Dynamic scapular movement analysis: is it feasible and reliable in stroke patients during arm elevation?

Abstract

Knowledge of three-dimensional scapular movements is essential to understand post-stroke shoulder pain. The goal of the present work is to determine the feasibility and the within and between session reliability of a movement protocol for three-dimensional scapular movement analysis in stroke patients with mild to moderate impairment, using an optoelectronic measurement system. Scapular kinematics of 10 stroke patients and 10 healthy controls was recorded on two occasions during active anteflexion and abduction from 0° to 60° and from 0° to 120°. All tasks were executed unilaterally and bilaterally. The protocol's feasibility was first assessed, followed by within and between session reliability of scapular total range of motion (ROM), joint angles at start position and of angular waveforms. Additionally, measurement errors were calculated for all parameters. Results indicated that the protocol was generally feasible for this group of patients and assessors. Within session reliability was very good for all tasks. Between sessions, scapular angles at start position were measured reliably for most tasks, while scapular ROM was more reliable during the 120° tasks. In general, scapular angles showed higher reliability during anteflexion compared to abduction, especially for protraction. Scapular lateral rotations resulted in smallest measurement errors. This study indicates that scapular kinematics can be measured reliably and with precision within one measurement session. In case of multiple test sessions, further methodological optimization is required for this protocol to be suitable for clinical decision-making and evaluation of treatment efficacy.

Figure 1. Overview of scapular rotations and marker placement.

Three-dimensional scapular rotations (A) and marker cluster placement (B).

Figure 2. Within and between session reliability of parameters of interest.

ICCs of range of motion in healthy controls (A), ICCs of range of motion in stroke patients (B) and ICCs of start position in healthy controls and stroke patients (C); FL: anteflexion; AB: abduction; BFL: bilateral anteflexion; BAB: bilateral abduction; No symbol is shown in case of calculation errors.

Figure 3. Within and between session reliability of angular waveforms.

CMCs in healthy controls (A) and CMCs in stroke patients (B); FL: anteflexion; AB: abduction; BFL: bilateral anteflexion; BAB: bilateral abduction; No symbol is shown in case of calculation errors.