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A SYSTEMATIC REVIEW :

TRUNK RESTRAINT TRAINING AFTER STROKE

Senthilkumar Jeyaraman,PT1; Ganesan Kathiresan, PT2; Kavitha Gopalsamy,PT3


1 , 2 Lecturer, Masterskill University college of Health sciences, Malaysia ;3 Physiotherapist, Malaysia

How trunk restraint training


Background Data analysis
improves reaching?
In hemiparetic patients, the unrestricted and unguided The effect size for the outcome measure was calculated by
repetition of a motor task may reinforce compensatory  Due to an adaption involving anticipation of
Cohen’s d. The effect sizes are especially important changed external load conditions.1
movements. Thus, in the short term, although
because they allow us to compare the magnitude of
compensatory movements may improve
experimental treatments from one experiment to another.  The adaptation was triggered by somato sensory
performance of the paretic arm, in the long term,
input from the trunk or shoulder caused by the
these may be maladaptive by preventing recovery or
reappearance of more efficient arm movement Results trunk restraint.1
patterns.  External feedback, that is, explicit information was
Trunk restraint allowed the patients to use joint ranges
Michaelsen Michaelsen Michaelsen Thielman Woodbury inherently built into the task practice with trunk
that were present but not recruited during unrestrained SM et al SM et al SM et al G et al ML et al
reaching.1,2,3 Later, studies combined the trunk restraint restraint context both as knowledge of results
(2001) (2004) (2006) (2008) (2009)
training with additional therapeutic interventions.4,5 (KR) and knowledge of performance (KP).5
With the growing number of studies on this intervention Anterior - 0.58 - - 5.53 huge
Trunk medium effect
in stroke population, there is a need to consolidate this
evidence to determine the potential use of trunk restraint
Displacement effect
Trunk Restraint
training in improving arm reaching in neurological Elbow 1.24 very 0.29 small - 0.27 0
Training in Future
Extension large effect small negligible
rehabilitation particularly for stroke patients. effect effect effect

Purpose of the Review Smoothness - - 0.22 small


effect
- -  Future studies should emphasize some
interventions to the hemiplegic lower limb
1. The primary aim is, to assess the effectiveness of Hand - - 0 negligible - - while giving trunk restraint training to the
trajectory effect
trunk restraint training on the recovery of reaching straightness hemiplegic upper limb.
movements in stroke patients.  In daily living, reaching is more likely to be
2. Secondary aim is, to find out the effectiveness of performed in a standing position. In future, we
trunk restraint training combined with other
recommend to study the influence of trunk
therapeutic interventions.
restraint training in arm reaching in standing
position.
Search Outcome
 Young and Schmidt6 showed that less retention of
Titles and learning occurs when continuous feedback is
abstracts given compared with less frequent feedback.
identified (n = 6) Hence further studies are necessary to determine
the efficacy of faded trunk-restraint program.

Conclusions
Studies retrieved for
evaluation of full text The results of our review demonstrated that the use
(n = 6) of trunk restraint as a treatment paradigm aimed at
Discussion decreasing compensatory strategies has the
potential of becoming an effective therapy. Further
Reaching ability is an important component for researches with randomized control trials are
Studies excluded after independent living. However, survivors of stroke often rely
evaluation of full text
necessary to determine the long term effect and
Potentially relevant on compensatory movement strategies to accomplish
(n = 1) Single group clinical efficacy of the trunk restraint training in
studies meeting the
design reaching tasks. Carr and shepherd suggest that hemiparetic patients.
inclusion criteria (n = 5)
compensatory strategies are the result of using
available movements given the post stroke state of the References
central system, which leads to long – term functional
Studies included in limitations. Hence Michaelsen et al studied the 1. Michaelsen SM, Lutta A, Roby – Brami A, Levin
systemic review MF. Effect of trunk restraint on the recovery of
effectiveness of trunk restraint training on arm recovery in
(n = 5) stroke patients and demonstrated that trunk restraint is a reaching movements in hemiparetic patients.
Stroke. 2001; 32: 1875 – 1883
treatment paradigm which decreases the compensatory
2. Michaelsen SM, DEA, Levin MF. Short term
strategies.1,2,3 effects of practice with trunk restraint on
Trunk restraint training is similar to the strategy of reaching movements in patients with chronic
Inclusion criteria constraining the unaffected arm to force the patient to stroke. Stroke. 2004; 35: 1914 – 1919
make more use of the affected arm with the additional 3. Michaelsen SM, Ruth Dannenbawn, Levin MF:
 Randomized controlled trials Task – specific training with trunk restraint on
feature that reduction of compensatory movement patterns
 Descriptive studies in the absence of RCTs arm recovery in stroke. Stroke. 2006; 37: 186 –
is also targeted. This was proved by the recent findings of 192
 Adult person with stroke, except those with pathology ML. Woodbury et al.5 He suggests that under lying 4. Thielman G, Terry Kaminski, Gentile AM:
of the cerebellum or the basal ganglia “normal” patterns of movement coordination are not rehabilitation of reaching after stroke:
 Trunk restraint training, Trunk restraint training entirely lost after stroke and that appropriate comparing 2 training protocol utilizing trunk
combined with other interventions treatments may be applied to uncover them to restraint. Neurorehabil Neural Repair. 2008; 22:
maximize function.5 697 – 705
Outcome measure Since task related training and resisted exercise21
5. Woodbury ML, Howland DR, Mcguirk TE, Davis
Sb, Senesac CR, Kautz S, Richards LG. Effects
demonstrated enhanced recovery in stroke patients, of trunk restraint combined with intensive task
 3D Motion Analysis (Kinematic Analysis) Thielman et al 4 compared the effects of task related practice on post stroke upper extremity reach
training and resisted exercise combined with trunk restraint and function: A pilot study. Neurorehabil Neural
1. Anterior trunk displacement
training in his recent trial. Extensive practice using task repair. 2009; 23: 78 – 91
2. Elbow extension 6. Young DE, Schmidt RA. Augmented kinematic
related training with truncal restraint appears to be a more
3.Smoothness & Hand trajectory straightness feedback for motor learning. J Mot Behav.
effective approach to rehabilitate reaching with the 1992; 24: 261-273.
hemiparetic arm.4

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