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Reaching higher: external scapula assistance can improve upper limb function in humans with irreversible scapula alata
Georgarakis AM, Xiloyannis M, Dettmers C, Joebges M, Wolf P, Riener R
Journal of NeuroEngineering & Rehabilitation 2021 Sep 3;18(131):Epub
clinical trial
2/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: No; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Scapular dyskinesis, ie, the deviant mobility or function of the scapula, hampers upper limb function in daily life. A typical sign of scapular dyskinesis is a scapula alata-a protrusion of the shoulder blade during arm elevation. While some reversible causes of scapula alata can be treated with therapy, other, irreversible causes require invasive surgical interventions. When surgery is not an option, however, severe limitations arise as standard approaches for assisting the scapula in daily life do not exist. The aim of this study was to quantify functional improvements when external, ie, non-invasive, scapula assistance is provided. METHODS: The study was designed as a randomized controlled crossover trial. Eight participants with a scapula alata due to muscular dystrophy performed arm elevations in shoulder flexion and abduction while unassisted (baseline), externally assisted by a trained therapist, and externally assisted by a novel, textile-based scapula orthosis. RESULTS: With therapist assistance, average arm elevation increased by 17.3 degrees in flexion (p < 0.001, 95% confidence interval of the mean CI 95% 9.8 to 24.9 degrees), and by 11.2 degrees in abduction (p < 0.01, CI 95% 4.7 to 17.7 degrees), constituting the potential of external scapula assistance. With orthosis assistance, average arm elevation increased by 6.2 degrees in flexion (CI 95% 0.4 to 11.9 degrees) and by 5.8 degrees in abduction (CI 95% 3.0 to 8.5 degrees). Remarkably, in three participants, the orthosis was at least as effective as the therapist. Moreover, orthosis assistance reduced average perceived exertion by 1.25 points (Borg Scale) when elevating a filled bottle during a simulated daily living task. CONCLUSION: These findings indicate a large potential for future advancements in orthotics. Already now, the textile-based scapula orthosis presented here is a feasible tool for leveraging the benefits of external scapula assistance when a therapist is unavailable, as encountered in daily life scenarios. TRIAL REGISTRATION: ClincalTrials.gov NCT04154098. Registered November 6th 2019.

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