Shoulder External Rotation Exercise 
Game co-designed with a stroke survivor and informed by current stroke rehabilitation examples
Post Stroke (2023)
Marinelli & de Palma (2009)

 
Aim
To support shoulder mobility and encourage an external rotation range-of-motion for the paretic upper limb.  This exercise recreates a functional shoulder movement pattern and is guided with musical cues which can help with the pacing and smooth execution of the movement .Different levels feature various repetition counts and game durations.
 
Overview
The External Shoulder Rotation Exercise targets external rotation at the shoulder joint, with the elbow stabilised at a 90-degree angle and close to the torso. Movement is isolated to the shoulder joint, avoiding compensatory motion. A switch press during the outward arc adds interaction, rhythm, and gamification to the rehab task.
 
How to Perform the External Shoulder Rotation Exercise
Sit upright in a comfortable position with your shoulders relaxed.
Bend your elbow to a 90-degree angle, keeping your upper arm close to your body.
Gently rotate your forearm outward to about 20 degrees (or as far as you can without pain or strain, the switch can be moved towards the body or away from the body to make the exercise suitable for your movement).
If the top of your arm begins to move away from your body you could use your opposite hand to hold your bicep in place.
Rotate the forearm outward until you activate the switch.
Slowly return the forearm to the starting position.Repeat the movement in a smooth and rhythmically timed fashion.
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Gaming and Musical Integration
The music is structured in a 4-note rhythmic loop.
On note 1, rotate the forearm outward and press the switch.
By note 3, return the forearm to the starting position.•
Note 4 acts as a brief pause or reset.
 
Tips for Best Results
 Maintain a relaxed shoulder and avoid tensing the upper arm.
Use slow, controlled movement rather than speed — the music will guide your pace.• If pain occurs, stop immediately.


Clinical Application
The External Shoulder Rotation Exercise can be used in a wide range of rehabilitation contexts, particularly:
Neurologic Music Therapy (NMT) – including Patterned Sensory Enhancement (PSE) and Rhythmic Auditory Stimulation (RAS)

 
Music: RebeccaColclasure
Gaming Platform: StepMania