REHABILITATION OF REACHING AFTER STROKE

Abstract

Purpose/Hypothesis: For post-stroke individuals, effects of Task-Related Training (TRT) and Resistive Exercise (RE) on reaching with the paretic limb were evaluated using a pre-/posttest/follow-up design. Forward trunk motion was curtailed during training by a stabilization device. Previously, posttest kinematic analysis indicated that reaching improved more with TRT than with RE, evidenced by: straighter hand paths, decreased proportion of time after first velocity peak and increased shoulder flexion at the difficult ipsilateral target. At follow-up, individuals performing both types of training were expected to show improved use of the arm during reaching. However, it was hypothesized that the TRT group would produce greater gains since prior work showed this group learned to use the trunk motion extensively to complete the task. Number of Subjects: Eleven individuals with moderate arm impairment (19 to 39 on the Fugl-Meyer upper arm subsection scale (FMA)), 7 months to 3 years post unilateral-stroke onset were randomly assigned to TRT or RE and tested at pre/post and follow-up. Materials/Methods: Subjects received 4 weeks of training while having the trunk restrained. In TRT, specific activities using the paretic upper-limb at varied locations across the workspace were performed. In RE, repetitive whole arm resistance exercises in planes and distances similar to those of the TRT movements were performed. During pre-/posttests and follow-up, conducted with trunk unrestrained, individual subjects reached to targets ipsilateral, midline and contralateral to the paretic upper limb. Additionally, individuals were administered the Wolf Motor Function test, the Fugl-Meyer scale (FMA) and AROM measures. Kinematic analysis (3-D) of individual's wrist and trunk motion during reaching was carried out. A 2 (training group) × 3 (pretest/ posttest/follow-up) × 3 (target position) analysis of variance (ANOVA), with repeated measures on the last two factors, was used. Results: At one-year follow-up, shoulder angle flexion and FMA was maintained for both groups overall (p<.03 eta sqr =.32 and p<.00 eta sqr =.66, respectively), while elbow angle extension increased for the TRT group over the three testing sessions (p<.00 eta sqr = .54). Conclusions: Initial kinematic analysis indicated that reaching improved more for TRT than for RE, evidenced by: straighter hand paths, decreased proportion of time after first velocity peak and increased shoulder flexion at the difficult ipsilateral target. One year after completing formal TRT and RE training with trunk restraint, these measures of reaching ability were maintained, with increases of elbow angle for the TRT group; indicating long-term effects from the original training for these chronic post-stroke individuals. Clinical Relevance: Although both training protocols demonstrated that reaching was maintained one year after training was completed, training under more realistic conditions associated with TRT (with trunk restrained) resulted in functional reaching improvements and should be encouraged for chronic post-stroke individuals.