Observation of arm behaviour in healthy elderly people: implications for contracture prevention after stroke

The purpose of this study was to observe normal arm movement in healthy older adults to determine the duration, frequency, and purpose of arm elevation and external rotation to guide clinical practice in the prevention of contracture. An observational study was undertaken in the homes and local community of 21 older people mean age 73 (SD 7) years. Participants' arm movements were observed for a median time of 254 (IQR 85) min during the day. The duration (min/hr) and frequency (movements/hr) which the arm spent in positions of 45 degrees to 90 degrees elevation, > 90 degrees elevation, and external rotation, as well as the purpose (manipulating, holding, reaching, pulling/pushing, or gesturing) for which these positions were adopted, were recorded. Participants' arms spent little time (3.6 min/hr) at 45 to 90 degrees elevation and almost no time (0.6 min/hr) at > 90 degrees elevation or external rotation (0.6 min/hr). Participants' arms moved to > 90 degrees elevation 13 times/hr and into external rotation 18 times/hr. Participants moved momentarily to elevation > 45 degrees and external rotation in order to reach for objects, while holding objects was the primary reason for maintaining positions for > 2 s. It may be possible to minimise the incidence of shoulder contracture in those patients with stroke who have regained some shoulder muscle activity by placing at-risk muscles in lengthened positions while replicating these features of everyday activities.