Home-based rehab benefits stroke patients

16 June 2009

Stroke researchers at the University of British Columbia and Vancouver Coastal Health Research Institute have developed a rehabilitation program that can dramatically improve recovery of arm function in stroke patients.

Results of their research, published in the June 1 edition of the high impact journal Stroke, reveal that patients who participated in the program had greater arm function after four weeks compared to the control group. These differences were retained even five months post-stroke. The researchers followed 103 stroke patients at Vancouver General Hospital and three other hospital sites in Vancouver, Kelowna, and Victoria.

The research team, led by Janice Eng – MSFHR Senior Scholar, scientist and physical therapist in the Rehabilitation Research Lab at the GF Strong Rehabilitation Centre, and a professor in the UBC Department of Physical Therapy – devised the Graded Repetitive Arm Supplementary Program (GRASP). The program, consisting of a set of exercises for the arm and hand that patients can do themselves with minimal supervision by therapists, can be delivered in a sub-acute care hospital setting and continued at home. Patients receive an exercise book with written instructions and detailed drawings for how to perform each exercise, such as stacking blocks, squeezing balls, holding lightly weighted bean bags, and folding, buttoning, and pouring.

"The exercises sound very simple, but more than 70% of people with stroke find it difficult to use their hands and arms for daily tasks," says Eng, who is also a senior scientist at the Brain Research Centre and the International Collaboration On Repair Discoveries (ICORD). "The ease of this program allows for a much higher amount of physical therapy for patients recovering from stroke in hospital than could ordinarily be delivered one-on-one by physical therapists. It also has the benefit of providing a way for patients' families to support the rehabilitation process."

Researchers also noted another intriguing finding, which showed patients in the GRASP group had less depressive symptoms compared to the control group. "This is a significant discovery, as up to 30% of people post-stroke can develop depression," says Jocelyn Harris, an occupational therapist in the Rehabilitation Research Lab at GF Strong who helped design the study.

"We need to further explore this finding," says Harris, a graduate from the PhD Rehabilitation Science program at UBC. “It could be because better arm function leads to less depressive symptoms, or also that the GRASP patients felt more empowered to have more direct involvement with their own rehabilitationThe ease of the program also allows for immediate uptake by health care providers. All four sites are now implementing GRASP, incorporating it into their inpatient or outpatient settings. The researchers are examining the application of a patient-managed program to leg rehabilitation following stroke.

Each year, 750,000 individuals in North America experience a new stroke. It is the leading cause of serious long term disability in older adults and approximately 50% of all stroke patients are left with severe to moderate disability.

Major funding for this research has been provided by the Heart and Stroke Foundation of British Columbia & Yukon. Eng is supported by career scientist awards from MSFHR and the Canadian Institutes of Health Research.