What is the role of physical therapy (PT) in the treatment of hemiplegic shoulder pain during the flaccid stage?

Updated: Feb 08, 2019
  • Author: Robert Gould, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

In patients with hemiplegia, ROM of the shoulder is usually lost early, so Hanger and colleagues recommended that preventive treatments begin as soon as possible, usually within the first 1-2 days poststroke. [7] Arm support and preservation of joint ROM is performed through early passive motion.

Before active rehabilitation exercises of the extremities are started, Cailliet suggests initiating trunk motions with side-to-side rolling. [10] As the patient progresses from the supine to the prone position, attempt to maintain the patient in reflex-inhibiting positions.

Gradually implement exercises to raise the arm overhead. Upon regaining the seated position, the patient begins gentle weight-bearing exercises through the impaired arm with the elbow and wrist extended, causing glenohumeral joint reduction and proprioceptive stimulation to the shoulder.

Cailliet has also contended that ROM should be evaluated often because of the almost daily progression or regression of the completed stroke. [10] Full ROM does not need to be a therapeutic objective but a means for preventing contractures. Also, during passive exercises, the patient should try to assist with motions and hold positions in hopes of encouraging active control of the extremity.

Sensory stimulation, as well as NMES, can be used to initiate sensory-motor reeducation. However, if functional gains plateau because of persistent weakness, then attention may need to focus on functional retraining of the unaffected limb or, through the use of assistive devices, on achieving independence with activities of daily living (ADL). Forced extremity use or constraint therapy also may be considered.


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