Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program.

Daniel K Zondervan,Xing Zhao,Enoch Chang,David J Reinkensmeyer,Renee Augsburger,Nizan Friedman,Steven C Cramer

doi:10.1682/jrrd.2015.04.0057

Abstract

Individuals with chronic stroke have limited options for hand rehabilitation at home. Here, we sought to determine the feasibility and efficacy of home-based MusicGlove therapy. Seventeen participants with moderate hand impairment in the chronic phase of stroke were randomized to 3 wk of home-based exercise with either the MusicGlove or conventional tabletop exercises. The primary outcome measure was the change in the Box and Blocks test score from baseline to 1 mo posttreatment. Both groups significantly improved their Box and Blocks test score, but no significant difference was found between groups. The MusicGlove group did exhibit significantly greater improvements than the conventional exercise group in motor activity log quality of movement and amount of use scores 1 mo posttherapy (p = 0.007 and p = 0.04, respectively). Participants significantly increased their use of MusicGlove over time, completing 466 gripping movements per day on average at study end. MusicGlove therapy was not superior to conventional tabletop exercises for the primary end point but was nevertheless feasible and led to a significantly greater increase in self-reported functional use and quality of movement of the impaired hand than conventional home exercises. ClinicalTrials.gov; "Influence of Timing on Motor Learning"; NCT01769326; https://clinicaltrials.gov/ct2/show/NCT01769326.

Highlights

Hand impairment after stroke contributes substantially to disability in the United States and around the world [1]
In previous pilot studies performed in a clinical setting, we found that the MusicGlove motivated individuals with chronic stroke to perform hundreds of functional gripping movements during a 30 min training session and that exercise with the device led to a significantly greater improvement in hand grasping ability, measured with the Box and Blocks test, than a time-matched dose of conventional tabletop therapy performed with a rehabilitation therapist [27,28]
In an exploratory analysis (n = 8), we found a significant linear relationship between the number of grips completed with the MusicGlove and the change in Motor Activity Log (MAL) Amount of Use (AOU) score at 1 mo posttherapy, with a slope of 0.05 points for every 1,000 grips completed with the MusicGlove (R2 = 0.61, p = 0.02)

Summary

Introduction

Hand impairment after stroke contributes substantially to disability in the United States and around the world [1]. Intensive movement practice can reduce hand impairment [2,3,4,5,6], but issues such as cost and access may limit the dose of rehabilitation exercise delivered one-onone with a therapist. Because of these and other factors, most individuals do not perform the large number of exercise repetitions required during therapy to maximize recovery [7,8]. The most common approach to home-based hand therapy is following a printed handout of exercises. This approach is often not motivating and is associated with low compliance and high dropout rates [9,10,11,12,13]

Methods

Results

Conclusion