Structured Abstract
Stroke Structured Abstract - S #18
Finger exercises may enhance stroke clients' grasp and release
CITATION: Trombly, C. A., Thayer-Nason, L., Bliss, G., Girard, C. A., Lyrist, L. A., & Brexa-Hooson, A. (1986). The effectiveness of therapy in improving finger extension in stroke patients. American Journal of Occupational Therapy, 40, 612-617.
LEVEL OF EVIDENCE: IIC2b
RESEARCH QUESTION
What is the effectiveness of three exercise treatments on finger extension?
DESIGN
Independent group design without randomization
Eighteen of the patients were randomly assigned to treatment groups. Two patients who could grasp but had no active release were assigned to the grasp task to prevent frustration.
SAMPLING PROCEDURE/INCLUSION CRITERIA
The first 23 patients admitted to New England Rehabilitation Hospital in Woburn, Massachusetts, after September 1, 1982 who could grasp a 2.5cm cylinder, could understand directions, were free of pain of the affected upper extremity, were willing to participate, were medically cleared for participation by their physician, and were expected to stay for several weeks.
SAMPLE
|
N = 23 |
Male = 9 |
Female = 11 |
Mean age = 66.8 |
|
LCVA = 11 |
RCVA = 9 |
Attrition = 3 (15%) Discharged after too few treatments. |
|
NR |
Acute |
NR |
Chronic |
NR = Not Reported
3 patients were not reported as either male or female or as LCVA or RCVA.
OUTCOME MEASURES
(R = Reliability established; V= Validity established)
Total AROM of the middle finger - R (intra-rater > .85)
Halstead Finger Tapping Test - R (intra-rater > .85)
Grasp-release of various sized cylinders (reliability not calculated)
INTERVENTION DESCRIPTION
Experimental Group 1: Resisted grasp - patients grasped a dynamometer loaded with the maximum number of elastics they could squeeze against.
Experimental Group 2: Resisted extension - patients extended their fingers against the maximum number of rubber bands that they could move against.
Experimental Group 3: Ballistic extension - patients flicked ping-pong balls at a paper cup target.
Control Group - patients engaged in any activity that did not involve the affected hand for 10 minutes between pre and postmeasurement on each day that treatment was given.
WHO DELIVERED INTERVENTION
Five OTs
SETTING
Clinics
FREQUENCY & DURATION
Patients performed the exercise 10 times every day, except weekends. Duration = maximum of 20 treatments, or until the subject was discharged, whichever occurred first.
RESULTS
Between Groups/Conditions/Times:
No significant differences in Immediate Daily Gains for:
Total ROM
Halstead Tapping Test
Grasp & release of cylinders
No significant differences in Pre-Post Program Gains for:
Total ROM
Halstead Tapping Test
Grasp & release of cylinders
The Ballistic Extension Group and the Resisted Extension Group improved more on the Halstead Tapping Test over the course of treatment than the Resisted Grasp or Control Groups.
Within Groups/Conditions/Times: Not tested
THREATS TO VALIDITY
Selection bias: By chance, there was an imbalance of patient assignment in which significantly more patients assigned to resisted and ballistic extension groups were at a higher level of recovery of motor control.
Experimenter expectancies.
AUTHORS' CONCLUSIONS
Analysis indicated that no exercise improved all three components of function (range and speed of movement and function) significantly more than another, or the control condition. Because no clear difference was found between the Control and treatment conditions, it was concluded that motor unit recruitment as an attibute of activity is insufficient to improve function in poststroke patients.
REVIEWERS' CONCLUSIONS
Ballistic extension and resisted extension exercises enhance stroke patients' speed of finger movement, especially for patients with better recovery of motor control
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent..
