Here is the full study:
http://stroke.ahajournals.org/cgi/reprint/40/6/2123
abstract here:
A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation
A Multi-Site Randomized Controlled Trial
From the Department of Physical Therapy (J.E.H., J.J.E.), the Department of Occupational Science and Occupational Therapy (W.C.M.), and the Department of Medicine (A.S.D.), University of British Columbia, Vancouver, Canada.
Correspondence to Janice Eng, PhD, Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, British Columbia, Canada, V6T 1Z3.
Background and Purpose— More than 70% of individuals who have a stroke experience upper limb deficits that impact daily activities. Increased amount of upper limb therapy has positive effects; however, practical and inexpensive methods of therapy are needed to deliver this increase in therapy.
Methods— This was a multi-site single blind randomized controlled trial to determine the effectiveness of a 4-week self-administered graded repetitive upper limb supplementary program (GRASP) on arm recovery in stroke. 103 inpatients with stroke were randomized to the experimental group (GRASP group, n=53) or the control group (education protocol, n=50). The primary outcome measure was the Chedoke Arm and Hand Activity Inventory (CAHAI), a measure of upper limb function in activities of daily living. Secondary measures were used to evaluate grip strength and paretic upper limb use outside of therapy time. Intention-to-treat analysis was performed. Group differences were tested using analysis of covariance.
Results— At the end of the 4-week intervention (approximately 7 weeks post stroke), the GRASP group showed greater improvement in upper limb function (CAHAI) compared to the control group (mean difference 6.2; 95% CI: 3.4 to 9.0; P<0.001). The GRASP group maintained this significant gain at 5 months post stroke. Significant differences were also found in favor of the GRASP protocol for grip strength and paretic upper limb use. No serious adverse effects were experienced.
Conclusion— A self-administered homework exercise program provides a cost-, time-, and treatment-effective delivery model for improving upper limb recovery in subacute stroke.
Exercises here:
http://www.rehab.ubc.ca/jeng/Our_Exercise_Manuals/GRASP.htm
I was still disappointed in the baseline because they never specified the penumbra or the dead brain area and as a result I don't believe this is scientifically reproducible.
I can't get the exercise page to open. Not that I was going to do them Dean just curious about what kind they were using.
ReplyDeleteSounds like it was a good study with good recomendations .. only big problem is people actually doing there Homework. My PT always seems amazed that I do my exercises daily.. He makes it sound like a rarity.
Linda
http://leadingahealthylife.blogspot.com/
TRy it now Linda, I re-enterd the link.
ReplyDeleteI have worked with stroke patients for the past 12 months in Occupational Therapy. Patients, who were not expected to have any movement back in their limbs, and who had a poor prognosis got movement back in their limbs. What I noticed is that Passive range of motion exercise made functional, for those who are not cognitively impaire, seems to get great results. That is for the weaker limb within passively ranging to incorporate it with functional tasks ie Active Assisted Range of Motion tasks such as Assisting the patient to use the weaker limb to comb hair, brush teeth, hold a cup. Even holding the hand extending the finger and rubbing their hand on their face or lip seems to get the synapses re connecting and allowing an amazing recovery with the affected limbs.
ReplyDeleteOne patient in particular had a Cerebral Palsy of unkown origin, this patient was a science student, young and very parylised. Almost locked in. Doctors gave the patient not a lot of hope for recovery.
With 6 weeks of PROM and AAROM exercise and music being played to stimulate,the patients eyes began tracking to their name, and movement returned slowly to the right side and with functional AAROM exercise the left limb although still weak began to release tension, and I could feel the want for movement in my hand as I held the patients arm and supported it through movement to Assist with brushing hair, putting lip balm on, and rubbing their hand on their face. This patient also started to nod in affirmation to questions asked all of which I believe the Functional AAROM exercises incorporated into the PROM exercise helped to establish.
I love working with stroke patients and I think it takes time repetition and persistance in the early stages of stroke to get results.
Dean, I can only imagine what its like to have a stroke. I started taking my high blood pressure medication every day when I started working with stroke patients. I have just started working with the GRASP program and look forward to assisting in recovery.
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