Treatment Protocol for Hemiplegic Shoulder Pain

Not Applicable

Completed

• Conditions: Stroke; Hemiplegia; Shoulder Pain
• Interventions: Other: Standard education/exercises for hemiplegic shoulder pain; Other: Three dimensional Scapular-Humeral Mobilizations

• Registration Number: NCT01232218
• Lead Sponsor: Toronto Rehabilitation Institute

Brief Summary

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.

Detailed Description

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 Timeline

• Study Start: 2010-10
• Study First Submitted: 2010-10-25
• Study First Submitted QC: 2010-11-01
• Study First Posted: 2010-11-02
• Primary Completion: 2012-05
• Study Completion: 2012-05
• Status Verified: 2012-07
• Last Update Submitted: 2012-07-26
• Last Update Posted: 2012-07-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 20

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).

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Current Standard Treatment	Standard education/exercises for hemiplegic shoulder pain	Current standard treatment for hemiplegic shoulder pain will be provided to this group.
Standard treatment + study technique	Three dimensional Scapular-Humeral Mobilizations	Participants will receive current standard treatment for hemiplegic shoulder pain PLUS an additional stretching/strengthening technique. Both groups will be allotted the same treatment time.

Primary Outcome Measures

Name	Time	Method
Measurement of active and passive pain-free shoulder range of motion	one month after intervention	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.

Secondary Outcome Measures

Name	Time	Method
Visual Analogue Scale (used to report the degree of pain experienced during different levels of functional reaching)	1 month after intervention	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.
Chedoke McMaster Pain Inventory	1 month after intervention	A descriptive scale for quantifying hemiplegic shoulder pain

Trial Locations

Locations (1)

Toronto Rehabilitation Institute; 🇨🇦 Toronto, Ontario, Canada