İnmeli Bireylerde Skapular Eğitimin Skapular Kinematik, Periskapular Kas Kalınlığı, Omuz Subluksasyonu ve Üst Ekstremite Fonksiyonelliği Üzerine Etkisi

Abstract

This randomized controlled study was planned to examine the effects of additional scapulo-humeral training to the Neurodevelopmental Treatment Approach on scapular kinematics, periscapular muscle thickness, subluxation and upper extremity functionality in individuals with stroke. 32 individuals were randomized into the scapulo-humeral training and the control group, and participants in both groups were included in the treatment program for 8 weeks/3 sessions/60 minutes. Exercises based on the Neurodevelopmental Treatment Approach were applied to both groups for 40 minutes. Additionally, the upper extremity and trunk exercises in this program were applied to the control group for 20 minutes, and a scapulo-humeral training program based on a specific protocol was applied in the other group. All the evaluations were performed by researchers who were blinded to the subject data. For clinical measurements of upper extremity motor impairment-function, trunk performance, shoulder pain, activities of daily living and quality of life were evaluated with Fugl-Meyer Upper Extremity Assessment (FMA-UE), Action Research Arm Test (ARAT), Trunk Impairment Scale 2.0.(TIS), Visual Analog Scale (VAS), ABILHAND, Modified Barthel Index (MBI), and Stroke-Specific Quality of Life Scale (SSQOL), respectively. Ultrasonographic evaluations and an electromagnetic system were used for periscapular muscle thickness (Serratus Anterior-SA / Lower Trapezius-LT) and shoulder subluxation (Acromion-Greater Tubercule-AGT / Acromiohumeral Distance-AH), 3-dimensional scapular kinematics, respectively. The research was completed with 30 individuals. The mean ages of individuals in the scapulo-humeral training and control groups were 52.87±10.17 and 53.06±12.09 years, respectively. After the treatment, there was a difference between the groups in FMA-UE, ARAT, VAS and TIS scores. Also, it was found that the change of paretic side AGT distance and LT muscle thickness were superior in the scapulo-humeral training group (p<0.05). In scapular kinematics, there was a difference between the groups in the posterior tilt of the non-paretic extremity during elevation (p<0.05). The FMA-UE, ARAT, TIS, ABILHAND and MBI scores were significantly increased in both groups (p<0.05). Additionally, there were significantly increases in VAS score in the scapulo-humeral training group; SSQoL score in the control group (p<0.05). While SA thickness on the paretic side increased in both groups; AGT and AH distances and LT muscle thickness on the paretic, SA and LT muscle thickness on the non-paretic sides improved only in the scapulo-humeral training group (p<0.05). The improvement on the scapular upward rotation in resting position was seen in the scapulo-humeral training group (p<0.05). The present results showed that scapulo-humeral training is superior to routine exercises in improving subluxation, periscapular muscle thickness, upper extremity functionality, shoulder pain and trunk performance, and some scapular kinematics. These results suggest that adding this training to the routine treatment plan will increase treatment success, especially in individuals with upper extremity impairments.