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Shoulder Protection Following Stroke
Stacey Maguire, PT, DPT, NCS and Brigitte Rohan, OT, MOT
Beth Israel Deaconess Medical Center Inpatient Rehabilitation Services
Introduction/Problem
The Beth Israel Deaconess Medical Center Neuro Medicine team identified a high frequency of
shoulder pain and subluxation in patients seen in follow-up clinic after a stroke. Reported
incidence of hemiplegic shoulder pain is widely variable but is commonly reported at
approximately 70% (Vasudevan & Browne 2014). Patients with pain following stroke have
been found to have greater cognitive decline, increased rates of depression, higher levels of
fatigue, and lower quality of life (Harrison & Field, 2015). The flaccid hemiplegic upper
extremity is at a higher risk for injury, particularly in patients who require assistance for
transfers (Vasudevan & Browne 2014). Patients are particularly susceptible to risk in the acute
care setting, as they require increased support during mobility at this stage. Targeted
interventions to minimize injury in the acute care setting could result in improved long term
outcomes for shoulder subluxation and pain.
Aim/Goal
To develop an evidence based program for management of the hemiplegic upper extremity at BIDMC in
the inpatient setting in order to decrease pain and improve long term functional outcomes.
The Team
Stacey Maguire, PT, DPT, NCS
Brigitte Rohan, OT, MOT
Nick Wendel, PT, DPT, NCS
Deb Adduci PT, Clinical Manager, Inpatient Rehab
Jane Wandel, RN, MS, Program Director, Patient and Staff Communications
The Interventions
Formulated patient education sheets on management of hemiplegic UE to be provided to patients
and their caregivers.
Formulated signs to position over patient bed as a reminder to staff for protection of hemiplegic
shoulder.
Presented in-services to nursing staff on shoulder protection for patients following a stroke (Farr11
Unit).
Presented in-service to inpatient rehab staff on shoulder protection for patients following a stroke.
Results/Progress to Date
In-services were provided to the rehab department and also nursing staff on care for patients
following stroke to minimize shoulder injury and subluxation.
Documents were formulated by inpatient physical and occupational therapists with assistance for
formatting and language from media services. These included:
Protecting your shoulder when you have weakness: Handout for patients and caregivers
including education regarding the shoulder joint, posture, positioning, and exercises
Positioning for left/right-sided arm weakness (2 documents): Handout for patients and
caregivers providing education about proper positioning for the hemiplegic shoulder
Left/Right shoulder protection (2 documents): Signs for placement above patient’s bed to alert
staff to support shoulder properly during positioning and mobility
These documents were made accessible on the BIDMC web portal for physical and occupational
therapy staff to access anywhere in the medical center to print for patient use.
Lessons Learned
Staff members caring for patients following stroke benefit from repetition of education (Smith 2012) as
well as visual reminders of safe care for patients to reinforce best practice.
Next Steps
Repeat nursing staff in-services. Expand to other areas caring for patients following stroke (including
Neuro ICU and Neuro Intermediate Care Unit).
In-service rehab staff on location and implementation of document use.
References
Harrison, R.A., & Field, T.S. (2015). Post stroke pain: Identification, assessment, and therapy.
Cerebrovascular Diseases. 39, 190-201.
Razaq, S., & Rathore, F.A. (2016). An overview of pathophysiology, assessment and management
strategies of post stroke shoulder subluxation. Pakistan Journal of Neurological Sciences. 11, 42-48.
Smith, M. (2012). Management of hemiplegic shoulder pain following stroke. Nursing Standard. 26, 3544.
Vasudevan, J.M., & Browne, B.J. (2014). Hemiplegic shoulder pain: An approach to diagnosis and
management. Physical Medicine & Rehabilitation Clinics of North America. 25, 411-437.
For more information, contact:
Brigitte Rohan, OT brohan@bidmc.harvard.edu
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Brigitte Rohan (<a href="mailto:brohan@bidmc.harvard.edu">brohan@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Inpatient Rehabilitation
Project Team
Stacey Maguire
Brigitte Rohan
Nick Wendel
Deb Adduci
Jane Wandel
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Shoulder Protection Following Stroke
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness