Trunk restraint therapy: the continuous use of the harness could promote feedback dependence in poststroke patients: a randomized trial

Roberta de Oliveira Cacho, Enio Walker A Cacho, Rodrigo L Ortolan, Alberto Cliquet Jr, Guilherme Borges, Roberta de Oliveira Cacho, Enio Walker A Cacho, Rodrigo L Ortolan, Alberto Cliquet Jr, Guilherme Borges

Abstract

The objective of this study was to evaluate the long-term effects of the task-specific training with trunk restraint compared with the free one in poststroke reaching movements. The design was randomized trial. The setting was University of Campinas (Unicamp). Twenty hemiparetic chronic stroke patients were selected and randomized into 2 training groups: trunk restraint group (TRG) (reaching training with trunk restraint) and trunk free group (TFG) (unrestraint reaching). Twenty sessions with 45 minutes of training were accomplished. The patients were evaluated in pretreatment (PRE), posttreatment (POST) and 3 months after the completed training (RET) (follow-up). Main outcome measures were modified Ashworth scale, Barthel index, Fugl-Meyer scale, and kinematic analysis (movement trajectory, velocity, angles). A significant improvement, which maintained in the RET test, was found in the motor (P < 0.001) and functional (P = 0.001) clinical assessments for both groups. For trunk displacement, only TFG obtained a reduction statistical significance from PRE to the POST test (P = 0.002), supporting this result in the RET test. Despite both groups presenting a significant increase in the shoulder horizontal adduction (P = 0.003), only TRG showed a significant improvement in the shoulder (P = 0.001--PRE to POST and RET) and elbow (P = 0.038--PRE to RET) flexion extension, and in the velocity rate (P = 0.03--PRE to RET). The trunk restraint therapy showed to be a long-term effective treatment in the enhancement of shoulder and elbow active joint range and velocity rate but not in the maintenance of trunk retention. Trial registration: NCT02364141.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Horizontal plane showing the 5 markers; 1, contralateral acromion; 2, ipsilateral acromion; 3, midsternum; 4, lateral humeral epicondyle; 5, wrist radial styloide process.
FIGURE 2
FIGURE 2
Flowchart of patient randomization on follow-up.
FIGURE 3
FIGURE 3
Harness and training platform. (A) Stroke patient performing a reaching training with trunk restraint by a harness. The numbers in the targets were used to perform cognitive tasks. (B) Posterior custom-designed harness.

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