Subluxation and Shoulder Pain

“And my problem with taping generally is, it’s kind of band-aidy because as soon as you take it off the arm could fall right back out. However, if you could get that to reduce pain and then have them do stuff, which then activates the SITS muscles and the deltoid and it brings that humerus back into where it needs to go, in the meantime because they are doing stuff...they’re driving cortical change, which reduces spasticity, which may indicate more movement and now we get this upward spiral of recovery that could be quite helpful. So taping may be a temporary thing but it might be a good temporary thing.”

EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified covers subluxation and pain. In this episode we learn:

• That moving the hand engages the shoulder and the muscles that reduce subluxation

Join Pete and Deb as we talk about subluxation statistics, how to prevent shoulder subluxation and/or soft tissue damage and the importance of safely moving a hemi-paretic shoulder. We discuss several braces that are commonly used to support the shoulder as well as common challenges experienced when donning and doffing them.  We also cover e-stim, NMES, functional e-stim, TENS, stretching, and taping as effective methods for addressing subluxation. We learned that brain controlled interfacing (BCI) with e-stim (which incorporates action observation and motor imagery) results in greater improvements in reducing subluxation and pain, than when functional e-stim is used alone.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Comley-White, N., Mudzi, W., & Musenge, E. (2018). Effects of shoulder strapping in patients with stroke: A randomized control trial. South African Journal of Physiotherapy, 1-11. ISSN. (Online) 2410-8219, (Print) 0379-6175.

Hartwig, M., Gelbrich, G., & Griewing, B. (2012). Functional orthosis in shoulder joint subluxation after ischaemic brain stroke to avoid post hemiplegic shoulder-hand syndrome: a randomized clinical trial. Clinical Rehabilitation 26 (9) 807-816. DOI: 10.1177/0269215511432355 cre.sagepub.com

Jang, Y., Kim, T., Lee, B. (2016). Effects of brain–computer interface-controlled functional electrical stimulation training on shoulder subluxation for patients with stroke: A randomized controlled trial. Occupational Therapy International, 23(2), 175–185. https://doi.org/10.1002/oti.1422

Chatterjee, S., Hayner, K., Arumugam, N., Goyal, M., Midha, D., Arora, A. (2016). The California tri-pull taping method in the treatment of shoulder subluxation after stroke: A randomized clinical trial. North American Journal of Medical Sciences (8)4

Kate Hayner's Calif Tri Pull Taping Method video

Where electrodes should be placed for NMES and subluxation

Products to help subluxation and shoulder pain:

OmoTrain

GivMohr Sling 

StimRouter

Research:

A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients

Effect of arm sling application on gait and balance in patients with post-stroke hemiplegia: a systematic review and meta-analysis

Questions and Comments about the podcast: [email protected]

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RESOURCES:

• Pete’s blog, book, Stronger After Stroke, and talks.

• Blog

Deb's OT Resources:

• Deb's OT resources

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MUSIC:

“Soft Inspiration” by Scott Holmes/Scott Holmes Music/scottholmesmusic.com

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