Cognitive Behavioural Therapy for Hemiplegic Shoulder Pain in Chronic Stroke Rehabilitation: A Case Mangement with Biopsychosocial Perspective

Stroke impairments can lead to various complications, including hemiplegia, sensory loss, dyspraxia, and hemianopsia. It is estimated that 16% to 84% of stroke patients experience Hemiplegic Shoulder Pain (HSP). In the present case, a 38-year-old man who had a left middle cerebral artery infarct two years prior showed good recovery of voluntary movement but continued to struggle with low self-esteem, psychological distress, mild weakness, and spasticity. He also experienced a dull ache in his right shoulder. To address these issues, a structured Cognitive Behavioural Therapy (CBT) programme was implemented. The programme consisted of 30-minute sessions held five days a week for four weeks and included three phases: educating the patient about stroke and CBT principles, focussing on cognitive restructuring and behavioural strategies, and consolidating skills learned. Depression, anxiety, and stress levels were measured using the Depression Anxiety Stress Scale (DASS) at baseline, after the intervention, and at a six-month follow-up. Significant reductions in psychological distress were noted after the CBT sessions, with sustained improvements observed at follow-up. The CBT programme was effective in addressing biopsychosocial factors and successfully reduced HSP in this patient with a chronic left Middle Cerebral Artery (MCA) infarct.