A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation: A Multi-Site Randomized Controlled Trial
Abstract
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.
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In the study by Rand et al., clinical test scores showed motor and functional improvements while upper extremity accelerometry data did not change.
“in the study by Rand et al. [16], there was a discrepancy between the clinical test scores and accelerometry: clinical test scores showed motor and functional improvements while upper extremity accelerometry data (mean activity counts) did not change”
From Accelerometer measurement of upper extremity movement after stroke: a systematic review of clinical studies (2014) · cites this paper as [16]
The Results (page not available) report improved clinical measures of arm function in Harris et al.’s GRASP trial. Our copy does not report a study by Rand et al. or upper-extremity accelerometry data, so it does not support the claimed discrepancy between clinical scores and unchanged activity counts. (LLM, conf=0.84)
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Self-citationClinical Practice Guideline for Stroke Rehabilitation in Korea
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Self-citationCounting Grasping Action Using Force Myography: An Exploratory Study With Healthy Individuals
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Self-citation
- Authors
- Harris, J. E., Eng, J. J., Miller, W. C., & Dawson, A. S.
- Affiliations
- University of British Columbia (CA)
- Venue
- Stroke
- Published
- 2009-06
- Volume
- 40
- Issue
- 6
- Pages
- 2123-2128
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W1998855961
- Cited by
- 259
- References
- 40
- Citations by year
- 2026: 10 · 2025: 21 · 2024: 16 · 2023: 20 · 2022: 21 · 2021: 14 · 2020: 19 · 2019: 18 · 2018: 15 · 2017: 17 · 2016: 19 · 2015: 28 · 2014: 11 · 2013: 7 · 2012: 9
- FWCI
- 7.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Strong
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Spatial Neglect and Hemispheric Dysfunction
- Keywords
- stroke rehabilitation, upper limb recovery, inpatient rehabilitation, upper limb function, grip strength, activities of daily living, Chedoke Arm and Hand Activity Inventory, subacute stroke
- MeSH terms
- Stroke Rehabilitation, Activities of Daily Living, Aged, Analysis of Variance, Arm, Exercise Therapy, Female, Humans, Male, Pilot Projects, Single-Blind Method, Treatment Outcome, Hand Strength, Muscle Strength
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