BACKGROUND: Scapular instability disrupts shoulder biomechanics, exacerbating upper extremity spasticity and motor dysfunction post-stroke. This leads to reduced performance in activities of daily living (ADLs). Scapular stabilization exercises (SSE) can improve rehabilitation outcomes. PURPOSE: To investigate the effects of adding SSE to neurorehabilitation (NR) on upper extremity spasticity, motor function, independence in ADLs, and quality of life (QOL) in patients post-stroke. METHODS: Thirty-six patients post-stroke were randomized into NR (n = 18, 16.77 +/- 6.03 months post-stroke), or NR plus SSE (n = 18, 15.11 +/- 7.62 months post-stroke) groups. Both groups underwent a 6-week (30 sessions/visits) rehabilitation program. Outcome measures included the Modified Ashworth Scale (MAS), Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Functional Independence Measure (FIM), Modified Barthel Index (MBI), and Stroke-Specific Quality of Life Scale (SS-QOL). RESULTS: While both groups improved significantly after intervention, the improvements were greater in the NR plus SSE group except for shoulder extensors: MAS (p = 0.001 to 0.002, d 1.20 to 2.34), FMA-UE (p = 0.001, d 2.54), WMFT functional ability and performance time (both p = 0.001; d 1.24, 1.22), FIM total (p = 0.001, d 1.73), FIM motor (p = 0.001, d 2.11), MBI (p = 0.001, d 1.78), and SS-QOL (p = 0.001, d 2.47). The FIM cognitive score improved only in the NR plus SSE group (p = 0.004, d 0.68). CONCLUSIONS: Adding SSE to NR enhances upper extremity spasticity management, leading to improved motor function independence in ADLs, and QOL. TRIAL REGISTRATION: ClinicalTrial.gov (NCT05609136).

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