Normalizing the Arm Reaching Patterns after Stroke through Forced Use Therapy– A Systematic Review
Senthilkumar Jeyaraman, Ganesan Kathiresan, Kavitha Gopalsamy
DOI: 10.4236/nm.2010.11003   PDF    HTML     5,959 Downloads   11,906 Views   Citations


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.

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S. Jeyaraman, G. Kathiresan and K. Gopalsamy, "Normalizing the Arm Reaching Patterns after Stroke through Forced Use Therapy– A Systematic Review," Neuroscience and Medicine, Vol. 1 No. 1, 2010, pp. 20-29. doi: 10.4236/nm.2010.11003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] S. J. Page, S. Sisto, P. Levine and R. E. Mcgrath, “Efficacy of Modified Constraint-Induced Movement Therapy in Chronic Stroke: A Single-Blinded Rendomized Controlled Trial,” Archives of Physical Medicine and Rehabilitation, Vol. 85, No. 1, 2004, pp. 14-18.
[2] N. A. Bernstein, “The Coordination and Regulation of Movement,” Pergamon Press, Oxford, UK, 1967.
[3] M. C. Cirstea and M. F. Levin, “Compensatory Strategies for Reaching in Stroke,” Brain, Vol. 123, No. 5, 2000, pp. 940-953.
[4] I. Q. Whishaw, “Loss of the Innate Cortical Engram for Action Patterns Used in Skilled Reaching and the Development of Behavioural Compensation Following Motor Cortex Lesions in the Rat,” Neuropharmacology, Vol. 39, No. 5, pp. 788-805.
[5] K. M. Friel and R. J. Nudo, “Recovery of Motor Function after Cortical Injury in Primates: Compensatory Movement Patterns Used During Rehabilitative Training,” Somatosensory and Motor Research, Vol. 15, No. 3, 1998, pp. 173-189.
[6] M. C. Cirstea, A. Ptito and M. F. Levin, “Arm Reaching Improvements with Short Term Practice Depend on the Severity of the Motor Deficit in Stroke,” Experimental Brain Research, Vol. 152, No. 4, 2003, pp. 476-488.
[7] L. Ada, C. Canning, J. H. Carr, S. L. Kilbreath and R. B. Shepherd, “Task—Specific Training of Reaching and Manipulation,” In: Bennet KMB, Castiello u, eds. Insights into Reach and Grasp Movement, Elsevier–Biosoft, Cambridge, UK, 1994, pp. 239-265.
[8] J. W. Krakauer, “Motor learning: Its Relevance to Stroke Recovery and Neurorehabilitation,” Current Opinion in Neurology, Vol. 19, No. 1, 2006, pp. 84-90.
[9] S. M. Michelsen, A. Lutta, A. Roby-Brami and M. F. Levin, “Effect of Trunk Restraint on the Recovery of Reaching Movements in Hemiparetic Patients,” Stroke, Vol. 32, No. 8, 2001, pp. 1875-1883.
[10] S. M. Michaelsen, D. E. A. and M. F. Levin, “Short Term Effects of Practice with Trunk Restraint on Reaching Movements in Patients with Chronic Stroke,” Stroke, Vol. 35, No. 8, 2004, pp. 1914-1919.
[11] S. M. Michaelsen, R. Dannenbawn and M. F. Levin, “Task–Specific Training with Trunk Restraint on Arm Recovery in Stroke,” Stroke, Vol. 37, No. 1, 2006, pp. 186-192.
[12] G. Thielman, T. Kaminski and A. M. Gentile, “Rehabilitation of Reaching after Stroke: Comparing 2 Training Protocol Utilizing Trunk Restraints,” Neurorehabil Neural Repair, Vol. 22, No. 6, 2008, pp. 697-705.
[13] M. L. Woodbury, D. R. Howland, T. E. Mcguirk, S. B. Davis, C. R. Senesac, S. Kautz and L. G. Richards, “Effects of Trunk Restraint Combined with Intensive Task Practice on Poststroke Upper Extremity Reach and Function: A Pilot Study,” Neurorehabil Neural repair, Vol. 23, No. 1, 2009, pp. 78-91.
[14] J. Cohen, “Statistical Power Analysis for the Behavioural Sciences,” 2nd Edition, Academic Press, New York, 1977.
[15] J. Carr and R. Shepherd, “Movement Science: Foundations for Physical Therapy in Rehabilitation,” 2nd Edition, Aspen Publishers, Gaithersburg, 2000.
[16] M. F. Levin, R. W. Selles, M. H. G. Verheul and O. G. Meijer, “Deficits in the Range of Regulation of Central Control over Arm Movement in Stroke Patients,” Brain Research, Vol. 853, 2000, pp. 352-369.
[17] S. V. Adamovich, P. Archambault, M. Ghafouri, M. F. Levin, H. Poizner and A. G. Feldman, “Hand Trajectory Variance in Reaching Movements Involving the Trunk,” Experimental Brain Research, Vol. 138, No. 3, 2001, pp. 288-303.
[18] E, Taub, N. E. Miller, T. A. Novack, E. W. Cook III, W. C. Fleming, C. S. Neomuceno, J. S. Connell and J. E. Crago, “Technique to Improve Chronic Motor Deficit after Stroke,” Archives Physical Medicine Rehabilitation, Vol. 74, No. 4, pp. 347-354.
[19] C. M. Dean, C. L. Richards and F. Malouin, “Task–Related Circuit Training Improves Performance of Locomotor Tasks in Chronic Stroke: A Randomized Controlled Pilot Trial,” Archives Physical Medicine Rehabilitation, Vol. 81, No. 4, pp. 409-417.
[20] C. M. Dean and R. B. shepherd, “Task Related Training Improves Performance of Seated Reaching Tasks after Stroke,” Stroke, Vol. 28, No. 4, 1997, pp. 722-728.
[21] S. L. Morris, K. J. Dodd and M. E. Morris, “Outcomes of Progressive Resistance Strength Following Stroke: A Systematic Review,” Clinical Rehabilitation, Vol. 18, No. 1, 2004, pp. 27-39.
[22] W. L. Hsu, Y. R Yang, C. T. Hong and R. V. Wang, “Ankle Muscle Activation during Functional Reach in Hemiparetic and Healthy Subjects,” American Journal of Physical Medicine and Rehabilitation, Vol. 84, No. 10, 2005, pp. 749-755.
[23] K, Andrews and J, Stewart, “Stroke Recovery: He Can But Does He?” Rheumatology Rehabilitation, Vol. 18, No. 1, 1979, pp. 43-48.
[24] C. M. Cirstea and M. F. Levin, “Compensatory Strategies for Reaching in Stroke,” Brain, Vol. 123, No. 5, 2000, pp. 940-953.
[25] M. F. Levin, S. M. Michaelsen, C. M. Cirstea and A. Roby–Brami, “Use of the Trunk for Reaching Targets Placed within and Beyond the Reach in Adult Hemiparesis,” Experimental Brain Research, Vol. 143, No. 2, pp. 171- 180.
[26] A. Roby–Brami, A. Feydy, M. Combeaud, E. V. Biryukova, B. Bussel and M. F. Levin, “Motor Compensation and Recovery for Reaching in Stroke Patients,” Acta Neurologica Scandinavica, Vol. 107, No. 5, 2003, pp. 369-381.
[27] K. L. Ustinova, V. M. Goussev, R, Balasubramaniam and M. F. Levin, “Disruption of Coordination between Arm, Trunk and Centre of Pressure Displacement in Patients with Hemiparesis,” Motor control, Vol. 8, No. 2, 2004, pp. 139-159.
[28] J. Carr and R. Shepherd, “Stroke Rehabilitation: Guidelines for Exercise and Training to Optimize Motor Skill,” NY, Elsevier, New York, 2003.
[29] P. Vanvliet, M. Sheriddan, D. G. Kerwin, et al., “The Influence of Functional Goals on the Kinematics of Reaching Following Stroke,” Neurology Report, Vol. 19, No. 1, 1995, pp. 11-16.
[30] N. A. Bernstein, “The Coordination and Regulation of Movement,” Pergamon Press, Oxford, UK, 1967.
[31] N. A. Bernstein and G. R. Buravtseva, “Coordination Disturbances and Restitution of the Biodynamics of Gait after Brain Damage,” Thesis, 7th session, Academy of Medical Science, Institute of neurology, Moscow, 1954.
[32] J. Whitall, “Stroke Rehabilitation Research: Time to Answer More Specific Questions?” Neurorehabil Neural Repair, Vol. 18, No. 1, 2004, pp. 3-8.
[33] W. Thalheimer and S. Cook, “How to Calculate Effect Sizes from Published Research: A Simplified Methodology. A Work-Learning Research Publication,” November 2009.
[34] D. E. Young and R. A. Schmidt, “Augmented Kinematic Feedback for Motor Learning,” Journal of Motor Behavior, Vol. 24, No. 3, 1992, pp. 261- 273.

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