Feedback device for improvement of coordination of reach-to-grasp after 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.