I do not have a high level of hand recovery so I look for studies that do not cherry-pick high functioning stroke survivors to test the efficacy of rehab. Many studies with positive results start with stroke survivors who already have beginning finger and thumb movement. To decide how excited to get I look at the outcome measures as well as the statistical differences before and after treatment. Looking at test scores is a good way to decide if research results apply to someone like you.
Franck and his associates studied stroke survivors with no spontaneous hand recovery (1).
Group 1 was taught to keep the affected arm/hand in an “optimal condition” and what to do when discomfort occurred. Before rehab, the highest score on the Fugl-Meyer test was a 9 out of 66 which can be achieved with arm movements like reaching. After 6 weeks of rehab for 4.5 hours per week, the highest Fugl-Meyer score was a 20 which can be achieved with NO hand or wrist movement. After rehab, object manipulation on the Action Research Arm Test (ARAT) improved from 0 to 1 out of 57 for the highest functioning subject. This is the bad news.
Before rehab Group 2 had ARAT scores for object manipulation ranging from 1 to 9 out of 57(1). They were given “high-intensity” therapy to use their hand during functional tasks. Before rehab, the highest Fugl-Meyer score was a 25 out of 66. After 6 weeks of rehab for 6.0 hours per week, the highest Fugl-Meyer score was a 54. This dramatic improvement can be achieved only with hand and wrist movements. After rehab, the highest ARAT score improved from 9 to 42 out of 57.
This dramatic improvement can only be achieved by gaining the ability to pick up objects like a ball.
This is good news because a client’s life can changed when he or she can manipulate objects.
- Franck J, Johannes R, Smeets E, Seelen H. Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation. PLOS One. 6/21/2017. doi.org/10.11371/journal.pone.0179453