Virtual GRASP program for post-stroke rehabilitation delivers results during pandemic

While the COVID-19 pandemic has turned lives upside-down, there have been some unexpected upsides in the world of stroke rehabilitation. It was found that popular, research-proven programs and therapies could deliver results when they pivoted to online platforms. And, these virtual programs were able to involve participants and caregivers who would not otherwise be able to take part.

A new publication that evaluates the made-in-Canada GRASP (Graded Repetitive Arm Supplementary Program) as an online offering describes one such success story.

Developed by Dr. Janice Eng at the University of British Columbia to help people regain use of their arms and hands after stroke, GRASP went virtual when COVID shut community-based programs in 2020.

“I am so pleased at how quickly this all came together,” says Dr. Eng. “Due to COVID, in-person community programs had shut down and hospitals were really limiting their outpatient programs.  The Stroke Recovery Association of BC (SRABC) approached us about pivoting the in-person GRASP program to virtual.  We worked with the SRABC team to work out all the logistics and within a few months we had people participating in the new program.”

Best of all? “We found that, as a virtual program, GRASP was effective and people liked it,” says Dr. Chieh-ling Yang, a post-doctoral fellow and CPSR-funded trainee in Dr. Eng’s lab and co-author of the study published in the March issue of Physical Therapy & Rehabilitation.

In fact, virtual GRASP will likely continue after life returns to normal because people who could not travel to attend sessions were able to join the program from home. Not only that, participation was higher than usual. “The pandemic opened up a lot of possibilities,” Dr. Yang says. “We learned to adapt and to do things usually done in person.”

Outcomes for people who participated in the virtual GRASP program were excellent. “Between baseline and post-test, participants with stroke demonstrated significant improvement in upper extremity function,” according to the published results.

Popular with clinicians around the world, GRASP is a seated exercise program to strengthen arm capacity and movement. In a small-group setting, whether virtual or in person, the program also allows participants to share personal insights into how they use stroke-affected arms and hands in daily life.

Interest in the program was so high during the virtual GRASP pilot study that word spread and sessions included participants from Vancouver Island, Northern BC, Alberta, and as far away as Nova Scotia. Although inquiries came in from around the world, the CIHR-funded pilot was restricted to Canadians for the study period.

“Virtual GRASP creates the possibility of enabling people recovering from stroke to connect with others from around the world,” Dr. Yang says.

“We will definitely continue to offer GRASP virtually,” says Anna Markey, regional coordinator, Fraser Valley, March of Dimes/SRABC. She says the online delivery has enabled program instructors to see participants doing the exercise program in their home environment. And it has been good to virtually interact with caregivers as well. “We are seeing a lot of benefits.”

Ms. Markey says people enjoyed the virtual sessions so much that they have asked to do reunions with the other participants. “They became quite social and encouraging and motivating to each other.”

Laura Stoicescu, who had a stroke at age 49, was among the virtual GRASP participants in the pilot study. She says she started the program in person before it was shut down during the pandemic. “I was seeing huge results with GRASP and then I didn’t quite know what would happen next.” She jumped at the chance to join the online pilot.

Ms. Stoicescu loved the virtual format and meeting and chatting with others facing similar challenges and she benefited greatly from working with the instructor.

“My right hand is back. My right arm is back,” she says. “The program made me very comfortable and I knew what I needed to do to make progress. My theory is everyone can recover to some degree if they follow the program.”

In addition to doing the intensive exercise regime as part of the therapy sessions, Ms. Stoicescu also took up knitting at the suggestion of another participant and she is teaching herself to play the piano. “I do it because I want to move my hands and I want to tune up my fine motor skills.”