After stroke, up to 81% of individuals develop shoulder subluxation, a condition frequently associated with poor upper limb function. Recently, electrical stimulation has been applied to shoulder muscles to treat shoulder subluxation. The purpose of this meta-analysis was to examine the efficacy of surface electrical stimulation for the prevention or reduction of shoulder subluxation after stroke. A meta-analysis of all eligible randomised or quasi-randomised trials of electrical stimulation for the treatment of shoulder subluxation identified by computerised and hand searches of the literature was carried out. The primary outcome measure of interest was subluxation. Seven (four early and three late) trials met the inclusion criteria. The mean PEDro score out of 10 for quality of the methods was 5.8 for the four early trials and 4.3 for the three late trials. Data were pooled when subluxation was measured in millimetres. Analysis found that, when added to conventional therapy, electrical stimulation prevented on average 6.5mm of shoulder subluxation (weighted mean difference, 95% CI 4.4 to 8.6) but only reduced it by 1.9mm (weighted mean difference, 95% CI -2.3 to 6.1) compared with conventional therapy alone. Therefore, evidence supports the use of electrical stimulation early after stroke for the prevention of, but not late after stroke for the reduction of, shoulder subluxation.

There is insufficient evidence to conclude whether slings and wheelchair attachments prevent subluxation, decrease pain, increase function or adversely increase contracture in the shoulder after stroke. There is some evidence that strapping the shoulder delays the onset of pain but does not decrease it, nor does it increase function or adversely increase contracture.

Background: Multiple sclerosis, Parkinson’s disease, and hemiplegia are common disorders that directly cause impairment of balance and gait. Aquatic exercises are used for neurological rehabilitation. It is suggested that the contributing factors of the water setting such as buoyancy, viscosity, and hydrostatic pressure offer an ideal environment for rehabilitative programmes. Objective: To conduct a systematic review of studies that assess the effect of aquatic exercises on balance in neurological patients (i.e., patients with multiple sclerosis, Parkinson’s disease, and hemiplegia). Methods: A systematic literature search of six databases (MEDLINE, PEDro, AMED, CINAHL, Embase, SPORTDiscus) for randomized controlled trials and quasi-experimental trials on aquatic exercises in three different neurological disorders, namely, multiple sclerosis, Parkinson’s disease, and hemiplegia, was performed. Reference lists from identified studies were manually searched for additional studies. Methodological quality was assessed using the Downs and Black checklist. The data were analyzed and synthesized by two independent reviewers. Disagreements in extracted data were resolved by discussion among the reviewers. Results: The methodological quality of eight studies included in this review ranged from fair to good. The findings illustrated that there were statistically significant improvements in static and dynamic balance in patients with multiple sclerosis and hemiplegia. The statistically significant improvements in gait ability were only found in the studies conducted on multiple sclerosis. No conclusions can be drawn in Parkinson’s populations as only two trials conducted with a small sample size were available. Conclusion: Aquatic exercises may be effective at improving balance impairment in patients with hemiplegia and multiple sclerosis. There is a need for further research investigating its effect on Parkinson’s disease before encouraging the use of aquatic exercises.

We found that there was a lack of high-level evidence to guide clinical practice. In order to determine evidence-based practice for the prevention of shoulder subluxation, there is a need to test the efficacy of the most promising supportive devices based on available evidence.

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