Approximately 70–80% of people who sustain a stroke have upper extremity impairment.1,2
Many of them do not regain functional use of the paretic arm,2,3
which can lead to difficulties in activities of daily living (ADL) and engagement in community life. At 6 months post stroke, a substantial proportion (25–53%) of people remain dependent in at least one ADL task, which often involves the use of unilateral or bilateral arm movement.4–6
Different approaches have been used to improve upper extremity function following stroke, such as functional training,7–12
and strength training,9,11,15–17
and the results are mixed. The majority of these studies have a small sample size and only a few are devoted to studying persons with chronic stroke.10,15,16
While increase in strength has been reported following strength training in persons with chronic stroke, there is no indication of improvement in the functional use of the affected upper extremity.15,16
Similarly, there was no change in hand function following a 12-week program with functional training, muscle strengthening/facilitation for persons with chronic stroke.10
There is mounting evidence that both motor and functional changes in the paretic upper extremity can occur many years post stroke with forced use.18–23
Indeed, cortical reorganization has been demonstrated following intensive movement therapy in persons with chronic stroke.24
Novel approaches such as constraint-induced movement therapy (CIMT)18–23
, repetitive bilateral arm training with rhythmic auditory cueing (BATRAC)25
and robot-aided exercise training26–31
have been developed to promote paretic upper extremity function following chronic stroke. However, these treatment approaches often involve one-to-one client-therapist ratio. In case of CIMT, extensive amount of daily therapy is also required.18–23
Considering the current limited health care resources, alternative rehabilitative programs are needed to reduce the long-term disability resulting from upper extremity hemiparesis.
A community-based group program may be a feasible alternative approach to upper extremity rehabilitation following a stroke. It is accessible to a large number of people in the community and does not require one-to-one supervision, thereby reducing the cost. The concept of community programs is also compatible with the emerging priority in health care policy to prevent secondary disabilities for persons living with chronic conditions.32,33
Community-based programs for promoting mobility and physical fitness in people with chronic stroke have been proposed and positive outcomes have been reported.34,35
An upper extremity group exercise program for people with chronic stroke has also been proposed by Dean et al.12
(used as the control group in their study). However, it failed to produce positive outcomes, probably due to the small sample size (n = 12).
A randomized controlled trial was conducted to examine the feasibility and efficacy of a community-based group exercise program. The participants were randomized into two different exercise groups: (1) arm exercise group and (2) leg exercise group. The trial was originally set out to test the effects of a leg exercise program on cardiorespiratory fitness, balance and leg muscle strength and the results have been reported in another article.36
However, the study design also allowed us to examine the results for the arm group. The purpose of the study was to determine (1) whether a community-based group exercise program for people with chronic stroke results in functional improvement in the paretic upper extremity, and (2) the relationship between severity of upper extremity impairment and gain from the treatment program. It was hypothesized that the arm group would have significantly more functional improvement in the paretic upper extremity than the leg group.