Effects of Trunk Restraint Combined With Intensive Task Practice on Poststroke Upper Extremity Reach and Function: A Pilot Study

• Published in: Neurorehabilitation and neural repair 2009-01, Vol.23 (1), p.78-91
• Main Authors: Woodbury, Michelle L., Howland, Dena R., McGuirk, Theresa E., Davis, Sandra B., Senesac, Claudia R., Kautz, Steve, Richards, Lorie G.
• Format: Article
• Language: English
• Subjects: Aged; Arm - innervation; Arm - physiopathology; Biomechanical Phenomena; Elbow - physiopathology; Exercise Therapy - methods; Female; Humans; Male; Middle Aged; Movement Disorders - etiology; Movement Disorders - physiopathology; Movement Disorders - rehabilitation; Muscle, Skeletal - innervation; Muscle, Skeletal - physiopathology; Paresis - etiology; Paresis - physiopathology; Paresis - rehabilitation; Physical Therapy Modalities; Pilot Projects; Postural Balance - physiology; Range of Motion, Articular - physiology; Recovery of Function - physiology; Restraint, Physical - methods; Restraint, Physical - physiology; Shoulder - physiopathology; Stroke - complications; Stroke Rehabilitation; Treatment Outcome
• ISSN: 1545-9683; 1552-6844
• DOI: 10.1177/1545968308318836

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). Conclusion. Intensive task practice structured to prevent compensatory trunk movements and promote shoulder flexion—elbow extension coordination may reinforce development of “normal” reaching kinematics.