Scapular Upward Rotation During Passive Humeral Abduction in Individuals With Hemiplegia Post-stroke

OBJECTIVE: To describe scapular upward rotation during passive humeral abduction in individuals with hemiplegia post-stroke compared to normal subjects. METHODS: Twenty-five individuals with hemiplegia post-stroke and 25 age- and gender-matched normal subjects voluntarily participated in this study. Scapular upward rotation during resting and passive humeral abduction at 30°, 60°, 90°, 120°, and 150° were measured using a digital inclinometer. RESULTS: In both groups, scapular upward rotation significantly increased as humeral abduction increased (p<0.001). Scapular upward rotation was significantly less in the hemiplegic group compared to that in the control at 90° (p=0.002), 120° (p<0.001), and 150° of humeral abduction (p<0.001). The mean difference in scapular upward rotation between these two groups ranged from 6.3° to 11.38°. CONCLUSION: Passive humeral abductions ranging from 90° to 150° can significantly alter scapular upward rotation in individuals with hemiplegia post-stroke compared to those of matched normal subjects. The magnitude of reduction of the scapular upward rotation may potentially lead to the development of hemiplegic shoulder pain after prolonged repetitive passive movement. Scapular upward rotation should be incorporated during passive humeral abduction in individuals with hemiplegia post-stroke, especially when the humeral is moved beyond 90° of humeral abduction. Combined movements of scapular and humeral will help maintain the relative movement between the scapula and humerus. However, further longitudinal study in patients with shoulder pain post-stroke is needed to confirm these findings.

Effects of Up-and Downslope Walking on Mean and Variability of Gait Parameters in Elderly Women

Background: It has been reported that inclinedand irregular walking surfaces are highly associated with falls among elderly persons. Nevertheless, only few studies have been directed towards the examination on how elders' walking patterns are modified during up-and downslope walking. Objective: To investigate the effects of up- and downslope walking on mean and variability of gait parameters in healthy elderly women. Method: Fifteen healthy elderly women with no history of fall walked on a treadmill at their preferred speed for 10 min in each testing condition. There were three testing conditions; 1) walked on level surface, 2) walk up 9o- slope and 3) walk down 9o- slope. Gait parameters and gait variability were captured using a 2-D motion analysis system then analyzed with a Silicon Coach program. Repeated measures ANOVA were conducted to determine the differences of each dependent variable among the three testing conditions. Results: Compared to the level surface, a significant increase in toe clearance and decrease in step length were observed in the 9o upslope walking condition. For the 9o downslope walking condition, a significant decrease in step length and maximal sole inclination were observed. Double-support time and gait variability were unchanged across the three testing conditions. Conclusion: Healthy, elderly women demonstrated a significant decrease in step length and increase in toe clearance while walking on the upslope surface. It was speculated that these changes reflected a cautious gait strategy the elders employed to ensure gait stability. Walking on the downslope surface resulted in a significant decrease step length and maximal sole inclination while other variables were unchanged. Stride length and stride time variability were relatively unchanged in the present study, suggesting efficiency of the neuromuscular control system in regulating gait and maintaining a steady walking pattern in healthy elders.