Rehabilitation of postural disturbances of hemiplegic patients by using trunk control retraining during exploratory exercises.

OBJECTIVE

To assess use of the Bon Saint Côme device for axial postural rehabilitation in hemiplegic patients, a technique based on voluntary trunk control during exploratory retraining.

DESIGN

A 3-month randomized controlled trial.

SETTING

A public neurorehabilitation center.

PATIENTS

Twenty consecutive hemiplegic patients with axial postural disturbance resulting from recent stroke were randomly assigned to a device group (DG) or control group (CG). The 2 groups of 10 patients were similar.

INTERVENTION

For 1 month, the DG patients followed an experimental program for 1 hour daily and conventional neurorehabilitation for 1 hour daily, whereas CG patients had conventional neurorehabilitation for 2 hours daily. For the next 2 months, all 20 patients had conventional neurorehabilitation for 2 hours daily.

MAIN OUTCOME MEASURES

Patients were assessed on days 0, 30, and 90 by using a battery of postural tests, gait evaluation, the Bells neglect test, and the FIM instrument.

RESULTS

On day 30, postural and neglect tests improved significantly more in DG than in CG. The benefit remained at day 90. Gait improved earlier in DG than in CG. FIM scores improved equally.

CONCLUSIONS

Voluntary trunk control retraining during spatial exploration with the Bon Saint Côme device appears to be a useful approach for rehabilitation of postural disorders in hemiplegic patients. Treatments designed to improve spatial cognition deficits probably enhance postural disorder recovery in hemiplegia.