Published Online
on December 8, 2005

A more recent version of this article appeared on January 1, 2006

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Submitted on July 25, 2005
Revised on October 11, 2005
Accepted on November 1, 2005

Task-Specific Training With Trunk Restraint on Arm Recovery in Stroke. Randomized Control Trial

Stella Maris Michaelsen PT, PhD; Ruth Dannenbaum PT, MSc; and Mindy F. Levin PT, PhD^*

From the Center for Interdisciplinary Research in Rehabilitation (S.M.M., R.D., M.F.L.), Montreal, Canada; the School of Rehabilitation (S.M.M.), University of Montreal, Canada; and the School of Physical and Occupational Therapy (M.F.L.), McGill University, Montreal, Canada.

^* To whom correspondence should be addressed. E-mail: mindy.levin{at}mcgill.ca.

Background and Purpose--Task-specific training improves functional outcomes after stroke. However, gains may be accompanied by increases in movements compensating for motor impairments. We hypothesized that restriction of compensatory trunk movements may encourage recovery of premorbid movement patterns leading to better functional outcomes. The goal was to determine whether task-specific training with trunk-restraint (TR) produces greater improvements in arm impairment and function than training without TR in patients with chronic hemiparesis.

Methods--Double-blind randomized control trial of a therapist-supervised home program (3 times per week, 5 weeks) in 30 patients with chronic hemiparesis stratified by arm impairment level (Fugl-Meyer) was performed. Intervention group (TR group) received progressive object-related reach-to-grasp training with prevention of trunk movements. Control group (C) practiced tasks without TR. Main outcome measures were upper limb impairment (Fugl-Meyer Arm Section) and function (TEMPA) and movement kinematics (trunk displacement, elbow extension; Optotrak, 10 trials) of a reach-to-grasp movement. Evaluations were repeated before, immediately after, and 1 month postintervention by blind evaluators.

Results--TR training led to greater improvements in impairment and function compared with C. Improvements were accompanied by increased active joint range and were greater in initially more severe patients. In these patients, TR decreased trunk movement and increased elbow extension, whereas C had opposite effects (increased compensatory movements). In TR, changes in arm function were correlated with changes in arm and trunk kinematics.

Conclusions--Treatment should be tailored to arm impairment severity with particular attention to controlling excessive trunk movements if the goal is to improve arm movement quality and function.

Key words: hemiplegia • rehabilitation • therapy

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