Effects of a dynamic hand orthosis for functional use of the impaired upper limb in sub-acute stroke patients: A multiple single case experimental design study

Article type: Research Article

Authors: Franck, Johan A.^{a; *} | Timmermans, Annick A.A.^{b; c} | Seelen, Henk A.M.^{b; c}

Affiliations: [a] Adelante Rehabilitation Centre, Department of Brain Injury, Hoensbroek, The Netherlands | [b] Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands | [c] Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands

Correspondence: [*] Address for correspondence: Johan (Han) A. Franck, Adelante Rehabilitation Centre, Department of Brain Injury, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands. Tel.: +31 45 528 28 28; E-mail: [email protected].

Abstract: Objective:To investigate the usability and the effects of a dynamic spring-loaded orthosis, adjunct to therapy-as-usual (TAU), on functional use of the impaired hand in moderately/severely impaired sub-acute stroke patients. Design:Single case experiment (A-B-A′-design). Subjects:Eight sub-acute stroke patients. Methods:The orthosis was used for six weeks, five days/week, 45′/day, and adjunct to TAU. Outcome measures: Action Research Arm Test (ARAT), ABILHAND, Intrinsic Motivation Inventory (IMI). Results:At group level, patients improved on ARAT (p=0.001) and ABILHAND (p=0.005). After detrending for baseline trends (caused by e.g. spontaneous recovery and/or TAU), such improvement was only found for ARAT (p=0.009). At individual level, three patients whose baseline ARAT changed little (0–3 points), had improved at follow-up, and four remained constant regarding detrended ARAT results. In four patients mean detrended ABILHAND results were higher during follow-up relative to baseline (p⩽0.036). Average IMI sub-scores were between 5.4 and 6.6 (of 7), except for ‘pressure/tension’ (2.1). Conclusion:Patients, who, in the early sub-acute phase after stroke, display only little/modest improvement on their capacity to perform activities or their perceived level of daily performance, seem to benefit most from training with a dynamic arm orthosis. Patients perceived a high intrinsic motivation and sense of self-regulation.

Keywords: Stroke, rehabilitation, upper extremity, orthotic devices, single case experimental design, motor skills

DOI: 10.3233/TAD-130374

Journal: Technology and Disability, vol. 25, no. 3, pp. 177-187, 2013