Open Access Open Access  Restricted Access Subscription or Fee Access

Effectiveness of Task-specific Training with Trunk Restraint on Lower Extremity Recovery in Stroke Patients

Sasanka Mahanta, Kangkan Talukdar, Mayur Das


Background: Stroke is considered as one of the major causes of impairments in activities of daily living. The majority of patients after stroke demonstrate excessive compensatory trunk deviation movement during activities of daily living. This compensatory trunk movement limits recovery of the lower extremity. Task-specific training is an effective intervention to improve recovery of the upper extremity. However, there was not much evidence about the effectiveness of task-specific training with restraining compensatory trunk movement in the recovery of the lower extremity. Objectives: The objectives of this study were to check the effectiveness of task-specific training with trunk restraint on lower extremity recovery and on reducing the impairment of the trunk in stroke patients. Materials and Method: 30 subjects diagnosed with stroke were included in this study. Among these, 19 were males and 11 were females. The trunk impairment scale (TIS) and lower extremity section of the Fugl- Meyer Assessment (FMA-LE) were assessed on the first day prior to the intervention. 30 subjects performed task-specific exercises which consists of 8 exercises. Each exercise was performed for 10–15 reps, 3 sets, 5 days/week, for 4 weeks. At the end of 4 weeks, TIS and FMA-LE were reassessed in all subjects, and pre- and post-intervention data were statistically analyzed. Results: Using SPSS software, the results of statistical analysis were tabulated in terms of mean, standard deviation, and p-value in the study. Result showed that there was significant improvement in the variables. Conclusion: It is concluded that task-specific training with trunk restraint is effective in improving lower extremity recovery and reducing impairment of the trunk in stroke patients.

Full Text:



O’Sullivan SB, Schmitz TJ, Fulk G. Physical Rehabilitation. 6th ed. Philadelphia: FA Davis; 2013 Jul 23.

Desai M, Gawde S, Prabhu S. A study of the relationship between trunk impairment and gait in patients with a cerebrovascular accident. Int J Health Sci Res. 2018;8(10):113–23.

American College of Cardiology. (2017). New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension—American College of Cardiology. [online] Available from: 2017. 4. Verheyden G, Nieuwboer A, De Wit L, Thijs V, Dobbelaere J, Devos H et al. Time course of trunk, arm, leg, and functional recovery after ischemic stroke. Neurorehabil Neural Repair. 2008;22(2):173–9. doi: 10.1177/1545968307305456.

Ryerson S, Byl NN, Brown DA, Wong RA, Hidler JM. Altered trunk position sense and its relation to balance functions in people post-stroke. J Neurol Phys Ther. 2008 Mar;32(1):14–20. doi: 10.1097/NPT.0b013e3181660f0c.

Karatas M, Cetin N, Bayramoglu M, Dilek A. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Am J Phys Med Rehabil. 2004 Feb;83(2):81–7. doi: 10.1097/01.PHM.0000107486.99756.C7.

Levangie PK Norkin CC Lewek MD. Joint Structure and Function: A Comprehensive Analysis. Sixth ed. Philadelphia: F.A. Davis Company; 2019.

Verheyden G, Vereeck L, Truijen S, Troch M, Herregodts I, Lafosse C et al. Trunk performance after stroke and the relationship with balance, gait, and functional ability. Clin Rehabil. 2006 May;20(5):451–8. doi: 10.1191/0269215505cr955oa.

Bohannon RW, Cassidy D, Walsh S. Trunk muscle strength is impaired multidirectionally after stroke. Clin Rehabil. 1995 Feb;9(1):47–51. doi: 10.1177/026921559500900107.

Dickstein R, Shefi S, Marcovitz E, Villa Y. Electromyographic activity of voluntarily activated trunk flexor and extensor muscles in post-stroke hemiparetic subjects. Clin Neurophysiol. 2004 Apr 1;115(4):790–6. doi: 10.1016/j.clinph.2003.11.018.

Davies PM. Problems associated with the loss of selective trunk activity in hemiplegia. Right Middle. 1990:31–65. doi: 10.1007/978–3–642–61502–3_4.

Levin MF, Musampa NK, Henderson AK, Knaut LA. New approaches to enhance motor function of the upper limb in patients with hemiparesis. H.K Phys J. 2005;23(1):2–5. doi: 10.1016/S1013– 7025(09)70052–1.

Ada L, Canning CG, Carr JH, Kilbreath SL, Shepherd RB. Task specific training of reaching and manipulation. Adv Psychol Insights Reach Grasp Mov. 1994;105;4115(08)61281–9:239–65. doi: 10.1016/S0166.

Cirstea MC, Levin MF. Improvement of arm movement patterns and endpoint control depends on type of feedback during practice in stroke survivors. Neurorehabil Neural Repair. 2007;21(5):398– 411. doi: 10.1177/1545968306298414.

Levin MF, Kleim JA, Wolf SL. What do motor “recovery” and “compensation” mean in patients following stroke? Neurorehabil Neural Repair. 2009 May;23(4):313–9. doi: 10.1177/1545968308328727.

Menezes KKP, Nascimento LR, Pinheiro MB, Scianni AA, Faria CD, Avelino PR et al. Lower- limb motor coordination is significantly impaired in ambulatory people with chronic stroke: a cross- sectional study. J Rehabil Med. 2017 Apr;49(4):322–6. doi: 10.2340/16501977–2215.

Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011 May;377(9778):1693– 702. doi: 10.1016/S0140–6736(11)60325–5.

Khallaf ME. Effect of task-specific training on trunk control and balance in patients with subacute stroke. Neurol Res Int. 2020;2020(7):5090193. doi: 10.1155/2020/5090193.

French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, et al. Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev. 2016 Nov 14;2016(11):CD006073. doi: 10.1002/14651858.CD006073.pub3.

Arya KN, Pandian S, Verma R, Garg RK. Movement therapy induced neural reorganization and motor recovery in stroke: a review. J Bodyw Mov Ther. 2011 Oct;15(4):528–37. doi: 10.1016/j.jbmt.2011.01.023.

Hubbard IJ, Parsons MW, Neilson C, Carey LM. Task-specific training: evidence for and translation to clinical practice. Occup Ther Int. 2009;16(3–4):175–89. doi: 10.1002/oti.275.

Salbach NM, Mayo NE, Wood-Dauphinee S, Hanley JA, Richards CL, Côté R. A task-orientated intervention enhances walking distance and speed in the first-year post stroke: a randomized controlled trial. Clin Rehabil. 2004 Aug;18(5):509–19. doi: 10.1191/0269215504cr763oa.

Michaelsen SM, Dannenbaum R, Levin MF. Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial. Stroke. 2006 Jan;37(1):186–92. doi: 10.1161/01.STR.0000196940.20446.c9.

Chung SH, Kim JH, Yong SY, Lee YH, Park JM, Kim SH, et al. Effect of task-specific lower extremity training on cognitive and gait function in stroke patients: A prospective randomized controlled trial. Ann Rehabil Med. 2019 Feb;43(1):1–10. doi: 10.5535/arm.2019.43.1.1.

Michaelsen SM, Levin MF. Short-term effects of practice with trunk restraint on reaching movements in patients with chronic stroke: a controlled trial. Stroke. 2004 Aug;35(8):1914–9. doi: 10.1161/01.STR.0000132569.33572.75.

Pain LM, Baker R, Richardson D, Agur AM. Effect of trunk-restraint training on function and compensatory trunk, shoulder and elbow patterns during post-stroke reach: a systematic review. Disabil Rehabil. 2015;37(7):553–62. doi: 10.3109/09638288.2014.932450.

Poole JL, Whitney SL. Motor assessment scale for stroke patients: concurrent validity and interrater reliability. Arch Phys Med Rehabil. 1988 Mar;69(3 Pt 1):195–7.

Lopez MN, Charter RA, Mostafavi B, Nibut LP, Whitney E. Smith Psychometric Properties of the Folstein Mini-Mental State Examination, sage Journals. Assessment June 2005;12(2137).

Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W. The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004 May;18(3):326–34. doi: 10.1191/0269215504cr733oa.

Kim H, Her J, Ko J, Park D, Woo J, You Y et al. Reliability, concurrent validity, and responsiveness of the Fugl-Meyer Assessment (FMA) for hemiplegic patients. J Phys Ther Sci. 2012;24(9):893–9. doi: 10.1589/jpts.24.893.

Levin MF. Should stereotypic movement synergies in hemiparetic patients be considered adaptive? Behav Brain Sci. 1996;19(1):79–80. doi: 10.1017/S0140525X00041613.

Cirstea MC, Levin MF. Compensatory strategies for reaching in stroke. Brain. 2000 May;123(5):940–53. doi: 10.1093/brain/123.5.940.

Michaelsen SM, Luta A, Roby-Brami A, Levin MF. Effect of trunk restraint on the recovery of reaching movements in hemiparetic patients. Stroke. 2001;32(8):1875–83. doi: 10.1161/01.str.32.8.1875.

Ghag V, Ganvir S. Task-oriented training in rehabilitation of gait after stroke: systematic review. J Med Biomed Sci. 2018;6(3):23–31.

Pu Y, Wei N, Yu D, Wang Y, Zou X, Soo YOY, et al. Sex differences do not exist in outcomes among stroke patients with intracranial atherosclerosis in China: subgroup analysis from the Chinese intracranial atherosclerosis study. Neuroepidemiology. 2017;48(1–2):48–54. doi: 10.1159/000469717.

Perna R, Temple J. Rehabilitation Outcomes: ischemic versus hemorrhagic Strokes. Behav Neurol. 2015;2015:891651. doi: 10.1155/2015/891651.



  • There are currently no refbacks.

Copyright (c) 2023 Research & Reviews: Journal of Neuroscience

This Journal archive has been shifted to: