Effect of trunk restraint on the recovery of reaching movements in hemiparetic patients.

BACKGROUND AND PURPOSE: Reaching movements made with the affected arm in hemiparetic patients are often accompanied by compensatory trunk or shoulder girdle movements, which extend the reach of the arm. We investigated the effects of the suppression of these compensatory movements on reaching ability in hemiparetic individuals. METHODS: Eleven healthy and 11 hemiparetic individuals participated. Three-dimensional kinematic analysis was used to quantify reaches made to a close and a distant target (near the limit of arm's length). Unrestrained reaches were compared with those in which shoulder girdle and trunk movements were restrained by a harness. RESULTS: During unrestrained reaching, abnormal trunk recruitment and limitations in elbow and shoulder movements were correlated with the degree of clinical stroke severity (r=-0.91 to -0.96) in hemiparetic patients. During trunk restraint, ranges of elbow and shoulder joint movement increased in both groups. In addition, elbow and shoulder interjoint coordination improved. This was caused by increases in the range of joint motion as well as by a better dynamic temporal relation between joints. CONCLUSIONS: Trunk restraint allowed patients with hemiparetic stroke to make use of arm joint ranges that are present but not normally recruited during unrestrained arm-reaching tasks. Thus, the underlying "normal" patterns of movement coordination may not be entirely lost after stroke. Appropriate treatments, such as trunk restraint, may be effective in uncovering latent movement patterns to maximize arm recovery in hemiparetic patients.

Addition of trunk restraint to home-based modified constraint-induced movement therapy does not bring additional benefits in chronic stroke individuals with mild and moderate upper limb impairments: A pilot randomized controlled trial.

BACKGROUND: People with stroke excessively move their trunk, when reaching and grasping objects. OBJECTIVE: To determine if the addition of trunk restraint to modified constraint-induced movement therapy (mCIMT) was better than mCIMT alone in improving strength, function, and quality of life after stroke. METHODS: A pilot randomized double-blinded clinical trial was conducted. Twenty-two participants with chronic stroke were randomly assigned to an experimental group that received mCIMT plus trunk restraint, or a control group (only mCIMT). Primary outcomes were the amount of use and quality of movement of the paretic upper limb (UL), determined by the Motor Activity Log (MAL) scores. Secondary outcomes included the observed performance of the paretic UL during unimanual and bimanual tasks, kinematics of reaching, strength, and quality of life. RESULTS: Both groups demonstrated significant improvements in the MAL scores and in the time to perform bimanual activities immediately after the interventions. However, no between-group differences were observed. CONCLUSIONS: The addition of trunk restraint to mCIMT resulted in no additional benefits, compared with mCIMT alone with stroke individuals with mild to moderate impairments. Unimanual and bimanual improvements were observed after mCIMT, regardless of trunk restraint, and the intervention did not adversely affect their reaching patterns.

Effects of skilled and unskilled training on functional recovery and brain plasticity after focal ischemia in adult rats.

Stroke is a leading cause of morbidity and mortality worldwide. Recovery of motor function after stroke can be modified by post-injury experience, but most of surviving patients exhibit persistence of the motor dysfunctions even after rehabilitative therapy. In this study we investigated if skilled and unskilled training induce different motor recovery and brain plasticity after experimental focal ischemia. We tested this hypothesis by evaluating the motor skill relearning and the immunocontent of Synapsin-I, PSD-95 and GFAP (pre and post-synaptic elements, as well as surrounding astroglia) in sensorimotor cortex of both hemispheres 6 weeks after endothelin-1-induced focal brain ischemia in rats. Synapsin-I and PSD-95 levels were increased by skilled training in ischemic sensorimotor cortex. The content of GFAP was augmented as a result of focal brain ischemia in ischemic sensorimotor cortex and that was not modified by rehabilitation training. Unexpectedly, animals remained permanently impaired at the end of motor/functional evaluations. Significant modifications in protein expression were not observed in undamaged sensorimotor cortex. We conclude that skilled motor activity can positively affect brain plasticity after focal ischemia despite of no functional improvement in conditions here tested.

Effect of skilled and unskilled training on nerve regeneration and functional recovery.

The most disabling aspect of human peripheral nerve injuries, the majority of which affect the upper limbs, is the loss of skilled hand movements. Activity-induced morphological and electrophysiological remodeling of the neuromuscular junction has been shown to influence nerve repair and functional recovery. In the current study, we determined the effects of two different treatments on the functional and morphological recovery after median and ulnar nerve injury. Adult Wistar male rats weighing 280 to 330 g at the time of surgery (N = 8-10 animals/group) were submitted to nerve crush and 1 week later began a 3-week course of motor rehabilitation involving either "skilled" (reaching for small food pellets) or "unskilled" (walking on a motorized treadmill) training. During this period, functional recovery was monitored weekly using staircase and cylinder tests. Histological and morphometric nerve analyses were used to assess nerve regeneration at the end of treatment. The functional evaluation demonstrated benefits of both tasks, but found no difference between them (P > 0.05). The unskilled training, however, induced a greater degree of nerve regeneration as evidenced by histological measurement (P < 0.05). These data provide evidence that both of the forelimb training tasks used in this study can accelerate functional recovery following brachial plexus injury.

Effect of skilled and unskilled training on nerve regeneration and functional recovery

The most disabling aspect of human peripheral nerve injuries, the majority of which affect the upper limbs, is the loss of skilled hand movements. Activity-induced morphological and electrophysiological remodeling of the neuromuscular junction has been shown to influence nerve repair and functional recovery. In the current study, we determined the effects of two different treatments on the functional and morphological recovery after median and ulnar nerve injury. Adult Wistar male rats weighing 280 to 330 g at the time of surgery (N = 8-10 animals/group) were submitted to nerve crush and 1 week later began a 3-week course of motor rehabilitation involving either "skilled" (reaching for small food pellets) or "unskilled" (walking on a motorized treadmill) training. During this period, functional recovery was monitored weekly using staircase and cylinder tests. Histological and morphometric nerve analyses were used to assess nerve regeneration at the end of treatment. The functional evaluation demonstrated benefits of both tasks, but found no difference between them (P > 0.05). The unskilled training, however, induced a greater degree of nerve regeneration as evidenced by histological measurement (P < 0.05). These data provide evidence that both of the forelimb training tasks used in this study can accelerate functional recovery following brachial plexus injury.

Confiabilidade da tradução e adaptação do Test d'Évaluation des Membres Supérieurs de Personnes Âgées (TEMPA) para o português e validação para adultos com hemiparesia / Reliability of the translation and adaptation of the Test d'Évaluation des Membres Supérieurs des Personnes Âgées (TEMPA) to the Portuguese language and validation for adults with hemiparesis

INTRODUÇÃO: O Test d'Évaluation des Membres Supérieurs de Personnes Âgées (TEMPA) é composto por tarefas padronizadas, representando atividades da vida diária e avalia a função do membro superior (MS) de pessoas com alteração motora. Além da medida do tempo e da graduação funcional, o instrumento propõe uma análise das tarefas executadas. OBJETIVO: Os objetivos do estudo foram: traduzir e adaptar para a língua portuguesa o formulário e o manual de administração do TEMPA; avaliar a confiabilidade teste reteste e interobservadores e a validade para pacientes com hemiparesia. MÉTODOS: Participaram deste estudo 23 pacientes (61±13 anos) com hemiparesia (30±29 meses) e 23 controles (60±12 anos). A confiabilidade interobservadores foi testada comparando o resultado de dois observadores, em avaliações realizadas no mesmo dia. A confiabilidade teste reteste foi testada comparando o resultado das avaliações, repetidas no intervalo de uma semana. A validade para hemiparéticos foi avaliada por meio da correlação com a escala de Fugl-Meyer (EFM). RESULTADOS: Os resultados mostram adequada confiabilidade interobservadores (coeficiente de correlação intraclasse - CCI=0,93) e teste reteste (CCI=0,99) para os escores totais. Nos pacientes com comprometimento motor moderado a grave (EFM<50), todos os itens mostraram adequada confiabilidade teste reteste e interobservadores (CCI entre 0,70 e 1,00). Nos pacientes com comprometimento motor leve (EFM>50), a confiabilidade para a velocidade na execução assim como para o escore funcional total (interobservadores, ICC=0,79 e teste-reteste, ICC=0,78), foi adequada. A correlação do TEMPA com a EFM foi de r=-0,85 (p=0,001). CONCLUSÕES: Os resultados sugerem adequada confiabilidade para a versão brasileira do TEMPA e validade para pacientes com hemiparesia.

INTRODUCTION: The Test d'Évaluation des Membres Supérieurs de Personnes Âgées (TEMPA) is composed of standardized tasks that represent activities of daily living. This test evaluates upper limb function in individuals with motor deficits. In addition to measuring time and functional level, this instrument also provides analysis of the tasks performed. OBJECTIVE: The aims were: to translate and to adapt the TEMPA form and administration manual to the Portuguese language; and to assess interrater and test-retest reliability and the validity of TEMPA for patients with hemiparesis. METHODS: Twenty-three patients (61±13 years) with hemiparesis (30±29 months) and 23 controls (60±12 years) participated in this study. The interrater reliability was tested by comparing the results from two examiners, in evaluations on the same day. The test-retest reliability was tested by comparing the results from evaluations repeated within a one-week interval. The validity of TEMPA for hemiparetics was assessed by correlation with the Fugl-Meyer scale (FMS). RESULTS: The results showed adequate interrater reliability (intraclass correlation coefficient - ICC=0.93) and test-retest reliability (ICC=0.99) for the total scores. In patients with moderate to severe motor deficits (FMS<50), all the items showed adequate test-retest and interrater reliability (ICC between 0.70 and 1.00). In patients with mild motor deficits (FMS>50), the reliability regarding speed of execution and total functional score (interrater, ICC=0.79 and test-retest, ICC=0.78) was adequate. The correlation of TEMPA with FMS was r=-0.85 (p=0.001). CONCLUSIONS: The results suggest that the Brazilian version of TEMPA is reliable and that it is valid for patients with hemiparesis.