Taping in hemiplegic shoulder subluxation

dislocated shoulder - study b

dislocated shoulder – study b (Photo credit: Jon Winters)

The left shoulder and acromioclavicular joints...

The left shoulder and acromioclavicular joints, and the proper ligaments of the scapula. (Photo credit: Wikipedia)

The shoulder complex consists of four separate joints, which afford it incredible mobility in all planes of motion, but at the expense of its stability.

The human shoulder joint

The glenohumeral joint (GHJ) relies on the integrity of muscular and capsuloligamentous structures rather than bony conformation for its
stability. Injury or paralysis of muscles around the shoulder complex may lead to GHJ subluxation.

Glenohumeral subluxation is a secondary complication to hemiplegia caused by a CVA, in which the head of the humerus drops out of the joint. Across the literature, anywhere from 17 to 66 percent of patients experience a shoulder subluxation after a CVA (Peters & Lee, 2003).

Patients with such a subluxation experience pain and decreased ability to perform activities of daily living. In fact, the pain caused by a glenohumeral subluxation has not been isolated. Some research even claims that shoulder subluxation is not the etiology for shoulder pain experienced post-CVA.

procedure of  taping

step 1. check the sulcus sign, and measure it. (no of finger)

step 2. check the range of movement, pain severity, end feel, capsular   tightness. record for pre and post checking for comparison.

step 3. shave the area of shoulder, scapular region up to inferior angle of scapula.

step 4. Take sticking plaster dynaplast of 4″ width. Measurement of para spinaltaping length. Measure from superior border of trapezius muscle till the inferior angle of scapula and cut the tape. Remove the polythene from the tape and stretch the tape to full length.

step 5. Postural alignment &  positioning:  make the patient stand erect so he/she gets a upright posture. correct the abducted scapula to neutral position

step 6. Stick the tape paraspinally starting from superior border of trapezius muscle up to lower sub costal area. take a note while taping that the black center line on the tape should align with the medial border of scapula. take care that there should not be any creases while taping the tape.

step 7. Preparation of second strapping of the tape. Measure from the medial tip of spine of scapula up to deltoids tuberosity level(insertion of deltoids).  cut the tape from middle up to one inch in line with black line in the middle of tape. then split it in the form of “Y” shape. then stretch it to full length.

Step 8. stick base of Y at deltoids tuberosity level. stick it in such a that the middle line of tape come over the anterior tip of acromian process. so that the half of tape  is anteriarly and half laterally  covering the shoulder for proving a better stability. out of the two strip of Y end, upper end in line of the spine of scapula and other strip towards inferior angle of scapula.

check the reduction in sulcus size

To view a video of the procedure please click on the link

  1. Griffin A, Bernhardt J. Strapping the hemiplegic shoulder prevents development
    of pain during rehabilitation: a randomized controlled trial. Clin Rehabil. 2006
    Apr;20(4):287-95. PubMed PMID: 16719027.http://www.ncbi.nlm.nih.gov/pubmed/16719027
  2. Painful Hemiplegic Shoulder.Robert Teasell MD, Norine Foley MSc, Sanjit K. Bhogal MSc http://www.ebrsr.com/uploads/Module-11_hemiplegic-shoulder.pdf
  3. S. Beth Peters1 and Gregory P. LeeProfessor2. Functional Impact of Shoulder Taping in the Hemiplegic Upper Extremity. Occupational Therapy in Health Care. 2003, Vol. 17, No. 2 , Pages 35-46 http://informahealthcare.com/doi/abs/10.1080/J003v17n02_03?journalCode=ohc
  4. Kinesiology Tape: The Little Miracle Worker (drkristakip.wordpress.com)
  5. Exercises for a Loose Shoulder – Orthopedics Doctor Houston TX (orthopedicsportsdoctor.com)
  6. Shoulder Pain (mycerebellarstrokerecovery.com)
  7. Shoulder Pain: Multi-factorial, confusing, and tiring to treat (My Rant) (jessephysio.wordpress.com)
  8. Build Big Strong Shoulder Muscles For V Shape Upper Body Build Big Deltoids (extrememuscles4u.wordpress.com)
  9. How Are You Healing Today? (ofekfamilychiropractic.wordpress.com)
  10. Shoulder Girdle: A Delicate Balance (theverticalworkshop.wordpress.com)
  11. Hemiplegic shoulder pain: defining the problem and its
    management. Bender L, McKenna K. Disabil Rehabil. 2001 Nov 10;23(16):698-705. Review. PubMed PMID:11732559. http://www.ncbi.nlm.nih.gov/pubmed/11732559
  12.  Therapeutic Taping for the Shoulder. Dr. Dyanna Haley-Rezac, PT,DPT, OCS, CSCS, CKTP. Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS

    13. Kinesio@Taping in Stroke:Improving Functional Use of the Upper in hemiplegic. Eva Jaraczeweska. http://www.kinesiotaping.com/images/kinesio-association/pdf/research/2006-1.pdf

    14. Strapping the hemiplegic shoulder prevents development of pain during rehabilitation: a randomized controlled trial.Griffin A, Bernhardt J. Clin Rehabil. 2006 Apr;20(4):287-95. http://www.ncbi.nlm.nih.gov/pubmed/16719027

    15. Hemiplegic shoulder pain: defining the problem and its management. Bender L, McKenna K. Disabil Rehabil. 2001 Nov 10;23(16):698-705.

    16. Arthrographic distension for adhesive capsulitis (frozen shoulder). Buchbinder R, Green S, Youd JM, Johnston RV, Cumpston M. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD007005.

    17. Functional Impact of Shoulder Taping in the Hemiplegic Upper Extremity. S. Beth Peters1 and Gregory P. LeeProfessor2



Outcome Measures used in Cerebral Palsy; Types of scales & Validity, reliability & sensitivity of scales

Outcome Measures used in Cerebral Palsy; Types of scales & Validity, reliability & sensitivity of scales

  • What is outcome measure?
  • Why do we have to measure the outcome?
  • How to choose the outcome measures?
  • Which scale will be able to pick up the change?
  • What is validity, reliability and sensitivity of a scale?
  • What level of ICF model do you want to target? (Body structure and function/ Activity/Participation)?

please go through the link: – OUTCOME MEASURES USED IN CEREBRAL PALSY

Evidences of cerebral palsy management

management of cerebral palsy is always a challenge. What should be plan of treatment?

What is effective what is not? what is the evidences of cerebral palsy management?

These are the common questions in the therapist and students mind.

Hear i have given an  overview of it. please click on the link.


TILT TABLE STANDING: early weight bearing and standing in patient with Total Hip Replacement with complications.

TILT TABLE STANDING:  early weight bearing and standing in patient with Total Hip Replacement with complications- para paresis, diabetic, high BP and cardiac problems.

This is patient with Total Hip Replacement rt side with bilateral lower limb weakness and trunk weakness. she was unable to stand on her even with walker. so we have to make her stand with help of tilt table. give her feedback of upright standing and weight bearing through legs. to improve the postural reactions and  to keep her engage in active participation patient is given a activity of ball catch and through. after few days of standing we made her stand with bilateral knee brace and walk with forearm support walker. initially we have passively start stepping forward for her. slowly she learned to take steps with help of walker with minimum assistance.

please click here for details of video

video will be live at: http://youtu.be/TbrKFsORYd0

SCI REHAB: Modified prone push up in high Paraplegics & Quadriplegics with weak triceps

Modified prone push up in high  paraplegics – who have weakness in trunk and unable to do push up for upper limb strengthening. in that case we can put a big bolster under the chest and  raise and support the upper trunk on the bolster that will help him balance and control the upper trunk and could put more efforts in prone push ups and help in strengthening of upper limb.

Quadriplegics with weak triceps also have difficulty in prone push up also can be benefited by this technique.

please check the link of video



Dear friends,
at the end of marc 2012 i have completed my
It unbelievable that i complete five years. what a journey….! i was a great experience. when i look back there are many more milestones and achievements i could do in and due to sancheti college of physiotherapy.

1. PUBLICATION:- i could done two publication (1 international -NDTA NETWORK and 1 national Journal of orthopedics and rehabilitation). Preparing for next 4-5 publications this year

a.Winner Of Young Presenters Scholarship From Epilepsy Foundation India, in the conference of“International congress on neurology and rehabilitation Goa April 2010”,
a. Winner of best paper award in engeering and technology category In Avishkar 2010 of Maharashtra university of health sciences (MUHS), Nashik India.
b.WINNER OF BEST PAPER FOR scientific paper presentation in AVISHKAR 2010 of Maharashtra University of Health Sciences (MUHS), AURANGABAD, India.

3.REESOURCE PERSON/COURSE INSTRUCTOR:- I have conducted Conducted workshop on
a. 2D & 3D Gait Analysis and its Management
b. two workshops of MOTOR RELEARNING PROGRAM- for stroke rehab
c. two workshops of Spinal Cord Injury Rehabilitation

4. Development of new NEURO DEPT thanks so sancheti hospital and sancheti healthcare academy

5. SUPPORT GROUP: we have started with Spinal Cord Injury Rehabilitation, and very soon we will start stroke, Parkinson and brain injury.

6. i got opportunity to treat DADA J. P. VASVANI.

7. May be this academic year i will be a post graduate teacher and i will get opportunity to guide 2 PG students and be a READER.

8. Be a imp part of scientica- students conference.

I am very thankful for support of
Dr. K. H SANCHETI, MS ORTHO, founder chairman, Sancheti hospital.
DR. PARAG SANCHETI, MS ORTHO,  chairman, Sancheti hospital.
MRS. MANISHA SANGHAVI, executive director, Sancheti healthcare Academy
DR. S. M. SABNIS, EX PRINCIPAL, Sancheti college of physiotherapy,

DR. S. A. RAIRIKAR, PRINCIPAL, Sancheti college of physiotherapy,
and all the consultant and staff of
Sancheti college of physiotherapy,
Sancheti healthcare academy and
Sancheti hospital.

Thankful to all students for giving me opportunity to teach them and making me COMPLETE TEACHER.


Spastic muscles cant do eccentric lengthening

Spastic muscles are in the state of concentric contractions can’t do eccentric lengthening. Spastic muscles are in shortened state and active eccentric contraction in difficult. This can be due to

a. Weakness of antagonistic muscle

b. Due to reciprocal inhibition causes relaxation of antagonistic muscle

Spastic muscles act like spring that work in concentric contraction and remains in contraction mostly (flexed position) which creates motor imbalance between them and antagonist to them. Therefore strengthening antagonist assists in reducing tone of spastic muscles as this allows lengthening of spastic muscle!!

So in the initial phase of neuro rehabilitation of hemiplegic patients we should concentrate more on eccentric and static (placing reaction) contraction.

Avoid strengthening the concentric contraction. Because if the spastic muscle becomes strong then it is difficult to initiate the eccentric contraction.

During training of upper limb control we train the elbow flexion and shoulder flexion. The common mode is to train concentric contraction. We tell the patient to lift upper limb against gravity. This indirectly trains the flexor synergy make it strong then it becomes difficult to break the synergy.

So what to do? Work on placing reaction in upper limb. Place the shoulder in flexion above 90 degree and let him hold it and followed by slow lowering the upper limb (eccentric contraction).

What is the advantage of eccentric contraction? Eccentric contraction helps early and better in recruitments of motor units than concentric contractions. Eccentric contraction can generate more force with less motor unit recruitment. Concentric contraction requires more motor unit recruitment for even generation minimum muscle contraction. So it becomes difficult to initiate concentric contraction than eccentric contraction.

So in the spastic muscles we should concentrate more on eccentric lengthening. Increase in eccentric lengthening of muscles indirectly helps in reducing spasticity.

My first International publication as Co Author in NDTA Network on the net, NOVEMBER/DECEMBER 2011, VOLUME 18, ISSUE 6: Thanks to Dr. Asha Chitnis, C/NDT

Thanks to Dr. Asha Chitnis, C/NDT for help and guidance in publishing the paper in NDTA NETWORK.

Participation and Participation Restrictions in a Teenager with Down Syndrome: an Indian Scenario
By by Reena Mody, PT, C/NDT, Gajanan Vithalrao Bhalerao, MPT, Sujata Noronha, PT, C/NDT Madhavi Kelapure, PT, C/NDT, Asha Chitnis, PT, C/NDT

NDTA Network  on the net November – December 2011 • Adults with Congenital Disabilities. Volume 18, Issue 6



Never plan the therapeutic management based on the medical diagnosis or cause of stroke

All students and the therapists who are treating patients with stroke must have thought or heard this kind of question in their practice.

What is the therapeutic management of frontal lobe bleed/infarction?

What is the therapeutic management of occipital bleed /infarction?

What is the therapeutic management of parietal bleed /infarction?

What is the therapeutic management of thalamic bleed?

Instead of answering these questions, we need to ask different questions

What are the sign & symptoms of these patients? What are the physical & perceptual impairments of patients?

What are the activity the patient is able to do and not able to do?

What impairments are limiting the activity? What are the contextual factors & personal and environmental factors are restricting his participation?

 Neurologist does the medical or neurological diagnosis of patient’s i. e. Stroke due to infarction or bleed. Bleed or infraction internal capsule, thalamus, basal ganglion, MCA territory etc. This different level of injury and severity will helps us in finding out the prognosis and planning of treatment according to level of lesion and severity of it.

 But for us as a physiotherapist we need to look at the movement dysfunction. We need to find the physiotherapeutic diagnosis of movement dysfunction. Such as hemiplegia, henianesthesia, cognitive and perceptual disorders, unilateral neglect, heminomus hemianopia, shoulder dislocation, genu recurvatum, hemiplegic hand, claw hand, fixed flexion deformity,

 “Stoke is Medical diagnosis, Hemilplegia is a Physical diagnosis ….!”

 We treat hemiplegia neurologist treats stroke.

We need to keep in mind that we as therapists don’t treat the cause of the stroke like the medical management. We don’t plan treatment directly with the causative factors of the stroke.

We treat physical & functional dysfunction –  “MOVEMENT DYSFUNCTION”.

We plan our management according to:-

  • What are activities limitations?
  • What impairments (signs and symptoms) of patients causing activity limitation
  • What is the need of the patients according to their lifestyle, age and occupational demands (personal & environmental factors, contextual factors)?

Any patient of stroke with any medical diagnosis the physical functional demands from life are same. These demands doesn’t change with diagnosis ( the prognosis & the ability to achieve these target might be affected due to level of lesion and severity of lesion).

Every patient basic physical functional demands from life are: -

  1. Bed mobility- rolling supine to sit, bed side sitting etc
  2. Toilet training
  3. Transfers from bed to chair or toilet transfers
  4. Sit to stand
  5. Standing with or without assistive devices
  6. Walking with or without assistive devices
  7. Upper limb function for hands skills & manipulations
  8. Activities of daily living (ADL) & Instrumental Activities of daily living (IADL)- dressing, feeding, brushing, combing, reading writing & bathing etc
  9. Indoor and outdoor ambulation with or without assistive devices
  10. Stair climbing

 These activities will be required to train in patients. We need to ask questions how to achieve these activities with current level of impairments and contextual, personal & environmental factors. Plan the gaol according to the activity & participation restrictions. Train the patient for his desired activity. Involve him in planning the treatment program. Ask him which activity he wants to learn first. Take his view point in account and set realistic, challenging but achievable goals. And plan the management according to it & try to accomplice that activity. Treat those impairments which are limiting the activity and his participation in community. He may have multiple impairments but not all the impairment limits the desired activity of the patients and his physical and functional demands in his lifestyle.

 To get the right answer for the management you need to ask the right question….!

If you ask a right question you will get the right answer for it.

Your main objective should be changing the participation and activity limitation in community (based on ICF model).

 “Our treatment should bring some change in his life and not in the impairment…!”


Every patient of thalamic bleed doesn’t show symptoms of thalamic syndrome…!

 Most of the patients with thalamic bleed don’t show the typical symptoms of thalamic syndrome or thalamic pain. These bleeds are around the basal ganglion and internal capsule so they do show signs of hemiplegia and some will show signs of hemianesthesia on opposite side of body. We assume that every patient of thalamic bleed will show signs and symptoms of thalamic pain but that’s not always true. We need to look at bleeding near thalamus or around basal ganglion with broader view.