Characteristics of neuromuscular control of the scapula after stroke: a first exploration

Liesbet De Baets, Ellen Jaspers, Luc Janssens, Sara Van Deun, Liesbet De Baets, Ellen Jaspers, Luc Janssens, Sara Van Deun

Abstract

This study aimed to characterize scapular muscle timing in stroke patients with and without shoulder pain. Muscle activity of upper trapezius, lower trapezius, serratus anterior, infraspinatus, and anterior deltoid (AD) was measured (Delsys Trigno surface EMG system, USA) in 14 healthy controls (dominant side) and 30 stroke patients (hemiplegic side) of whom 10 had impingement-like shoulder pain. Participants performed 45° and full range anteflexion, in two load conditions. The impact of group, anteflexion height, load condition, and muscle was assessed for onset and offset of the different muscles relative to the onset and offset of AD, using a 3 (group) × 2 (height) × 2 (load) × 4 (muscle) mixed model design. Recruitment patterns were additionally described. Across all load conditions and groups, serratus anterior had a significantly earlier onset and, together with lower trapezius, a significantly later offset in 45° compared to full range anteflexion tasks (p < 0.001). In stroke patients without pain, lower trapezius had furthermore a significantly earlier onset in comparison to stroke patients with shoulder pain (all tasks, p = 0.04). Serratus anterior also showed a significantly earlier offset in stroke patients with shoulder pain in comparison to controls (p = 0.01) and stroke patients without pain (p < 0.001). Analysis of muscle recruitment patterns indicated that for full range tasks, stroke patients without pain used early and prolonged activity of infraspinatus. In stroke patients with shoulder pain, recruitment patterns were characterized by delayed activation and early inactivity of serratus anterior. These timing results can serve as a reference frame for scapular muscle timing post-stroke, and when designing upper limb treatment protocols and clinical guidelines for shoulder pain after stroke.

Keywords: muscle timing; recruitment patterns; rehabilitation; scapula; stroke.

Figures

Figure 1
Figure 1
Visual representation of the calculation of muscle onset and offset. In this example, infraspinatus was active after the onset of anterior deltoid, resulting in negative onset time, and inactive before the offset of the anterior deltoid, resulting in a positive offset time.

References

    1. Bey M. J., Brock S. K., Beierwaltes W. N., Zauel R., Kolowich P. A., Lock T. R. (2007). In vivomeasurement of subacromial space width during shoulder elevation: technique and preliminary results in patients following unilateral rotator cuff repair. Clin. Biomech. 22, 767–773.10.1016/j.clinbiomech.2007.04.006
    1. Cram J. R., Kasman G. S. (1998). Introduction to Surface Electromyography. Gaithersburg, MD: Aspen Publishers Inc.
    1. De Baets L., Jaspers E., Desloovere K., Van Deun S. (2013). A systematic review of 3D scapular kinematics and muscle activity during elevation in stroke subjects and controls. J. Electromyogr. Kinesiol. 23, 3–13.10.1016/j.jelekin.2012.06.007
    1. Di Fabio R. P. (1987). Reliability of computerized surface electromyography for determining the onset of muscle activity. Phys. Ther. 67, 43–48.
    1. Ebaugh D. D., McClure P. W., Karduna A. R. (2005). Threedimensional scapulothoracic motion during active and passive arm elevation. Clin. Biomech. 20, 700–709.10.1016/j.clinbiomech.2005.03.008
    1. Hardwick D. D., Lang C. E. (2011). Scapular and humeral movement patterns of people with stroke during range-of-motion exercises. J. Neurol. Phys. Ther. 35, 18–25.10.1097/NPT.0b013e318208efa1
    1. Hermens H. J., Freriks B., Merletti R., Hägg G., Stegeman D., Blok J. (2009). Seniam 8: European Recommendations for Surface Electromyography. Available at:
    1. Hodges P. W., Bui B. H. (1996). A comparison of computer-based methods for the determination of onset of muscle contraction using electromyography. Electroen Clin Neuro 101, 511–519.
    1. Inman V. T., Saunders J. B., Abbott L. C. (1944). Observations on the function of the shoulder joint. J.Bone Joint Surg. 26A, 1–30.
    1. Larsen C. M., Søgaard K., Chreiteh S. S., Holtermann A., Juul-Kristensen B. (2013). Neuromuscular control of scapula muscles during a voluntary task in subjects with subacromial impingement syndrome. A case-control study. J. Electromyogr. Kinesiol. 23, 1158–1165.10.1016/j.jelekin.2013.04.017
    1. Lawrence R. L., Braman J. P., Laprade R. F., Ludewig P. M. (2014). Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. J. Orthop. Sports Phys. Ther. 44, 636–A8.10.2519/jospt.2014.5339
    1. Lindgren I., Brogårdh C. (2014). Poststroke shoulder pain and its association with upper extremity sensorimotor function, daily hand activities, perceived participation, and life satisfaction. PM R 6, 781–789.10.1016/j.pmrj.2014.02.015
    1. Lindgren I., Ekstrand E., Lexell J., Westergren H., Brogårdh C. (2014). Somatosensory impairments are common after stroke but have only a small impact on post-stroke shoulder pain. J. Rehabil. Med. 46, 307–313.10.2340/16501977-1274
    1. Lindgren I., Lexell J., Jönsson A. C., Brogårdh C. (2012). Left-sided hemiparesis, pain frequency, and decreased passive shoulder range of abduction are predictors of long-lasting poststroke shoulder pain. PM R 4, 561–568.10.1016/j.pmrj.2012.04.007
    1. Littell R. C., Stroup W. W., Freund R. J. (2002). SAS for Linear Models, Fourth Edition. Cary, NC: SAS Institute, Inc.
    1. Ludewig P. M., Braman J. P. (2011). Shoulder impingement: biomechanical considerations in rehabilitation. Man. Ther. 16, 33–39.10.1016/j.math.2010.08.004
    1. Ludewig P. M., Cook T. M. (2000). Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys. Ther. 80, 276–291.
    1. Moraes G. F., Faria C. D., Teixeira-Salmela L. F. (2008). Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome. J. Shoulder Elbow Surg. 17, 48–53.10.1016/j.jse.2007.08.007
    1. Neer I. I. C. S., Foster C. R. (1980). Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J. Bone Joint Surg. 62, 897–908.
    1. Niessen M., Janssen T., Meskers C., Koppe P., Konijnenbelt M., Veeger D. (2008). Kinematics of the contralateral and ipsilateral shoulder: a possible relationship with post-stroke shoulder pain. J. Rehabil. Med. 40, 482–486.10.2340/16501977-0201
    1. Phadke V., Ludewig P. M. (2013). Study of the scapular muscle latency and deactivation time in people with and without shoulder impingement. J. Electromyogr. Kinesiol. 23, 469–475.10.1016/j.jelekin.2012.10.004
    1. Platz T., Pinkowski C., van Wijck F., Kim I. H., di Bella P., Johnson J. (2005). Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer test, action research arm test and box and block test: a multicentre study. Clin. Rehabil. 19, 404–411.10.1191/0269215505cr832oa
    1. Roy C. W., Sands M. R., Hill L. D. (1994). Shoulder pain in the acutely admitted hemiplegics. Clin. Rehabil. 18, 334–34010.1177/026921559400800410
    1. Struyf F., Cagnie B., Cools A., Baert I., Van Brempt J., Struyf P., et al. (2014). Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability. J. Electromyogr. Kinesiol. 24, 277–284.10.1016/j.jelekin.2013.12.002
    1. Twitchell T. E. (1951). The restoration of motor function following hemiplegia in man. Brain 74, 443–48010.1093/brain/74.4.443
    1. Verbeke G., Lesaffre E. (1997). The effect of misspecifying the random effects distribution in linear mixed models for longitudinal data. Comput. Stat. Data Anal. 23, 541–55610.1016/S0167-9473(96)00047-3
    1. Wadsworth D. J., Bullock-Saxton J. E. (1997). Recruitment patterns of the scapular rotator muscles in freestyle swimmers with subacromial impingement. Int. J. Sports Med. 18, 618–624.10.1055/s-2007-972692
    1. Wickham J., Pizzari T., Stansfeld K., Burnside A., Watson L. (2010). Quantifying ‘normal’ shoulder muscle activity during abduction. J. Electromyogr. Kinesiol. 20, 212–222.10.1016/j.jelekin.2009.06.004
    1. Worsley P., Warner M., Motram S., Gadola S., Veeger H. E. J., Hermans H., et al. (2013). Motor control retraining exercises for shoulder impingement: effects on function, muscle activation, and biomechanics in young adults. J. Shoulder Elbow Surg. 22, 11–19.10.1016/j.jse.2012.06.010

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever