Added Effect of Muscle Energy Technique for Scapular Muscles on Upper Limb Function in Chronic Hemiplegia: A Randomized Controlled Pilot Study
Abstract
Background Upper limb dysfunction affects the majority of stroke survivors and often persists into the chronic stage5. Scapular muscle imbalance compromises proximal stability and limits distal upper limb function, and conventional physiotherapy often fails to specifically target this deficit1,7,10. Muscle Energy Technique (MET) may address scapular hypertonicity and imbalance, but its added effect in chronic hemiplegia is underexplored. Objective To evaluate the added effect of scapular Muscle Energy Technique combined with conventional physiotherapy, compared with conventional physiotherapy alone, on upper limb function in patients with chronic hemiplegia. Methods Design: Two-arm, parallel-group, randomized controlled pilot trial. Setting: Tertiary care teaching hospital, over 6 months. Participants: Twelve adults with chronic hemiplegia (>6 months post-stroke), upper extremity and hand Brunnstrom grade ≥3, Mini-Mental State Examination (MMSE) score >23, randomly allocated (1:1) to a Control group (conventional physiotherapy, n=6) or an Experimental group (conventional physiotherapy plus scapular MET directed at trapezius, pectoralis major, infraspinatus, subscapularis and latissimus dorsi, n=6). Both groups received their respective protocols five sessions per week for 4 weeks. The primary outcome was the Upper Extremity Functional Index (UEFI), assessed before and after the 4-week intervention. Results All 12 randomized participants (6 per group) completed the trial and were analyzed (no losses to follow-up). Both groups showed statistically significant within-group improvement in UEFI scores (Wilcoxon signed-rank test, p = 0.031 for each group). Mean improvement was 12.83 ± 5.04 points in the Experimental group versus 6.33 ± 1.37 points in the Control group. The between-group difference favored the Experimental group (Mann-Whitney U = 34, p = 0.009). Conclusion In this pilot trial, adding scapular MET to conventional physiotherapy produced significantly greater improvement in upper limb function than conventional physiotherapy alone in chronic hemiplegia. Findings should be interpreted cautiously given the small sample size, and confirmation in an adequately powered, blinded, registered trial is warranted.