Objectives: 1-Comparison of electrical interferential current stimulation and electrical acupuncture in the treatment of hemiplegic shoulder pain in ischemic stroke patients; 2- Comparison of electrical interferential current stimulation and electrical acupuncture in the treatment of shoulder functional disability in ischemic stroke patients.
Design: single- blinded randomized clinical trial
Participants including major eligibility criteria: patients who are suffering from hemiplegic shoulder pain due to ischemic stroke with duration of one month to one year after stroke with or without subluxation will be selected. Patients with history of physiotherapy within the previous one month, history of local injection of steroid/Botox into shoulder joint, presence of pacemaker or skin lesions in shoulder area, intra cerebral hemorrhage or impaired congintion will be excluded.
Setting, conduct and interventions: Eligible patients who are referred to physiotherapy center of Tabriz Imam-Reza university hospital will be randomly assigned in two groups of 20 people. In both groups, anteroposterior and lateral x-ray will be taken before treatment for evaluation of shoulder subluxtaion.
All patients in both groups undergone conventional physical therapy including superficial heat therapy (infra-red), faradic electrical stimulation (FES) for shoulder antigravity muscles and exercise programs such as range of motion and strengthening exercises for a total of ten-session period. Then, two groups will be separated and compared regarding the following agents: in group A, additional treatment including acupuncture concomitant electrical stimulation will be performed. Acupuncture needles with 25 *0.25 sizes will be inserted inside the acu points: SI 10-12 (supraspinatus fossa), Du 14 (2cm lateral to C7 cervical spinus process), LI 14 (deltoid insertion), LI 10-11 (lateral epicondyl), Du 20( vertex of head), LI 4 (web of first dorsal intersooses of hand), GB20( top of upper trapezius) and two tender points of each patient. Electrical acupuncture will be done for 20 minutes by expert physiatrist 2 times a week for 5 weeks. In group B, interferential current therapy with (IFC) using carrier frequency of 100 HZ with four electrodes attached to infraspinatus and serratus anterior via one channel and attached to supraspinatus and deltoid muscles via second channel will be performed. Electrodes arrangement will be crossed shape and cloverleaf current will be applied 3 times a week for 3 weeks by an expert therapist.
Variables of main outcome measure: Function and pain will be assessed be shoulder pain and disability index (SPADI) questionnaire and range of motion will be measured for active and passive flexion, abduction, internal and external rotation by goniometry. All assessments will be done before and after treatment and finally all obtained data will be analyzed.