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

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 ( $\mathit{p}=0.001$ ) and ABILHAND ( $\mathit{p}=0.005$ ). After detrending for baseline trends (caused by e.g. spontaneous recovery and/or TAU), such improvement was only found for ARAT ( $\mathit{p}=0.009$ ). 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 ( $\mathit{p}⩽0.036$ ). 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.