Feedback device for improvement of coordination of reach-to-grasp following stroke

Objective: To describe a novel feedback device (Grasp Rehabilitation Accessory for Stroke Patients [GRASP]) that gives feedback on the time lag between the start of hand opening and the start of transport during reach-to-grasp movements, and to report the results of a preliminary series of single case studies to assess the utility of the device for improving the coordination of arm and hand at the beginning of a reach-to-grasp movement. Design: A multiple baseline design across 6 subjects was used, with each subject performing 40 repetitions of reaching to grasp a jar. Two subjects each performed 10, 15, or 20 randomly assigned baseline repetitions. Setting: Physiotherapy department or at the participant's home. Participants: Participants with middle cerebral artery or parietal stroke (n=6) were consecutively recruited from physiotherapy departments. Additional inclusion criteria were a Rivermead Motor Assessment score of 5 or more and time between start of hand opening and transport of more than 60ms. Interventions: During the intervention phase, feedback on time between start of transport and start of grasp was communicated via GRASP. Participants were encouraged to reduce the time. Main Outcome Measure: The outcome measure was the time between start of transport and start of grasp, measured with GRASP. Results: All participants decreased the mean time lag during the intervention phase compared with the baseline phase. Participants 1 to 6 showed decreases of 35, 296, 34, 34, 1212, and 114ms, respectively. Two out of 6 participants demonstrated a significant decrease in time lag in the intervention compared with the baseline phase. Conclusions: GRASP is potentially beneficial as an adjunct to physiotherapy training of reach-to-grasp coordination after stroke.