Brief research report 67 Improvements in the upper limb of hemiparetic patients after reaching movements training Roberta de Oliveira, Enio Walker Azevedo Cacho and Guilherme Borges Reaching movements made with hemiparetic upper limbs are often followed by compensatory trunk and shoulder- girdle movements, especially in reach-to-grasp strategies. We investigated the effect of restraint therapy on movement aiming at targets placed within arm reach. Eleven subjects were selected to participate in this study and were submitted to training with the trunk fixed to a chair during the reaching movement. Quantitative and qualitative scales (Modified Ashworth Scale, Fugl-Meyer Assessment Scale – upper limb section, Berg Balance Scale and Barthel Index) were used to evaluate reaching in three periods – pre-treatment, post-treatment and follow-up 3 months after training was completed. We found that in the arm section of the Fugl-Meyer Assessment Scale, pain (x 2 = 8.22, P = 0.016), proprioception (x 2 = 6.00, P = 0.049), flexor synergy (x 2 = 6.07, P = 0.048), wrist (x 2 = 6.50, P = 0.039), coordination velocity (x 2 = 7.05, P = 0.029) and the total score for the upper limb (x 2 = 7.95, P = 0.019) had statistical significance, especially in the pre-treatment and follow-up phases. The same happened using the Barthel Index (x 2 = 8.33, P = 0.016). Trunk restraint allowed patients with hemiparetic stroke to make use of active arm joint ranges that are present but not normally recruited during unrestrained arm reaching tasks. Appropriate treatments, such as trunk restraint, may be effective in uncovering latent movement patterns to maximize arm recovery in hemiparetic patients. International Journal of Rehabilitation Research 30:67–70  c 2007 Lippincott Williams & Wilkins. International Journal of Rehabilitation Research 2007, 30:67–70 Keywords: motor learning, repetitive training, restraint therapy, stroke Neurosurgery Physiotherapy Ambulatory, Medical School Hospital of the State University of Campinas (UNICAMP), Campinas, SP, Brazil Correspondence and requests for reprints to Roberta de Oliveira – Rua Senador Vergueiro, 687 – apto 133 Centro, 13480-900 Limeira, SP, Brazil Tel: + 55 (19) 3032 0152/ + 55 (19) 9747 5185; e-mail: rofisio@fcm.unicamp.br Sponsorship: We would like to thank Fundac ¸a ˜ o de Amparo a ` Pesquisa do Estado de Sa ˜ o Paulo (FAPESP – 05/51565-1) and Conselho Nacional de Pesquisa (CNPq – 302189/2004-1) for their financial support. Received 7 June 2006 Accepted 10 September 2006 Introduction After stroke, upper limb function impairment is the most common sequel that could lead to permanent dysfunction (Nakayama et al., 1994). Previous studies in hemiparetic patients have described excessive trunk or shoulder girdle movements in pointing (Roby-Brami et al., 1997) and in reach-to-grasp move- ments (Michaelsen et al., 2001). Levin (1996) has suggested that this increased recruitment is a compensa- tory mechanism through which the central nervous system (CNS) may extend arm reach when control of the arm joints’ active range is limited. The presence of excessive trunk movement in hemiparetic individuals while reaching may limit the potential recovery of normal arm movement patterns (Cirstea et al., 1998). Reducing the compensatory mechanism by limiting trunk displacement may encourage the return of movement patterns typically seen in healthy individuals. Trunk restraint blocks undesirable movements and facilitates normal patterns in the hypothesis that recovery of voluntary control may lead to functional improvement (Michaelsen et al., 2001). This is similar to the Constraint Induced Therapy (CIT) of the non-affected arm that induces the subject to make use of the affected arm in the performance of daily living functional activities (Taub et al., 1993). This study proposes the application of restraint therapy during reaching tasks and assesses its clinical effects in the rehabilitation of the upper limb. Methods Eleven subjects were selected from the Rehabilitation Program of the Neurosurgery Physiotherapy Outpatient Clinic, Medical School Hospital, UNICAMP, Campinas, SP, Brazil, and all of them signed informed consent forms previously approved by the Research Ethics Committee of the University. All of the subjects had sustained a single unilateral stroke of non-traumatic origin, were in the chronic phase of the complaint ( > 6 months post- event), with hemiparetic sequelae in the upper limb, no hemispatial neglect or apraxia, could understand simple instructions and had a good sitting balance. Those with shoulder pain or other neurological and orthopedic conditions affecting the arm or trunk were excluded. 0342-5282  c 2007 Lippincott Williams & Wilkins Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.