Compensatory Trunk Research Articles

Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass

Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study groups. The number of movement units, total movement time, and peak angular velocity of elbow discriminated best between healthy participants and those with stroke as well as between those with moderate (Fugl-Meyer scores of 39-57) versus mild (Fugl-Meyer scores of 58-64) arm impairment. In addition, the measures of compensatory trunk and arm movements discriminated between those with moderate and mild stroke impairment. Conclusion. Kinematic analysis in this study identified a set of movement variables during a functional task that may serve as an objective assessment of upper-extremity motor performance in persons who can complete a task, such as reaching and drinking, after stroke.

Rehabilitation of Reaching Poststroke

For individuals poststroke, reaching with the paretic limb is often associated with compensatory trunk movement due to limited active arm movement. We conducted a pilot feasibility study to compare the effects of task-related training on reaching with the paretic limb using each of 2 different techniques for providing feedback about trunk position. We hypothesized that the use of an auditory feedback signal in response to pressure (Sensor group) would be more effective than feedback arising from an external device used to restrain the trunk (Stabilizer group). Sixteen individuals with chronic stroke were enrolled. Participants had scores of 20 to 44 on the Upper-Arm subsection of the Fugl-Meyer Scale and demonstrated some trunk movement during the pretest assessment of the Reaching Performance Scale (RPS). Participants were randomly assigned to either the Sensor or the Stabilizer group. Both groups participated in 12 structured rehabilitation sessions with equal time duration, number of repetitions, and task-related training activities. Feedback was systematically and equally faded for all training. Clinical outcome measures were assessed prior to and following training. Both forms of feedback were associated with changes in active shoulder motion, Wolf Motor Function Test (WMFT), Fugl-Meyer Scale and RPS (near and far) as determined by a 2 x 2 (Group x Time) analysis of variance. An interaction of RPS-near revealed that the Sensor group improved more than the Stabilizer group for this measure. However, sample size may not have been sufficient to identify differences in other measures. Although both forms of feedback led to improvements in the majority of outcome measures, the auditory feedback signal was associated with greater improvement in RPS-near scores. In the rehabilitation of reaching function in individuals with stroke, the use of an auditory signaling device appears to be a feasible alternative to imposed trunk stabilization. Additional studies with larger sample sizes are needed to determine whether one approach is superior to the other.

The effectiveness of task-oriented intervention and trunk restraint on upper limb movement quality in children with cerebral palsy

The goal of this study was to contribute evidence towards the effectiveness of task-oriented training with and without restriction of trunk movement (trunk restraint) on the quality of upper limb movement in children with cerebral palsy (CP). We used a prospective, single-subject research design in 12 children (three males, nine females; aged 6-11 y; median 9 y) with di-, hemi-, or quadriplegia. Movements of the most affected arm were assessed five times: three times before training, immediately after training, and 3 months after training. The main outcome measures were the Melbourne Assessment of Unilateral Upper Limb Function (Melbourne) and upper limb movement kinematics during a functional reaching task. Children were randomly allocated to one of two groups: task-oriented training with or without trunk restraint. Treatment consisted of three 1-hour sessions per week for 5 weeks (total training duration 15 h). Treatment effects were determined using single-subject research design analysis--regression through baseline data and standard mean differences. Although the Melbourne scores were largely unchanged after training, some children in each group improved arm trajectory smoothness (effect size 0.55-1.87), and most children improved elbow extension range (effect size 0.55-4.79). However, more children in the trunk restraint group than in the no restraint group demonstrated reduced trunk displacement (effect size 0.94-2.25) and longer-term improvements in elbow extension and trunk use. Among the group who underwent training without trunk restraint, trunk displacement was unchanged or increased, and fewer carry-over effects were apparent at follow-up. This proof-of-principle study showed that greater improvement in the quality of upper limb movement in children with CP, including less compensatory trunk use and better carry-over effects, was achieved by training with trunk restraint.

Compensatory trunk flexion in elderly reach-to-grasp movement

Until now, studies on ageing prehension have been focused only on simple flexion and extension elbow or pointing movements (Cooke et al. 1989; Ketcham et al. 2002) However, constrained movements ar...

Rhythmic Auditory-Motor Entrainment Improves Hemiparetic Arm Kinematics During Reaching Movements: A Pilot Study

Purpose: Recovery of skilled upper limb movement remains a critical focus of rehabilitation in individuals post stroke. Conventional treatments, however, have demonstrated limited capability to produce substantial improvements in poststroke quality of movement. Recently, rhythmic auditory stimulation (RAS) has emerged as efficacious in improving and normalizing limb movements in neurologically impaired populations. This pilot study examined changes in pre- to post-RAS reach kinematics and functional outcomes in survivors of stroke. Method: Five individuals in the chronic poststroke phase participated in a 2-week program of RAS training. Kinematic reaching variables were trunk, shoulder, and elbow segment contribution; movement time; and reach velocity. Functional outcomes were the Wolf Motor Function Test, Motor Activity Log, and Fugl-Meyer Assessment. Results: Post-RAS assessment of reaching kinematics revealed a significant (p < .05) decrease in compensatory trunk movement, increase in shoulder flexion, and a slight increase in elbow extension. Movement time and velocity significantly improved post RAS. Significant gains were observed on all functional assessments. Conclusions: Post RAS, participants demonstrated substantial decreases in compensatory reaching movements. These changes in motor control strategy were paralleled by gains in functional abilities, suggesting that reduced reliance on compensatory movements may translate to improved performance of daily activities.

Rehabilitation of Reaching After Stroke: Comparing 2 Training Protocols Utilizing Trunk Restraint

Background and Purpose . Task-related training (TRT) but not resistive exercise (RE) was found to improve the path of the hand of a hemiparetic upper extremity when reaching to targets. Forward movement of the trunk, however, compensated for the poststroke motor impairment. Prior studies also demonstrated that short-term practice of reaching to grasp objects with truncal motion restrained (compared to unrestrained practice) increased elbow extension, lessened compensatory trunk movement, and improved interjoint coordination during performance with the trunk unrestrained. Objective. To determine the effects of TRT and RE on unrestrained reaching following extended practice in which compensatory truncal motion was limited. Methods. Using a restraining device to reduce movement of the trunk, hemiparetic patients with moderately severe motor impairment were given 12 sessions over 4 weeks of TRT (n = 5) or RE (n = 6). Reaching when the trunk was not restrained to targets located ipsilateral, midline, and contralateral to the impaired arm was tested before and 2 days after training by 3D kinematic analyses. Results. After both training protocols, kinematic analysis showed that trunk flexion decreased (P < .01, η2 = .53) scapular motion shifted toward protraction (P < .01, η2 = .57) and elbow extension increased (P < .04, η2 = .39). Only after TRT did the path of the hand straighten (P < .02, η2 = .46), deceleration time decrease (P < .03, η2 = .44), and, at the difficult ipsilateral target, shoulder flexion increase (P < .03, η 2 = .31). Conclusions. Training that restricted compensatory truncal motion during TRT improved the precision of reaching more than during RE. Truncal restraint during rehabilitation of reaching may be an effective therapeutic strategy in patients with moderately severe hemiparetic stroke, especially when combined with TRT.

Gait Characteristics of a Soldier With a Traumatic Hip Disarticulation

No reports have analyzed the temporal-spatial, kinematic, or kinetic components of gait coupled with a metabolic analysis of patients with hip disarticulations. Most of the research on this population is based on older adults. As a result, guidelines for reasonable functional outcomes for patients with hip disarticulations who are young, premorbidly fit, and goal oriented are lacking. This report describes quantitative measures of energy cost and gait characteristics of a young soldier with a unilateral traumatic hip disarticulation. One patient, a soldier with a unilateral hip disarticulation, was evaluated in the Gait and Motion Analysis Laboratory at 3 months and 38 months postinjury. The patient progressed from use of crutches at 3 months postinjury to independent ambulation at the follow-up visit at 38 months postinjury. At 38 months postinjury, he wore his prosthesis 12 hours per day and achieved step-length symmetry, and his oxygen consumption was 14.49 mL/kg/min at self-selected walking speed. Self-selected walking speed increased from 0.57 m/s at 3 months to 0.86 m/s at 38 months postinjury. During both visits, support time remained greater on the intact limb (72%) than the involved limb (57%), compensatory trunk and pelvic motions were used to advance the prosthetic limb, and the vertical ground reaction force profile was within 2 standard deviations of the data for an uninjured comparison group on the prosthetic side and plateaued on the sound limb. Young individuals with traumatic hip disarticulations can achieve and maintain functional independent ambulation with gait deviations. However, metabolic demands may not be as great as previously expected.

Effects of Trunk Restraint Combined With Intensive Task Practice on Poststroke Upper Extremity Reach and Function: A Pilot Study

Background. Poststroke reaching is characterized by excessive trunk motion and abnormal shoulder—elbow coordination. Little attention is typically given to arm—trunk kinematics during task practice. Preventing compensatory trunk motion during short-term practice immediately improves kinematics, but effects of longer-term practice are unknown. Objective. This study compared the effects of intensive task practice with and without trunk restraint on poststroke reaching kinematics and function. Methods. A total of 11 individuals with chronic stroke, baseline Fugl-Meyer Upper Extremity Assessment scores 26 to 54, were randomized to 2 constraint-therapy intervention groups. All participants wore a mitt on the unaffected hand for 90% of waking hours over 14 days and participated in 10 days/6 hours/day of supervised progressive task practice. During supervised sessions, one group trained with a trunk restraint (preventing anterior trunk motion) and one group did not. Tasks for the trunk-restraint group were located to afford repeated use of a shoulder flexion—elbow extension reaching pattern. Outcome measures included kinematics of unrestrained targeted reaching and tests of functional arm ability. Results. Posttraining, the trunk-restraint group demonstrated straighter reach trajectories (P = .000) and less trunk displacement (P = .001). The trunk-restraint group gained shoulder flexion (P = .006) and elbow extension (P = .022) voluntary ranges of motion, the nonrestraint group did not. Posttraining angle—angle plots illustrated that individuals from the trunk-restraint group transitioned from elbow flexion to elbow extension during mid-reach; individuals in the nonrestraint group retained pretraining movement strategies. Both groups gained functional arm ability (P < .05 all tests). Conclusion. Intensive task practice structured to prevent compensatory trunk movements and promote shoulder flexion—elbow extension coordination may reinforce development of “normal” reaching kinematics.

Gait analysis of patients in early stages after total hip arthroplasty: effect of lateral trunk displacement on walking efficiency

BackgroundControl of the mediolateral displacement of the center of gravity (COG) is considered to be important for efficient walking. Few studies have been published on the relation between walking efficiency and the lateral displacement of the trunk, pelvis, or COG in patients soon after total hip arthroplasty (THA). The present study was undertaken to examine the effects of lateral displacement on walking efficiency after THA. MethodsThe subjects of this study were 15 women who had undergone unilateral THA 4 weeks before and 14 healthy women as controls. Using a force plate and a three-dimensional motion analyzer, we measured (1) gait speed, stride length, cadence; (2) lateral trunk displacement (LTD) and lateral pelvis displacement (LPD); (3) lateral displacement of the center of gravity; and (4) the total internal work done per unit mass and distance walked (a negative index of walking efficiency) (WE−1). ResultsCompared with healthy persons, THA patients showed significantly increased amplitude of LTD and greater WE−1 (P < 0.01). The WE−1 value of the THA group was 21.4% higher than that of the control group. The results suggest that the patients need more energy to progress their body forward in a gait cycle, indicating reduced walking efficiency. In THA patients, the stepwise multiple regression analysis selected LTD as the sole significant variable affecting WE−1 (R2 = 0.72, P < 0.01). ConclusionsThese results suggest that trunk compensation strategy for hip abductor weakness in patients soon after THA can lead to increased energy expenditure.

THE EFFECT OF LOAD CARRIAGE AMONG PRIMARY SCHOOL BOYS: A PRELIMINARY STUDY

Backpack carrying is a considerable daily "occupational" load among schoolchildren. Most of the research on children's backpacks have focused on gait pattern and trunk forward lean; only a few researches have investigated the impact of backpack carrying on children using the measurements of static posture and gait kinetics. This study investigated the changes in ground reaction force (GRF) and trunk inclination among primary students when carrying heavy backpacks. A randomized controlled experimental study was conducted on seven boys aged between 9 and 11 years old with a similar body mass index. Observations were done when the boys were carrying school bags of 0% (as control), 10%, 15%, and 20% of their own body weight while walking normally. Data acquisition was carried out using force platforms and a 3D motion analysis system. A significant difference in GRF at a load of 20% of body weight was found: the vertical GRF increased almost three times when loads increased up to 20% of body weight compared to 10% of body weight. The anterior–posterior GRFs were asymmetrical when loads were increased. When carrying a load of 15% of body weight, all of the seven subjects adopted a compensatory trunk inclination. The emphasis on GRF and trunk inclination suggests that the safest load applied does not exceed 15% of body weight.

A body-fixed-sensor based analysis of compensatory trunk movements during unconstrained walking

This paper presents a body-fixed-sensor (BFS) based approach for quantifying compensatory trunk movements during unconstrained walking. Orientation of trunk segments was calculated by fusing low-pass filtered accelerometer data and high-pass filtered data from gyroscopes. To evaluate accuracy, frontal plane angular movements of the pelvis during different treadmill walking conditions were compared to results based on a high-accuracy camera system. Mean differences between the two methods remained within 0.31°, standard deviations of differences within 1.4° and error percentages within 17.7%. Correlations ranged from 0.87 to 0.99. To test whether the method could discriminate between hip arthroplasty patients with and without compensatory trunk movements, the BFS based method was applied to patients and healthy controls during overground walking. Within a walking speed range of 0.40–1.10 m/s, the peak-to-peak amplitudes of trunk movements ranged from 5.7° to 7.9° in healthy subjects and from 13.5° to 26.3° versus 7.4° to 13.8° in patients with and without compensatory trunk movements, respectively. The presented BFS based approach can be used to assess spatio-temporal gait parameters and trunk movements and thus to objectively monitor gait function in hip arthroplasty patients in a clinical setting.

Improvements in the upper limb of hemiparetic patients after reaching movements training

Reaching movements made with hemiparetic upper limbs are often followed by compensatory trunk and shoulder-girdle movements, especially in reach-to-grasp strategies. We investigated the effect of restraint therapy on movement aiming at targets placed within arm reach. Eleven subjects were selected to participate in this study and were submitted to training with the trunk fixed to a chair during the reaching movement. Quantitative and qualitative scales (Modified Ashworth Scale, Fugl-Meyer Assessment Scale-upper limb section, Berg Balance Scale and Barthel Index) were used to evaluate reaching in three periods--pre-treatment, post-treatment and follow-up 3 months after training was completed. We found that in the arm section of the Fugl-Meyer Assessment Scale, pain (x2=8.22, P=0.016), proprioception (x2=6.00, P=0.049), flexor synergy (x2=6.07, P=0.048), wrist (x2=6.50, P=0.039), coordination velocity (x2=7.05, P=0.029) and the total score for the upper limb (x2=7.95, P=0.019) had statistical significance, especially in the pre-treatment and follow-up phases. The same happened using the Barthel Index (x2=8.33, P=0.016). Trunk restraint allowed patients with hemiparetic stroke to make use of active arm joint ranges that are present but not normally recruited during unrestrained arm reaching tasks. Appropriate treatments, such as trunk restraint, may be effective in uncovering latent movement patterns to maximize arm recovery in hemiparetic patients.

Systematic literature review of treatment interventions for upper extremity hemiparesis following stroke

The primary purpose of this review article is to critically analyse the literature from 1999 to 2005 regarding effective interventions for upper extremity hemiparesis following stroke. The researchers narrowed the scope of the review based on inclusion and exclusion criteria, which yielded 11 pertinent studies congruent with the selection criteria. Studies were categorized using Sackett's levels of evidence, level I being the highest degree of certainty and level V the lowest. Grades of recommendations were then developed, grade A being highly recommended, grade B discretionary and grade C not endorsed. Two studies were endorsed as level I - grade A, six were level II - grade B, and three were level III - grade C. Clinical recommendations inferred from the present evaluation are as follows:* Electrical stimulation can be used to improve upper limb outcomes in patients with moderate to severe upper limb dysfunction and is feasible for home-based interventions.* Therapy that utilizes goal-directed reaching behaviours promotes more typical reaching patterns than non-goal-directed interventions.* Reach-to-grasp movements show greater improvement when compensatory trunk movements are reduced.* As an addition to regular exercise therapy time, Arm BASIS training may enhance selective movements of the upper extremity (i.e. reaching).* When performed in conjunction with active neuromuscular stimulation, random and blocked practice may improve pre-motor, motor and total reaction times of the upper extremity.

Locomotive Control of a Wearable Lower Exoskeleton for Walking Enhancement

This article presents a wearable lower extremity exoskeleton (LEE) designed to augment the ability of a human to walk while carrying payloads. The ultimate goal of the current research is to design and control a wearable power-assisted system that integrates a human’s intellect as the control command. The system in this work consists of an inner exoskeleton and an outer exoskeleton. The inner system measures the movements of the human and controls the outer system, which follows the human movements and supports the payload. A special foot-unit was designed to measure the zero moment points (ZMPs) of the human and the exoskeleton simultaneously. Using the measured human ZMP as the reference, the exoskeleton’s ZMP is controlled by trunk compensation to achieve stable walking. A COTS program, xPC Target, together with toolboxes from MATLAB, were used as a real-time operating system and integrated development environment, and real-time locomotion control of the exoskeleton was successfully implemented in this environment. Finally, some walking experimental results, by virtue of the ZMP control for the inner and outer exoskeletons, show that the stable walking can be achieved.

Deficits in Upper-Limb Task Performance in Children With Hemiplegic Cerebral Palsy as Defined by 3-Dimensional Kinematics

Mackey AH, Walt SE, Stott NS. Deficits in upper-limb task performance in children with hemiplegic cerebral palsy as defined by 3-dimensional kinematics. Objective To define upper-limb movement deficits in children with hemiplegia using 3-dimensional (3-D) kinematic analysis of functional tasks. Design Cohort study. Setting University gait laboratory. Participants Ten children with hemiplegic cerebral palsy (mean age, 13.3y; range, 10–17y) and 10 control children (mean age, 9.8y; range, 6–12y). Interventions Not applicable. Main Outcome Measure 3-D upper-limb movement analysis. Results 3-D kinematics detected clinically significant between-group differences. Children with hemiplegia were significantly slower than control children in time taken to complete tasks ( P<.05) and achieved slower movement velocities ( P<.05). Group differences in range of motion (ROM) occurred in all 3 tasks examined (hand to mouth, hand to head, reach). Children with hemiplegia had significantly less supination ( P<.03) and shoulder flexion ( P<.03) and increased compensatory trunk flexion ( P<.01) compared with control data (hand-to-mouth task). The reach task highlighted restriction of elbow extension in children with hemiplegia (minimum elbow extension: hemiplegia, 24±18°; control, 3±7°). Completing tasks bilaterally did not alter performance of the tasks in children with hemiplegia. Conclusions 3-D kinematics detected deficits in timing, ROM, and proximal compensatory strategies during upper-limb functional task performance in children with hemiplegia.

Design and Implementation of NTU Wearable Exoskeleton as an Enhancement and Assistive Device

This article presents a wearable lower extremity exoskeleton (LEE) developed to enhance the ability of a human’s walking while carrying heavy loads. The ultimate goal of the current research work is to design and control a power assist system that integrates a human’s intellect for feedback and sensory purposes. The exoskeleton system in this work consists of an inner exoskeleton and an outer exoskeleton. The inner exoskeleton measures the movements of the wearer and provides these measurements to the outer exoskeleton, which supports the whole exoskeleton system to walk following the wearer. A special footpad, which is designed and attached to the outer exoskeleton, can measure the zero moment point (ZMP) of the human as well as that of the exoskeleton in time. Using the measured human ZMP as the reference, the exoskeleton’s ZMP is controlled by trunk compensation so that the exoskeleton can walk stably. A simulation platform has first been developed to examine the gait coordination through inner and outer exoskeletons. A commercially available software, xPC Target, together with other toolboxes from MATLAB, has then been used to provide a real-time operating system for controlling the exoskeleton. Real-time locomotion control of the exoskeleton is implemented in the developed environment. Finally, some experiments on different objects showed that the stable walking can be achieved in the real environment.

Task-Specific Training With Trunk Restraint on Arm Recovery in Stroke

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. 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. 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. 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.

Functional recovery of chronic complete idiopathic transverse myelitis after administration of neurotrophic factors

Case report. To evaluate the functional recovery of chronic complete idiopathic transverse myelitis (ITM) after administration of acidic fibroblast growth factor (aFGF). A 28-year-old woman presented with a 4-year history of spastic paralysis, sensory level at T10, urinary retention and constipation due to ITM. In all, 20 microg aFGF bolus injection was applied via intradural lumbar puncture, which was repeated every 5 months for 15 months. At 3 weeks after first injection, the patient experienced vague sensation at approximately T12-L1 dermatomes. At 2 months after the second injection, muscle activities and gait pattern were recorded in bilateral gluteus and hip abductors as she ambulated with long leg brace and axillary crutches. Increased walking speeds, reduced pelvic tilting and reduced compensatory trunk rotation during the swing phase were also demonstrated as compared to the initial gait analysis. At 18 months after injection, motor evoked potentials were obtained in hip abductors of both legs. aFGF may increase the efficacy of spinal reactivation/regeneration and is a potential remedy for chronic transverse myelitis.

Rehabilitation of reaching after stroke: Task-related training versus progressive resistive exercise

Thielman GT, Dean CM, Gentile AM. Rehabilitation of reaching after stroke: task-related training versus progressive resistive exercise. Arch Phys Med Rehabil 2004;85:1613–8. Objective To evaluate the effectiveness of 2 rehabilitative approaches for improving paretic limb reaching by chronic stroke subjects. Design Pre- and posttest reaching to targets ipsilateral, midline, and contralateral to the impaired side. Setting Training in subjects’ homes; testing in a laboratory setting. Participants Twelve poststroke volunteers were matched using the Motor Assessment Scale (MAS) and then were randomly assigned to 1 of 2 training conditions. Subjects were subsequently categorized as at a high or low functional level, using the reaching pretest movement time scores. Interventions Training (trunk unrestrained) using the paretic limb was 4 weeks (12 sessions). Task-related training (TRT) involved reaching to objects placed across the workspace. Progressive resistive exercise (PRE) involved whole-arm pulling against resistive therapeutic tubing in planes and distances similar to that in TRT. Main outcome measures Kinematic analysis of arm trajectory and trunk motion using the Peak Performance System, as well as scores on the MAS and the Rivermead Motor Assessment (RMA). Results For low-level groups, TRT resulted in increased substitutive trunk use at the target ipsilateral to the moving arm, and for midline and contralateral targets after PRE. Only low-level, TRT subjects straightened hand paths, which suggested better coordination of elbow-shoulder motion, and improved on the RMA. High-level subjects decreased trunk use at ipsilateral target after PRE, which was not observed after TRT. No significant differences between training conditions were found for other kinematic variables. Conclusions Training benefits appear to depend on initial level of functioning. Although compensatory trunk use was evident, low-level subjects seemed to benefit most from TRT. High-level subjects, whose kinematics showed fairly normal movement organization, demonstrated less compensatory movement after PRE.

Centre of mass motion during gait in persons with myelomeningocele

The movement of the centre of mass in the vertical and lateral directions during gait in children with myelomeningocele was analyzed. The children were classified into five groups depending on the successive paresis of lower limb muscle groups and compared to a control group. In the groups with dorsi- and plantarflexor weakness, the excursions increased and an anterior trend in the centre of mass was observed. In the groups with additional abductor paresis, the lateral excursion was highest and the vertical excursion low due to increased transverse and frontal motion and reduced sagittal motion. With further paresis of the hip extensors, the centre of mass was more posteriorly positioned due to compensatory trunk extension. Improved understanding of individual children's solutions to their muscle paresis can be obtained by visualizing the centre of mass relative to the pelvis. Centre of mass analyses in myelomeningocele offer an important complement to standard gait analysis.