August 16, 2016

A Practical Way to Get More Repetitions

Problem.  PTs often make stroke survivors make 8 trips around the gym each day while OTs may
             treat the upper extremity for only 4 to 11 minutes out of a 47 minute treatment session (1).
             It is not surprising that repeated practice in PT produces quick leg recovery after a stroke. 
Problem.  Constraint therapy is for stroke survivors who can tolerate 2 hours of hand therapy per
             day and who agree to wear a mitt on their sound hand for the rest of the day which forces
             them to use their hemiplegic hand.

Harris designed a self-administered hand therapy program for a large range of stroke survivors with a less intensive approach (2).  One-hundred and three subjects with mild, moderate, and severe impairment on the upper extremity Fugl-Meyer test (UEFM) were recruited soon after they were admitted to a rehab hospital.  Subjects in the experimental group were given booklets and equipment graded to their level and asked to do exercises and functional tasks for 1 hour a day
6 days a week during breaks in the therapy schedule.  Subjects actually did an average of 3 hours spread over 4.8 days per week for 4 weeks.  Subjects in the control group read about stroke and did homework on the readings during breaks in the therapy schedule.  A site coordinator taught the program and monitored each subject once a week.

Experimental subjects were significantly better than control subjects at reaching for and grasping objects on the ARAT (p=0.031) and using their hand during functional tasks on the Chedoke (p<0.001).  A limitation for self-administered therapy is cognitive and language deficits.  Stroke survivors in this study were excluded if they had receptive aphasia or had a score lower than 20 on the Mini Mental Status Examination (MMSE).

Bottom-line: Numerous studies have shown that therapy which exceeds a typical rehab schedule improves outcomes.  A self-administered hand therapy program to supplement in-patient OT required minimal therapist time but produced significant gains in hand recovery for stroke survivors with minimal cognitive impairments.

1.  Berhardt J, Chan J, Nicola I, Collier J. Little therapy, little physical activity: rehabilitation within
     the first 14 days of organized stroke unit care. J Rehabil Med. 2007;39:43-48.

2. Harris JE, Eng JJ, Miller WC, Dawson AS. A self-administered graded repetitive arm
    supplementary program (GRASP) improves arm function during inpatient stroke rehabilitation.
    Stroke. 2009;40:2123-2128.

1 comment:

  1. I have been thinking about this topic a lot lately.. More specific hand therapy both short and longer time after the stroke. I certainly did not get enough help with hand use through normal channels. My stroke recovery association has many members who swear that being a former knitter who tries to keep knitting and crafting post stroke is the answer to getting back hand use.