PUSH then GRASP: implementation of supplementary arm exercise programs

Background: The Graded Repetitive Arm Supplementary Program
(GRASP) has been implemented at Bankstown-Lidcombe Hospital
Stroke Unit This evidence-based program provides arm exercises
supplementary to usual therapy. A recent controlled trial demonstrated
improved arm function in those completing the GRASP
program. However, we found that many stroke survivors in our
unit did not have enough arm function to complete the GRASP
program. To address this problem, we created the Promoting Use
of Shoulder and Hand (PUSH) program. This easier program provides
supplementary arm exercises for patients with only minimal
muscle activity.
Aims: To establish the proportion of stroke survivors eligible for the
programs who received the appropriate program.
(i) To investigate compliance with the programs.
(ii) To explore participants’ opinions of the programs.
Methods: Data was collected using a mixed method design over
3 weeks. These included ward audits of program distribution, data
recording sheets for completion of the program and a written survey
of stroke survivors and/or relatives to determine their views.
Results: All patients eligible for either the PUSH/GRASP program
received it. Most patients completed the program daily or every second
day. Patients with family support were more likely to complete
the program everyday. Participants believed the program helped their
recovery. They requested more support from nursing staff to execute
the program effectively. The largest barrier to completing the program
was fatigue post intensive gym sessions.
Conclusion: Supplementary arm programs can be effectively implemented
on a stroke unit. Stroke survivors respond favourably and
most complete the exercises at least every second day.