Journal of Taiwan Occupational Therapy Research and Practice
Objective: Stroke patients often use compensatory strategies to perform daily routines. Compensatory strategies include the use of the less affected side or excessive trunk movements to accomplish functional tasks. Research is needed to examine the effects of trunk restraint during practicing functional tasks on trunk compensation and on functional use of the affected upper limb (UL). This study was designed to investigate the effects of trunk restraint combined with constraint- induced therapy, relative to conventional rehabilitation, on UL motor function and trunk control in patients with stroke. Methods: Fourteen chronic stroke patients were randomly assigned to receive trunk restraint combined with distributed constraint-induced therapy (the combined therapy group) or traditional rehabilitation (the control group). Both groups received 3-week intensive therapy and evaluation was performed before and after intervention. Outcome measures included kinematic analysis of reaching-to-grasp task with target located at 125% of arm length,, the Motor Activity Log (MAL), and the Wolf Motor Function Test (WMFT). Kinematic measures include inter-segment coordination, trunk involvement, and range of motion during a reach-to-grasp task. Results: The results showed moderate to large effects on the correlation of shoulder and elbow, the correlation of shoulder and trunk, trunk compensation in favor of the combined therapy. The results showed large effects on clinical measures. Patients in the combined group had higher WMFT quality scores and MAL scores after training than the control group. Conclusion: This research showed the benefits of constraint-induced therapy combined with trunk restraint on facilitating typical motor patterns and improving movement quality in patients with chronic stroke. The findings indicate that the combined therapy may produce treatment effects by reducing motor impairment, rather than improving functional outcomes by means of the use of compensatory strategies.