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KEY WORDS
* bandages
* shoulder dislocation
* shoulder joint
* stroke
* treatment outcome
OBJECTIVE. I evaluated the effectiveness of the California Tri-Pull Taping method for clients with poststroke inferior shoulder subluxation of the glenohumeral joint.
METHOD. Ten participants were followed for 9 wk using an interrupted time series quasi-experimental single-subject ABA design to examine shoulder pain, activities of daily living (ADL) function, active range of motion, tape comfort, and subluxation.
RESULTS. The California Tri-Pull Taping method decreased inferior subluxation significantly from baseline to intervention but not at postintervention. Active range of motion was significantly increased in shoulder flexion and abduction between the baseline and intervention and the intervention and postintervention phases. Functional ADL scores were significant. The taping was reported to be comfortable. No significant difference in pain was found.
CONCLUSION. This intervention is a promising adjunct to the management of the hemiplegic subluxed shoulder that warrants further research.
Kate A. Hayner, EdD, OTR/L, is Associate Professor and Chairperson, Occupational Therapy Department, Samuel Merritt University, 450 30th Street, 4th Floor, Oakland, CA 94609; [email protected]
Between 46% and 66% of patients with hemiplegia after a stroke have an inferior subluxation of the glenohumeral joint, in which the head of the humerus is lowered relative to the glenoid fossa of the scapula (Najenson & Pikielny, 1965; Smith, Cruikshank, Dunbar, & Akhtar, 1982; Van Langenberghe & Hogan, 1988). Pain is associated with subluxation and may occur for a variety of reasons. Pain may impede rehabilitation and is associated with longer hospital stays and poorer outcomes (Turner-Stokes & Jackson, 2002) as well as reduced arm function (Lindgren, Jönsson, Norrving, & Lindgren, 2007) and performance of activities of daily living (ADLs; Lee et al., 2009; Lindgren et al., 2007).
The causes of inferior subluxation after stroke are unclear, although many factors have been proposed as contributory (Andersen, 1985; Basmajian & Bazant, 1959; Ikai, Tei, Yoshida, Miyano, & Yonemoto, 1998; Moskowitz, Goodman, Smith, Balthazar, & Mellins, 1969; Runyan, 1995). In approximately 90% of patients early poststroke, the affected extremity is initially flaccid (Moskowitz et al., 1969). The flaccid paralysis of the shoulder muscles compromises the stability of the muscular support of the shoulder because of the abnormal muscle activity of the supraspinatus (Basmajian & Bazant, 1959; Chaco...