Combined Restraint Therapy for Improving Upper-Limb Functional Performance after Stroke: A Kinematic Analysis
Date Issued
2009
Date
2009
Author(s)
Ching-Ping Chao
Abstract
Background: After stroke, patients make increased use of the redundancy of motor system to acheive the goals of motor tasks. Trunk anterior displacement is a common compensatory movement used by stroke patients for arm transport during reaching. However, the presence of compensatory movements is associated with pain, discomfort, and joint contractures. It also limits recovery of “normal” motor pattern of the affected arm. Numerous studies have provided strong evidence that constraint-induced therapy (CIT), or distributed/modified CIT can improve the function of the affected hand. A previous study suggested that CIT may encourage patients to generate movement through synergy-dominated compensatory movement. The aim of this present study is to determine whether dCIT combined with trunk restraint lead to better motor control performance as reflected by kinematic variables.ethods: We employed the randomized controlled design. 18 chronic stroke patients were recruited into this study from the rehabilitation departments of participating hospitals. Patients were individually randomized into the dCIT combined with trunk restraint (dCITRes) or the dCIT groups. Each patient received treatment of equal intensity for 2 hours on weekdays for 3 weeks under direct supervision of the occupational therapists. The kinematic analyses were administered before and after the 3-weeks intervention period.esults: The dCITRes group showed a greater elbow extension and less trunk flexion than those in the dCIT group. Patients in the dCITRes group also showed a greater increase ininterjoint coordination of reaching during bimanual task. There was no significant group difference in the normalized shoulder flexion angular change and arm-trunk coordination in this research.onclusions: This study provided evidences that there were greater improvements in motor control during reaching movement after dCIT combined with trunk restraint therapy than after dCIT. Patients who received this combined therapy exhibited more active range of motion of UE, less abnormal compensatory movement of trunk and better interjoint coordination than those receiving dCIT. Utilizing this combined therapy may be an effective approach for regaining interjoint coordination of the affected upper extremity and avoiding trunk compensation.
Subjects
Cerebrovascular accident
Rehabilitation
Kinematics
Constraint-induced therapy
Trunk restraint
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