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.
RCT Entities:
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.
Authors: Michelle Woodbury; Craig A Velozo; Paul A Thompson; Kathye Light; Gitendra Uswatte; Edward Taub; Carolee J Winstein; David Morris; Sarah Blanton; Deborah S Nichols-Larsen; Steven L Wolf Journal: Neurorehabil Neural Repair Date: 2010-07-08 Impact factor: 3.919