The immediate effect of handling technique on range of movement in the hemiplegic shoulder

Scapular Upward Rotation During Passive Humeral Abduction in Individuals With Hemiplegia Post-stroke

Objective

To describe scapular upward rotation during passive humeral abduction in individuals with hemiplegia post-stroke compared to normal subjects.

Methods

Twenty-five individuals with hemiplegia post-stroke and 25 age- and gender-matched normal subjects voluntarily participated in this study. Scapular upward rotation during resting and passive humeral abduction at 30°, 60°, 90°, 120°, and 150° were measured using a digital inclinometer.

Results

In both groups, scapular upward rotation significantly increased as humeral abduction increased (p<0.001). Scapular upward rotation was significantly less in the hemiplegic group compared to that in the control at 90° (p=0.002), 120° (p<0.001), and 150° of humeral abduction (p<0.001). The mean difference in scapular upward rotation between these two groups ranged from 6.3° to 11.38°.

Conclusion

Passive humeral abductions ranging from 90° to 150° can significantly alter scapular upward rotation in individuals with hemiplegia post-stroke compared to those of matched normal subjects. The magnitude of reduction of the scapular upward rotation may potentially lead to the development of hemiplegic shoulder pain after prolonged repetitive passive movement. Scapular upward rotation should be incorporated during passive humeral abduction in individuals with hemiplegia post-stroke, especially when the humeral is moved beyond 90° of humeral abduction. Combined movements of scapular and humeral will help maintain the relative movement between the scapula and humerus. However, further longitudinal study in patients with shoulder pain post-stroke is needed to confirm these findings.

Caring for patients with hemiplegia in an arm following a stroke

The patient's arm affected by hemiplegia is a common problem following a stroke. The term hemiplegia is a limited physiological description of the effects of a stroke on a patient's limb. Any nurse involved in the care of stroke patients must possess essential knowledge on the pathophysiology of hemiplegia and its subsequent treatment and care management programmes. This article reviews the stroke literature for patients with arms affected by hemiplegia. It describes common complications that may arise and subsequent preventive care management strategies that need to be considered. Finally it discusses why success in rehabilitation and recovery programmes need to be considered from the patient's perspective and measured in the context of the patient's experiences and feelings of well-being.