Our team first developed a community-based group upper extremity program. This functional program of upper extremity strengthening, fine motor tasks and repetitive functional tasks was found to improve outcome measures of the Wolf Motor Function Test and Fugl-Meyer Upper Extremity Scale in a study involving 63 people with chronic stroke (> 1 year post-stroke). This paper was published in Archives of Physical Medicine and Rehabilitation.
GRASP (Graded Repetitive Arm Supplementary Program)
Following the success of this trial, we developed GRASP. GRASP has been tested in a Canadian multi-centred randomized controlled trial with 103 sub-acute stroke patients (generally in their first month post-stroke). Two of the sites were large urban centres, while the other two were smaller cities. Stroke patients are admitted to an inpatient rehabilitation program following stabilization of their medical needs in acute care. The average length of inpatient rehabilitation is 4 weeks. Both the GRASP and control group (educational program) received standard inpatient stroke rehabilitation (daily physical therapy and occupational therapy). The site coordinator (physical therapist or occupational therapist) instructed the GRASP group in the exercises or instructed the Control group in the educational module (information on stroke, nutrition, pain management, bone health management, etc). Both the GRASP and Control group then did their respective programs as “homework” on their own with occasional checks by the therapist.
The GRASP group demonstrated improvements in arm and hand function (Chedoke Arm and Hand Activity Inventory, Action Research Arm Test), use of the hand (outside of therapy) and grip strength. A variety of arm and hand exercise programs for people living with stroke have been developed, but the GRASP program stands alone in showing that it is effective with very little resources (therapy, equipment) required. The tasks in the program were selected for their 1. proven effectiveness in improving upper extremity function, 2. ease of performing without specialized or expensive equipment, 3. ability to be progressed and graded, 4. safety with minimal chance of injury, and 5. task-specificity and meaningfulness to the patient. The main GRASP study was published in the journal Stroke and a secondary paper published in the journal Physical Therapy.