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Reliability of an Association between Patients with Spatial Neglect after Stroke and their Shoulder PainAbstractChapter 1: IntroductionResearch indicates shoulder pain in post-stroke patients often results in disrupting the rehabilitation program and causing mental and physical discomfort to the patient (English, Hillier, Stiller & Warden-Flood, 2007). Further, shoulder pain may result into serious disabilities such as paralysis and spasticity and therefore, should be given due importance (Lindgren, Jonsson, Norrving & Lindgren, 2007), however, it is interesting to note that assessment of shoulder pain in post-stroke patients has not been evaluated definitively, especially in patients with spatial neglect. It is often found to be difficult and time consuming to identify the cause or nature of shoulder pain in post-stroke patients.

Therefore, most physicians attribute shoulder pain to lack of movement (Turner-Stokes & Jackson, 2002; Lo et al. , 2003), long-term hospitalisation (Roy, Sands, & Hill, 1994) or even depression (Gamble et al. , 2000). However, the diagnosis may become complicated in case the patient suffers from behavioural syndrome of spatial neglect, which makes it difficult for the patient to express his or her problems properly to the physician.

Spatial neglect will lead to patient’s inability to report shoulder pain, which if left untreated may result into permanent disabilities (Turner-Stokes & Jackson, 2002). Thus, the serious implication of the behavioural syndrome on the general wellness of the patient emphasises the importance of conducting this study to find out the between post-stroke patients with shoulder pain and spatial neglect. Further, secondary research has revealed that minimal studies have been conducted so far to establish the link between shoulder pain and spatial neglect. Although there have been various studies on shoulder pain in patients with hemiplegia (Wanklyn, 1996) and the general cause of shoulder pain in post-stroke patients, not stud ha been found that focused on shoulder pain in post-stroke patients with spatial neglect.

The results from the study would greatly help in preventing and managing shoulder pain in such patients. It would also reduce the rehabilitation period and resources spent on treating these patients. Finally, in order to reduce the healthcare cost and services efforts, it is important to identify spatial neglect at the onset and provide the right treatment.

Chapter 2: Methodology2.1: Research DesignThe main objective of the study was to find the between post-stroke shoulder pain in patients and spatial neglect. In order to determine the, five post-stroke patients with shoulder pain were studied and spatial neglect was measured using tests such as Visual Analogue Scale (VAS), Albert’s TestBells Test. Further, the information was collated and the data was analysed using chi square. The results helped in identifying the underlying problems in each patient easily as well as understanding whether a existed between shoulder pain in post-stroke patients with spatial neglect.

The entire study was conducted within eight weeks on five patients with stroke diagnosis after 72 hours of their hospital admission. The primary outcome was measured using VAS on every second day to find out stiffness and pain in the shoulder. The secondary outcome was measured by analysing the data using chi square. However, before undertaking the test, the patients were asked to sign consent forms and were given a brochure containing all the required information about the study.

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