Peripheral Neuropathies in Nonparetic Upper Extremities of Stroke Patients Induced by Excessive Use of a Walking Device

• Published in: Journal of stroke and cerebrovascular diseases 2015-08, Vol.24 (8), p.1841-1847
• Main Authors: Dozono, Koichiro, MD, Hachisuka, Akiko, MD, Wada, Futoshi, MD, Hachisuka, Kenji, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Canes - adverse effects; Cardiovascular; Cumulative Trauma Disorders - complications; Electromyography; Entrapment neuropathies; Functional Laterality - physiology; Humans; Male; Middle Aged; Neural Conduction - physiology; Neurologic Examination; Neurology; nonparetic side; overuse; Peripheral Nervous System Diseases - etiology; rehabilitation; Statistics, Nonparametric; Stroke - complications; Upper Extremity - physiopathology; walking device
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.022

Background Poststroke patients reportedly experience entrapment neuropathies in the nonparetic upper extremities, and the use of an assistive device for long periods may increase this risk. We examined nerve conduction velocities in hemiparetic patients and investigated the relationship between abnormal measurements and duration of walking. Methods Twenty-eight male hemiparetic outpatients who used a cane or a crutch participated in this study. Clinical characteristics such as age, period of time from stroke onset, side and severity of paresis, activities of daily living, and basic ability to walk, as well as each patient's approximate number of hours walking per day, were collected. Electrophysiological evaluation was performed via nerve conduction studies of the median, ulnar, and radial nerves. The clinical features were compared between patients with and without peripheral neuropathies. Results Twelve patients (43%) had peripheral neuropathies involving a total of 15 nerves. There was no difference in age, duration of hemiparesis, side and severity of paresis, Barthel index, and Functional Ambulation Classification between the 2 groups. Abnormalities were absent in the patients who walked at or less than an hour but were present in 50% and 63.4% of patients with walking times of 1-2 hours and more than 2 hours, respectively. Conclusions Excessive use of a T-cane or a Lofstrand crutch was hypothesized to induce entrapment neuropathies in the nonparetic upper extremity. To prevent these injuries, a well-balanced gait should be established to reduce the load on the walking device.