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Scapular and Humeral Movement Patterns of People With Stroke During Range-of-Motion Exercises

Hardwick, Dustin D. PT, PhD; Lang, Catherine E. PT, PhD

Journal of Neurologic Physical Therapy: March 2011 - Volume 35 - Issue 1 - p 18–25
doi: 10.1097/NPT.0b013e318208efa1
Research Articles

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.

Program in Physical Therapy (D.D.H., C.E.L.), Program in Occupational Therapy (C.E.L.), and Department of Neurology (C.E.L.), Washington University School of Medicine, St. Louis, Missouri.

Correspondence: Catherine E. Lang, PT, PhD, Program in Physical Therapy, Washington University in St. Louis–School of Medicine, Campus Box 8502, 4444 Forest Park Blvd, St Louis, MO 63108 (langc@wustl.edu).

A portion of this work was presented at the following scientific meetings: APTA Section on Research Retreat (August 2009) and APTA Combined Sections Meeting (February 2009).

Supported by an American Heart Association Predoctoral Fellowship Award 0810101Z, Foundation for Physical Therapy PODS I, NIH HD047669, and NIH HD007434. We thank Justin Beebe, PT, PhD, and Stacey DeJong, PT, for their assistance with data collection.

We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated.

© 2011 Neurology Section, APTA