A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation

Harris, Jocelyn E.; Eng, Janice J.; Miller, William C.; Dawson, Andrew S.

doi:10.1161/strokeaha.108.544585

Cited by 217 publications

(222 citation statements)

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“…Therapists working in stroke rehabilitation are being challenged to find new ways of increasing the intensity of practice that stroke survivors engage in each day 7 with suggested strategies including self-administered exercise 9 , group exercise 10 and family assisted exercise 11 . Despite the strength of evidence supporting intensity, objectively quantifying intensity of therapy in stroke rehabilitation remains problematic.…”

Section: Introductionmentioning

confidence: 99%

“…This study will use three measures of intensity (i) time, (ii) repetitions and (iii) wrist accelerometers to describe the intensity of exercise carried out during a session using the Graded Repetitive Arm Supplementary Program (GRASP). GRASP is a self-directed and structured upper limb exercise programme which has been shown to be effective in improving upper limb recovery in sub-acute stroke 9 . As the content of this exercise programme is already defined, it will be possible to more accurately define observed repetitions.…”

Section: Introductionmentioning

confidence: 99%

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Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

Connell

McMahon

Simpson

et al. 2014

Archives of Physical Medicine and Rehabilitation

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Objectives-To use three measures of intensity (i) time, (ii) observed repetitions and (iii) wrist accelerometer activity counts to describe the intensity of exercise carried out when completing a structured upper limb exercise programme. To explore if a relationship exists between wrist accelerometer activity counts and observed repetitions. Design-Observational study design. Setting-Rehabilitation centre research laboratory.Participants-Thirteen community dwelling stroke survivors with upper limb hemiparesis. Intervention-Not applicable.Main Outcome Measures-Time engaged in exercise, total repetitions and accelerometer activity counts for the affected upper limb.Results-Mean session time was 48.5 minutes (SD 7.8 minutes). Participants were observed to be engaged in exercises for 63.8% (SD 7.5%) of the total session time. The median number of observed repetitions per session was 340 of which 251 (IQR 80-309) were purposeful repetitions. Wrist accelerometers showed the stroke survivors' upper limbs to be moving for 75.7% (SD 15.9%) of the total session time. Purposeful repetitions and activity counts were found to be significantly correlated (r s =0.627, p<0.05).Correspondence: Louise Connell, Senior Research Fellow, Brook 426, Clinical Practice Research Unit, School of Health, University of Central, Lancashire, Preston, PR1 2HE, Phone: 01772 893725, laconnell@uclan.ac.uk. Conflicts of interest None declared SUPPLIER'S LIST CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptConclusions-Stroke survivors were not actively engaged in exercises for approximately one third of each exercise session. Overall session time may not be the most accurate measure of intensity. Counting repetitions was feasible when using a structured exercise programme and provides a clinically meaningful way of monitoring intensity and progression. Wrist accelerometers provided an objective measure for how much the arm moves, which correlated with purposeful repetitions. Further research using repetitions and accelerometers as measures of intensity is warranted. KeywordsStroke; rehabilitation; time; repetitions; accelerometer Every year, 15 million people worldwide suffer a stroke 1 . Two thirds of stroke survivors achieve independent ambulation after stroke, but less than half recover upper limb function at six months 2 . Best evidence for improving functional recovery after stroke suggests rehabilitation should consist of high intensity repetitive task-specific practice 3-6 . However despite this, the amount of therapy time dedicated to upper limb rehabilitation remains low 7 and upper limb exercises, when prescribed, are often of low intensity 8 .Therapists working in stroke rehabilitation are being challenged to find new ways of increasing the intensity of practice that stroke survivors engage in each day 7 with suggested strategies including self-administered exercise 9 , group exercise 10 and family assisted exercise 11 . Despite the strength of evidence supporting intensity, objectively quantifying intensity...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

Connell

McMahon

Simpson

et al. 2014

Archives of Physical Medicine and Rehabilitation

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“…It is likely that, in the clinic, individual goals may cover a broader range of deficits, including cognitive and attentional dysfunction. While all deficits merit attention, this study aimed to provide a more comprehensive understanding of individual goals relative to the UE, given that over 70% of individuals experience hemiparesis after a stroke [28,29]. Finally, age was treated as a dichotomous variable when it is actually a continuous one.…”

Section: Discussionmentioning

confidence: 99%

An Exploratory Analysis of the Self-Reported Goals of Individuals With Chronic Upper-Extremity Paresis Following Stroke

Birkenmeier¹,

Waddell²

2015

The American Journal of Occupational Therapy

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Purpose-To classify the self-identified goals of individuals post-stroke with chronic upper extremity (UE) paresis, and determine if age, UE functional capacity, and pre-stroke hand dominance influence overall goal selection.Method-Sixty five subjects participated. Using the Canadian Occupational Performance Measure (COPM) to establish treatment goals, the top five goals were categorized using the Occupational Therapy Practice Framework into five categories: activities of daily living (ADL), instrumental activities of daily living (IADL), leisure, work, and general UE movement. A chisquare analysis determined if age, UE functional capacity (measured by the Action Research Arm Test), and UE hand dominance influenced individual goal selection.Results-The majority of goals were in the ADL (37%) and IADL (40%) categories. A small percentage (12%) was related to general UE movement. Individuals with moderate UE functional capacity identified more ADL goals than those with higher UE functional capacity. There was not a difference between age and UE dominance across all five goal areas.Conclusions-Individuals with chronic UE paresis had specific goals that were not influenced by age or hand dominance, but partially influenced by severity. General UE movement goals were identified less than goals related to specific activities.After a stroke, an individual's capacity to participate in activities that are personally meaningful is often compromised. On average, individuals post-stroke discontinue 57% of their activities [1]. Decreased participation is often a result of many stroke-related deficits, the primary one being upper extremity (UE) paresis. At 6 months post-stroke, 65% of survivors cannot incorporate their affected hand into routine activity [2]. Given the vital role of both upper extremities in daily activities [3], deficits in participation following a stroke can be attributed, in part, to UE paresis and its resulting loss of function.

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“…Assist patients in achieving self-management plan for motor rehabilitation after a stroke (33,37,41,(49)(50) *.…”

Section: A's Methods Assistmentioning

confidence: 99%

“…They are: to implement an intervention of self-monitoring patient-centered (13,45) according to their difficulties, for example, the ability to dress up (46) . Allow the patient to discover their own abilities (20,29,47) , avoiding an overprotection that impede the achievement of autonomy; presence of multi-professional teams for the care (18,20,27,29,48) ; implementation of more intensive physical rehabilitation plans, with more professional presence and encouragement to the self-management of the exercises (33,37,41,(49)(50) .…”

Section: Continuationmentioning

confidence: 99%

Strategies for self-management support by patients with stroke: integrative review

Morais

Gonzaga

Aquino

et al. 2015

Rev. esc. enferm. USP

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Objective:To analyze strategies for self-management support by patients with stroke in the light of the methodology of the five A's (ask, advice, assess, assist and arrange). Methods: Integrative review conducted at the following databases CINAHL, SCOPUS, PubMed, Cochrane and LILACS. Results: A total of 43 studies published between 2000 and 2013 comprised the study sample. All proposed actions in the five A's methodology and others were included. We highlight the Assist and Arrange, in which we added actions, especially with regard to the use of technological resources and joint monitoring between patients, families and professionals. No study included all five A's, which suggests that the actions of supported self-management are developed in a fragmented way. Conclusion: The use of five A's strategy provides guidelines for better management of patients with stroke with lower cost and higher effectiveness.

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A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation

Abstract: A self-administered homework exercise program provides a cost-, time-, and treatment-effective delivery model for improving upper limb recovery in subacute stroke.

Cited by 217 publications

References 36 publications

Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

An Exploratory Analysis of the Self-Reported Goals of Individuals With Chronic Upper-Extremity Paresis Following Stroke

Strategies for self-management support by patients with stroke: integrative review

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