{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:27:36Z","timestamp":1792600056945,"version":"4.5.0"},"reference-count":43,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T00:00:00Z","timestamp":1724112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: We investigated the effects of sling-suspension-based active shoulder joint exercise training on shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke. Materials and Methods: Twenty-eight patients with subacute stroke were randomly assigned to either the sling-suspension-based active shoulder joint exercise (SASE) group (n = 14) or the motorized upper extremity exercise (MUEE) group (n = 14). The SASE group actively performed shoulder joint flexion, extension, abduction, adduction, external and internal rotation, and horizontal abduction and adduction using a sling suspension system, whereas the MUEE group underwent an exercise program using a motorized upper extremity exercise machine. All participants underwent a 4-week intervention with 30 min of exercise once a day for 5 days a week. Additionally, both groups received general physical therapy and functional electrical stimulation for 30 min twice a day for 5 days a week. Shoulder joint subluxation was measured by radiographic examination before and after training, and pain was evaluated in the splenius, upper trapezius, and infraspinatus muscles using pressure parameters. In addition, a manual muscle tester was used to assess the muscle strength of the shoulder joint flexors, extensors, abductors, adductors, and external and internal rotators, and the Fugl\u2013Mayer Assessment (FMA) and Manual Functional Test (MFT) were used to evaluate upper extremity function. Results: A significant group\u2013time interaction was observed for pain, with F-values of F(1, 26) = 7.470, p &lt; 0.011 for the splenius and F(1, 26) = 9.623, p &lt; 0.005 for the upper trapezius. A significant time\u2013group interaction was observed for the muscle strength of the shoulder, with F-values of F(1, 26) = 13.211, p &lt; 0.001; F(1, 26) = 4.974, p = 0.035 and F(1, 26) = 9.674, p = 0.004 for flexors, abductors, and external rotators, respectively. A significant time\u2013group interaction was observed in the FMA, with F-values of F(1, 26) = 13.243, p &lt; 0.001. When comparing the interaction effects between time and group for MFT scores, a significant difference was observed, with F-values of F(1, 26) = 32.386, p &lt; 0.001. Conclusions: This study confirmed that sling-suspension-based active shoulder joint exercises are effective in improving shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke.<\/jats:p>","DOI":"10.3390\/medicina60081350","type":"journal-article","created":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T01:38:45Z","timestamp":1724117925000},"page":"1350","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effects of Sling-Suspension-Based Active Shoulder Joint Exercise on Shoulder Joint Subluxation, Pain, Muscle Strength, and Upper Limb Function in Patients with Subacute Stroke"],"prefix":"10.3390","volume":"60","author":[{"given":"Young-Jun","family":"Kim","sequence":"first","affiliation":[{"name":"Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1409-6069","authenticated-orcid":false,"given":"Jungae","family":"An","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9766-6068","authenticated-orcid":false,"given":"Byoung-Hee","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1080\/10749357.2017.1383712","article-title":"Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: A systematic review","volume":"25","author":"Arya","year":"2018","journal-title":"Top. Stroke Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/00002060-199809000-00012","article-title":"Evaluation and treatment of shoulder subluxation in hemiplegia: Relationship between subluxation and pain1","volume":"77","author":"Ikai","year":"1998","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_3","first-page":"1885","article-title":"Post stroke shoulder subluxation and shoulder pain: A cohort multicenter study","volume":"91","author":"Suethanapornkul","year":"2008","journal-title":"Med. J. Med. Assoc. Thail."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.gaitpost.2010.09.008","article-title":"The effect of arm sling on balance in patients with hemiplegia","volume":"32","author":"Acar","year":"2010","journal-title":"Gait Posture"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e4525","DOI":"10.1097\/MD.0000000000004525","article-title":"Prediction of motor outcome by shoulder subluxation at early stage of stroke","volume":"95","author":"Jang","year":"2016","journal-title":"Medicine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1097\/PHM.0b013e318214e976","article-title":"Underlying pathology and associated factors of hemiplegic shoulder pain","volume":"90","author":"Kalichman","year":"2011","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1053\/apmr.2001.23310","article-title":"Comparing stimulation-induced pain during percutaneous (intramuscular) and transcutaneous neuromuscular electric stimulation for treating shoulder subluxation in hemiplegia","volume":"82","author":"David","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_8","first-page":"409","article-title":"The source of shoulder pain in hemiplegia","volume":"73","author":"Joynt","year":"1992","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1310\/tsr1905-444","article-title":"Current and future interventions for glenohumeral subluxation in hemiplegia secondary to stroke","volume":"19","author":"Stolzenberg","year":"2012","journal-title":"Top. Stroke Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/S0004-9514(14)60165-3","article-title":"Efficacy of electrical stimulation in preventing or reducing subluxation of the shoulder after stroke: A meta-analysis","volume":"48","author":"Ada","year":"2002","journal-title":"Aust. J. Physiother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1053\/apmr.2002.33098","article-title":"Effect of an arm sling on gait pattern in patients with hemiplegia","volume":"83","author":"Yavuzer","year":"2002","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_12","first-page":"175","article-title":"The California tri-pull taping method in the treatment of shoulder subluxation after stroke: A randomized clinical trial","volume":"8","author":"Chatterjee","year":"2016","journal-title":"N. Am. J. Med. Sciences."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Chen, L., Chen, J., Peng, Q., Chen, J., Zou, Y., and Liu, G. (2016). Effect of sling exercise training on balance in patients with stroke: A meta-analysis. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0163351"},{"key":"ref_14","first-page":"87","article-title":"Sling exercise therapy (SET): A total concept for exercise and active treatment of musculoskeletal disorders","volume":"7","author":"Kirkesola","year":"2001","journal-title":"J. Korean Acad. Orthop. Man. Phys. Ther."},{"key":"ref_15","first-page":"4849","article-title":"The effects of active shoulder exercise with a sling suspension system on shoulder subluxation, proprioception, and upper extremity function in patients with acute stroke","volume":"25","author":"Jung","year":"2019","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_16","first-page":"582","article-title":"Shoulder subluxation in hemiplegia: Effects of three different supports","volume":"72","author":"Brooke","year":"1991","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_17","first-page":"253","article-title":"Radiological Projection for Diagnosis of Shoulder Subluxation in Patients with Post-Stroke Hemiplegia","volume":"32","author":"Cho","year":"2009","journal-title":"J. Radiol. Sci. Technol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/0304-3959(88)90176-5","article-title":"Tender points in fibromyalgia","volume":"34","author":"Tunks","year":"1988","journal-title":"Pain"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.jmpt.2016.03.003","article-title":"Manual and instrument applied cervical manipulation for mechanical neck pain: A randomized controlled trial","volume":"39","author":"Gorrell","year":"2016","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_20","first-page":"777","article-title":"Gait performance of hemiparetic stroke patients: Selected variables","volume":"68","author":"Bohannon","year":"1987","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1177\/154596802401105171","article-title":"The Fugl-Meyer assessment of motor recovery after stroke: A critical review of its measurement properties","volume":"16","author":"Gladstone","year":"2002","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/PHM.0b013e3181951133","article-title":"Reliability and validity of the Manual Function Test in patients with stroke","volume":"88","author":"Miyamoto","year":"2009","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Byrne, B.M. (2013). Structural Equation Modeling with Mplus: Basic Concepts, Applications, and Programming, Routledge.","DOI":"10.4324\/9780203807644"},{"key":"ref_24","unstructured":"Calliet, R. (1991). Neck and Arm Pain: Pain Series, FA Davis & Co."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/S0031-9406(05)60412-9","article-title":"Management of the subluxed low tone shoulder: Review of the evidence","volume":"88","author":"Morley","year":"2002","journal-title":"Physiotherapy"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1191\/0269215503cr612oa","article-title":"Shoulder pain in people with a stroke: A population-based study","volume":"17","author":"Ratnasabapathy","year":"2003","journal-title":"Clin. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"252","DOI":"10.2340\/16501977-0049","article-title":"A randomized study of new sling exercise treatment vs traditional physiotherapy for patients with chronic whiplash-associated disorders with unsettled compensation claims","volume":"39","author":"Vikne","year":"2007","journal-title":"J. Rehabil. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/S1050-6411(99)00008-5","article-title":"Reduction in subluxation and improved muscle function of the hemiplegic shoulder joint after therapeutic electrical stimulation","volume":"9","author":"Kobayashi","year":"1999","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.clinbiomech.2017.12.005","article-title":"Scapular-focused exercise treatment protocol for shoulder impingement symptoms: Three-dimensional scapular kinematics analysis","volume":"51","author":"Hotta","year":"2018","journal-title":"Clin. Biomech."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/j.1600-0838.2010.01274.x","article-title":"Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability","volume":"21","author":"Struyf","year":"2011","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"259","DOI":"10.5604\/15093492.1058421","article-title":"Subluxation of the shoulder joint in stroke patients and the influence of selected factors on the incidence of instability","volume":"15","author":"Pop","year":"2013","journal-title":"Ortop. Traumatol. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1177\/0269215510375919","article-title":"The effect of electrical stimulation in combination with Bobath techniques in the prevention of shoulder subluxation in acute stroke patients","volume":"25","author":"Fil","year":"2011","journal-title":"Clin. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1093\/ptj\/72.9.624","article-title":"Agonist and antagonist activity during voluntary upper-limb movement in patients with stroke","volume":"72","author":"Gowland","year":"1992","journal-title":"Phys. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.clinbiomech.2010.04.014","article-title":"Neuro-rehabilitation robot-assisted assessments of synergy patterns of forearm, elbow and shoulder joints in chronic stroke patients","volume":"25","author":"Kung","year":"2010","journal-title":"Clin. Biomech."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1002\/ca.21123","article-title":"A comprehensive analysis of muscle recruitment patterns during shoulder flexion: An electromyographic study","volume":"24","author":"Wattanaprakornkul","year":"2011","journal-title":"Clin. Anat."},{"key":"ref_36","unstructured":"Criswell, E. (2010). Cram\u2019s Introduction to Surface Electromyography, Jones & Bartlett Publishers."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S1474-4422(09)70150-4","article-title":"Motor recovery after stroke: A systematic review","volume":"8","author":"Langhorne","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1080\/02699050110103337","article-title":"Functional recovery and instrumental activities of daily living: Follow-up 1-year after treatment in a stroke unit","volume":"16","author":"Herrero","year":"2002","journal-title":"Brain Inj."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/pri.349","article-title":"Shoulder subluxation after stroke: Relationships with pain and motor recovery","volume":"12","author":"Paci","year":"2007","journal-title":"Physiother. Res. Int."},{"key":"ref_40","unstructured":"Potturi, G., Dubey, N., Agarwal, A., and Chaudhary, R.S. (2024). A narrative review on various therapeutic approaches used by physiotherapists in stroke patients. Int. J. Med., 8."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1743-0003-9-44","article-title":"Influence of gravity compensation training on synergistic movement patterns of the upper extremity after stroke, a pilot study","volume":"9","author":"Krabben","year":"2012","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1179\/1945511915Y.0000000003","article-title":"Minimal clinically important difference of the lower-extremity fugl\u2013meyer assessment in chronic-stroke","volume":"23","author":"Pandian","year":"2016","journal-title":"Top. Stroke Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1310\/LADU-8LJY-KTQ0-L5DJ","article-title":"Recovery patterns of shoulder subluxation after stroke: A six-month follow-up study","volume":"8","author":"Zorowitz","year":"2001","journal-title":"Top. Stroke Rehabil."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/8\/1350\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:39:21Z","timestamp":1760110761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/8\/1350"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,20]]},"references-count":43,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["medicina60081350"],"URL":"https:\/\/doi.org\/10.3390\/medicina60081350","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,20]]}}}