Rehabilitation of Reaching After Stroke: Comparing 2 Training Protocols Utilizing Trunk Restraint

Abstract

Background and Purpose . Task-related training (TRT) but not resistive exercise (RE) was found to improve the path of the hand of a hemiparetic upper extremity when reaching to targets. Forward movement of the trunk, however, compensated for the poststroke motor impairment. Prior studies also demonstrated that short-term practice of reaching to grasp objects with truncal motion restrained (compared to unrestrained practice) increased elbow extension, lessened compensatory trunk movement, and improved interjoint coordination during performance with the trunk unrestrained. Objective. To determine the effects of TRT and RE on unrestrained reaching following extended practice in which compensatory truncal motion was limited. Methods. Using a restraining device to reduce movement of the trunk, hemiparetic patients with moderately severe motor impairment were given 12 sessions over 4 weeks of TRT (n = 5) or RE (n = 6). Reaching when the trunk was not restrained to targets located ipsilateral, midline, and contralateral to the impaired arm was tested before and 2 days after training by 3D kinematic analyses. Results. After both training protocols, kinematic analysis showed that trunk flexion decreased ( P < .01, η2 = .53) scapular motion shifted toward protraction ( P < .01, η2 = .57) and elbow extension increased ( P < .04, η2 = .39). Only after TRT did the path of the hand straighten ( P < .02, η2 = .46), deceleration time decrease ( P < .03, η2 = .44), and, at the difficult ipsilateral target, shoulder flexion increase ( P < .03, η 2 = .31). Conclusions. Training that restricted compensatory truncal motion during TRT improved the precision of reaching more than during RE. Truncal restraint during rehabilitation of reaching may be an effective therapeutic strategy in patients with moderately severe hemiparetic stroke, especially when combined with TRT.