Upper Limb Training with a Dynamic Hand Orthosis in Early Subacute Stroke: A Pilot Randomized Trial

Abstract

Objectives: To investigate the effect of the addition of a dynamic hand orthosis to unilateral task-oriented training in early subacute stroke. Design: Pilot randomized trial with concealed allo­cation, measurer blinding, and intention-to-treat analysis. Setting: Rehabilitation hospital. Participants: Thirty subacute stroke patients with moderate-to-severe upper limb disability. Intervention: All participants received 4 weeks (60 min per day, 5 days a week) of unilateral task-oriented training. The experimental group (n = 15) wore a dynamic hand orthosis during half of the training time (i.e. 30 min per day). Outcome measures: Primary outcome was the upper limb activity measured using the Action Research Arm Test (ARAT) measured at baseline and 4 weeks. Secondary outcomes were the Nine-hole Peg Test, Fugl-Meyer Assessment for upper extremity, grip strength, modified Ashworth Scale, Barthel Index and EuroQol-5D. Results: No difference between groups was found for the primary outcome ARAT (mean difference 4/57, 95% confidence interval (95% CI) –5 to 13) nor for any secondary outcome. Conclusion: No additional benefit was found of wea­ring a dynamic hand orthosis during unilateral task-oriented training in the early subacute period.

The use of medical devices in people with hemiparesis of the upper limb and the presentation of the competence of the master and specialist of physiotherapy in the prescription of orthopedic supplies

“…However, another study by Wong et al [16] indicates that task training combined with a dynamic hand orthosis did not significantly improve motor function, compared to task-oriented training alone, in subacute stroke survivors. Therefore, further studies are needed to determine whether orthoses combined with task-oriented training positively affect post-stroke patients.…”

A study of dynamic hand orthosis combined with unilateral task-oriented training in subacute stroke: A functional near-infrared spectroscopy case series

“…All eight participants showed improvements after intervention for the ARAT, FMA-arm, and grip strength scores. But whether the effectiveness of the dynamic hand orthosis in the early subacute stroke period would rely on RCT study will be discussed in another paper ( 15 ).…”

“…In recent years, case reports of assistive technologies in acute stroke have been emerging ( 12 – 14 ). Even though in our resent research team's study, the use of orthosis was highly satisfying to participants, no additional benefit was found in wearing a dynamic hand orthosis during unilateral task-oriented training in the early subacute period ( 15 ).Furthermore, strong imaging technological evidence on the use of dynamic hand orthoses combined with task-oriented training in subacute stroke remains scarce ( 9 ).…”