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

BACKGROUND AND PURPOSE: 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 hemiparesis post stroke 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 three commonly prescribed ROM exercises: person-assisted ROM, self-assisted ROM, and cane-assisted ROM. Their data were compared to 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 three ROM exercises compared to 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