Therapy Incorporating a Dynamic Wrist-Hand Orthosis Versus Manual Assistance in Chronic Stroke

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Abstract
The purpose of this study was to compare the effect of therapy using a wrist-hand orthosis (WHO) versus manual-assisted therapy (MAT) for individuals with chronic, moderate-to-severe hemiparesis. The relationship between the repetitions during therapy and functional change was also examined. Nineteen participants were randomly assigned to either the WHO group (n = 10) or the MAT group (n = 9). The WHO group performed therapy while wearing a dynamic WHO (SaeboFlex), the MAT group performed therapy with manual assistance of a therapist. Both groups participated in 1 hour of therapy per week for 6 weeks and were prescribed exercises to perform at home 4 days per week. Pre- and posttraining assessments included grip strength, the Action Research Arm Test (ARAT), Box and Blocks (B&B) test, and Stroke Impact Scale (SIS). There were no significant between-group differences for any of the measures. Within-group differences showed that the WHO group had a significant improvement in the ARAT score (mean = 2.2; P = 0.04). The MAT group had a significant improvement on the percent recovery on the SIS (mean = 9.3%; P = 0.03) and approached a significant improvement on the ARAT (mean = 1.4; P = 0.08). When analyzing all participants together, the relationship between the number of exercise repetitions and functional improvement was moderate for the ARAT and the B&B test (r = 0.55, P = 0.02, and r = 0.30, P = 0.10, respectively). Small improvements in function and perception of recovery were observed in both groups, with no definite advantage of the WHO. This study adds to the evidence that individuals with chronic stroke can improve arm use with therapy incorporating functional hand training, and that there is a relationship between amount of change and amount of practice.

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