Treatment Protocol for Hemiplegic Shoulder Pain

Toronto Rehabilitation Institute20 enrolled

Overview

The purpose of this study is to determine if a specific stretching and strengthening protocol, in addition to current standard treatment, is more effective for treating post-stroke shoulder pain than current standard treatment alone.

Current standard treatment of post-stroke shoulder pain includes joint protection (i.e., slings and protective positioning) and stretching/strengthening exercises through a pain-free range. Although the added movement of the shoulder blade when moving the post-stroke arm has been recommended in the literature, no studies to date have been found which directly looks at the impact of providing synchronized three-dimensional scapular and humeral movement during therapy. Due to the integral relationship between the scapula and the humerus during movement, it is hypothesized that an increase in 3-dimensional shoulder blade mobility in the painful post-stroke shoulder will contribute to increased pain-free 3-dimensional arm movement. This double-blind randomized-controlled study aims to investigate the effectiveness of this 3-D approach at addressing post-stroke shoulder pain.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Stroke Hemiplegia Shoulder Pain

Interventions

Standard education/exercises for hemiplegic shoulder painOTHER

Each participant will receive standard education for safe positioning and movement of the painful hemiplegic shoulder. Participants will also be provided with standard stretching and strengthening exercises by and experienced Occupational Therapist who will grade the level of exercise to suit their needs. Intervention will take place 3x/week for 1 hour.

Three dimensional Scapular-Humeral MobilizationsOTHER

Each participant will receive standard education for safe positioning and movement of the painful hemiplegic shoulder. Participants will also be provided with stretching and strengthening exercises by and experienced Occupational Therapist who will grade the level of exercise to suit their needs. Intervention will take place 3x/week for 1 hour. Participants in this group will receive an additional scapular humeral mobilization while simultaneously performing the standard stretching/strengthening exercise protocol.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * diagnosis of shoulder pain secondary to altered alignment and/or neuro-muscular movement patterns post-stroke; * medically stable and 2-24 months post onset of stroke; * between stages of 2-5 of the Chedoke-McMaster stages of upper extremity motor recovery; * not currently receiving any other active neuro-rehabilitation intervention to promote stroke recovery; * cognitively able to provide informed consent, follow specific testing commands, and communicate their level of pain during assessment and treatment. Exclusion Criteria: * a history of shoulder pain prior to the onset of the stroke; * shoulder pain which is secondary to any history of trauma, fractures, arthritis or joint instability of the neck, spine, ribs, or shoulder girdle before or after the stroke; possible rotator cuff tears; * shoulder-hand syndrome; thalamic or central pain; spinal cord pathology; osteoporosis; * any medical condition which may affect the ability to participate in an active rehabilitation exercise program (i.e., uncontrolled hypertension or angina).

Locations (1)

Toronto Rehabilitation Institute

Toronto, Ontario, Canada

Outcomes

Primary Outcomes

Measurement of active and passive pain-free shoulder range of motion

Using a 3-dimensional motion capture system and digitizer system, we will determine degrees of pain-free active and passive movement of the shoulder and arm for each participant. Changes in range of motion between pre and post-treatment will be calculated.

Time frame: 1 week prior to intervention

Measurement of active and passive pain-free shoulder range of motion

Time frame: 1 week after intervention

Measurement of active and passive pain-free shoulder range of motion

Time frame: one month after intervention

Secondary Outcomes

Visual Analogue Scale (used to report the degree of pain experienced during different levels of functional reaching)

Participants will be asked to subjectively rate their level of pain (on a scale of 1-10) when progressively reaching to the top of the head and behind the back.

Time frame: 1 week prior to intervention

Chedoke McMaster Pain Inventory

A descriptive scale for quantifying hemiplegic shoulder pain

Time frame: 1 week prior to intervention

Visual Analogue Scale (used to report the degree of pain experienced during different levels of functional reaching)

Data from ClinicalTrials.gov

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