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To therapists: In our quest to deliver and to impress, common observation I’ve seen time and time again when we are dealing with spastic UE and torso, typical of stroke cases. The go-to goal and maneuver is to passively lift and stretch the arm (shoulder) in its entirety to reach the normal ROM on all planes, most commonly in flexion and abduction. I say for what purpose when the functional range of the shoulder is around 120-140 degrees? Meaning, 120 degrees is good enough to wash your face, brush your teeth or feed yourself, unless you are a trapeze performer, a lineman or a deodorant endorser. You may reason back, why not when the goal should be optimal anyway right? I say yes and feel free to do so by all means, but ask yourselves this first. Considering the scapulohumeral rhythm in which the scapula moves along with the movement of the humerus (2:1 ratio – e.g. 90 degrees of shoulder flexion is a combination of 60 degrees glenohumeral and 30 degrees scapulothoracic movements) to elicit normal shoulder ROM. What happens when we fail to address the scapulothoracic mobility on a patient with spastic torso? Passively stretching the glenohumeral joint to the normal range (170-180 degrees)without scapulothoracic mobility increases the chances of additional injuries to the shoulder not limited to impingement, tears and shoulder instability. With proximity-distal approach, prioritizing scapulothoracic before glenohumeral mobility, control and strength training, even concurrently will benefit the patient more in the long run. Here is an example of active scapulothoracic mobility training in its early stage concurrently working on shoulder joint stability/co-contraction through weight bearing on a patient with left sided spasticity.
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