Effect of task-oriented training with and without trunk Restraint on Reaching Activity in Adult Hemiparetics (original) (raw)
Related papers
Effect of Trunk Restraint on the Recovery of Reaching Movements in Hemiparetic Patients
Stroke, 2001
Background and Purpose — Reaching movements made with the affected arm in hemiparetic patients are often accompanied by compensatory trunk or shoulder girdle movements, which extend the reach of the arm. We investigated the effects of the suppression of these compensatory movements on reaching ability in hemiparetic individuals. Methods — Eleven healthy and 11 hemiparetic individuals participated. Three-dimensional kinematic analysis was used to quantify reaches made to a close and a distant target (near the limit of arm’s length). Unrestrained reaches were compared with those in which shoulder girdle and trunk movements were restrained by a harness. Results — During unrestrained reaching, abnormal trunk recruitment and limitations in elbow and shoulder movements were correlated with the degree of clinical stroke severity ( r =−0.91 to −0.96) in hemiparetic patients. During trunk restraint, ranges of elbow and shoulder joint movement increased in both groups. In addition, elbow and ...
Journal of rehabilitation medicine, 2016
To evaluate the evidence for, and clinical relevance of, immediate and long-term effects of trunk restraint during reach-to-grasp training poststroke on movement patterns and functional abilities within the framework of the International Classification of Functioning, Disability and Health. PubMed, Web of Science, CINAHL, Embase, PEDro, Cochrane Library (publication dates January 1985 to March 2015). Randomized controlled trials comparing training using trunk restraint with any other exercise training. Data were extracted by one researcher and checked by two other researchers. The Cochrane Collaboration's tool for assessing risk of bias and the Physiotherapy Evidence Database scale were used by two researchers to assess study quality and risk of bias. Eight studies met the inclusion criteria. Five studies found better recovery of movement patterns (trunk displacement, elbow extension, and/or shoulder flexion - body function/structure) at post-test in the experimental compared wi...
Stroke, 2004
Background and Purpose-In prehension tasks with objects placed within arm's reach, patients with hemiparesis caused by stroke use excessive trunk movement to compensate for arm motor impairments. Compensatory trunk movements may improve motor function in the short term but may limit arm recovery in the long term. Previous studies showed that restriction of trunk movements during reach-to-grasp movements results in immediate increases in active arm joint ranges and improvement in interjoint coordination. To evaluate the potential of this technique as a therapeutic intervention, we compared the effects of short-term reach-to-grasp training (60-trial training session) with and without physical trunk restraint on arm movement patterns in patients with chronic hemiparesis. Methods-A total of 28 patients with hemiparesis were assigned to 2 groups: 1 group practiced reach-to-grasp movements during which compensatory movement of the trunk was prevented by a harness (trunk restraint), and the second group practiced the same task while verbally instructed not to move the trunk (control). Kinematics of reaching and grasping an object placed within arm's length were recorded before, immediately after, and 24 hours after training. Results-The trunk restraint group used more elbow extension, less anterior trunk displacement, and had better interjoint coordination than the control group after training, and range of motion was maintained 24 hours later in only the trunk restraint group. Conclusions-Restriction of compensatory trunk movements during practice may lead to greater improvements in reach-to-grasp movements in patients with chronic stroke than practice alone, and longer-term effects of this intervention should be evaluated.
Stroke, 2004
Background and Purpose-In prehension tasks with objects placed within arm's reach, patients with hemiparesis caused by stroke use excessive trunk movement to compensate for arm motor impairments. Compensatory trunk movements may improve motor function in the short term but may limit arm recovery in the long term. Previous studies showed that restriction of trunk movements during reach-to-grasp movements results in immediate increases in active arm joint ranges and improvement in interjoint coordination. To evaluate the potential of this technique as a therapeutic intervention, we compared the effects of short-term reach-to-grasp training (60-trial training session) with and without physical trunk restraint on arm movement patterns in patients with chronic hemiparesis. Methods-A total of 28 patients with hemiparesis were assigned to 2 groups: 1 group practiced reach-to-grasp movements during which compensatory movement of the trunk was prevented by a harness (trunk restraint), and the second group practiced the same task while verbally instructed not to move the trunk (control). Kinematics of reaching and grasping an object placed within arm's length were recorded before, immediately after, and 24 hours after training. Results-The trunk restraint group used more elbow extension, less anterior trunk displacement, and had better interjoint coordination than the control group after training, and range of motion was maintained 24 hours later in only the trunk restraint group. Conclusions-Restriction of compensatory trunk movements during practice may lead to greater improvements in reach-to-grasp movements in patients with chronic stroke than practice alone, and longer-term effects of this intervention should be evaluated.
Use of the trunk for reaching targets placed within and beyond the reach in adult hemiparesis
Experimental Brain Research, 2002
Multijoint movements such as reaching are impaired after brain lesions involving sensorimotor areas and pathways. However, the mechanisms by which such lesions affect motor control are not fully understood. Direct effects of the lesion may be partly compensated by both the system's redundancy and its plasticity. Indeed stroke patients with limited arm movement can reach objects placed within the reach of the arm by using a compensatory strategy involving trunk recruitment. A similar strategy is observed in healthy individuals reaching for objects placed beyond the reach of the arm. Determining the control mechanism(s) governing this compensatory strategy in stroke patients was the goal of this study. Kinematics of reaching movements in hemiparetic and healthy participants to targets placed within and beyond the length of the arm were analysed. Targets were placed sagittally in front of the midline of the body. Two targets (targets 1 and 2) were within reaching distance defined as the length of the stretched arm from axilla to wrist crease. Two others were beyond arm's reach so that one required a forward trunk inclination (target 3) and the other required body raising to a semi-standing position (target 4). Healthy participants used minimal trunk displacement for reaches to targets 1 and 2. For reaches to targets 3 and 4, trunk displacement increased with target distance. Whenever the trunk was involved, there was a stereotyped sequential recruitment of the arm and trunk in that the trunk began moving simultaneously with or before the hand and stopped moving after the end of hand movement. This suggested that the control system predicts that the trunk movement will be needed to extend the reach and includes the trunk, in an anticipatory way, into the reach. In contrast, most hemiparetic participants recruited their trunk for reaches to all four targets, even those placed close to the body. Similar to healthy individuals, the sequence of hand and trunk recruitment was stereotyped, suggesting that temporal planning aspects of the motor program underlying movement coordination were relatively unaffected. In contrast to healthy participants, the contribution of the trunk movement to the endpoint displacement was substantially higher in the hemiparetic group and occurred earlier in the reach. It is suggested that the target distance at which the trunk is integrated into the movement to extend the reach of the arm is attained around the limit of arm extension and that this limit is reduced in hemiparetic individuals.
Physical therapy, 2004
Recent movement analysis studies have described compensatory movement strategies used by people with hemiparesis secondary to stroke during reaching and grasping tasks. The purpose of this article is to describe the development of a new scale--the Reaching Performance Scale (RPS)--for assessing compensatory movements for upper-extremity reaching in people with hemiparesis secondary to stroke. Twenty-eight individuals with hemiparesis, with a mean age of 54.9 years (SD=18.6), participated. The study design involved scale development with expert panels and criterion standards for validity. Participants were evaluated on the new scale as well as other clinical tests for validity. They were videotaped while performing reaching and grasping movements. The RPS scores correlated with measurements of grip force and Chedoke-McMaster Stroke Assessment and Upper Extremity Performance Test for the Elderly (TEMPA) scores. The RPS discriminated patients with different impairment levels according ...
Effect of robot-assisted and unassisted exercise on functional reaching in chronic hemiparesis
2001
A common therapeutic approach for the rehabilitation of patients with hemiparesis involves repetitive voluntary movements with manual assistance from a therapist ("active-assist therapy"). We used a novel robotic device to deliver a controlled form of active-assist therapy in chronic stroke patients (N = 7). To examine the utility of direct mechanical assistance in rehabilitation of voluntary arm movements, a matched group of subjects with chronic hemiparesis (N = 7) performed the same repetitive exercises without the aid of the robotic device. Each group performed 24 therapy sessions over 8 weeks. We found that both groups demonstrated significant improvements in straightness of voluntary reaching movements, with limited improvements in range. Only the group that received robotic therapy significantly improved the smoothness of reaching. Improvements in both groups transferred to an unpracticed reaching movement and the timed performance of functional tasks. There were no significant differences in the magnitude of improvements between the two groups. These results suggest that it is the action of repetitively attempting to move, rather than the mechanical assistance provided by the robot, that stimulates arm movement recovery. However, imposing a smooth trajectory during practice of the reaching movements may help subjects learn how to produce smoother movements. In addition, practicing robot-assisted or unassisted reaching movements apparently improves control processes that generalize to other functional movements.
Archives of Physical Medicine and Rehabilitation, 2004
Objectives: To characterize fine motor control through finger tapping in both arms of 10 patients with chronic stroke, to make baseline comparisons with matched controls, and to examine the responsiveness of deficits seen in stroke patients after 6 weeks of bilateral arm-based training. Design: Nonrandomized controlled, cohort before-after trial. Setting: Research institution. Participants: Ten people from the community with chronic unilateral ischemic stroke and 10 age-and sex-matched healthy controls. Participants with hemiparesis had completed all conventional care and were more than 6 month poststroke. Inclusion criteria were at least 6 months since a unilateral stroke, ability to follow simple instructions and 2-step commands, volitional control of the nonparetic arm, and at least minimal antigravity movement in the shoulder of the paretic arm. Interventions: Not applicable. Main Outcome Measures: Measurements included rate and timing consistency of unilateral tapping at a preferred and a maximal rate and the accuracy and stability of interlimb coordination in bilateral simultaneous (inphase) and alternating (antiphase) tapping at a preferred rate. Results: Nonparetic finger control was similar to that of the nondisabled participants except under bilateral conditions, where it was less consistent. A subgroup with residual paretic finger function, had slower and less consistent paretic finger tapping, as well as less accurate and more variable interlimb coordination; however, basic bilateral coupling relationships were preserved. Bilateral arm-based training improved bilateral nonparetic consistency but slowed unilateral preferred tapping. Training also improved paretic fine motor control in 2 of 4 participants with mild stroke severity. The 2 responders, with dominant hemisphere lesions, indicated a possible recovery advantage with bilateral training for such lesions. Conclusions: In general, nonparetic finger control for tapping was preserved but paretic finger control was compromised. Disruption of nonparetic control of tapping, particularly consistency of tapping, occurred during bilateral tapping tasks but was responsive to 6 weeks of bilateral arm-based training. Despite the apparent lack of training specificity, the generalizable effects of bilateral arm training to fine motor interlimb coordination may reflect central motor control mechanisms for upper-extremity coordination, which may be accessed and may influence the recovery of arm function after stroke.
Experimental Brain Research, 2006
Upper extremity (UE) hemiparesis results in decreased movement speed and impaired coordination leading to functional limitations and disability. The effects of UE hemiparesis on bilateral functional reaching have not been studied even though most activities of daily living are bilateral tasks. We examined the characteristics of bilateral simultaneous (SIM-B) and bilateral sequential paretic-lead (SEQ-P) and nonparetic-lead (SEQ-NP) functional reaching tasks at preferred and fast speeds. Sixteen patients with chronic hemiparesis completed three bilateral reaching tasks as fast as possible. A subset of eight participants attempted to complete the tasks at both preferred and fastest possible speeds. Paretic (P) and nonparetic (NP) arms were not different from each other in movement time (MT) or peak velocity in the SIM-B condition. MT and peak velocity differed between the two arms during both SEQ tasks. P MT was shorter and NP MT longer in the SIM-B task compared to SEQ-P and SEQ-NP. The P arm MT was the shortest when moving with the NP arm in a simultaneous task compared to both P and NP lead sequential movements. Despite hemiparesis, the two arms demonstrate a temporal coupling when moving simultaneously. When attempting to move at fastest speed, P arm MT time is better when reaching before or with the NP arm than when reaching after the NP arm showing coupling to the NP limb and increased speed of movement. These coupling effects support the rationale for bilateral arm training for individuals with UE hemiparesis.