Effect of Graded Motor Imagery on Shoulder Dysfunction Post Mastectomy

Effect of Graded Motor Imagery on Shoulder Dysfunction Post Mastectomy

One of the most common complications after breast cancer surgery is a functional limitation of the upper body. Up to 67% of breast cancer patients experience arm or shoulder impairment, including pain, numbness, loss of strength, and reduced ROM, after surgery.

Graded motor imagery is effective in reducing pain interference with function using a graded sequence of strategies including left/right judgements (implicit motor imagery), imagined movements (explicit motor imagery) and mirror therapy.

54 female patients who have shoulder dysfunction post-mastectomy will participate in this study. Their ages will be ranged 35 to 55 years.

In this study the patients will be randomly assigned into two equal groups (27 patients for each group):

1. Group A (study group):

   This group includes 27 patients who will receive graded motor imagery (GMI) along with the conventional physiotherapy (It will include exercise like codman's pendulum exercises in flexion-extension, abduction-adduction, and circular motion, active assisted ROM exercises with a wand, capsular stretching, wall ladder, and shoulder wheel exercises). GMI is consists of a three-step process. Each step of will be carried out for two weeks, for 30 minutes on two separate days, for total 6 weeks.

2. Group B (control group):

This group includes 27 patients who will receive conventional physiotherapy treatment. It will include exercise like codman's pendulum exercises in flexion-extension, abduction-adduction, and circular motion, active assisted ROM exercises with a wand, capsular stretching, wall ladder, and shoulder wheel exercises, 2 times / week for 6 weeks.

Inclusion Criteria:

• Age range of 35 to 55 years.
• All patients are post-mastectomized unilaterally.
• Female patients only.
• Patients have shoulder ROM restriction.
• Patients have shoulder pain more than 3 months (chronic).

Exclusion Criteria:

• Having double mastectomy.
• Psychopathological disorders.
• Having other orthopedic problems (e.g. tendinitis, dislocation, osteoarthritis, referred pain to shoulder).
• Motor problems (e.g. tremor, dyskinesia).
• Metastasis.
• Visual impairment such that they could not read unaided or with their reading glasses.
• Having previously received GMI treatment.
• Diabetes mellitus.
• Having neurological problems as hemiplegia.
• Patients with lymphedema