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

Objective: To assess use of the Bon Saint Came 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 (TM) 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 Came 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. (C) 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.