Hemiparetic Optimal Practice and Evaluation (H.O.P.E.) for the Stroke Survivor with Very Low Hand Function

Abstract

Purpose: The purpose of this study is to describe an approach that may benefit persons with severe hemiparesis following stroke. Method: The subjects were 3 stroke survivors who had experienced a stroke that left their dominant right extremity severely disabled (mean age 43 years, mean time since stroke 26.6 months, mean Fugl-Meyer UE motor score 14.3/66). A multiple baseline, preintervention-postintervention case series design was used. The intervention consisted of structured whole body, increased intensity, activity-dependent practice strategy, with 3 to 5 sessions lasting for more than 3 hours per day, for 1–5 weeks for an average of 170 hours of therapy over 2.5 years. Subjects completed therapies such as body weight—supported treadmill training, overground multidirectional gait training, balance retraining, upper extremity functional activity, and trunk and extremity mobility. Results: The subjects experienced decreased fall risk (mean Timed Up and Go [TUG] scores decreased from 14.9 s to 6.8 s) and improved community safety (mean speed of gait in 10 m improved from 18.3 s to 8.3 s) and decreased impairment level as measured by the Fugl-Meyer Assessment (FMA: mean UE motor score from 14.3/66 to 53/66). Finally, subjects demonstrated an increase in their hemiparetic UE functional ability (mean amount of tasks completed in the Wolf Motor Function Test [WMFT] from 3.6/15 tasks to 15/15 tasks) following the intervention. Conclusion: The findings indicate that hemiparetic optimal practice and evaluation (H.O.P.E) rehabilitation led to a decrease in the level of impairment along with a corresponding increase in function of the severely hemiparetic arm. The outcomes are significant: few treatment approaches have demonstrated an increase in the function of the severely affected arm in this population.

Keywords:

• hemiparesis
• low function
• stroke
• neuroplasticity
• rehabilitation