BACKGROUND: Clinical scapulohumeral tests are lacking post-stroke. OBJECTIVE: To test reliability... more BACKGROUND: Clinical scapulohumeral tests are lacking post-stroke. OBJECTIVE: To test reliability and discriminant validity of clinical scapulohumeral assessments post-stroke. METHODS: Following tests were assessed in 57 individuals with stroke (IwS) (subdivided in a low, moderate, high proximal arm function (PAF) group) and 15 healthy controls: (1) Observation of tilting/winging; (2) shoulder girdle position tests (pectoralis minor index, acromial index, scapular distance test); (3) scapular lateral rotation measurement; (4) maximal humeral elevation and (5) medial rotation test were executed. 15 IwS were measured twice by the same assessor to determine test-retest reliability. Differences between controls and IwS and between IwS with different levels of PAF were assessed. RESULTS: ICCs were very high for all tests (>0.80), except the pectoralis minor index (0.66). Weighted Kappas were high for observation and the medial rotation test (>0.70). Group differences were found for observation, lateral rotation and humeral elevation. IwS compared to controls, and IwS with lower compared to higher PAF generally showed increased lateral rotation (p < .01); decreased maximal active humeral elevation (p < .001); and more often tilting and winging (p < .05). CONCLUSIONS: The use of these tests in clinical settings will allow for identification of altered scapular characteristics, which will enhance treatment planning for PAF post-stroke.
Poor scapulothoracic control is a risk for developing shoulder pathology, but has received little... more Poor scapulothoracic control is a risk for developing shoulder pathology, but has received little attention so far in individuals with stroke (IwS). Trunk and scapular kinematics and surface muscle activity were measured in 15 healthy controls and 18 IwS during a low and high forward flexion (FF). Group-differences in trunk and scapular kinematics were assessed during low and high FF using a t-test (independent samples). Differences in muscle onset and offset time relative to movement start (both FF tasks) were determined using a mixed model taking into account the different groups and muscles. Recruitment patterns per group and task were described based on significant differences between muscles. In IwS, earlier lower trapezius and late infraspinatus offset were found during low FF, as well as a later onset and earlier offset of serratus anterior. For low FF, significantly more trunk axial rotation was found in IwS during both elevation and lowering. During high FF, IwS showed significantly less scapular posterior tilt during elevation and more scapular lateral rotation during lowering. IwS demonstrated adaptive muscle timing with earlier initiation and late inactivation of lower trapezius and infraspinatus, possibly to compensate for a late activation and early deactivation of the serratus anterior and to establish as such the correct pattern of scapulothoracic movement.
This study aimed to characterize scapular muscle timing in stroke patients with and without shoul... more This study aimed to characterize scapular muscle timing in stroke patients with and without shoulder pain. Muscle activity of upper trapezius, lower trapezius, serratus anterior, infraspinatus, and anterior deltoid (AD) was measured (Delsys Trigno surface EMG system, USA) in 14 healthy controls (dominant side) and 30 stroke patients (hemiplegic side) of whom 10 had impingement-like shoulder pain. Participants performed 45° and full range anteflexion, in two load conditions. The impact of group, anteflexion height, load condition, and muscle was assessed for onset and offset of the different muscles relative to the onset and offset of AD, using a 3 (group) × 2 (height) × 2 (load) × 4 (muscle) mixed model design. Recruitment patterns were additionally described. Across all load conditions and groups, serratus anterior had a significantly earlier onset and, together with lower trapezius, a significantly later offset in 45° compared to full range anteflexion tasks (p < 0.001). In str...
BACKGROUND: Clinical scapulohumeral tests are lacking post-stroke. OBJECTIVE: To test reliability... more BACKGROUND: Clinical scapulohumeral tests are lacking post-stroke. OBJECTIVE: To test reliability and discriminant validity of clinical scapulohumeral assessments post-stroke. METHODS: Following tests were assessed in 57 individuals with stroke (IwS) (subdivided in a low, moderate, high proximal arm function (PAF) group) and 15 healthy controls: (1) Observation of tilting/winging; (2) shoulder girdle position tests (pectoralis minor index, acromial index, scapular distance test); (3) scapular lateral rotation measurement; (4) maximal humeral elevation and (5) medial rotation test were executed. 15 IwS were measured twice by the same assessor to determine test-retest reliability. Differences between controls and IwS and between IwS with different levels of PAF were assessed. RESULTS: ICCs were very high for all tests (>0.80), except the pectoralis minor index (0.66). Weighted Kappas were high for observation and the medial rotation test (>0.70). Group differences were found for observation, lateral rotation and humeral elevation. IwS compared to controls, and IwS with lower compared to higher PAF generally showed increased lateral rotation (p < .01); decreased maximal active humeral elevation (p < .001); and more often tilting and winging (p < .05). CONCLUSIONS: The use of these tests in clinical settings will allow for identification of altered scapular characteristics, which will enhance treatment planning for PAF post-stroke.
Poor scapulothoracic control is a risk for developing shoulder pathology, but has received little... more Poor scapulothoracic control is a risk for developing shoulder pathology, but has received little attention so far in individuals with stroke (IwS). Trunk and scapular kinematics and surface muscle activity were measured in 15 healthy controls and 18 IwS during a low and high forward flexion (FF). Group-differences in trunk and scapular kinematics were assessed during low and high FF using a t-test (independent samples). Differences in muscle onset and offset time relative to movement start (both FF tasks) were determined using a mixed model taking into account the different groups and muscles. Recruitment patterns per group and task were described based on significant differences between muscles. In IwS, earlier lower trapezius and late infraspinatus offset were found during low FF, as well as a later onset and earlier offset of serratus anterior. For low FF, significantly more trunk axial rotation was found in IwS during both elevation and lowering. During high FF, IwS showed significantly less scapular posterior tilt during elevation and more scapular lateral rotation during lowering. IwS demonstrated adaptive muscle timing with earlier initiation and late inactivation of lower trapezius and infraspinatus, possibly to compensate for a late activation and early deactivation of the serratus anterior and to establish as such the correct pattern of scapulothoracic movement.
This study aimed to characterize scapular muscle timing in stroke patients with and without shoul... more This study aimed to characterize scapular muscle timing in stroke patients with and without shoulder pain. Muscle activity of upper trapezius, lower trapezius, serratus anterior, infraspinatus, and anterior deltoid (AD) was measured (Delsys Trigno surface EMG system, USA) in 14 healthy controls (dominant side) and 30 stroke patients (hemiplegic side) of whom 10 had impingement-like shoulder pain. Participants performed 45° and full range anteflexion, in two load conditions. The impact of group, anteflexion height, load condition, and muscle was assessed for onset and offset of the different muscles relative to the onset and offset of AD, using a 3 (group) × 2 (height) × 2 (load) × 4 (muscle) mixed model design. Recruitment patterns were additionally described. Across all load conditions and groups, serratus anterior had a significantly earlier onset and, together with lower trapezius, a significantly later offset in 45° compared to full range anteflexion tasks (p < 0.001). In str...
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