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how you can enhance your shoulder patient outcomes using visual feedback :

Shoulder application of the Motion Guidance tool can include simply visualizing range of motion, tracing patterns with sustained shoulder elevation in various positions, or working on more specific proprioceptive exercise.

As a shoulder specialist I have been using MG for over a year now as a way to objectively assess my patients upper limb proprioceptive ability as well as monitor its improvement, or lack of, with rehabilitation.
I find the MG unit is a quick, easy, and simple to use device as well as being comfortable and unobtrusive for patients to wear. I have found it helps patients to externalize the movement feedback, which can help improve coordination as well as reduce fearful and painful movements.

— Adam Meakins, Specialist Shoulder Physiotherapist UK: www.thesports.physio

Here are a few ways enhance shoulder rehab with visual feedback:

 

Shoulder Joint Positional Awareness Testing: 

The small strap is wrapped over the patients forearm or humerus, and the parallel mount is used. The patient's position is dependent if the desired shoulder motion is flexion, scaption, or abduction. The patient first practices centering a target, then repeats the exercise without looking. The goal is to improve joint positional awareness, and return to the start position as accurately as possible. 

  • Balke et al. The laser-pointer assisted angle reproduction test for evaluation of proprioceptive shoulder function in patients with instability. Arch Orthop Trauma Surg. 2011 Aug;131(8):1077-84. doi: 10.1007/s00402-011-1285-6. Epub 2011 Feb 25.

Shoulder External Rotation ROM:

  • This video shows how you can add a visual cue for your patient to quantify glenohumeral external rotation: whether encouraging increased ROM, or setting an ROM limitation post shoulder surgery, the visual cue will add valuable real-time feedback. Add a dumbbell to load it up!

Shoulder External Rotation "Joint Positional Awareness" in 90 degrees Abduction:

Research supports a loss of shoulder positional awareness in athletes after injury (similar to the neck after whiplash): you can easily test and train this with Motion Guidance: simply bring the patient to desired position, adjust the laser so its on target, have them practice eyes open relocating the target eyes open, then practice eyes closed (opening to check accuracy).

https://www.ncbi.nlm.nih.gov/pubmed/20129119

Shoulder Horizontal Extension in Various Degrees of Abduction:

This is an example of the "bring the limb to desired position, turn on the laser, then have them get back and move beyond..." concept. Adding a second laser to the thorax ensures the patient is performing pure shoulder ROM.

Shoulder Abduction (Horizontal Abduction ROM):

Add visuals to shoulder ROM, and adjust the laser pointer to promote more or less motion"

Shoulder ROM and Thoracic Disassociation: Isolate Shoulder ROM:

This video adds a visual on both the thorax and the shoulder, to visualize shoulder ROM end range without thoracic rotation compensation (shoulder horizontal abduction)

Shoulder Motor Control Drills:

The small strap is wrapped over the patients forearm or humerus, and the parallel mount is used. The patient's position is dependent if the desired shoulder motion is flexion, scaption, or abduction. The patient practices tracing patterns on the flag, slowly and controlled, both clock wise and counter clock wise. 


Shoulder Stabilization Drills:

The small strap is wrapped  over the patients forearm or humerus, and the parallel mount is used. The patient's position is dependent if the desired shoulder motion is flexion, scaption, or abduction. The patient attempts to keep the laser in target while the clinician can apply perturbations. The patient can target different ranges (higher target or lower target) depending on the desired zone of strengthening and stability. 


Shoulder Active Motion:

The small strap is placed over the patients forearm or humerus, and the parallel mount is used. The patient's position is dependent if the desired shoulder motion is flexion, scaption, or abduction. The patient can perform external and internal rotation, indirect abduction and adduction, as well as protraction and retraction at various ranges. For instance, protraction might be performed at the highest target to emphasize the serratus anterior muscle in shoulder stability drills. 


Shoulder Position Awareness During Specific Exercise:
This video demonstrates the creative use of motion guidance for giving external cues to alert the patient as to possible compensations or movement goals during exercise. Examples could be using the laser for ROM goals during lower trap lift aways, or to guide specific movement in and avoid compensation during typical external rotation exercise.


We are constantly increasing our database of visual assisted exercise. Send us your ideas on social media!