Effects of Scapular Stabilization Exercise on Function of Paretic Upper Extremity of Chronic Stroke Patients

Innovative boxing training program outperforms the traditional scapular stabilization training program in post-stroke patients

Facilitating the restoration of upper limb functionality is a key objective of stroke rehabilitation. This study aimed to compare the effects of boxing and scapular stabilization training on scapular mobility, balance angle, muscle strength, motor function, and satisfaction in hemiparetic patients. A total of sixty patients were randomly assigned to one of three groups: the boxing group (BG; n = 20), the scapular stabilization group (SSG; n = 20), or the control group (CG; n = 20) which received no treatment at all. Each treatment group participated in three sessions per week for a total of eight weeks. The scapular mobility, balance angle (SBA), muscle strength, upper extremity motor functions (Manual Function Test-MFT), and treatment satisfaction were evaluated. The BG group showed greater improvements in the SBA (F = 59,951; p = 0.000; η2 = 0.682), mobility-frontal plane (F = 7998; p = 0.000; η2 = 0.222), mobility-sagittal plane (F = 91,632; p = 0.000; η2 = 0.766), and mobility-transverse plane (F = 48,713; p = 0.000; η2 = 0.635) than did the CG group. BG strengthened the serratus anterior (F = 42,227; p = 0.000; η2 = 0.601), while SSG strengthened the infraspinatus (F = 31,772; p = 0.000; η2 = 0.532) more than did CG. Compared with those in the SSG, supraspinatus (F = 52,589; p = 0.000; η2 = 0.653), upper trapezius (F = 42,890; p = 0.000; η2 = 0.605), anterior deltoideus (F = 30,844; p = 0.000; η2 = 0.524), latissimus dorsi (F = 84,345; p = 0.000; η2 = 0.751), MFTs (F = 52,363; p = 0.000; η2 = 0.652) and satisfaction (p = 0.008) were greater in the BG. Both approaches had a beneficial impact on the recovery process. However, boxing training was more effective than scapular stabilization training for several parameters. Clinical Trial Number: NCT05568173 date 5/10/2022.

Effects of scapulo-humeral training on ultrasonographic and clinical evaluations in stroke: a randomized controlled trial

BACKGROUND

After stroke, the effects of focused scapulo-humeral training with simultaneous assessment of the changes in shoulder subluxation, related muscle thicknesses and upper limb performance have not been studied in the literature.

OBJECTIVES

This study aimed to investigate the effects of an 8-week scapulo-humeral training program in addition to conventional rehabilitation on upper extremity/trunk functions, shoulder pain, and sonographic measurements of the shoulder joint and periscapular muscles.

METHODS

Thirty stroke individuals were randomly separated into two groups as Group I-scapulo-humeral training (5F/10 M) and Group II - control (5F/10 M). Conventional rehabilitation program was applied to both groups, and a scapulo-humeral training exercise protocol was added for the scapulo-humeral group. All the treatments were applied for 1 hour/day, 3 days/week, 8 weeks. Clinical evaluations were made using the Fugl Meyer Assessment-Upper Extremity(FMA-UE), Action Research Arm Test(ARAT), ABILHAND, Visual Analog Scale, and Trunk Impairment Scale(TIS). Ultrasound was used to measure serratus anterior/lower trapezius muscle thicknesses, and acromion-greater tubercule/acromio-humeral distances.

RESULTS

FMA-UE, ARAT, ABILHAND and TIS scores increased in both groups, with greater increases in most parameters in the scapulo-humeral training group. Shoulder pain decreased only in the scapulo-humeral training group. Subacromial distances were decreased on the paretic side, and muscle thicknesses increased on both sides in the scapulo-humeral training group, and in the control group, only serratus anterior muscle thickness increased on the paretic side (p < 0.05 for all).

CONCLUSIONS

Additional scapulo-humeral exercises to conventional rehabilitation was seen to improve upper extremity/trunk performance and shoulder pain, and to increase scapula stabilizer muscle thicknesses in stroke individuals with mild-moderate upper extremity disability.

Immediate effects of scapular stabilizing exercise in chronic stroke patient with winging and elevated scapula: a case study

[Purpose] The purpose of this study was to investigate the effect of scapular stabilizing exercise in a stroke patient with winging and elevated scapula. [Subject and Methods] The subject was a 46-year-old female with a history of stroke. She had right side hemiplegia with winging and elevated scapula on the right side, and had compensatory motions of the neck and shoulder when using the paretic upper extremity. The subject participated in scapular stabilizing exercises for four days. This exercise program consisted of scapular protraction-retraction in an upright seated position. Scapular position was measured as distance between scapular medial border and thoracic vertebrae 3, 4. Upper extremity function was measured as time required for lifting and lowering a cup with the affected arm. [Results] After intervention, distance between scapular medial border and spinouse process of T3, 4 decreased. Time required for lifting and lowering a cup with the affected arm decreased. Compensatory motions of the neck and shoulder joint decreased. [Conclusion] Despite the short period, scapular stabilizing exercises had a positive effect on scapular position and upper extremity function.

Effect of shoulder girdle strengthening on trunk alignment in patients with stroke

[Purpose] This study investigated the effect of shoulder girdle strengthening, particularly the scapular muscles, on poststroke trunk alignment. [Subjects and Methods] The study involved 30 patients with residual hemiparesis following cerebrovascular stroke. Patient assessment included measuring shoulder muscle peak torque, scapular muscles peak force, spinal lateral deviation angle, and motor functional performance. Patients were randomly allocated either to the control group or the study group and received an 18-session strengthening program including active resisted exercises for shoulder abductors and external rotators in addition to trunk control exercises. The study group received additional strengthening exercises for the scapular muscles. [Results] The two groups showed significant improvement in strength of all shoulder and scapular muscles, with higher improvement in the study group. Similarly, the lateral spinal deviation angles significantly improved in both groups, with significantly higher improvement in the study group. Transfer activity, sitting balance, upper limb functions, and hand movements significantly improved in the two groups, with higher improvement in the latter two functions in the study group. [Conclusion] Strengthening of shoulder girdle muscles, particularly scapular muscles, can significantly contribute to improving the postural alignment of the trunk in patients with poststroke hemiparesis.