Subluxed Shoulders Need TLC: Pilot Study of the T-L-C Taping Method to Address Hemiplegic Shoulder Pain,Passive Range of Motion,and Subluxation

Abstract

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

Hemiplegic shoulder pain and subluxation are prevalent sequelae following stroke. A gap in the literature exists for shoulder assessments specifically for taping, a common intervention. Studies and tape methods primarily focus on mechanical corrections. However, muscle tone and management, which are prevalent topics in neurological rehabilitation, are rarely addressed. The T-L-C taping method consists of a uniform assessment approach of the shoulder specifically to guide Kinesio® Tape application

Primary Author and Speaker: Steven Frey

Additional Authors and Speakers: Mark Stumpf, Jacob Wright, and Sara Stephenson

Contributing Authors: John Wong, Lauren Loges

A pilot study to determine the effectiveness of The Tight, Loose, Correction (T-L-C) Method in addressing passive range of motion (PROM), hemiplegic shoulder pain (HSP), and subluxation in clients due to tone and scapular/shoulder malalignment. This was a quasi-experimental pilot study, AB design with 10 participants. Participants served as their own control. Baseline (A) = control period. Intervention (B) = taping. Recruitment spanned 18 months on a rehabilitation unit and the primary investigator (PI) completed eligibility screens. Participants were screened via medical record and clinical observations by the PI. Inclusion criteria: current HSP and or shoulder subluxation, as a result of a neurological diagnosis, minimum 18 years of age, current patient on the rehabilitation unit, and the ability to communicate pain levels on a visual analog scale (VAS). Exclusion criteria: history of adhesive allergy, bilateral shoulder subluxation, active cancer in the taping area, poor skin integrity, loose and or sagging skin, inability to communicate pain levels, current deep vein thrombosis in the taping area, congestive heart failure, and renal insufficiency. Subluxation was measured in centimeters (cm). Pain was measured via visual analog scale (VAS). Indication of pain number on a 0-10 scale. PROM of shoulder flexion assessed using degrees. Data are presented as median (interquartile range [IQR]). Wilcoxon Signed Rank Tests were used to compare change in PROM, pain, and subluxation from pre-tape to post-tape to assess immediate relief, and then from pre-tape to day 3 to assess reversion. An alpha of 0.05 (two-tailed) was used as the criterion for statistical significance.

RESULTS: 10 participants (3 men, 7 women) ages ranging 27-73 (M = 51.8 years, SD = 18.8). 6 right and 4 left upper extremities (UE) were taped. Participants had an onset of symptoms less than 3 months and broad diagnosis categories included stroke (5), brain tumor (2), spinal cord injury (2) and central nervous system lymphoma (1). PROM shoulder flexion: median end range PROM pre-tape was 75 (IQR: 65, 100) degrees, and increased to105 (IQR: 100, 122.5) degrees immediately post-tape (p = 0.005). Day three median of 125 (IQR: 107.5, 132.5) degrees remained significantly greater than the pre-tape measurement, p = 0.005. Pain: median pain pre-tape was 5.5 (IQR: 4.0, 8.25), and decreased to 0.0 (IQR: 0.0, 0.0) immediately post-tape, this change was not statistically significant (p = 0.068). The day three median of 0.0 (IQR: 0.0, 0.0) remained less than the pre-tape measurement, p = 0.066. Subluxation: median pre-tape subluxation score was 1.1 (IQR: 0.5, 3.0) cm. This decreased to 0.0 (IQR: 0.0, 0.0) immediately post tape (p = 0.005), and remained at 0.0 (IQR: 0.0, 0.25) at day three, p = 0.005. This pilot study suggests that the T-L-C method, using Kinesio® tape, resulted in a decrease in pain scores, reduced subluxation, and increase in PROM in the neurological population tested. This information suggests that following the T-L-C method of shoulder assessment and taping procedure for neurological populations may provide an effective intervention to impact client symptoms and positively influence the client's ability to actively participate in OT sessions. As part of the Effectiveness Pillar in Vision 2025, the T-L-C method is cost-effective, individualized, and evidence informed approach to reduce symptoms common in neurologic based conditions. Exploring methods of evaluating current intervention practices, such as the T-L-C, is important to give clinicians evidence-based tools that can be applied to practice. Despite inherent challenges in translational rehabilitation research, clinicians can engage in science to practice and practice to science methods to advance client outcomes.

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