Effects of trunk restraint combined with intensive task practice on poststroke upper extremity reach and function: a pilot study.
BACKGROUND
Poststroke reaching is characterized by excessive trunk motion and abnormal shoulder-elbow coordination. Little attention is typically given to arm-trunk kinematics during task practice. Preventing compensatory trunk motion during short-term practice immediately improves kinematics, but effects of longer-term practice are unknown.


OBJECTIVE
This study compared the effects of intensive task practice with and without trunk restraint on poststroke reaching kinematics and function.


METHODS
A total of 11 individuals with chronic stroke, baseline Fugl-Meyer Upper Extremity Assessment scores 26 to 54, were randomized to 2 constraint-therapy intervention groups. All participants wore a mitt on the unaffected hand for 90% of waking hours over 14 days and participated in 10 days/6 hours/day of supervised progressive task practice. During supervised sessions, one group trained with a trunk restraint (preventing anterior trunk motion) and one group did not. Tasks for the trunk-restraint group were located to afford repeated use of a shoulder flexion-elbow extension reaching pattern. Outcome measures included kinematics of unrestrained targeted reaching and tests of functional arm ability.


RESULTS
Posttraining, the trunk-restraint group demonstrated straighter reach trajectories (P=.000) and less trunk displacement (P=.001). The trunk-restraint group gained shoulder flexion (P=.006) and elbow extension (P=.022) voluntary ranges of motion, the nonrestraint group did not. Posttraining angle-angle plots illustrated that individuals from the trunk-restraint group transitioned from elbow flexion to elbow extension during mid-reach; individuals in the nonrestraint group retained pretraining movement strategies. Both groups gained functional arm ability (P<.05 all tests).


CONCLUSIONS
Intensive task practice structured to prevent compensatory trunk movements and promote shoulder flexion-elbow extension coordination may reinforce development of "normal" reaching kinematics.
Woodbury
Michelle L
ML
Brain Rehabilitation Research Center, Malcom Randall Veterans Administration Medical Center, Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA. mwoodbur@phhp.ufl.edu
Howland
Dena R
DR
McGuirk
Theresa E
TE
Davis
Sandra B
SB
Senesac
Claudia R
CR
Kautz
Steve
S
Richards
Lorie G
LG
D000368:Aged; D001132:Arm / Q000294:innervation / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D004550:Elbow / Q000503:physiopathology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology*; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D004856:Postural Balance / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012149:Restraint, Physical / Q000379:methods / Q000502:physiology; D012782:Shoulder / Q000503:physiopathology; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome