Scapular and humeral movement patterns of people with stroke during range-of-motion exercises

Abstract

Background and purpose: In people with stroke, range-of-motion (ROM) exercises may contribute to hemiparetic shoulder pain, but the underlying mechanisms are unknown. This study examined scapular and humeral movement patterns in people with poststroke hemiparesis as they performed commonly prescribed ROM exercises.

Methods: Using kinematic techniques, we studied 13 people with hemiparesis, both with and without pain, as they performed 3 commonly prescribed ROM exercises: person-assisted ROM, self-assisted ROM, and cane-assisted ROM. Their data were compared with those of a group of 12 matched control subjects performing scapular plane shoulder elevation, using mixed-model ANOVAs. Correlation analyses were used to examine the relationship between participants' ratings of pain and kinematic data.

Results: The hemiparetic group had mild pain at rest that increased during the performance of the exercises. During shoulder elevation, humeral external rotation in the hemiparetic group was decreased in all 3 ROM exercises compared with that in the control group. Scapular upward rotation in the hemiparetic group was decreased for the person-assisted ROM exercise only. No differences in scapular tilt were found between groups. The extent of movement abnormalities was not related to pain severity.

Discussion and conclusions: People with hemiparesis had altered scapular and humeral movement patterns and increased shoulder pain when performing the ROM exercises. These data can assist clinicians in making decisions regarding which exercises to prescribe to preserve shoulder motion and prevent contractures in this population.

Figures

Figure 1

Sensor placement for testing. Note that although not shown in picture, sensors and trailing wires were secured with tape and Coban to prevent slippage and arbitrary sensor movement.

Figure 2

Schematic illustration of rotations shown on a right sided scapula. A: The triangle represents the scapula and the bar represents the humerus as viewed from behind the subject. Scapular upward rotation occurs when the inferior angle moves laterally as shown by the arrow. B: The small rectangle represents the scapula and the bar represents the humerus as viewed from the side. Scapular posterior tilt occurs when the superior border of the scapula rotates posteriorly. Humeral external rotation occurs when the humerus spins on its long axis laterally.

Figure 3

Illustrations of exercise performance. A: Person-assisted ROM; B: Self-assisted ROM; C: Cane-assisted ROM.

Figure 4

Group data. Values are means ± SEs of each data point.