Pilot trial of distributed constraint-induced therapy with trunk restraint to improve poststroke reach to grasp and trunk kinematics

Background. Constraint-induced therapy (CIT) is effective in improving upper extremity motor function, but evidence is lacking about effectiveness grasp and trunk control. Objective. This study investigated whether distributed CIT combined with trunk restraint (dCIT + TR) benefited movement kinematics of grasping and the trunk, as well as motor ability of the upper extremity, more than dCIT alone. Methods. A total of 45 stroke participants received 2 hours of dCIT + TR, dCIT, or the dose-matched control intervention for 3 weeks. Movement kinematics, motor ability, and daily function were the outcome measures. Movement kinematics included grasping, joint range, and trunk movement at various phases of reach-to-grasp tasks. Motor ability and daily function of all participants were evaluated using the Fugl-Meyer Assessment and the Motor Activity Log. Results. Four to 5 participants in each group were not included for kinematic analysis because of their inability to grasp a can. The dCIT + TR group showed better preplanned grasping movement and less trunk motion at the early phase of the reach-to-grasp movements than the dCIT or control groups. Compared with the controls, the dCIT + TR participants showed better motor ability in the overall and distal arm scores of the Fugl-Meyer Assessment. The dCIT + TR and dCIT participants demonstrated significantly greater functional use of the affected arm. Conclusions. Administering dCIT + TR produced additional benefits by improving grasping control and reversing the compensatory trunk movement at the early phase of a reach-to-grasp movement. The use of experimental tasks beyond and within arm's length might improve our understanding of optimal upper extremity rehabilitation.