Related Experiment Video
Updated: Mar 19, 2026
Robotic Mirror Therapy System for Functional Recovery of Hemiplegic Arms
Published on: August 15, 2016
Lap-tray and triangular sling are no more effective than a hemi-sling in preventing shoulder subluxation in those at
Louise Ada1, Anchalee Foongchomcheay2, Birgitta Langhammer3
1Discipline of Physiotherapy, The University of Sydney, Sydney, Australia - ada@sydney.edu.au.
Background:
Shoulder subluxation is a common secondary impairment of the upper limb following stroke. A range of supportive devices are used in rehabilitation to prevent shoulder subluxation, including hemi-slings and firm supports, such as arm troughs, however, there is little evidence regarding their efficacy.
Aim:
To determine whether a modified lap-tray during sitting and a triangular sling during standing is more effective than a hemi-sling in preventing shoulder subluxation, pain, contracture and upper limb activity limitation after stroke.
Design:
A prospective, randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis.
Setting:
Three inpatient rehabilitation units in Australia and Norway.
Population:
Forty-six acute stroke survivors within 3 weeks of stroke who were at risk of subluxation.
Methods:
The experimental group used a modified lap-tray while sitting and a triangular sling while standing to support the affected arm for four weeks. The control group used a hemi-sling while sitting and standing. The primary outcome was amount of shoulder subluxation on X-ray. Secondary outcomes were upper limb activity, pain and contracture.
Results:
There was no significant difference between groups in terms of shoulder subluxation (MD -3 mm, 95% CI -8 to 3). There was a trend for the experimental group to develop less pain at rest (MD -0.7 out of 10, 95% CI -2.2 to 0.8) and during shoulder external rotation (MD -1.7 out of 10, 95% CI -3.7 to 0.3) and a trend towards having less contracture of shoulder external rotation (MD -10 deg, 95% CI -22 to 2). There was no significant difference between groups in terms of other contractures and activity of the upper limb.
Conclusions:
A lap-tray during sitting combined with a triangular sling during standing is no more effective than a hemi-sling in preventing subluxation, pain, contracture and activity limitation in acute stroke survivors at risk of shoulder subluxation.
Clinical Rehabilitation Impact:
The use of a lap-tray during sitting and triangular sling during standing is not indicated as an alternative to the hemi-sling to prevent shoulder subluxation in patients after stroke, so alternative strategies with proven efficacy, such as electrical stimulation, should be considered.
