AIM:
To train reaching and manipulation using trunk restraint to prevent excessive trunk flexion
Rationale:
Excessive trunk flexion is a common adaptive strategy patients use when reaching for and manipulating objects. Whole-task training is set up so the patient can practice reaching and manipulation without excessive trunk flexion, with feedback and/or manual guidance from the therapist if necessary. Training is structured so that flexibility of performance is encouraged, ie, the cognitive and/or physical demands of the activity are increased.
Equipment:
- Table
- Chair
- Bandage
- Ruler
- Objects, eg, cup, bottle coins, comb
Key Points:
- Patient is positioned in sitting in front of a table
- Therapist applies a bandage diagonally across the patient’s chest to restrict trunk flexion
- Patient reaches for a variety of objects
- A ruler may be positioned to provide feedback about excessive shoulder internal rotation (as shown in video)
- Ensure explanation for using trunk restraint is given and consent granted
Common Errors:
- Patient elevates and/or abducts the shoulder
Progression and Variety:
- Remove trunk restraint
- Decrease/remove manual guidance
- Increase speed of movement
- Increase amplitude of movement
- Vary manipulation component of the tasks and include bimanual tasks
- Increase cognitive demand