Rehabilitation of reaching after stroke: Task-related training versus progressive resistive exercise

Objective: To evaluate the effectiveness of 2 rehabilitative approaches for improving paretic limb reaching by chronic stroke subjects. Design: Pre- and posttest reaching to targets ipsilateral, midline, and contralateral to the impaired side. Setting: Training in subjects' homes; testing in a laboratory setting. Participants: Twelve poststroke volunteers were matched using the Motor Assessment Scale (MAS) and then were randomly assigned to 1 of 2 training conditions. Subjects were subsequently categorized as at a high or low functional level, using the reaching pretest movement time scores. Interventions: Training (trunk unrestrained) using the paretic limb was 4 weeks (12 sessions). Task-related training (TRT) involved reaching to objects placed across the work-space. Progressive resistive exercise (PRE) involved whole-arm pulling against resistive therapeutic tubing in planes and distances similar to that in TRT. Main Outcome Measures: Kinematic analysis of arm trajectory and trunk motion using the Peak Performance System, as well as scores on the MAS and the Rivermead Motor Assessment (RMA). Results: For low-level groups, TRT resulted in increased substitutive trunk use at the target ipsilateral to the moving arm, and for midline and contralateral targets after PRE. Only low-level, TRT subjects straightened hand paths, which suggested better coordination of elbow-shoulder motion, and improved on the RMA. High-level subjects decreased trunk use at ipsilateral target after PRE, which was not observed after TRT. No significant differences between training conditions were found for other kinematic variables. Conclusions: Training benefits appear to depend on initial level of functioning. Although compensatory trunk use was evident, low-level subjects seemed to benefit most from TRT. High-level subjects, whose kinematics showed fairly normal movement organization, demonstrated less compensatory movement after PRE. (C) 2004 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.