Effects of training in a restricted range
elbow flexor spasticity, abnormal’ movement patterns, elbow motor impairment
The results do not unequivocally support the hypothesis that training in the restricted range would increase the elbow flexor TSRT since similar improvements in elbow TSRT angles and clinical outcomes occurred in both groups. This suggests that repetitive UL training had an overall positive effect on increasing the active elbow extension range. However, only when training was specifically structured to avoid evoking ‘abnormal’ movement patterns in the restricted-range training group did participants produce movements that were more like those made by healthy subjects.We implemented personalized impairment-based reaching training defined according to the individual’s active range of elbow extension (i.e., defined by the TSRT angle), which was associated with their specific elbow motor impairment. By identifying the angle at which elbow flexor spasticity began to interfere with elbow extension, we could shape the training so that repetitive reaching could be done without evoking unwanted elbow flexor muscle resistance leading to abnormal movement patternsParticipants who trained in the Restricted-range showed an overall improvement in UL movement compared to the Non-restricted-range training group. However, the movement quality improvements were insufficient to substantially increase clinical motor impairment and activity scores. It is likely, however, that increases in the active range of one joint (elbow) may have been too modest to lead to meaningful changes in overall UL function and that future trials could shape training according to multiple joint limitations. Another explanation is that clinical scales are not sensitive enough to the specific effects of training on movement-quality variables that are detected by kinematic analyses