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Stroke is a clinically defined syndrome of acute, focal neurological deficit attributed to vascular injury (infarction, hemorrhage) of the central nervous system. Stroke is the second leading cause of death and disability worldwide. Stroke is not a single disease but can be caused by a wide range of risk factors. (1) . Several conditions known to increase stroke risk have a pathophysiology with an autonomic component in the form of increased sympathetic nervous system (SNS) activation. These include hypertension. (2,3) There are threemajor stroke subtypes (4). Ischemic strokes, caused by an occluded vessel (thrombus and embolism), account for around 80% of strokes. Intracerebral hemorrhages account for about 15% of all strokes, and subarachnoid hemorrhages make up the remaining 5%(5)
Medical complications as Urinary incontinence: Exclude precipitating risk factors. Consider using catheter as a last resort. Bowel incontinence: Review of medications, improving diet/fluid intake, Cognitive impairment: Control of risk factors to prevent recurrence. Physical and cognitive stimulation. Musculoskeletal complications as Spasticity and hypertonicity: Physiotherapy, splinting, positioning of limbs can be used . and for Hemiplegic shoulder pain: Proper handling and positioning, refer to physiotherapy, simple analgesic, transcutaneous electrical nerve stimulation in selected patients. Wrist and hand flexion spasticity: Physiotherapy (both active and passive), splints (ready-made splints or custom made). Psychosocial complications as post-stroke depression, psychological counselling is helpful. Mood/emotional changes as caregivers and support groups therapy may be helpful.(6)
Shoulder pain
The affected arm of stroke is at risk of damage during acute stage (flaccid stage) or sub-acutestage,and 5%ofthestrokepatientreportedhavingpersistentpain,itsassociatedwith an initial subluxation in shoulder(7)
The Bobath approach, also known as neurodevelopmental treatment (NDT), is a widely used concept in the rehabilitation of stroke patients with hemiplegia in many countries. This technique is being used since years all over the world. (8) The Bobath Concept is referred to as the neuro-developmental technique (NDT) worldwide. People working in the field of rehabilitation have developed a special interest in this concept recently, especially for the recovery of stroke patients. Bobath textbooks published in 1970, 1985, and 1990 have mentioned developing, incorporating principles and techniques regarding new concepts and methods for motor improvement. (9,10,11) .Sensory re-education is used to stimulate sensory pathways. Many Techniques can be used astouching different textured objects, massage, vibration, pressure, determining joint position, different temperatures. But it is not definite that the sensation will always recover and be completely normal.
The aim of this case report is to treat the patient and focus on shoulder pain and sensory impairment.