Shoulder Abduction for Stroke

Overseen By Neha Reddy, BS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Northwestern University

Must not be taking: CNS suppressants

Disqualifiers: Multiple sclerosis, Dementia, Parkinson's, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

32 Participants Needed

Trial Summary

What is the purpose of this trial?

This study uses functional magnetic resonance imaging to map neural activity throughout the central nervous system during a shoulder abduction task to characterize what motor pathways are being used post-stroke.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are using medications that suppress central nervous system activity.

What data supports the effectiveness of the treatment Shoulder Abduction for stroke patients?

Research shows that progressive abduction loading therapy, which involves gradually increasing the weight or resistance during shoulder abduction exercises, can significantly improve reaching distance and speed in stroke patients. This suggests that shoulder abduction exercises may help improve arm function after a stroke. ^{1 2 3 4 5}

How does the treatment of shoulder abduction for stroke differ from other treatments?

The shoulder abduction treatment for stroke is unique because it focuses on improving reaching function by targeting the abnormal coupling of shoulder and elbow movements, known as flexion synergy, using progressive abduction loading therapy. This approach uses rehabilitation robotics to enhance dynamic strength and control, which is different from standard therapies that may not specifically address these movement patterns. ^{2 5 6 7 8}

Research Team

Molly G Bright, DPhil

Principal Investigator

Northwestern University

Eligibility Criteria

This trial is for individuals who have experienced a stroke and are living with hemiparesis, which means they have weakness on one side of their body. Participants should be able to perform a shoulder abduction task, which involves lifting the arm away from the body.

Inclusion Criteria

I do not have any severe health problems besides my cancer.

I can concentrate and focus on tasks.

I do not have cancer in my brainstem or cerebellum.

Exclusion Criteria

I am currently taking medication that affects my brain's activity.

Pregnant women

MRI contraindications

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Imaging and Data Collection

Participants undergo fMRI to map neural activity during shoulder abduction tasks

3 days to 3 months

Follow-up

Participants are monitored for safety and effectiveness after imaging

4 weeks

Treatment Details

Interventions

• Shoulder Abduction

Trial Overview The study is using functional magnetic resonance imaging (fMRI) to observe and map how different parts of the brain and nervous system are activated during a shoulder abduction exercise in people who have had a stroke.

Participant Groups

Group I: Shoulder Abduction Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

Northwestern University

Lead Sponsor

Trials

1,674

Recruited

989,000+

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Collaborator

Trials

2,103

Recruited

2,760,000+

Findings from Research

In a study of 98 hemiplegic stroke patients, shoulder strapping did not significantly reduce shoulder pain, preserve range of movement, or improve overall functional outcomes compared to no strapping after six weeks.

Despite no significant benefits, there were trends suggesting less pain and better upper limb function in strapped patients, indicating that early intervention may be crucial for preventing complications in shoulder movement post-stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of strapping to prevent post-stroke shoulder pain. Hanger, HC., Whitewood, P., Brown, G., et al.[2022]

A study involving 31 participants with severe stroke demonstrated significant improvements in both reaching distance and peak reaching velocity after undergoing targeted rehabilitation robotics with progressive abduction loading therapy.

This research highlights the potential of progressive abduction loading as an effective rehabilitation strategy for restoring function in individuals with chronic stroke, addressing the common issue of impaired joint control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Progressive abduction loading therapy targeting flexion synergy to regain reaching function in chronic stroke: Preliminary results from an RCT. Ellis, MD., Carmona, C., Drogos, J., et al.[2020]

In a study of 57 stroke patients with hemiplegic shoulder, those with poor motor function exhibited significantly worse proprioception, spasticity, subluxation, and shoulder rotation compared to those with good motor function, indicating a clear link between motor function and shoulder health.

The study found that 85% of patients had shoulder soft tissue injuries and 67% experienced hemiplegic shoulder pain, with factors like impaired sensation, spasticity, and abnormal sonographic findings correlating with the severity of pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical findings and sonography of hemiplegic shoulder in patients after acute stroke during rehabilitation. Huang, YC., Liang, PJ., Pong, YP., et al.[2016]

Positioning the affected shoulder in maximum external rotation for at least 30 minutes a day significantly reduces the risk of developing contractures in stroke patients, based on a study of 36 participants within 20 days post-stroke.

In contrast, positioning the shoulder in 90 degrees of flexion did not show any significant effect in preventing contractures, indicating that external rotation is the more effective strategy for shoulder care after a stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Thirty minutes of positioning reduces the development of shoulder external rotation contracture after stroke: a randomized controlled trial. Ada, L., Goddard, E., McCully, J., et al.[2022]

The study involving 76 patients with post-stroke shoulder pain found no significant difference in pain intensity at day 7 between those positioned with a specific technique and those receiving usual care, indicating that the new positioning strategy may not be effective.

However, the intervention group showed a lower rate of depression at 2 months post-stroke, suggesting potential psychological benefits despite the lack of impact on shoulder pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early multidisciplinary prevention program of post-stroke shoulder pain: A randomized clinical trial. Glize, B., Cook, A., Benard, A., et al.[2022]

In a study of 22 stroke patients, fluoroscopically guided analysis revealed significant differences in shoulder abduction motion between affected and unaffected sides in patients at Brunnstrom stages 3-4, indicating potential for targeted rehabilitation strategies.

The analysis showed that patients with more synergistic movement patterns relied on compensatory motions, such as shoulder shrugging, rather than proper scapular stabilization, highlighting the need for tailored interventions to improve shoulder biomechanics in hemiplegic patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Abduction motion analysis of hemiplegic shoulders with a fluoroscopic guide. Yoon, TS., Lee, SJ.[2018]

In a study involving 18 individuals with stroke, it was found that increased shoulder abduction torque led to abnormal coupling of elbow flexion, which reduced the range of motion for reaching tasks.

The results suggest that after a stroke, individuals may rely more on remaining neural pathways, like bulbospinal connections, which can negatively impact their ability to perform coordinated arm movements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Shoulder abduction-induced reductions in reaching work area following hemiparetic stroke: neuroscientific implications. Sukal, TM., Ellis, MD., Dewald, JP.[2022]

Individuals with hemiplegia post-stroke exhibit significantly less scapular upward rotation during passive humeral abduction compared to normal subjects, particularly at angles of 90°, 120°, and 150°, which may increase the risk of shoulder pain.

Incorporating scapular upward rotation during passive humeral abduction is crucial for individuals with hemiplegia, especially beyond 90° of abduction, to maintain proper shoulder mechanics and potentially prevent complications like hemiplegic shoulder pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Scapular Upward Rotation During Passive Humeral Abduction in Individuals With Hemiplegia Post-stroke. Ratanapinunchai, J., Mathiyakom, W., Sungkarat, S.[2020]

References

1. England pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of strapping to prevent post-stroke shoulder pain. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Progressive abduction loading therapy targeting flexion synergy to regain reaching function in chronic stroke: Preliminary results from an RCT. [2020]

3. Sweden pubmed.ncbi.nlm.nih.gov

Physical findings and sonography of hemiplegic shoulder in patients after acute stroke during rehabilitation. [2016]

4. United States pubmed.ncbi.nlm.nih.gov

Thirty minutes of positioning reduces the development of shoulder external rotation contracture after stroke: a randomized controlled trial. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Early multidisciplinary prevention program of post-stroke shoulder pain: A randomized clinical trial. [2022]

6. Korea (South) pubmed.ncbi.nlm.nih.gov

Abduction motion analysis of hemiplegic shoulders with a fluoroscopic guide. [2018]

7. Germany pubmed.ncbi.nlm.nih.gov

Shoulder abduction-induced reductions in reaching work area following hemiparetic stroke: neuroscientific implications. [2022]

8. Korea (South) pubmed.ncbi.nlm.nih.gov

Scapular Upward Rotation During Passive Humeral Abduction in Individuals With Hemiplegia Post-stroke. [2020]