The Efficacy of a Forearm Rotation Orthosis for Persons with a Hemiparetic Arm

Abstract

Objectives. To examine the efficacy of a dynamic forearm rotation orthosis used as the sole intervention and in combination with the Occupational Therapy Task-Oriented (OTTO) approach as well as to evaluate the efficacy of the OTTO approach on the functional performance of persons post-stroke with a hemiparetic arm. Method. A matched, randomized, two- group, single-blinded, repeated measures designed was used. Volunteer sample of persons with chronic stroke (N=14) were first matched on motor function and then randomly assigned to Group A or B. Group A (N=8) experienced six weeks of orthotic intervention followed by six weeks of orthosis plus OTTO intervention (3 hour/week for 6 weeks). Group B (N=6) experience no treatment for six weeks followed by another six weeks of OTTO intervention. The primary outcome measures were functional performance, including self-perceived performance and satisfaction (Canadian Occupational Performance Measure (COPM)), motor function (Wolf Motor Function Test (WMFT)), and self-reported use of the affected limb (Motor Activity Log (MAL)). The secondary outcome measures were impairments, including active range of motion and strength of the upper extremity, grip, and pinch. Participants were evaluated before and after each intervention phase. Results. No significant differences were found between participants who received orthotic intervention and those who had no treatment. By the end of study, participants who receive the OTTO intervention as the sole intervention and in combination with orthosis showed clinically important improvements in self-perceived performance and satisfaction on the COPM and statistical significant improvement in self-report amount and quality of use of the affected limb on the MAL. No significant differences in functional performance and impairment measures were found between participants who received the OTTO intervention as the sole intervention and in combination with the orthosis. Conclusions. The 6 weeks of functional training protocol provided clinically important benefits to persons post-stroke in self-perceived functional performance (COPM), but not in motor function (WMFT) and impairment measures (active ROM and strength of UE, grip, and pinch). However, due to technical failure for monitoring adherence to orthotic use, the efficacy of the forearm rotation orthosis for persons post-stroke remains unclear.