Normalizing the Arm Reaching Patterns after Stroke through Forced Use Therapy– A Systematic Review

Senthilkumar Jeyaraman,Kavitha Gopalsamy,Ganesan Kathiresan

doi:10.4236/nm.2010.11003

Abstract

Hemiparesis is common following stroke. The ability to reach and grasp is a necessary component of many daily life functional tasks, hence reduced upper limb function has an impact on the ability to perform activities of daily living. In hemiparetic patients, the unrestricted and unguided repetition of a motor task may reinforce compensatory movements. Trunk restraint allowed the patients to use joint ranges that were present but not recruited during unrestrained reaching. Later, studies combined the trunk restraint training with additional therapeutic interventions. With the growing number of studies on this intervention in the stroke population, there is the need to consolidate this evidence to determine the potential use of trunk restraint training in improving arm reaching in neurological rehabilitation particularly for stroke patients. A considerable research effort had assessed the effects of trunk restraint training on the recovery of reaching movements in hemiparetic patients. This review identified 5 relevant trials in which one trial is a pilot study. Among 5 trials, three trials recorded the movement kinematics (outcome measure) by Optotrak Motion analysis System, in the other two trials the movement kinematics (outcome measure) were analysed by a 6 – camera, 3D Motion analysis system and 10 – camera Motion Analysis System respectively. The effect size for the intervention was calculated by Cohen’s d. In this review, for the meta-analysis we used trunk displacement, trunk flexion, elbow extension, Smoothness and hand trajectory straightness (movement variables in kinematic analysis). The results of our review demonstrated that the use of trunk restraint as a treatment paradigm aimed at decreasing compensatory strategies has the potential of becoming an effective therapy. Further studies are necessary to determine the long term effect of the trunk restraint training.

Highlights

Research on the effectiveness of rehabilitation techniques for patients with stroke is important for stroke survivors and for care givers, treatment providers and society alike
The results of our review demonstrated that the use of trunk restraint as a treatment paradigm aimed at decreasing compensatory strategies has the potential of becoming an effective therapy
Michaelsen et al studied the effectiveness of trunk restraint training on arm recovery in stroke patients and demonstrated that trunk restraint is a treatment paradigm which decreases the compensatory strategies

Summary

Introduction

Research on the effectiveness of rehabilitation techniques for patients with stroke is important for stroke survivors and for care givers, treatment providers and society alike. In the months after stroke, function of the paretic arm can improve as reaching; grasping and manipulating ability is regained. Premorbid movement patterns may be regained because of true motor recovery In another way, because of the redundancy in the number of degrees of freedom (DFs) of the body [2], actions can be accompanied by substitution of other DFs for movements of impaired joints. Because of the redundancy in the number of degrees of freedom (DFs) of the body [2], actions can be accompanied by substitution of other DFs for movements of impaired joints These alternative movements or motor compensations [3] are observed in animals recovering from experimental stroke [4,5]

Results

Discussion

Conclusion