Rehabilitation of reaching after stroke: comparing 2 training protocols utilizing trunk restraint

Area of Science:

• Neurorehabilitation
• Biomechanics
• Motor Control

Background:

• Task-related training (TRT) improves reaching in hemiparesis, but compensatory trunk movement can limit gains.
• Resistive exercise (RE) has shown less efficacy in improving reaching paths.
• Prior studies suggest trunk restraint during training enhances upper extremity kinematics.

Purpose of the Study:

• To evaluate the effects of TRT and RE on reaching performance after limited compensatory trunk motion during training.
• To compare the efficacy of TRT versus RE in improving upper extremity function in hemiparetic stroke patients.

Main Methods:

• Hemiparetic patients (n=11) underwent 12 sessions of TRT (n=5) or RE (n=6) over 4 weeks, with trunk motion limited by a restraining device.
• 3D kinematic analysis assessed reaching to ipsilateral, midline, and contralateral targets before and after training.
• Trunk and upper extremity joint kinematics were analyzed to quantify movement patterns.

Main Results:

• Both TRT and RE reduced trunk flexion and increased scapular protraction and elbow extension.
• TRT significantly improved hand path straightness and reduced deceleration time.
• TRT also increased shoulder flexion for ipsilateral targets, indicating improved reaching accuracy.

Conclusions:

• TRT with trunk restraint is more effective than RE in improving reaching precision in moderately severe hemiparetic stroke.
• Incorporating trunk restraint into TRT may be a valuable therapeutic strategy for stroke rehabilitation.
• This approach enhances upper extremity motor control and reduces reliance on compensatory movements.