Effectiveness of a Dynamic Wrist-hand Orthosis in Early Outpatient Rehabilitation of the Upper Extremity Post Stroke

Recruiting

Phase N/A Results N/A

Trial Description

The purpose of this study is to explore the effectiveness of the SaeboFlex orthosis in improving upper extremity recovery for people in the early phases of rehabilitation post stroke. The objectives of the study are:
1. to explore the effectiveness of the SaeboFlex orthosis in improving upper extremity function, strength, movement, spasticity and self-perceived occupational performance, in addition to conventional therapy, with continued use immediately after discharge from inpatient stroke rehabilitation and while waiting for outpatient occupational therapy services
2. to explore the relationship between the participants' level of self-efficacy and use of the SaeboFlex orthosis in the home environment
3. to explore the participants' experience of use of the SaeboFlex orthosis in the home environment.

Detailed Description

Although intensive and repetitive use of the paretic upper extremity has been shown to improve upper extremity outcomes post stroke, few therapeutic approaches allow those with moderate to severe upper extremity impairment to independently participate in repetitive grasp and release activities. The SaeboFlex orthosis is a dynamic wrist-hand orthosis that assists with finger and thumb extension after functional grasping with the paretic hand and therefore may allow those with more affected upper extremities post stroke to participate in repetitive grasp and release activities that they otherwise would be unable to do. More research is required on the effectiveness of this orthosis in improving upper extremity recovery post stroke especially when used at home as a continuation of therapy received during inpatient rehabilitation. It has been suggested that guided home rehabilitation programs can improve the ability of stroke survivors to be more independent in their activities of daily living. This study is a mixed methods study combining a quantitative single subject ABA design and qualitative post study individual interviews to first capture quantitative information on the effectiveness of the SaeboFlex intervention and then qualitative information that will build on and further explain the quantitative data. Three participants who are using a SaeboFlex orthosis as part of their upper extremity rehabilitation program will be recruited from an inpatient stroke rehabilitation unit as they are being discharged from inpatient rehabilitation and will be seen by the principal investigator in their homes for 1 hour 3 times a week for 2 weeks and then once a week for 6 weeks while they are on the waiting list for outpatient occupational therapy services. The intervention will follow a set protocol of grasp-release activities using the SaeboFlex orthosis for 50 minutes at least 3 times per week, followed by 10 minutes of grasp-release activities without the orthosis, both of which will be graded to provide optimal upper extremity challenge throughout the intervention period. Repeated baseline assessments will be completed by a trained research assistant, in the participants' homes, within one week of discharge from inpatient stroke rehabilitation and will be repeated after 4 and 8 weeks of intervention, followed by individual interviews in the participants' homes.

Conditions

Interventions

  • SaeboFlex Device
    Other Names: functional dynamic orthosis
    Intervention Desc: Use of the SaeboFlex orthosis for a set protocol of grasp-release activities for 50 minutes at least 3 times per week, followed by 10 minutes of grasp-release activities without the orthosis for 8 weeks. Will occur in participants' homes after discharge from inpatient rehabilitation with visit from principal investigator to progress program for 1 hour 3 times a week for the first 2 weeks and then once a week for 6 weeks.
    ARM 1: Kind: Experimental
    Label: SaeboFlex
    Description: Use of the SaeboFlex orthosis for a set protocol of grasp-release activities

Outcomes

Type Measure Time Frame Safety Issue
Primary Arm Activity Measure (ArmA) Change from baseline upper extremity function to 4 and 8 weeks
Primary Chedoke Arm and Hand Activity Inventory-7 (CAHAI-7) Change from baseline upper extremity function to 4 and 8 weeks
Secondary Fugl-Meyer Assessment-Upper Extremity (FMA-UE) Change from baseline upper extremity impairment to 4 and 8 weeks
Secondary Stroke Impact Scale (SIS) Change from baseline perception of recovery to 4 and 8 weeks
Secondary Modified Ashworth Scale (MAS) Change from baseline spasticity to 4 and 8 weeks
Secondary Hand Grip Strength (measured using dynamometry) Change from baseline grip strength to 4 and 8 weeks
Secondary Stroke Self-Efficacy Questionnaire (SSEQ) Change from baseline self-efficacy to 4 and 8 weeks
Secondary Canadian Occupational Performance Measure (COPM) Change from baseline perception of occupational performance to 4 and 8 weeks

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