This experimental study (n=11) compared the effects of task-related training (TRT) and resistive exercise (RE), both with trunk restraint, on reaching with the hemiparetic arm in subjects with chronic stroke and moderately severe motor impairment. The use of trunk restraint was shown to increase elbow extension, lessen compensatory trunk movement and improve inter-joint coordination producing straighter hand paths in earlier studies. Selected subjects, who demonstrated partially isolated movement of the arm on the Motor Assessment Scale, were randomly assigned to one of two training protocols and participated in twelve training sessions, typically forty five minutes per session, over four weeks of either TRT using real objects (n = 5) or RE using repetitive movements (n = 6) with the trunk restrained. During each session, two hundred movements were performed using the hemiparetic arm. Reaching, when the trunk was not restrained to targets located ipsilateral, midline, and contralateral to the impaired arm, was tested before and two days after training by 3D kinematic analyses. Subjects were also assessed using the Fugl-Meyer Assessment (FMA) and the Wolf Motor Function Test (WMFT). Significance levels for all tests were p< .05. After both training protocols kinematic analysis showed that trunk flexion decreased (p < .01) scapular motion shifted toward protraction (p < .01) and elbow extension increased (p < .04) and performance on FMA improved (p < .01). The WMFT did not change. Only after TRT did the path of the hand straighten (p < .02), deceleration time decrease (p < .03), and, at the difficult ipsilateral target, shoulder flexion increase (p < .03). The authors conclude that training that restricts compensatory trunk movement during TRT improved the precision of reaching more than during RE, although these findings are limited by the restricted number of subjects. Extensive practice using TRT with trunk restraint during rehabilitation of reaching may be an effective therapeutic strategy in patients with moderately severe hemiparetic stroke and as such requires further inquiry.
Bobath Concept: Theory and Clinical Practice in Neurological Rehabilitation
Authored by members of the British Bobath Tutors Association, Bobath Concept: Theory and Clinical Practice in Neurological Rehabilitation is a practical illustrated guide that offers a detailed exploration of the theoretical underpinning and clinical interventions of the Bobath Concept.
This book guides the reader through general principles to more specific application of neurophysiological principles and movement re-education in the recovery of important areas, including moving between sitting and standing, locomotion and recovery of upper limb function.