Sensor-Based Assessment of Post-Stroke Shoulder Pain and Balance

Background/Objectives: Hemiplegic shoulder pain (HSP) is a frequent post-stroke complication affecting 30-65% of survivors, contributing to motor dysfunction and reduced quality of life. Balance impairment is another major concern that increases fall risk. This study aimed to examine the associations between HSP, shoulder range-of-motion (ROM) limitations and balance performance using both clinical and sensor-based evaluations. Methods: In this cross-sectional study, 108 stroke survivors (54 with HSP, 54 without) were assessed. Pain intensity was evaluated using the Visual Analog Scale (VAS), balance with the Berg Balance Scale (BBS), and shoulder mobility and postural sway with the validated Euleria Lab IMU-based system integrated with a force platform. Between-group differences were analyzed using the Mann-Whitney U test, and correlations between pain, ROM, balance, and fall-risk indices were determined via Spearman coefficients. Results: Participants with HSP had significantly lower BBS scores (20.96 ± 8.71) than those without HSP (34.58 ± 11.71; p < 0.001). VAS activity scores were negatively correlated with BBS (r = -0.196, p = 0.043) and positively correlated with postural sway and fall-risk parameters, particularly under eyes-closed conditions. Shoulder ROM limitations were linked to poorer balance, and both static and dynamic fall-risk indices were strongly correlated with pain severity (r = 0.676 and r = 0.657; p < 0.001). Conclusions: HSP was associated with impaired balance and elevated fall risk in stroke survivors. The combination of clinical scales and wearable sensor-based measurements provides a comprehensive understanding of postural control deficits. These findings emphasize the need for rehabilitation strategies targeting pain reduction, shoulder mobility, and balance to support functional recovery.