Introduction

Approximately 70% of individuals with stroke have upper limb impairment. Inability to use the upper limb can lead to difficulties in activities of daily living. Increased time spent in therapy improves outcome of the upper limb post stroke however, length of stay in rehabilitation has decreased. Innovative ways of increasing therapy intensity need to be explored.

Purpose

1. To undertake a meta-analysis to determine the treatment effect of upper limb strengthening on strength, function and activities of daily living.
2. To determine the effectiveness of a four week self-administered in-patient homework exercise program (GRASP) on upper limb function and depressive symptoms in individuals in the sub-acute stage of stroke recovery.
3. To determine modifiable predictors of upper limb function in individuals in the subacute stage of stroke recovery.

Methods

Design:​ Chapter 2 is a meta-analysis of upper limb strength training in individuals with stroke. Electronic databases were searched from 1950-September 2008. 14 articles were reviewed.

Chapter 3-5 involved a four week multi-site single blind randomized controlled trial of a self-administered upper limb exercise program (GRASP) compared to control.

Subjects:​ 103 individuals with stroke were recruited from four rehabilitation units.

Results

Chapter 2:​ The meta-analysis showed strength training is effective in increasing paretic upper limb strength and function but not performance in activities of daily living. Chapters 3-5:​ The GRASP program improved upper limb function significantly more than the control group (p<0.001) and reported less depressive symptoms (p<0.001). Baseline Fugl-Meyer, change in grip strength, treatment intensity and family involvement were significant predictors of upper limb function (R²=0.507 to 0.597, p<0.001).

Conclusions

Strength training is a viable method to improve upper limb function in individuals with stroke. The randomized controlled trial showed that a self-administered homework exercise program for the upper limb is an effective method for 1) improving upper limb function and 2) decreasing depressive symptoms among individuals with subacute stroke. The trial provided evidence that modifiable variables are significant determinants of upper limb function among individuals with stroke. Further studies to evaluate the GRASP protocol within other conditions and treatment settings are warranted.