What is the blended approach to physical therapy (PT) for hemiplegic shoulder pain?

Updated: Feb 08, 2019
  • Author: Robert Gould, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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As of yet, numerous clinical trials have not proven that application of any one facilitative approaches improves patient outcome over conventional therapy. [67, 68, 69, 70, 71, 72] They have also not yet proven that any of these approaches is clearly superior to the others. [8, 47, 60]

Currently, common clinical practice involves implementing elements of various techniques, with Cailliet suggesting that the following basic concepts be used during muscle reeducation [10] :

  • Patient should visualize (ie, mirror) specific movements

  • Verbally reinforce intended movements and encourage the feel of specific motions

  • Copy similar motions performed simultaneously by the contralateral arm

  • Position the upper extremity to decrease scapular depression and retraction

  • Apply sensory stimulation simultaneously to movements

  • Use prone exercises to stimulate righting reflexes that tend to imitate primitive motor function

  • Start seated and standing stimulation exercises to help decrease subluxation and modify synergy patterns

  • Attempt to increase passive range of motion (PROM) with gentle slow motion, rhythmic stabilization, or voluntary contraction followed by relaxation or gentle stretching.

  • Avoid vigorous traction on the arm when stretching connective tissue around the spastic joint

  • Use of electric stimulation can enhance muscle relaxation

  • Use the functional arm to simultaneously train the paretic arm to improve ROM and proprioceptive stimulation.

  • Use modalities (eg, ice, transcutaneous electrical nerve stimulation [TENS], vibration) to diminish spasticity

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