Trunk Restraint and the TUTOR As Tools for Reach and Grasp

Since the goal in physical rehabilitation is to return the patient‘s functional ability to as near as possible to the pre event state it is necessary for the patient to become as independent as possible and  to relearn basic skills like eating, dressing, walking and grasping. This will preserve the patient’s dignity and reduce the burden on family.

A study was performed by Stella M. Michaelsen, PhD etal from the School of Rehabilitation, University of Montreal and the Centre for Interdisciplinary Research in Rehabilitation, Rehabilitation Institute of Montreal, Quebec, Canada. The Purpose of the study was to discover the advantages of trunk movement restriction when attempting to reach an item placed within arm’s reach by patients with hemiparesis caused by stroke. Compensatory trunk movements may improve motor function in the short term but may limit arm recovery in the long term. Previous studies showed that restriction of trunk movements during reach-to-grasp movements results in immediate increases in active arm joint ranges and improvement in interjoint coordination. To evaluate the potential of this technique as a therapeutic intervention, a comparison was made as to the effects of short-term reach-to-grasp training with a 60 session trial with and without physical trunk restraint on arm movement.

 A total of 28 patients with hemiparesis were divided into 2 groups: One group practiced reach-to-grasp movements during which compensatory movement of the trunk was prevented by a harness as a trunk restraint, and the second group practiced the identical task but they were verbally instructed not to move the trunk (control group). Before, immediately after and 24 hours after training, Kinematics of reaching and grasping an object placed within arm’s length were recorded.

 The results showed that the trunk restraint group used more elbow extension, less anterior trunk displacement and had better interjoint coordination than the control group after training. In addition range of motion was maintained 24 hours later in only the trunk restraint group.

Therefore it was concluded that restriction of compensatory trunk movements during practice may lead to greater improvements in reach-to-grasp movements by chronic stroke patients than practice alone.

Also, in order to train grasp through hand therapy, the occupational and physical therapists have to improve both the patient’s finger range of motion and movement. This means that the OT and PT have to work on the patient’s motor movement in terms of strength, accuracy and balance of antagonistic muscle movements as well as pattern of joint movements.

In addition to hand therapy the OT and PT will have to work on the patient’s shoulder, elbow and wrist movement ability as these joints are also used during a reach, grab and grasp task.

Proper exercise practice using the TUTOR system will allow the patient to implement the correct pattern of multijoint movements in order to perform the functional grasp task. Therefore the OT and the PT will use the ARMTUTOR for shoulder and elbow intensive exercise practice and the HANDTUTOR for wrist and finger movement practice.

The dedicated rehabilitation software of the TUTOR system allows the occupational and physical therapists to  work on the correct pattern of joint movement with feedback from the shoulder and the elbow. Together with the accompanying motion feedback from the HANDTUTOR the patient will learn how to perform the grasp task through repetitive exercise practice.

The TUTOR system is used extensively in rehabilitation hospitals and clinics in the U.S.and Europe and are fully certified by the FDA and CE.

Telerehabilitation allows the patient to continue his exercise program at home or if he is located too far from a rehabilitation facility.

See WWW.MEDITOUCH.CO.IL for further information.



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