StrokeNCT05568173
Boxing and Scapular Stabilization Training in Hemiparetics
A study testing Boxing Training and Scapular Stabilization in people with Stroke and Hemiparesis, run by Eastern Mediterranean University at 1 site in Cyprus.
Trial summary
In recent years, it has been observed that scapular stabilization exercises given in addition to stretching exercises in stroke patients strengthen the scapular muscles and improve walking and trunk alignment. Read more about this study
- Who is it for?
- Ages 40 to 70 years
- Conditions the study is for
- Stroke, Hemiparesis
- What is being tested?
- Boxing Training and Scapular Stabilization
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteCyprus
- Study dates
- 13 Oct 2022to 10 Sep 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 40 to 70 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients diagnosed with first time ever stroke
- Patients with hemiparesis
- Patients who are between the ages of 40-70
- Patients who has Mini Mental Test score above 23
- Patients whose functional level is less than 4 according to the Modified Rankin Scale
- Patients who has upper extremity spasticity lower than 2 on Modified Ashworth Scale
- Patients who can do 120 degrees of shoulder flexion
Who cannot join
- Having a chronic disease (for example: uncontrolled hypertension,heart disease…)
- Subluxation and fracture at the shoulder
- Risk of fracture and pain at the shoulder
- Visual and hearing impairment
- Unilateral neglect
- Botulinum toxin administration or surgical operation in the last 6 months patients
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Comparison of the Effects of Boxing and Scapular Stabilization Training in Hemiparetic Patients
In recent years, it has been observed that scapular stabilization exercises given in addition to stretching exercises in stroke patients strengthen the scapular muscles and improve walking and trunk alignment. In a study published in 2020, in which the investigators compared the effects of virtual and real boxing training on upper extremity functions, balance and cognitive functions in stroke patients, significant improvement was observed in each parameter in both groups.
When the investigators look at the literature, the investigators see that there is no study comparing the effects of both scapular stabilization and boxing training on upper extremity functions and trunk balance in stroke patients.
Therefore the aim of this study, compare the effects of boxing and scapular stabilization training on scapular mobility (primary outcome measure), upper extremity range of motion, shoulder proprioception, scapular balance angle, scapular muscle strength, trunk muscle strength, upper extremity motor functions, trunk balance and treatment satisfaction (secondary outcome measures) in hemiparetic individuals with stroke.
Read the detailed description
Upper extremity dysfunction can be seen in approximately 30% to 66% of hemiplegic patients. Loss of the Betz cell, which is the most abundant in the cerebral cortex and is responsible for the control of the hand, leads to impaired hand functions in hemiparetic patients who have had a stroke. Flexor spasticity predominates in the upper extremities. In addition to internal rotation and adduction of the shoulder, retraction and depression of the scapula are observed. The subscapularis and pectoral muscles are the muscles whose tone increases the most in this process. In addition, the rhomboids, serratus anterior, deltoid, trapezius middle, and lower parts are the muscles that weaken the most. For upper extremity elevation, the humeral head must be located within the glenoid fossa. Deltoid and rotator cuff muscles work as a force couple to achieve this. The most important muscles preventing glenohumeral joint subluxation are the posterior deltoid, supraspinatus, and infraspinatus.
A visible change in the movement pattern and position of the scapula relative to the thorax is defined as scapular dyskinesia. In the literature, there is no consensus on whether scapular dyskinesia occurs secondary to any pathology or influence, or whether it is the cause of these pathologies. In an EMG study performed during shoulder flexion in stroke patients, delayed muscle activation of the lower trapezius muscle was observed in stroke patients with shoulder pain compared to stroke patients without shoulder pain. In the electromyography study conducted by Betz et al. in 2014, they observed that the Serratus anterior muscle was inactive or late active in some of the stroke patients with shoulder pain, while the infraspinatus muscle was activated earlier and the activation lasted longer in stroke patients without shoulder pain. The researchers pointed out that these results show the role of the timing of activation of the infraspinatus muscle in shoulder stabilization and prevention of shoulder pain in stroke patients, and that infraspinatus muscle strengthening exercises should be added to rehabilitation to prevent shoulder impingement syndrome, and they drew attention to the importance of serratus anterior and lower trapezius muscle in scapular motor control to provide dynamic stabilization.
Postural stability is defined as the relationship of body parts to the center of gravity. It has been said that the basic prerequisite for movements requiring complex controlled ability is postural stability. Many studies have investigated the relationship between balance disorder and lower extremity dysfunction in stroke, however, it is thought that upper extremity dysfunction also affects balance significantly.Williams et al. showed in their study that scapulothoracic joint stabilization, mostly generated by the trapezius and serratus anterior muscles, contributes significantly to trunk core stability. During voluntary arm movements, force moments occur in the shoulder depending on the weight and dynamics of the arm. These forces and moments can affect the ability to sit, stand and also change positions. Body stabilization during walking is provided by ± 1.5 ° movement of the upper body. This movement can increase the stability of the head by reducing false signals from the otolith and vestibular systems. In the study conducted by Awad et al. in hemiparetic patients with stroke, stretching exercises for the pectorals, latissimus dorsi, rhomboids, and teres major muscles, scapular stabilization exercises in addition to trunk control exercises were applied 3 times a week for 6 weeks, and it was observed that scapular muscle strength increased and trunk alignment improved. In another study by Jo et al. in 2019, it was observed that strengthening exercises given to the scapular muscles 3 times a week for 8 weeks in addition to stretching exercises improved upper extremity and walking functions.
In a study published in 2020, in which the investigators compared the effects of virtual and real boxing training on upper extremity functions, balance, and cognitive functions in stroke patients, significant improvement was observed in each parameter in both groups .
When the investigators look at the literature, the investigators see that there is no study comparing the effects of both scapular stabilization and boxing training on upper extremity functions and trunk balance in stroke patients.
Therefore the aim of this study, compare the effects of boxing and scapular stabilization training on scapular mobility (primary outcome measure), upper extremity range of motion, shoulder proprioception, scapular balance angle, scapular muscle strength, trunk muscle strength, upper extremity motor functions, trunk balance and treatment satisfaction (secondary outcome measures) in hemiparetic individuals with stroke.
- Conditions
- Stroke, Hemiparesis
- Being tested
- Boxing Training, Scapular Stabilization
- Keywords
- boxing, upper extremity function, balance, Stroke
- Medical subject headings
- Stroke, Paresis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Boxing TrainingOther
In addition to boxing training, stretching exercises and posture training will be given at BG. A physiotherapist with a boxing training certificate will perform modified boxing training that progresses according to the degree of difficulty. There will be four difficulty levels. The complexity of the exercises will increase at 2-week intervals as the patient progresses. As a result, 0-2 weeks 1st level, 2-4 weeks 2nd level, 4-6 weeks 3rd level and 6-8 weeks 4th level exercises will be done.
In the first level, patients will be asked to punch the fixed boxing mat hanging on the wall with various instructions. Then, in levels 2-4, target gloves and heavy punching bags will be used to increase the difficulty level. As the sessions progress, the resistance and frequencies between the levels will be increased by the physiotherapist. There will be 3 sessions of 30-minute boxing training per week for 8 weeks at BG.
Scapular StabilizationOther
In addition to scapular stabilization training, stretching exercises and posture training will be given in SSG. Progressive strengthening training for the scapular muscles will be used in the SSG. There will be four difficulty levels. The complexity of the exercises will increase at 2-week intervals as the patient progresses. As a result, 0-2 weeks 1st level, 2-4 weeks 2nd level, 4-6 weeks 3rd level and 6-8 weeks 4th level exercises will be done.
At the first level, scapular clock exercise, obstacle crossing exercise, wall gliding exercise with teraband, push up exercise, trunk rotation and maximum hip flexion will be performed. Then at levels 2-4, as the levels increase, the exercises at the first level will be more difficult (ball weight, surface, number of hurdles and hurdle crossing exercise position, by changing the teraband elasticity, push-up position). In SSG, 3 sessions of 30-minute scapular stabilization training will be applied per week for 8 weeks.
| Study group | Role | What they receive |
|---|---|---|
| Boxing Training | Experimental | In the Boxing Training Group (BG) boxing training will be given. Additionally, stretching exercises and postural training will be applied. Receives: Other: Boxing Training |
| Scapular Stabilization | Experimental | In the Scapular Stabilization Group (SSG) scapular stabilization training will be given. Additionally, stretching exercises and postural training will be applied. Receives: Other: Scapular Stabilization |
| Control | No intervention | Individuals in this group will not receive any treatment. Evaluations will be made before treatment and after 8 weeks of treatment. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Scapular Mobility Assessment
Upward and downward rotation in the scapular plane, anterior and posterior tilt in the sagittal plane and internal and external rotation in the transverse plane will be measured by using an electronic goniometer (The EasyAngle electric goniometer Meloq AB). After the device is calibrated in all three planes, the gradual difference in shoulder elevation and scapular movement enables the angular determination of the mobility of the scapula in three planes. In the reliability study, the inter-session evaluator reliability was found to be moderate to good (ICC [2,3] range = 0.628-0.874). In-session interpreter reliability was moderate to excellent(ICC [2,3] range = 0.545-0.912).
Measured: 0-8 week
Secondary outcomes (10)
Glenohumeral Joint Range of Motion Measurement
Shoulder flexion, extension, abduction, and internal and external rotation will be measured by using an electronic goniometer (The EasyAngle electric goniometer Meloq AB)
Measured: 0-8 weeks
Shoulder Proprioception Measurement
The assessment process will begin by showing the angle of reference of the patient's arm to the desired position (active assisted motion). The position will be actively held by the patient and when it reaches the desired degree, the patient will be asked to stop the arm at that point and it will be recorded. The arm will then return to a neutral position and the examiner will actively attempt to re-establish the reference position. Positions targeting the assigned points at 125°, 55°, and 90° shoulder flexion will be introduced to the participants. Participants will be instructed to memorize the location of the joint in various postures before their eyes are closed. It will then be prompted to redo positions randomly. This procedure will be repeated 3 times. Electro goniometer will be used while measuring (The EasyAngle electric goniometer Meloq AB) .
Measured: 0-8 weeks
Scapular Balance Angle Measurement (SBA)
The lower angle of the scapula will be marked bilaterally and another vertical line will be drawn between the line connecting these marks and the C7 and T9 - T10 spinous processes. Angles formed by the line connecting both lower angles of the scapula with the vertical line passing through the spine will be measured with a goniometer. The absolute value of the difference between these angles will correspond to the SBA.The absolute difference between these two angles referred to the SBA. In normal non-affected subjects, the values for the SBA were 2.505 ± 2.340° while the abnormal results were with an angle greater than 7.185°. An intraobserver intraclass correlation coefficient (ICC) of 0.87 and interobserver ICC of 0.84 was reported. SBA manual measurement is viewed as a straightforward and reproducible evaluation of the position of the scapula in clinical practice.
Measured: 0-8 weeks
Scapular Muscle Strength Measurement
A hand-held dynamometer (HHD) will be used to measure isometric muscle strength of the supraspinatus, upper, middle, and lower trapezius, subscapularis, infraspinatus, serratus anterior, rhomboids, pectoralis major, latissimus dorsi, anterior, middle and posterior deltoid muscles. Three attempts will be made for each muscle with a 15-20 second rest period. The supraspinatus and upper trapezius muscle peak forces will be recorded at a sitting position with the hips and knees flexed 90° and the feet on a supported stool. Serratus anterior muscle strength will be tested in the supine position
Measured: 0-8 weeks
Trunk Muscle Strength Measurement
Trunk flexor muscle strength will be measured in the supine position at 30° flexion, trunk rotators in the supine position with the trunk towards the most/least affected side, trunk extensors in the prone position, and trunk lateral flexors on the most/least affected side in the sitting position using a HHD. It has been proven by Karthikbabu et al. that the HHD is a reliable tool to measure trunk muscle strength in individuals with chronic stroke
Measured: 0-8 weeks
Pectoralis Minor Length Measurement
The length of the pectoralis minor muscle (PML) in the resting position will be measured according to the guidelines established by Borstad and Ludewig. Participants to be tested will be asked to stand upright, and the arm to be tested will be comfortably supported. Two anatomical reference points will be palpated, respectively representing the PML the inferomedial aspect of the coracoid process and the caudal edge of the fourth rib at the sternum. The distance between these two bone reference points will be measured with a Vernier caliper (Wheather Forecast, China, 0-150 mm). The average of three measurements will be taken; the average will be divided by the participant's height and multiplied by 100 to calculate the PML index. The PML index allows each measurement to be normalized to each participant's height to provide the relative resting length of the individual pectoralis minor.
Measured: 0-8 weeks
Total Scapular Distance
Total Scapula Distance (TSD) is defined as the distance from the inferior angle of the acromion to the spinous process of the third thoracic vertebra. To determine the distance between the inferior angle of the acromion and the spinous process of the third thoracic vertebra while the participants are standing in a comfortable position, the physiotherapist will first palpate, then mark the distance with a black pen, then measure the distance via a digital Vernier caliper ( Wheather Forecast, China, 0-150 mm) The reliability value (ICC) for the scapular distance was found to be .94.
Measured: 0-8 weeks
Upper-Extremity Motor Function Assessment
The Manual Function Test (MFT) was developed to measure the motor function deficits in the upper extremities of hemiplegic individuals and to analyze the functional recovery that may occur after rehabilitation. The MFT consists of 8 sections and 32 items that measure arm movements and manipulative activities. The participant can get a maximum of 32 and a minimum of 4 points from this test. Purdue peg-board test will be used in the test content . The validity and reliability study of the scale in stroke patients was conducted in 2009
Measured: 0-8 weeks
Trunk Balance Assessment:
Trunk İmpairment Scale is a scale used to evaluate the static-dynamic sitting balance and coordination of the trunk It is a 17-item scale used to evaluate the motor loss of the trunk after stroke. 3 items of this scale are used to evaluate static sitting balance, 10 items are used to evaluate dynamic sitting balance and 4 items are used to evaluate coordination. 3 items of this scale are used to evaluate static sitting balance, 10 items are used to evaluate dynamic sitting balance and 4 items are used to evaluate coordination. The minimum score is 0 and the maximum score is 23, with the highest score showing the best performance. The Turkish validity and reliability study of the scale was conducted by Sağ et al. in 2019
Measured: 0-8 weeks
Treatment Satisfaction
Treatment satisfaction will be measured after boxing and scapular stabilization training with a visual analog scale (VAS). A VAS for satisfaction is a horizontal line of 100-mm long. At the beginning and at the end, there are two descriptors representing extremes of satisfaction (i.e. no satisfaction and extreme satisfaction). Patient will rate satisfaction by making a vertical mark on the 100 mm line. (0 = least satisfied, 100 = most satisfied) The measurement in millimetres was converted to the same number of points ranging from 0 to 100 points. The exact question was "How satisfied were you with the treatment you received? " A standard explanation of how to fill in the VAS form was mentioned beneath the VAS horizontal line.
Measured: 8th week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Oct 2022
- Study start13 Oct 2022
- Primary completion10 Sep 2023
- Study completion10 Sep 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (27)Papers the sponsor has linked to this study.
- Other trials for StrokeStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 60 participants (actual)
Sponsor and investigators
- Lead sponsor
- Eastern Mediterranean University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Ceren Ersoy, Eastern Mediterranean University
- Investigators
- Gözde İyigün, Assoc.Prof., Study chair, Eastern Mediterranean University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05568173
- Sponsor's protocol ID
- ETK00-2022-0181
- Status last verified
- Nov 2023
- First submitted
- 1 Oct 2022
- Last updated
- 7 Nov 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994 Aug;75(8):852-7. doi: 10.1016/0003-9993(94)90108-2.
PubMed 8053790Jaraczewska E, Long C. Kinesio taping in stroke: improving functional use of the upper extremity in hemiplegia. Top Stroke Rehabil. 2006 Summer;13(3):31-42. doi: 10.1310/33KA-XYE3-QWJB-WGT6.
PubMed 16987790Mantone JK, Burkhead WZ Jr, Noonan J Jr. Nonoperative treatment of rotator cuff tears. Orthop Clin North Am. 2000 Apr;31(2):295-311. doi: 10.1016/s0030-5898(05)70149-8.
PubMed 10736398Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg. 2012 Jun;20(6):364-72. doi: 10.5435/JAAOS-20-06-364.
PubMed 22661566De Baets L, Jaspers E, Janssens L, Van Deun S. Characteristics of neuromuscular control of the scapula after stroke: a first exploration. Front Hum Neurosci. 2014 Nov 17;8:933. doi: 10.3389/fnhum.2014.00933. eCollection 2014.
PubMed 25477805Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the 'Scapular Summit'. Br J Sports Med. 2013 Sep;47(14):877-85. doi: 10.1136/bjsports-2013-092425. Epub 2013 Apr 11.
PubMed 23580420Genthon N, Gissot AS, Froger J, Rougier P, Perennou D. Posturography in patients with stroke: estimating the percentage of body weight on each foot from a single force platform. Stroke. 2008 Feb;39(2):489. doi: 10.1161/STROKEAHA.107.493478. Epub 2008 Jan 3.
PubMed 18174486Triolo R, Wibowo M, Uhlir J, Kobetic R, Kirsch R. Effects of stimulated hip extension moment and position on upper-limb support forces during FNS-induced standing--a technical note. J Rehabil Res Dev. 2001 Sep-Oct;38(5):545-55.
PubMed 11732832Hardwick DD, Lang CE. Scapular and humeral movement patterns of people with stroke during range-of-motion exercises. J Neurol Phys Ther. 2011 Mar;35(1):18-25. doi: 10.1097/NPT.0b013e318208efa1.
PubMed 21475080Winter DA, Patla AE, Frank JS, Walt SE. Biomechanical walking pattern changes in the fit and healthy elderly. Phys Ther. 1990 Jun;70(6):340-7. doi: 10.1093/ptj/70.6.340.
PubMed 2345777Awad A, Shaker H, Shendy W, Fahmy M. Effect of shoulder girdle strengthening on trunk alignment in patients with stroke. J Phys Ther Sci. 2015 Jul;27(7):2195-200. doi: 10.1589/jpts.27.2195. Epub 2015 Jul 22.
PubMed 26311953Kim JO, Lee J, Lee BH. Effect of Scapular Stabilization Exercise during Standing on Upper Limb Function and Gait Ability of Stroke Patients. J Neurosci Rural Pract. 2017 Oct-Dec;8(4):540-544. doi: 10.4103/jnrp.jnrp_464_16.
PubMed 29204011Ersoy C, Iyigun G. Boxing training in patients with stroke causes improvement of upper extremity, balance, and cognitive functions but should it be applied as virtual or real? Top Stroke Rehabil. 2021 Mar;28(2):112-126. doi: 10.1080/10749357.2020.1783918. Epub 2020 Jun 23.
PubMed 32574096Silverson OA, Lemaster NG, Hettrich CM, Heebner NR, Uhl TL. Reliability and Validity of a Clinical Assessment Tool for Measuring Scapular Motion in All 3 Anatomical Planes. J Athl Train. 2021 Jun 1;56(6):586-593. doi: 10.4085/276-20.
PubMed 33150418Luedtke K, Schoettker-Koniger T, Hall T, Reimer C, Grassold M, Hasselhoff-Styhler P, Neulinger C, Obrocki M, Przyhoda P, Schafer A. Concurrent validity and reliability of measuring range of motion during the cervical flexion rotation test with a novel digital goniometer. BMC Musculoskelet Disord. 2020 Aug 11;21(1):535. doi: 10.1186/s12891-020-03525-6.
PubMed 32781990
Study at a glance
From the registry record, last updated by the sponsor on 7 Nov 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of the Effects of Boxing and Scapular Stabilization Training in Hemiparetic Patients
- ClinicalTrials.gov ID
- NCT05568173
- Acronym / sponsor ID
- ETK00-2022-0181
- Conditions
- Stroke, Hemiparesis
- Keywords
- boxing, upper extremity function, balance, Stroke
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 60 participants (actual)
- Lead sponsor
- Eastern Mediterranean UniversityUniversity, hospital or other
- Study start
- 13 Oct 2022 (actual)
- Primary completion
- 10 Sep 2023 (actual)
- Study completion
- 10 Sep 2023 (actual)
- First posted
- 5 Oct 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
In recent years, it has been observed that scapular stabilization exercises given in addition to stretching exercises in stroke patients strengthen the scapular muscles and improve walking and trunk alignment. In a study published in 2020, in which the investigators compared the effects of virtual and real boxing training on upper extremity functions, balance and cognitive functions in stroke patients, significant improvement was observed in each parameter in both groups.
When the investigators look at the literature, the investigators see that there is no study comparing the effects of both scapular stabilization and boxing training on upper extremity functions and trunk balance in stroke patients.
Therefore the aim of this study, compare the effects of boxing and scapular stabilization training on scapular mobility (primary outcome measure), upper extremity range of motion, shoulder proprioception, scapular balance angle, scapular muscle strength, trunk muscle strength, upper extremity motor functions, trunk balance and treatment satisfaction (secondary outcome measures) in hemiparetic individuals with stroke.
Detailed description
Upper extremity dysfunction can be seen in approximately 30% to 66% of hemiplegic patients. Loss of the Betz cell, which is the most abundant in the cerebral cortex and is responsible for the control of the hand, leads to impaired hand functions in hemiparetic patients who have had a stroke. Flexor spasticity predominates in the upper extremities. In addition to internal rotation and adduction of the shoulder, retraction and depression of the scapula are observed. The subscapularis and pectoral muscles are the muscles whose tone increases the most in this process. In addition, the rhomboids, serratus anterior, deltoid, trapezius middle, and lower parts are the muscles that weaken the most. For upper extremity elevation, the humeral head must be located within the glenoid fossa. Deltoid and rotator cuff muscles work as a force couple to achieve this. The most important muscles preventing glenohumeral joint subluxation are the posterior deltoid, supraspinatus, and infraspinatus.
A visible change in the movement pattern and position of the scapula relative to the thorax is defined as scapular dyskinesia. In the literature, there is no consensus on whether scapular dyskinesia occurs secondary to any pathology or influence, or whether it is the cause of these pathologies. In an EMG study performed during shoulder flexion in stroke patients, delayed muscle activation of the lower trapezius muscle was observed in stroke patients with shoulder pain compared to stroke patients without shoulder pain. In the electromyography study conducted by Betz et al. in 2014, they observed that the Serratus anterior muscle was inactive or late active in some of the stroke patients with shoulder pain, while the infraspinatus muscle was activated earlier and the activation lasted longer in stroke patients without shoulder pain. The researchers pointed out that these results show the role of the timing of activation of the infraspinatus muscle in shoulder stabilization and prevention of shoulder pain in stroke patients, and that infraspinatus muscle strengthening exercises should be added to rehabilitation to prevent shoulder impingement syndrome, and they drew attention to the importance of serratus anterior and lower trapezius muscle in scapular motor control to provide dynamic stabilization.
Postural stability is defined as the relationship of body parts to the center of gravity. It has been said that the basic prerequisite for movements requiring complex controlled ability is postural stability. Many studies have investigated the relationship between balance disorder and lower extremity dysfunction in stroke, however, it is thought that upper extremity dysfunction also affects balance significantly.Williams et al. showed in their study that scapulothoracic joint stabilization, mostly generated by the trapezius and serratus anterior muscles, contributes significantly to trunk core stability. During voluntary arm movements, force moments occur in the shoulder depending on the weight and dynamics of the arm. These forces and moments can affect the ability to sit, stand and also change positions. Body stabilization during walking is provided by ± 1.5 ° movement of the upper body. This movement can increase the stability of the head by reducing false signals from the otolith and vestibular systems. In the study conducted by Awad et al. in hemiparetic patients with stroke, stretching exercises for the pectorals, latissimus dorsi, rhomboids, and teres major muscles, scapular stabilization exercises in addition to trunk control exercises were applied 3 times a week for 6 weeks, and it was observed that scapular muscle strength increased and trunk alignment improved. In another study by Jo et al. in 2019, it was observed that strengthening exercises given to the scapular muscles 3 times a week for 8 weeks in addition to stretching exercises improved upper extremity and walking functions.
In a study published in 2020, in which the investigators compared the effects of virtual and real boxing training on upper extremity functions, balance, and cognitive functions in stroke patients, significant improvement was observed in each parameter in both groups .
When the investigators look at the literature, the investigators see that there is no study comparing the effects of both scapular stabilization and boxing training on upper extremity functions and trunk balance in stroke patients.
Therefore the aim of this study, compare the effects of boxing and scapular stabilization training on scapular mobility (primary outcome measure), upper extremity range of motion, shoulder proprioception, scapular balance angle, scapular muscle strength, trunk muscle strength, upper extremity motor functions, trunk balance and treatment satisfaction (secondary outcome measures) in hemiparetic individuals with stroke.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Boxing Training | Experimental | Other: Boxing TrainingIn the Boxing Training Group (BG) boxing training will be given. Additionally, stretching exercises and postural training will be applied. |
| Scapular Stabilization | Experimental | Other: Scapular StabilizationIn the Scapular Stabilization Group (SSG) scapular stabilization training will be given. Additionally, stretching exercises and postural training will be applied. |
| Control | No intervention | –Individuals in this group will not receive any treatment. Evaluations will be made before treatment and after 8 weeks of treatment. |
Who may qualify
- Ages
- 40 to 70 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (7 listed)
- Patients diagnosed with first time ever stroke
- Patients with hemiparesis
- Patients who are between the ages of 40-70
- Patients who has Mini Mental Test score above 23
- Patients whose functional level is less than 4 according to the Modified Rankin Scale
Key exclusion criteria (6 listed)
- Having a chronic disease (for example: uncontrolled hypertension,heart disease…)
- Subluxation and fracture at the shoulder
- Risk of fracture and pain at the shoulder
- Visual and hearing impairment
- Unilateral neglect
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Boxing TrainingIn addition to boxing training, stretching exercises and posture training will be given at BG. A physiotherapist with a boxing training certificate will perform modified boxing training that progresses according to the degree of difficulty. There will be four difficulty levels. The complexity of the exercises will increase at 2-week intervals as the patient progresses. As a result, 0-2 weeks 1st level, 2-4 weeks 2nd level, 4-6 weeks 3rd level and 6-8 weeks 4th level exercises will be done. In the first level, patients will be asked to punch the fixed boxing mat hanging on the wall with various instructions. Then, in levels 2-4, target gloves and heavy punching bags will be used to increase the difficulty level. As the sessions progress, the resistance and frequencies between the levels will be increased by the physiotherapist. There will be 3 sessions of 30-minute boxing training per week for 8 weeks at BG. | Other | Boxing Training |
| Scapular StabilizationIn addition to scapular stabilization training, stretching exercises and posture training will be given in SSG. Progressive strengthening training for the scapular muscles will be used in the SSG. There will be four difficulty levels. The complexity of the exercises will increase at 2-week intervals as the patient progresses. As a result, 0-2 weeks 1st level, 2-4 weeks 2nd level, 4-6 weeks 3rd level and 6-8 weeks 4th level exercises will be done. At the first level, scapular clock exercise, obstacle crossing exercise, wall gliding exercise with teraband, push up exercise, trunk rotation and maximum hip flexion will be performed. Then at levels 2-4, as the levels increase, the exercises at the first level will be more difficult (ball weight, surface, number of hurdles and hurdle crossing exercise position, by changing the teraband elasticity, push-up position). In SSG, 3 sessions of 30-minute scapular stabilization training will be applied per week for 8 weeks. | Other | Scapular Stabilization |
Primary outcome
Scapular Mobility Assessment
Time frame: 0-8 week
Upward and downward rotation in the scapular plane, anterior and posterior tilt in the sagittal plane and internal and external rotation in the transverse plane will be measured by using an electronic goniometer (The EasyAngle electric goniometer Meloq AB). After the device is calibrated in all three planes, the gradual difference in shoulder elevation and scapular movement enables the angular determination of the mobility of the scapula in three planes. In the reliability study, the inter-session evaluator reliability was found to be moderate to good (ICC [2,3] range = 0.628-0.874). In-session interpreter reliability was moderate to excellent(ICC [2,3] range = 0.545-0.912).
10 secondary outcomes
Glenohumeral Joint Range of Motion Measurement
Time frame: 0-8 weeks
Shoulder Proprioception Measurement
Time frame: 0-8 weeks
Scapular Balance Angle Measurement (SBA)
Time frame: 0-8 weeks
Scapular Muscle Strength Measurement
Time frame: 0-8 weeks
Trunk Muscle Strength Measurement
Time frame: 0-8 weeks
Pectoralis Minor Length Measurement
Time frame: 0-8 weeks
Total Scapular Distance
Time frame: 0-8 weeks
Upper-Extremity Motor Function Assessment
Time frame: 0-8 weeks
Trunk Balance Assessment:
Time frame: 0-8 weeks
Treatment Satisfaction
Time frame: 8th week
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Nov 2023.
- Background: PubMed 8053790Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994 Aug;75(8):852-7. doi: 10.1016/0003-9993(94)90108-2.
- Background: PubMed 16987790Jaraczewska E, Long C. Kinesio taping in stroke: improving functional use of the upper extremity in hemiplegia. Top Stroke Rehabil. 2006 Summer;13(3):31-42. doi: 10.1310/33KA-XYE3-QWJB-WGT6.
- Background: PubMed 10736398Mantone JK, Burkhead WZ Jr, Noonan J Jr. Nonoperative treatment of rotator cuff tears. Orthop Clin North Am. 2000 Apr;31(2):295-311. doi: 10.1016/s0030-5898(05)70149-8.
- Background: PubMed 22661566Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg. 2012 Jun;20(6):364-72. doi: 10.5435/JAAOS-20-06-364.
- Background: PubMed 25477805De Baets L, Jaspers E, Janssens L, Van Deun S. Characteristics of neuromuscular control of the scapula after stroke: a first exploration. Front Hum Neurosci. 2014 Nov 17;8:933. doi: 10.3389/fnhum.2014.00933. eCollection 2014.
- Background: PubMed 23580420Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the 'Scapular Summit'. Br J Sports Med. 2013 Sep;47(14):877-85. doi: 10.1136/bjsports-2013-092425. Epub 2013 Apr 11.
- Background: PubMed 18174486Genthon N, Gissot AS, Froger J, Rougier P, Perennou D. Posturography in patients with stroke: estimating the percentage of body weight on each foot from a single force platform. Stroke. 2008 Feb;39(2):489. doi: 10.1161/STROKEAHA.107.493478. Epub 2008 Jan 3.
- Background: PubMed 11732832Triolo R, Wibowo M, Uhlir J, Kobetic R, Kirsch R. Effects of stimulated hip extension moment and position on upper-limb support forces during FNS-induced standing--a technical note. J Rehabil Res Dev. 2001 Sep-Oct;38(5):545-55.
- Background: PubMed 21475080Hardwick DD, Lang CE. Scapular and humeral movement patterns of people with stroke during range-of-motion exercises. J Neurol Phys Ther. 2011 Mar;35(1):18-25. doi: 10.1097/NPT.0b013e318208efa1.
- Background: PubMed 2345777Winter DA, Patla AE, Frank JS, Walt SE. Biomechanical walking pattern changes in the fit and healthy elderly. Phys Ther. 1990 Jun;70(6):340-7. doi: 10.1093/ptj/70.6.340.
- Background: PubMed 26311953Awad A, Shaker H, Shendy W, Fahmy M. Effect of shoulder girdle strengthening on trunk alignment in patients with stroke. J Phys Ther Sci. 2015 Jul;27(7):2195-200. doi: 10.1589/jpts.27.2195. Epub 2015 Jul 22.
- Background: PubMed 29204011Kim JO, Lee J, Lee BH. Effect of Scapular Stabilization Exercise during Standing on Upper Limb Function and Gait Ability of Stroke Patients. J Neurosci Rural Pract. 2017 Oct-Dec;8(4):540-544. doi: 10.4103/jnrp.jnrp_464_16.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Gözde İyigün, Assoc.Prof. study chair
Eastern Mediterranean University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Boxing Training and Scapular Stabilization in people with Stroke and Hemiparesis, run by Eastern Mediterranean University at 1 site in Cyprus.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 7 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Cyprus. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Scapular Mobility Assessment (time frame: 0-8 week). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05568173, which also lists 27 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Nov 2023; AzTrials last refreshed its copy on 31 Oct 2026.