Changes in hemiplegic grasp following distributed repetitive intervention: a case series

The purpose of this pilot study was to investigate the efficacy of a distributed model of repetitive and focused intervention on grasp force, and clinical and functional hand measures in persons with chronic hemiplegia and limited hand recovery from self-reported stroke. A case series design was used. Focused repetitive unilateral and bilateral interventions were provided in a distributed manner (three times a week for 6 weeks) to three persons with upper limb hemiplegia of more than 1 year. Data from instrumented grasp force, and clinical and functional measures were obtained at weeks 0, 3, 6 and 9. Each participant improved in at least one measure of grasp force, as well as in clinical skill and function. All participants improved in the quality of handwriting. Improved outcomes remained above baseline levels following 3 weeks of non-intervention. The findings are compatible with current evidence of adaptive cortical plasticity following increased repetition. The findings show that, for these three persons, distributed repetitive practice was sufficient to effect change. Localization by cerebral area affected is not possible, nor is it possible to parse the effectiveness of any component of the intervention. A larger group study is warranted to determine whether similar results may be found for other persons with chronic hemiplegia. Future studies should incorporate kinematic handwriting analysis and a greater range of functional tasks.