Bilateral changes in 3-D scapular kinematics in individuals with chronic stroke


      • Individuals with chronic stroke present bilateral scapular kinematics alterations.
      • Chronic stroke favors increased scapular internal rotation and anterior tilt.
      • Scapular kinematics are not correlated with the use of the paretic arm.



      Stroke can lead to altered scapular motion that may limit the ability to perform activities of daily living. The aims were to evaluate scapular kinematics of individuals with chronic stroke and the correlation with paretic arm function.


      Scapular kinematics was assessed in thirty-four individuals (Chronic stroke = 17; controls = 17) during arm elevation and lowering in scapular and self-selected planes, and during hair combing. The use of the paretic arm to perform activities of daily living was assessed by the Motor Activity Log (MAL-30). Scapular kinematics was compared among paretic and non-paretic arms, and controls. Correlation between scapular kinematics and MAL-30 was also verified.


      Paretic and non-paretic arms showed increased scapular internal rotation (p < 0.05) during arm lowering in the scapular plane, and during arm elevation and lowering in the self-selected plane compared to controls. Increased internal rotation (p < 0.05) was also found in the paretic arm during hair combing compared to controls. Increased scapular anterior tilt (p < 0.05) was observed in the paretic arm during arm elevation while performing the activity of hair combing and during arm elevation and lowering in the scapular and self-selected planes compared to controls. The non-paretic arm showed increased anterior tilt (p < 0.05) during arm elevation and lowering in self-selected plane compared to controls. No difference in scapular upward rotation among neither arms, nor correlation between scapular kinematics and MAL-30 were found (p > 0.05).


      Individuals with chronic stroke showed bilateral scapular kinematics alterations. However, these alterations are not correlated with paretic arm function.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Avila M.A.
        • Romaguera F.
        • Oliveira A.B.
        • Camargo P.R.
        • Fatima T.F.
        Bilateral impairments of shoulder abduction in chronic hemiparesis: electromyographic patterns and isokinetic muscle performance.
        J. Electromyogr. Kinesiol. 2013; 23: 712-720
        • Beebe J.A.
        • Lang C.E.
        Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke.
        Clin. Neurophysiol. 2008; 119: 2074-2085
        • Bertolucci P.H.
        • Brucki S.M.
        • Campacci S.R.
        • Juliano Y.
        O Mini-Exame do Estado Mental em uma população geral.
        Impacto da escolaridade. Arq. Neuropsiquiatr. 1994; 52: 1-7
        • Bohannon R.W.
        • Smith M.B.
        Interrater reliability of a modified Ashworth scale of muscle spasticity.
        Phys. Ther. 1987; 67: 206-207
        • Buttaci C.J.
        • Stitik T.P.
        • Yonclass P.P.
        • Foye P.M.
        Osteoarthritis of the acromioclavicular joint.
        Clin. Orthop. Relat. Res. 2004; 58: 69-73
        • Carvalho-Pinto B.
        • Faria C.
        Health, function and disability in stroke patients in the community.
        J. Phys. Ther. 2016; 20: 355-366
        • Cohen J.
        The concepts of power analysis.
        in: Cohen J. Statistical Power Analysis for the Behavioral Sciences. Academic Press, Inc., New Jersey1988: 1-17
        • De Baets L.
        • Jaspers E.
        • Desloovere K.
        • Van Deun S.
        A systematic review of 3D scapular kinematics and muscle activity during elevation in stroke subjects and controls.
        J. Electromyogr. Kinesiol. 2012; 23: 3-13
        • De Baets L.
        • Van Deun S.
        • Desloovere K.
        • Jaspers E.
        Dynamic scapular movement analysis: is it feasible and reliable in stroke patients during arm elevation?.
        PLoS One. 2013; 8
        • Ebaugh D.D.
        • Spinelli B.a.
        Scapulothoracic motion and muscle activity during the raising and lowering phases of an overhead reaching task.
        J. Electromyogr. Kinesiol. 2010; 20: 199-205
        • Endo K.
        • Yukata K.
        • Yasui N.
        Influence of age on scapulo-thoracic orientation.
        Clin. Biomech. 2004; 19: 1009-1013
        • English C.
        • McLennan H.
        • Thoirs K.
        • Coates A.
        • Bernhardt J.
        Reviews: loss of skeletal muscle mass after stroke: a systematic review.
        J. Stroke. 2010; 5: 395-402
        • Feigin V.L.
        • Lawes C.M.
        • Bennett D.a.
        • Barker-Collo S.L.
        • Parag V.
        Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.
        Lancet Neurol. 2009; 8: 355-369
        • Harris J.E.
        • Eng J.J.
        Paretic upper-limb strength best explains arm activity in people with stroke.
        Phys. Ther. 2007; 87: 88-97
        • Hawkins R.J.
        • Kennedy J.C.
        Impingement syndrome in athletes.
        Am. J. Sport. Rehab. 1980; 8: 151-158
        • Hung C.J.
        • Jan M.H.
        • Lin Y.F.
        • Wang T.Q.
        • Lin J.J.
        Scapular kinematics and impairment features for classifying patients with subacromial impingement syndrome.
        Man. Ther. 2010; 15: 547-551
        • Jobe F.W.
        • Jobe C.M.
        Painful athletic injuries of the shoulder.
        Clin. Orthop. Relat. Res. 1983; 173: 117-124
        • Kalichman L.
        • Ratmansky M.
        Underlying pathology and associated factors of hemiplegic shoulder pain.
        Am. J. Phys. Med. Rehabil. 2011; 90: 768-780
        • Ludewig P.M.
        Motion of the shoulder complex during multiplanar humeral elevation.
        J. Bone Jt. Surg. 2009; 91: 378
        • Ludewig P.M.
        • Cook T.M.
        Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement.
        Phys. Ther. 2000; 80: 276-291
        • Ludewig P.M.
        • Reynolds J.F.
        The association of scapular kinematics and glenohumeral joint pathologies.
        J. Orthop. Sports Phys. Ther. 2009; 39: 90-104
        • Magee D.J.
        Orthopedic Physical Assessment.
        3rd Ed. 1997
        • Magermans D.J.
        • Chadwick E.K.J.
        • Veeger H.E.J.
        • Van Der Helm F.C.T.
        Requirements for upper extremity motions during activities of daily living.
        Clin. Biomech. 2005; 20: 591-599
        • Makii T.
        • Quagliato E.M.A.B.
        • Cacho E.W.A.
        • Paz L.P.S.
        • Nascimento N.H.
        • Inque M.M.E.A.
        • Viana M.A.
        Rev. Bras. Fisioter. 2006; 10: 177-183
        • McClure P.W.
        • Michener L.a
        • Karduna A.R.
        Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome.
        Phys. Ther. 2006; 86: 1075-1090
        • Meskers C.G.M.
        • Koppe P.A.
        • Konijnenbelt H.
        • Veeger H.E.J.
        • Janssen T.W.J.
        Kinematic Alterations in the Ipsilateral Shoulder of Patients with Hemiplegia Due to Stroke.
        2005: 97-105
        • Molina Rueda F.
        • Rivas Montero F.M.
        • Pérez de Heredia Torres M.
        • Alguacil Diego I.M.
        • Molero Sánchez A.
        • Miangolarra Page J.C.
        Movement analysis of upper extremity hemiparesis in patients with cerebrovascular disease: a pilot study.
        Neurologija. 2012; 27 (English Ed.): 343-347
        • Munro B.H.
        Correlations, Statstical Methods for Health Care Research.
        Co, JB Lippincott, Philadelphia1993
        • Neer C.S.
        • Welsh R.P.
        The shoulder in sports.
        Orthop. Clin. North Am. 1997; 8: 583-591
        • Niessen M.
        • Janssen T.
        • Meskers C.
        • Koppe P.
        • Konijnenbelt M.
        • Veeger D.J.
        Kinematics of the contralateral and ipsilateral shoulder: a possible relationship with post-stroke shoulder pain.
        J. Rehabil. Med. 2008; 40: 482-486
        • Pang M.Y.C.
        • Eng J.J.
        Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: implications for stroke rehabilitation.
        Bone. 2005; 37: 103-111
        • Parker V.M.
        • Wade D.T.
        • Langton H.R.
        Loss of arm function after stroke: measurement, frequency, and recovery.
        Int. Rehabil. Med. 1986; 8: 69-73
        • Pascual-leone A.
        • Amedi A.
        • Fregni F.
        • Merabet L.B.
        The Plastic Human Brain Cortex.
        • Pereira N.D.
        • Ovando A.C.
        • Michaelsen S.M.
        • Anjos S.M. Dos
        • Lima R.C.M.
        • Nascimento L.R.
        • Teixeira-Salmela L.F.
        Motor Activity Log-Brazil: reliability and relationships with motor impairments in individuals with chronic stroke.
        Arq. Neuropsiquiatr. 2012; 70 (doi:S0004-282X2012000300008 [pii]): 196-201
        • Phadke V.
        • Camargo P.R.
        • Ludewig P.M.
        Scapular and rotator cuff muscle activity during arm elevation: a review of normal function and alterations with shoulder impingement.
        Rev. Bras. Fisioter. 2009; 13: 1-9
        • Puga V.O.D.O.
        • Lopes A.D.
        • Shiwa S.R.
        • Alouche S.R.
        • Costa L.O.P.
        Clinimetric testing supports the use of 5 questionnaires adapted into Brazilian Portuguese for patients with shoulder disorders.
        J. Orthop. Sport. Phys. Ther. 2013; 43: 404-413
        • Rundquist P.J.
        • Obrecht C.
        • Woodruff L.
        Three-dimensional shoulder kinematics to complete activities of daily living.
        Am. J. Phusical Med. Rehabil. 2009; 88: 623-629
        • Rundquist P.J.
        • Dumit M.
        • Hartley J.
        • Schultz K.
        • Finley M.A.
        Three-dimensional shoulder complex kinematics in individuals with upper extremity impairment from chronic stroke.
        Disabil. Rehabil. 2011; 1–6
        • Saliba V.A.
        • Magalhães L.D.C.
        • Faria C.D.C.D.M.
        • Laurentino G.E.C.
        • Cassiano J.G.
        • Teixeira-Salmela L.F.
        Adaptação transcultural e análise das propriedades psicométricas da versão brasileira do instrumento Motor Activity Log. Rev. Panam.
        Salud Pública. 2011; 30: 262-271
        • Shrout P.E.
        • Fleiss J.L.
        Intraclass correlations: uses in assessing rater reliability.
        Psychol. Bull. 1979; 86: 420-428
        • Sousa Cde O.
        • Camargo P.C.
        • Ribeiro I.L.
        • Reiff R.
        • Michener L.A.
        • Salvini T.F.
        Motion of the shoulder complex in individuals with isolated acromioclavicular osteoarthritis and associated with rotator cuff dysfunction: part 1 — three-dimensional shoulder kinematics.
        J. Electromyogr. Kinesiol. 2014;
        • Veeger H.E.J.
        • Magermans D.J.
        • Nagels J.
        • Chadwick E.K.J.
        • Van Der Helm F.C.T.
        A kinematical analysis of the shoulder after arthroplasty during a hair combing task.
        Clin. Biomech. 2006; 21: 39-44
        • Walmsley S.
        • Rivett D.A.
        • Osmotherly P.G.
        Adhesive capculitis: estabilishing consensus on clinical identifiers for stage 1 using the Delphi technique.
        Phys. Ther. 2009; 89: 906-917
        • Wu G.
        • Van Der Helm F.C.T.
        • Veeger H.E.J.
        • Makhsous M.
        • Van Roy P.
        • Anglin C.
        • Nagels J.
        • Karduna A.R.
        • McQuade K.
        • Wang X.
        • Werner F.W.
        • Buchholz B.
        ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion — part II: shoulder, elbow, wrist and hand.
        J. Biomech. 2005; 38: 981-992
        • Yoshizaki K.
        • Hamada J.
        • Tamai K.
        • Sahara R.
        • Fujiwara T.
        • Fujimoto T.
        Analysis of the scapulohumeral rhythm and electromyography of the shoulder muscles during elevation and lowering: comparison of dominant and nondominant shoulders.
        J. Shoulder Elb. Surg. 2009; 18: 756-763