Compensatory Trunk Research Articles

Comparative analysis of results of treatment patients with severe spinal deformities using screw and a hybrid hardware

Purpose: evaluation of efficacy of operative treatment with the use of screw and hybrid metal constructions in idiopathic scoliosis associated with severe spine deformities. Material and methods: The outcomes of treatment of 34 patients aged 15 to 27 years old with severe scoliosisoperated on using screw metal constructions, were reviewed. 22 patients operated on with the use of hybrid metal constructions, made a control group. The groups were compared by the following parameters: pre- and postoperative Cobb angle, deformity mobility according to traction test, total sagittal/frontal balance, CT apical vertebra rotation, operation time, intraoperative blood loss, the number of instrumented vertebrae, and correction failure at 24-hr spondylograms. Results: Group A (screw spine fixation) demonstrated better outcomes compared to group B (combined spine fixation) in the following parameters. Postoperative correction was 48% and 41%;apical vertebra rotation decreased from 78° to 55° (30%) and from 74° to 59°(21%);total sagittal/frontal balance decreased from 39/25 mmto 14/12 mm (64/52%) and from 35/26 mm to 16/15 mm (55/43%), correspondingly. These results suggest better trunk compensation and postoperative correction in a group of patients with screw fixation. Smaller values of correction failure of the main arc as well as insignificant increase of thoracic kyphosis in the postoperative period (24 months) 3.8%/4.3% in group A compared to 6.2%/7.5% in group B testify to greater reliability and stability of ‘all screw’ metal constructions. The number of fixed elements was on average one more in a group with combined fixation (13 and 14, correspondingly).

Immediate effect of Masai Barefoot Technology shoes on knee joint moments in women with knee osteoarthritis

Footwear modification can beneficially alter knee loading in patients with knee osteoarthritis. This study evaluated the effect of Masai Barefoot Technology shoes on reductions in external knee moments in patients with knee osteoarthritis. Three-dimensional motion analysis was used to examine the effect of Masai Barefoot Technology versus control shoes on the knee adduction and flexion moments in 17 women (mean age, 63.6 years) with radiographically confirmed knee osteoarthritis. The lateral and anterior trunk lean values, knee flexion and adduction angles, and ground reaction force were also evaluated. The influence of the original walking pattern on the changes in knee moments with Masai Barefoot Technology shoes was evaluated. The knee flexion moment in early stance was significantly reduced while walking with the Masai Barefoot Technology shoes (0.25±0.14Nm/kgm) as compared with walking with control shoes (0.30±0.19Nm/kgm); whereas the knee adduction moment showed no changes. Masai Barefoot Technology shoes did not increase compensatory lateral and anterior trunk lean. The degree of knee flexion moment in the original walking pattern with control shoes was correlated directly with its reduction when wearing Masai Barefoot Technology shoes by multiple linear regression analysis (adjusted R2=0.44, P<0.01). Masai Barefoot Technology shoes reduced the knee flexion moment during walking without increasing the compensatory trunk lean and may therefore reduce external knee loading in women with knee osteoarthritis.

Effect of compensatory trunk movements on knee and hip joint loading during gait in children with different orthopedic pathologies

Ipsilateral trunk lean toward the affected stance limb has been identified as a compensatory mechanism to unload the hip joint. However, this altered gait pattern increases the lever arm around the knee joint by shifting the ground reaction vector more lateral to the knee joint center, which could be sufficient to deform the lateral compartment of the knee. The purpose of the present study was to show the effect of ipsilateral trunk lean on hip and knee joint moments in the frontal plane in 132 young patients with different orthopedic diagnosis. Linear correlations between ipsilateral trunk lean and the external knee and/or hip adduction moment were detected for patients with Legg–Calvé–Perthes disease (LCPD), arthrogryposis multiplex congenita, myelomeningocele, and unilateral cerebral palsy (CP). In contrast, children with bilateral CP did not show such a relationship due to an increased internal foot placement. In comparison to the hip joint, the effect of ipsilateral trunk lean in patients with LCPD is obviously more pronounced in the knee joint. The valgus thrust of the knee could initiate degenerative changes by placing altered loads on regions of the articular cartilage that were previously conditioned for different load levels. The results suggest that the ipsilateral trunk lean should not be considered and recommended as unloading mechanism for the hip joint on its own but also as a potential increased joint loading of the lateral knee compartment. Therefore, an acceptable therapy concept for limping patients should aim for an inconspicuous gait pattern with a reduced trunk movement.

Predictors of compensatory and adaptive trunk movements during gait in children with arthogryposis multiplex congenita

Predictors of compensatory and adaptive trunk movements during gait in children with arthogryposis multiplex congenita

Unilateral versus bilateral robot-assisted rehabilitation on arm-trunk control and functions post stroke: a randomized controlled trial

BackgroundAlthough the effects of robot-assisted arm training after stroke are promising, the relative effects of unilateral (URT) vs. bilateral (BRT) robot-assisted arm training remain uncertain. This study compared the effects of URT vs. BRT on upper extremity (UE) control, trunk compensation, and function in patients with chronic stroke.MethodThis was a single-blinded, randomized controlled trial. The intervention was implemented at 4 hospitals. Fifty-three patients with stroke were randomly assigned to URT, BRT, or control treatment (CT). Each group received UE training for 90 to 105 min/day, 5 days/week, for 4 weeks. The kinematic variables for arm motor control and trunk compensation included normalized movement time, normalized movement units, and the arm-trunk contribution slope in unilateral and bilateral tasks. Motor function and daily function were measured by the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and ABILHAND Questionnaire.ResultsThe BRT and CT groups elicited significantly larger slope values (i.e., less trunk compensation) at the start of bilateral reaching than the URT group. URT led to significantly better effects on WMFT-Time than BRT. Differences in arm control kinematics and performance on the MAL and ABILHAND among the 3 groups were not significant.ConclusionsBRT and URT resulted in differential improvements in specific UE/trunk performance in patients with stroke. BRT elicited larger benefits than URT on reducing compensatory trunk movements at the beginning of reaching. In contrast, URT produced better improvements in UE temporal efficiency. These relative effects on movement kinematics, however, did not translate into differential benefits in daily functions.Trial registrationClinicalTrials.gov: NCT00917605.

The influence of hip abductor weakness on frontal plane motion of the trunk and pelvis in patients with cerebral palsy

Trendelenburg walking pattern is a common finding in various disorders, including cerebral palsy (CP), where it is seen in children and adults. Clinically, this deviation is viewed as a consequence of hip abductor weakness resulting in pelvic obliquity. Trunk lean to the ipsilateral side is a common compensatory mechanism to counteract pelvic obliquity and to maintain gait stability. However, no published investigations objectively address pelvic and trunk motions in the frontal plane or examine the correlation with hip abductor weakness in patients with CP. We selected 375 ambulatory (GMFCS I-III) patients with spastic bilateral CP and 24 healthy controls from our gait laboratory database. They had all undergone a standardized three-dimensional analysis of gait, including trunk motion, and a clinical examination including hip abductor strength testing. Selected frontal plane kinematic and kinetic parameters were investigated and statistically tested for correlation (Spearman rank) with hip abductor strength. Only a weak (r=0.278) yet highly significant correlation between trunk lean and hip abductor strength was found. Hip abductor weakness was accompanied by decreased hip abduction moment. However, no significant differences in pelvic position were found between the different strength groups, indicating that the pelvis remained stable regardless of the patients' strength. Our findings indicate that weak hip abductors in patients with CP are accompanied by increased trunk lean to the ipsilateral side while pelvic position is preserved by this compensatory mechanism. However, since this correlation is weak, other factors influencing lateral trunk lean should be considered. In patients with severe weakness of the hip abductors compensatory trunk lean is no longer fully able to stabilize the pelvis, and frontal pelvic kinematics differs from normal during loading response. The results indicate that the stable pelvic position seems to be of greater importance than trunk position for patients with CP. Further studies are needed to investigate other factors influencing lateral trunk lean.

Unraveling the interaction between pathological upper limb synergies and compensatory trunk movements during reach-to-grasp after stroke: a cross-sectional study

The aim of the present study was to identify how pathological limb synergies between shoulder and elbow movements interact with compensatory trunk movements during a functional movement with the paretic upper limb after stroke. 3D kinematic joint and trunk angles were measured during a reach-to-grasp movement in 46 patients with stroke and 12 healthy individuals. We used principal component analyses (PCA) to identify components representing linear relations between the degrees of freedom of the upper limb and trunk across patients with stroke and healthy participants. Using multivariate logistic regression analysis, we investigated whether component scores were related to the presence or absence of basic limb synergies as indicated by the arm section of the Fugl-Meyer motor assessment (FMA). Four and three principal components were extracted in patients with stroke and healthy individuals, respectively. Visual inspection revealed that the contribution of joint and trunk angles to each component differed substantially between groups. The presence of the flexion synergy (Shoulder Abduction and Elbow Flexion) was reflected by component 1, whereas the compensatory role of trunk movements for lack of shoulder and elbow movements was reflected by components 2 and 3 respectively. The presence or absence of basic limb synergies as determined by means of the FMA was significantly related to components 2 (p = 0.014) and 3 (p = 0.003) in patients with stroke. These significant relations indicate that PCA is a useful tool to identify clinically meaningful interactions between compensatory trunk movements and pathological synergies in the elbow and shoulder during reach-to-grasp after stroke.

Arm Motor Recovery Using a Virtual Reality Intervention in Chronic Stroke

Introduction. Despite interest in virtual environments (VEs) for poststroke arm motor rehabilitation, advantages over physical environment (PE) training have not been established. Objective. The authors compared kinematic and clinical outcomes of dose-matched upper-limb training between a 3D VE and a PE in chronic stroke. Methods: Participants (n = 32) were randomized to a 3D VE or PE for training. They pointed to 6 workspace targets (72 trials, 12 trials/target, randomized) for 12 sessions over 4 weeks with similar feedback on precision, movement speed, and trunk displacement. Primary (kinematics, clinical arm motor impairment) and secondary (activity level, arm use) outcomes were compared by time (PRE, POST, and follow-up, RET), training environment, and impairment severity (mild, moderate-to-severe) using mixed-model analyses of variance (ANOVAs). Results. Endpoint speed, overall performance on a reach-to-grasp task, and activity levels increased in both groups. Only participants in the VE group improved shoulder horizontal adduction at POST (9.5°) and flexion at both POST (6.3°) and RET (13°). Impairment level affected outcomes. After VE training, the mild group increased elbow extension (RET, 25.5°). The moderate-to-severe group in VE increased arm use at POST (0.5 points) and reaching ability at RET (2.2 points). The moderate-to-severe group training in PE increased reaching ability earlier (POST, 1.7 points) and both elbow extension (10.7°) and arm use (0.4 points) at RET, but these changes were accompanied by increased compensatory trunk displacement (RET, 30.2 mm). Conclusion. VE training led to more changes in the mild group and a motor recovery pattern in the moderate-to-severe group indicative of less compensation, possibly because of a better use of feedback.

Instructions emphasizing speed improves hemiparetic arm kinematics during reaching in stroke

Stroke severely compromises the capacity for skilled motor control including the ability to reach with the stroke-affected upper-extremity. Research incorporating intensive motor therapies has broadly demonstrated the ability to improve hemiparetic reaching post-stroke, yet the role of specific task parameters has received less attention. These task parameters, such as speed-of-performance, may be important to the structure and delivery of motor rehabilitation. The objective of the study was to determine the influence of task pacing demands on hemiparetic reaching strategies in survivors of stroke. Kinematic motion analysis was used to examine upper-extremity reaching patterns in 11 survivors of stroke. Participants were instructed to reach between two targets at a self-selected pace and as fast as possible. Outcome measures included maximal movement speed, accuracy, movement smoothness, and reaching strategies (anterior trunk flexion, elbow extension, and shoulder flexion). Participants reached significantly faster and smoother during the task that emphasized speed while maintaining target accuracy. Participants used significantly less anterior trunk displacement during the fast condition, yet no change in shoulder flexion. Task parameters that emphasize speed positively influence reaching strategies with the more-affected upper-extremity. Survivors of stroke were able to respond to changes in pacing demands while significantly reducing reliance on compensatory trunk movement. This outcome highlights the need to further understand the impact of task parameters during intensive motor therapies.

Kinematic Motion Analysis and Muscle Activation Patterns of Continuous Reaching in Survivors of Stroke

ABSTRACT Coordinated reaching requires continuous interaction between the efferent motor output and afferent feedback; this interaction may be significantly compromised following a stroke. The authors sought to characterize how survivors of stroke generate continuous, goal-directed reaching. Sixteen survivors of stroke completed functional testing of the stroke-affected side and a continuous reaching task between 2 targets with both sides. Motion analysis and electromyography data were collected to determine segmental contributions to reach (e.g., amount of compensatory trunk), spatiotemporal parameters (e.g., peak velocities), and muscle activation patterns (MAP). Repeated measures analyses of variance compared how survivors of stroke reach with the stroke-affected versus less affected sides. Correlations were determined between kinematic outcomes and functional ability. Participants used significantly more trunk movement and less shoulder flexion and elbow extension when reaching with the stroke-affected side. This corresponded with less muscle activity in the proximal musculature including the anterior, middle, and posterior deltoid on the stroke-affected side. There were significant correlations between the segmental contributions to reach, functional ability, and MAPs. Survivors of stroke generate reduced MAPs in the stroke-affected side corresponding to altered segmental kinematics and function ability. These findings suggest that impairments in the ability to generate sufficient MAPs may contribute to the difficulty in generating continuous reaching motions.

Effect of Therapist-Based Versus Robot-Assisted Bilateral Arm Training on Motor Control, Functional Performance, and Quality of Life After Chronic Stroke: A Clinical Trial

Although bilateral arm training (BAT) has been widely studied, the comparative effects of therapist-based BAT (TBAT) versus robot-assisted BAT (RBAT) remains unknown. This study compared the efficacy of TBAT, RBAT, and a control treatment (CT) on motor control, functional performance, and quality of life after chronic stroke. A randomized, pretest-posttest, control group design was used. Forty-two patients (mean age=54.49 years, SD=9.69; mean length of time since stroke onset=17.62 months, SD=10.50) were randomly assigned to TBAT, RBAT, and CT groups. Each group received treatment for 90 to 105 minutes per session, 5 sessions on weekdays, for 4 weeks. Outcome measures included kinematic analyses, the Fugl-Meyer Assessment (FMA), the Motor Activity Log, and the Stroke Impact Scale (SIS). Large and significant effects were found in the kinematic variables, distal part of upper-limb motor impairment, and certain aspects of quality of life in favor of TBAT or RBAT. Specifically, the TBAT group demonstrated significantly better temporal efficiency and smoothness, straighter trunk motion, and less trunk compensation compared with the CT and RBAT groups. The RBAT group had increased shoulder flexion compared with the CT and TBAT groups. On the FMA, the TBAT group showed higher distal part scores than the CT group. On the SIS, the RBAT group had better strength subscale, physical function domain, and total scores than the CT group. Limitations This study recruited patients with mild spasticity and without cognitive impairment. Compared with CT, TBAT and RBAT exhibited differential effects on outcome measures. Therapist-based BAT may improve temporal efficiency, smoothness, trunk control, and motor impairment of the distal upper limb. Robot-assisted BAT may improve shoulder flexion and quality of life.

Characterization of Compensatory Trunk Movements During Prosthetic Upper Limb Reaching Tasks

Metzger AJ, Dromerick AW, Holley RJ, Lum PS. Characterization of compensatory trunk movements during prosthetic upper limb reaching tasks. ObjectiveTo characterize the compensatory movements of the trunk during functional reaching tasks performed by upper limb prosthesis users. DesignSurvey. SettingClinical laboratory at a national rehabilitation hospital. ParticipantsTranshumeral and transradial prosthesis users (n=10) and uninjured control subjects (n=10). InterventionsNot applicable. Main Outcome MeasuresThree-dimensional motion analysis data were collected during simulated reaching tasks, such as donning a cap, placing a nut, and sorting clothes. The metrics were range of motion of the trunk in the 3 anatomical directions and elbow and shoulder path distance. ResultsProsthesis users had significantly larger truncal movements than controls during all 3 reaching tasks in all 3 directions (P≤.03). Shoulder path distance in persons with amputation was larger than in controls in all 3 tasks (P<.01). Elbow path distance in persons with amputation was larger than in controls in the nut and clothes tasks (P≤.02). The subgroup of transradial prosthesis users displayed these abnormal movements despite the presence of an intact elbow. ConclusionsThe altered physiologic structure of the arm caused the individuals to develop a different motor control strategy than an intact arm. Functional limitations, such as the loss of distal degrees of freedom, required persons with amputation to use trunk displacement in place of arm/hand movement. These compensatory movements during reaching tasks may be a cause of prosthesis rejection and, in some cases, may be resolved with proper rehabilitative training. Analysis of compensatory trunk movements may also provide a useful endpoint for evaluating new prosthesis designs.

Abstract P289: Therapist-Based and Robot-Assisted Physical Training Have Differential Effects on Motor Control of Upper Limb and Quality of Life after Chronic Stroke

Introduction: Compensatory strategies for stroke-related motor impairment may cause a pattern of disuse that might limit the improvement of upper limb (UL) motor function, and incomplete UL motor recovery might detrimentally impact quality of life. Previous studies showed that bilateral arm physical training (BAT) can improve UL function after stroke and improves trunk stabilization. However, it remains uncertain that whether BAT can reduce trunk compensation during reaching. Furthermore, there is no study investigating therapist-guided bilateral arm training (TBAT) versus robot-assisted bilateral arm training (RBAT). Hypothesis: We tested the hypothesis that TBAT and RBAT, compared with control treatment (CT), would result in the better outcomes on movement control in the affected UL and less trunk compensation in reaching tasks and would improve quality of life. In addition, TBAT and RBAT may have differential effects on motor control and quality of life. Methods: Forty-two community dwelling chronic stroke survivors (54 years old; 18 months after stroke) were randomized to TBAT (N=14), RBAT (N=14), or CT (N=14) groups. Each group received a 90- to 105-minute training session, 5 days/week, for 4 weeks. The TBAT participants practiced a variety of bilateral functional tasks with each arm simultaneously under one-on-one supervision of therapists. In the RBAT, the robot-assisted arm trainer, Bi-Manu-Track, was introduced. The CT group involved some conventional therapeutic activities on the paretic arms, unilateral and bilateral fine motor tasks, and compensatory practice on functional tasks. Outcome measures consisted of kinematic analyses for motor control in unilateral and bilateral reaching tasks, and the Stroke Impact Scale for quality of life. Results: The kinematic results indicated that the TBAT group experienced better temporal efficiency and smoothness in unilateral reaching than the CT group. The TBAT group demonstrated less compensatory trunk movement than the CT or RBAT groups in both unilateral and bilateral tasks. In contrast, the RBAT engendered a larger improvement in shoulder flexion than the other groups. The RBAT demonstrated improved quality of life than the CT group characterized by better strength, physical function, and total scores of Stroke Impact Scale. Conclusions: TBAT and RBAT engendered differential effects on outcome measures than CT. TBAT may have better results on temporal efficiency, smoothness, and trunk control. In contrast, RBAT may experience the improved shoulder flexion and quality of life.

Constraint-Induced Therapy With Trunk Restraint for Improving Functional Outcomes and Trunk-Arm Control After Stroke: A Randomized Controlled Trial

Studies have suggested that constraint-induced therapy combined with trunk restraint (CIT-TR) improves arm movement and reduces trunk compensation. Whether participants who receive CIT-TR can translate the benefits to real-life circumstances awaits further investigation. The effects of distributed CIT-TR (dCIT-TR) on motor function, daily function, quality of life (QOL), and arm-trunk control were investigated. The study was a single-blind, randomized controlled trial. The study took place at 4 hospitals. Participants were 57 people who had had a stroke 6 to 55 months earlier. Participants received a dose-matched intervention (2 hours per day, 5 days per week, for 3 weeks) of dCIT-TR, distributed constraint-induced therapy (dCIT), or control therapy. The Action Research Arm Test (ARAT), Motor Activity Log, Frenchay Activities Index (FAI), and Stroke Impact Scale (SIS) were used to evaluate motor function, daily function, and QOL. Data for reaching kinematics were recorded. Participants receiving dCIT-TR and dCIT exhibited higher overall scores on the ARAT, FAI, and hand function domain of the SIS and better quality of movement and larger amount of use (of the affected arm) on the Motor Activity Log than participants in the control group. Participants receiving dCIT-TR further demonstrated greater improvements on the ARAT grip subscale and FAI outdoor activities scale than participants receiving dCIT or participants in the control group. However, participants receiving dCIT showed greater improvements on the strength domain of the SIS after training than participants receiving dCIT-TR or participants in the control group. Limitations Research with a larger sample size is needed. Participants who received dCIT-TR were able to translate gains in arm-trunk control into functional performance and QOL, specifically in grip function and outdoor activities. A long-term study to examine the recovery course for force output may be needed to evaluate people's perception of less improvement in strength after dCIT-TR.

Subjects with hip osteoarthritis show distinctive patterns of trunk movements during gait-a body-fixed-sensor based analysis

BackgroundCompensatory trunk movements during gait, such as a Duchenne limp, are observed frequently in subjects with osteoarthritis of the hip, yet angular trunk movements are seldom included in clinical gait assessments. Hence, the objective of this study was to quantify compensatory trunk movements during gait in subjects with hip osteoarthritis, outside a gait laboratory, using a body-fixed-sensor based gait analysis. Frontal plane angular movements of the pelvis and thorax and spatiotemporal parameters of persons who showed a Duchenne limp during gait were compared to healthy subjects and persons without a Duchenne limp.MethodsA Body-fixed-sensor based gait analysis approach was used. Two body-fixed sensors were positioned at the dorsal side of the pelvis and on the upper thorax. Peak-to-peak frontal plane range of motion (ROM) and spatiotemporal parameters (walking speed, step length and cadence) of persons with a Duchenne limp during gait were compared to healthy subjects and persons without a Duchenne limp. Participants were instructed to walk at a self-selected low, preferred and high speed along a hospital corridor. Generalized estimating equations (GEE) analyses were used to assess group differences between persons with a Duchenne limp, without a Duchenne limp and healthy subjects.ResultsPersons with a Duchenne limp showed a significantly larger thoracic ROM during walking compared to healthy subjects and to persons without a Duchenne limp. In both groups of persons with hip osteoarthritis, pelvic ROM was lower than in healthy subjects. This difference however only reached significance in persons without a Duchenne limp. The ratio of thoracic ROM relative to pelvic ROM revealed distinct differences in trunk movement patterns. Persons with hip osteoarthritis walked at a significantly lower speed compared to healthy subjects. No differences in step length and cadence were found between patients and healthy subjects, after correction for differences in walking speed.ConclusionsDistinctive patterns of frontal plane angular trunk movements during gait could be objectively quantified in healthy subjects and in persons with hip osteoarthritis using a body-fixed-sensor based gait analysis approach. Therefore, frontal plane angular trunk movements should be included in clinical gait assessments of persons with hip osteoarthritis.

Development of the coordination between posture and manual control

Studies have suggested that proper postural control is essential for the development of reaching. However, little research has examined the development of the coordination between posture and manual control throughout childhood. We investigated the coordination between posture and manual control in children (7- and 10-year-olds) and adults during a precision fitting task as task constraints became more difficult. Participants fit a block through an opening as arm kinematics, trunk kinematics, and center of pressure data were collected. During the fitting task, the precision, postural, and visual constraints of the task were manipulated. Young children adopted a strategy where they first move their trunk toward the opening and then stabilize their trunk (freeze degrees of freedom) as the precision manual task is being performed. In contrast, adults and older children make compensatory trunk movements as the task is being performed. The 10-year-olds were similar to adults under the less constrained task conditions, but they resembled the 7-year-olds under the more challenging tasks. The ability to either suppress or allow postural fluctuations based on the constraints of a suprapostural task begins to develop at around 10 years of age. This ability, once developed, allows children to learn specific segmental movements required to complete a task within an environmental context.

Pilot Trial of Distributed Constraint-Induced Therapy With Trunk Restraint to Improve Poststroke Reach to Grasp and Trunk Kinematics

Background. Constraint-induced therapy (CIT) is effective in improving upper extremity motor function, but evidence is lacking about effectiveness grasp and trunk control. Objective. This study investigated whether distributed CIT combined with trunk restraint (dCIT + TR) benefited movement kinematics of grasping and the trunk, as well as motor ability of the upper extremity, more than dCIT alone. Methods. A total of 45 stroke participants received 2 hours of dCIT + TR, dCIT, or the dose-matched control intervention for 3 weeks. Movement kinematics, motor ability, and daily function were the outcome measures. Movement kinematics included grasping, joint range, and trunk movement at various phases of reach-to-grasp tasks. Motor ability and daily function of all participants were evaluated using the Fugl-Meyer Assessment and the Motor Activity Log. Results. Four to 5 participants in each group were not included for kinematic analysis because of their inability to grasp a can. The dCIT + TR group showed better preplanned grasping movement and less trunk motion at the early phase of the reach-to-grasp movements than the dCIT or control groups. Compared with the controls, the dCIT + TR participants showed better motor ability in the overall and distal arm scores of the Fugl-Meyer Assessment. The dCIT + TR and dCIT participants demonstrated significantly greater functional use of the affected arm. Conclusions. Administering dCIT + TR produced additional benefits by improving grasping control and reversing the compensatory trunk movement at the early phase of a reach-to-grasp movement. The use of experimental tasks beyond and within arm’s length might improve our understanding of optimal upper extremity rehabilitation.

Poster 422 Characterization of Compensatory Trunk Movements During Upper Limb Prosthetic Limb Reaching Tasks

Poster 422 Characterization of Compensatory Trunk Movements During Upper Limb Prosthetic Limb Reaching Tasks

Compensatory Trunk Movements in Patients with Hip Osteoarthritis

This study examined the accuracy and reproducibility of a body-fixed sensor-based assessment for quantifying frontal plane angular movements of the (upper) thorax and pelvis of patients with hip osteoarthritis at different walking speeds. To evaluate accuracy, the angular movements of sensors attached to the thorax and pelvis of three patients were compared with results based on an optical motion analysis system. Accuracy was high, with small and consistent mean differences (<1.0 degree) and corresponding standard deviations (<1.3 degrees) between optical motion analysis system and body-fixed sensor data. To evaluate reproducibility, angular trunk movements were assessed twice in 15 patients. Reproducibility was high (intraclass correlation coefficients ranged from 0.86 to 0.97), and the values of the mean differences between the test and retest were small, with the 95% confidence interval containing zero. This body-fixed sensor-based assessment is an accurate and reproducible method for quantifying frontal plane compensatory trunk movements during gait of patients with hip osteoarthritis at different walking speeds.

Effects of Distributed Constraint-induced Therapy on Trunk Control, Daily Function, and Quality of Life in Patients with Chronic Stroke

Objective: Patients commonly have impaired arm trunk coordination following a stroke. The trunk compensation often used by stroke patients may hinder recovery of the affected arm. Given that the extent to which constraint-induced therapy (CIT) affects arm-trunk coordination has not been investigated previously, this study examines how distributed CIT (dCIT) affects arm trunk coordination and trunk compensation strategy, as well as functional performance and quality of life. Materials and Methods: Sixteen participants (at least 6 months post-onset) after stroke were randomly assigned to either the dCIT group which received training 2 hours daily for 3 weeks, with the unaffected arm restrained 6 hours daily or the control group which received traditional rehabilitation for equivalent intensity and duration). Kinematic analysis was performed to investigate the arm-trunk coordination during unilateral and bilateral tasks. Additionally, functional ability and quality of life of the participants were assessed by using two clinical measures (Functional Independent Measure, FIM and Stroke Specific Quality of Life Scale, SSQOL). All outcomes were measured at the beginning and end of the 3-week intervention. Results: The two groups did not differ at baseline (p＞0.05). Experimental results indicated that the two groups statistically differed during the unilateral tasks on elbow extension angular change (p=0.030), trunk flexion angular change (p=0.045), elbow extension & trunk flexion correlation (p=0.020), and early part, terminal part, and total of the trunk contribution slope (p＜0.05). The two groups also statistically differed in elbow extension angular change (p=0.017), trunk-arm delay (p=0.030), and the total trunk contribution slope (p=0.033) during bilateral tasks. Statistically different on transfer domains of FIM (p=0.046) and family role domain of SSQOL (p=0.013) were noted as well. Conclusion: After 3 weeks of dCIT, the participants reduced trunk compensation more than the control group did in terms of better elbow joint control during both unilateral or bilateral tasks, thus demonstrating that dCIT elicits better arm trunk coordination and motor control. Participants in the dCIT group also performed better than the control group in terms of functional ability and quality of life.