, with 30 cases and 27 cases respectively.

On the same day, patients wore forearm slings (Kang-style multiple support slings) and walked without aids. The patient first selects a speed to complete a 10-meter walking test to calculate the walking speed.

After the break, wear a portable gas analyzer (Metamax 3B) to walk back and forth on the 10-meter trail and perform a 6-minute walk test to obtain energy expenditure, heart rate, and walking endurance (6 minutes of walking distance).

The results showed that the energy consumption and oxygen consumption of the forearm sling group were lower than those of the unused sling group. Patients with hemiplegia who use single leg and forearm slings have better walking endurance.

    This study is the first study on the effect of forearm slings on energy consumption during walking of patients with hemiplegia using assistive devices. It was found that patients with hemiplegia who use one leg have significantly improved walking endurance and energy when using forearm slings without using a forearm Consumption is down.

    Therefore, both clinicians, therapists, nurses, and our patients and their families should pay more attention to the importance of forearm sling use.