[Abstract Title]. - Society for Neuroscience

Canadian Institute of Health Research
Title: The effects of a graded repetitive arm supplementary program (GRASP) in individuals
with stroke: a multi-site randomized controlled trial
Authors: *J. E. HARRIS 1 , J. J. ENG 2 , W. C. MILLER 3 , A. S. DAWSON 4 ;
2 Physical Therapy, 3 Occup. Sci. and Occup. Therapy, 4 Med., 1 Univ. British Columbia,
Vancouver, BC, Canada
Abstract: Purpose: To determine the effectiveness of a four week in-patient graded repetitive
arm supplementary (GRASP) program on upper limb recovery in stroke.
Methods: This was a multi-site single blind randomized controlled trial. All individuals who
sustained a stroke and were admitted to one of 4 inpatient stroke rehabilitation sites were
screened for study eligibility.
Measures: Chedoke Arm and Hand Activity Inventory (primary outcome), Action Research Arm
Test, Motor Activity Log, Grip strength, SF-12 (secondary). Baseline measurements were taken
within 72 hours of study admission, post intervention at the end of the 4 week intervention and
retention at 3 months.
Protocol: Participants were randomly assigned to either the control or experimental group. The
experimental group received the GRASP protocol, a home-work based exercise program
designed to improve paretic upper limb strength, active range of motion, and functional
performance. Three protocols (mild, moderate, and severe) were developed into exercise binders
and kits. Participants were asked to complete the exercises 6 days per week, 60 minutes each day
on their own or with family. The control group received an education binder with 4 modules (e.g.
information on arm recovery, bone health). The study coordinator taught and monitored both
protocols. All participants received usual care in addition to the study protocols.
Statistical analysis: Intention-to-treat analyze was performed. Group differences were tested
using analysis of covariance (ANCOVA). At each evaluation period the baseline score was used
as the covariate.
Results: Fifty four individuals were randomized to the GRASP protocol and fifty three to the
control. At the end of the 4 week intervention, participants receiving the GRASP protocol
showed greater improvement on the CAHAI compared to the control group (change score of
14.1 versus 7.9, p