What steps are necessary to establish a program for managing shoulder subluxations in a healthcare facility?

In today’s episode, we dive into the topic of creating a stroke shoulder subluxation program in acute and subacute settings. This is a topic of interest for many therapists, yet it's often overlooked in most facilities. To shed more light on this topic, we are joined by Jenna Barber, who has successfully created a subluxation program at her facility.

“Most facilities are not preemptively addressing this issue. Why pass the buck to outpatient when you have the opportunity to attack it now?"

During our discussion with Jenna, we debunk the effectiveness of slings and taping in reducing or preventing subluxation. Instead, we emphasize that strengthening exercises, particularly for patients with volitional movement, are the most effective approach. We also highlight the importance of proper electrode placement during electrical stimulation (e-stim) therapy, focusing on the posterior deltoid rather than the supra. We stress the importance of evidence-based practice and the need for therapists to be trained and competent in using e-stim therapy.

"I don't know if I would change the program to maybe like shoulder e-stim program. I'm still debating on this one, but I really stressed in the beginning that it's not just shoulder subluxation, it's for those who don't have one yet to prevent one from happening."

Jenna explains the implementation process of the subluxation program for stroke survivors at Froedtert. Patients are evaluated on day one or two after a stroke to determine if they would benefit from the program. Regardless of whether the patient currently has shoulder subluxation or not, they start them on the program to prevent it from happening.

In This Episode

Introduction to Jenna and her subluxation program (0:00)
Subluxation and its effects (7:00)
Strengthening and electrical stimulation for subluxation mitigation (11:25)
Questioning the use of supra for shoulder subluxation treatment (12:19)
Jenna’s motivation to start the program (14:58)
The developmental process and challenges of starting a therapy program (17:00)
The synergy between nursing and therapist training in healthcare (20:45)
Contraindications for the subluxation program (24:29)
Managing the subluxation program at a large neuro hospital (30:20)
The waitlist issue (30:59)
Transition to subacute facilities (33:36)
Communication with subacute therapists (36:34)
How billing for unattended electrical stimulation contributes to therapist productivity (44:41)
Plans to expand the shoulder subluxation program (47:27)
The potential benefits of using tools like mirror boxes and mental practice (50:40)

Our Guest

Jenna Barber, MOT OTR/L, is an accomplished occupational therapist with a Bachelor's in Kinesiology from UW-Eau Claire and a Master's in Occupational Therapy from Concordia University Wisconsin. She excels at Froedtert & MCW, specializing in neuro and orthopedic conditions. Jenna is also an adjunct faculty member, recognized for exceptional patient care, and enjoys family time with her husband and two daughters.

Resources & Links

Jenna Barber on LinkedIn   / jennifer-barber-83906011a  
Stroke Guidelines 2023 https://www.ahajournals.org/doi/10.11...

Henry Hoffman on LinkedIn   / henry-hoffman-01a09312  

Saebo’s Stroke Caregiver Support Group   / 423786023009376  
Saebo’s Stroke Survivor Support Group   / saebostrokesupport  

Download your FREE Saebo Exercise Guide here:
https://www.saebo.com/stroke-exercise...

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Saebo, Inc. is a medical device company primarily engaged in the discovery, development, and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 500,000 clients around the globe achieve a new level of independence.