Paralytic Stroke
Conditions
Keywords
stroke, upper limb rehabilitation, treatment, movement recovery from sever paralytic upper limb, neuro hand orthosis, self practice program, subacute
Brief summary
The implementation of Neuro Hand Orthosis Upper Limb Program can significantly improve the severe stroke paralytic arm in subacute rehabilitation as compared with the use of conventional therapy.
Detailed description
The neuro hand orthosis is based on a design of dynamic hand orthosis for orthopaedic patients. We attempt to apply such an orthosis on stroke patients to aid in regaining movement from severe paralytic arm by helping the patients to support their wrist and finger in a functional position for grasping. The patient is then encouraged to produce voluntary movement from the severe paralytic arm to transport an object (ball) from place to place either in sitting or standing position. Since intensive arm usage is associated with neuro reorganisation, we propose designing a program with the neuro hand to encourage usage of the paralysed hand and help overcome the barriers of poor motivation and lack of arm usage through self practice program.
Interventions
OTHERConventional upper limb stroke rehabilitation
Patient will be given a ten weeks conventional upper limb therapy. 3 sessions will be provided weekly in the first 4 weeks and 2 therapy sessions will be provided weekly in the subsequent 6 weeks. Patients will receive half an hour of conventional therapy in each session. Patient will be taught to carry out two and half hours conventional self practice exercise daily for a period of ten weeks.
DEVICENeuro Hand Orthosis Program (NHOP)
The NHO is based on a design of dynamic hand orthosis for orthopaedic patients after hand surgery. We use it to support CVA patient's wrist and finger to perform grasping to transport an object (ball) from place to place to achieve the follows; 1. NHO can assist stroke patients to experience successful hand grasping with an object and produce voluntary movement from their paralytic arm. This successful experience will positively reinforce the patient to continue to use their paralytic arm and change the patient's behavior and perception in the arm usage. 2. The NHO Program is able to engage patients to perform their exercises and activities by themselves independently with the effect of intensive therapy. The intervention (NHOP) group will receive same treatment intensity as the control group but with a Neuro Hand Orthosis.
Sponsors
National Council Of Social Service, Singapore
St Luke's Hospital, Singapore
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
50 Years to 89 Years
Healthy volunteers
No
Inclusion criteria
* Post stroke between one week to three months and medically stable * Right Hemiplegia with right hand dominant * Able to stand with minimum assistance * AMT score not lesser then 7/10 * Motricity Index Arm Score \<36/100
Exclusion criteria
* Unable to commit to the Neuro Hand Orthosis Program (either as in or out patients) for 10 weeks according to the program regime or unable to follow the control group regime for 10 weeks * Pre-existence shoulder or upper limb pain * Pre-existence moderate or severe hand oedema * Patients with terminal disease * Resident of Institution (eg, Nursing home etc prior to admission) * Pre-existing upper limb disability on affected arm * Psychiatric problem
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Action Research Arm Test (ARAT) | week 4 , week 10 , 6 months and 12 months |
| Motricity Index | week 4 , week 10 , 6 months and 12 months |
Secondary
| Measure | Time frame |
|---|---|
| Motor Activity Log (MAL) | At admission, week 4 , week 10 , 6 months and 12 months |
| Modified Ashworth Scale for grading Spasticity | At admission, week 4 , week 10 , 6 months and 12 months |
| Shoulder pain at admission | At admission, week 4 , week 10 , 6 months and 12 months |
Countries
Singapore
Contacts
Primary ContactGribson Yu Chun Chan, Master
Outcome results
None listed