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(Stroke. 2009;40:2123.)
© 2009 American Heart Association, Inc.

Original Contributions

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

A Multi-Site Randomized Controlled Trial

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

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. E-mail janice.eng{at}ubc.ca

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 poststroke), 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 poststroke. 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.

Key Words: stroke • rehabilitation • upper limb