G.T.A.R.A. (Grip/Grasp Training with Active Range of Motion Activities using Guitar): Guitar Lessons for Restoring Hand Function Among Patients with Unilateral Hand Impairment from Chronic Stroke

G.T.A.R.A. (Grip/Grasp Training with Active Range of Motion Activities using Guitar): Guitar Lessons for Restoring Hand Function Among Patients with Unilateral Hand Impairment from Chronic Stroke

1. Measure of pre- and post-treatment hand function of those in the control group (conventional occupational therapy) and interventional group (guitar lessons), in terms of:

   a. Physical evaluation: range of motion, tone, muscle strength

   b. Objective tools

   1. Beery-Buktenica Developmental Test of Visual-Motor Integration

   2. Jebsen-Taylor Hand Function test

   3. Purdue Pegboard test of Manual Dexterity

   4. Hand grip and pinch strength test

       

1. To determine the demographics of participants in the study (e.g. age, sex, handedness pre-CVD, affected hand post-CVD, type of CVD, hobbies, pre- CVD employment, pre-employment activities, length of time participant has had the hand impairment)

2. Level of satisfaction of participants between treatment groups (control group versus interventional group)

3. Level of compliance between treatment groups (control group versus interventional group)

Inclusion criteria (p7):
Participants must be 19 to 65 years old who sustained unilateral hand impairment (left or right upper extremity) secondary to stroke (cerebrovascular disease), either infarct or hemorrhagic, for the past 6 months (at the least), patient of DRM-PGH, with controlled comorbidities (HPN, diabetes, cardiac disease), must be fully vaccinated against COVID-19, willing to visit DRM-PGH for evaluation and treatment, may have had formal hand therapy sessions through physical therapy or occupational therapy, muscle tone of the affected upper extremity may either be spastic (1, 1+ or 2), wrist and hand of the affected limb of the patient must be at least 3/5 on manual muscle test strength, with good sitting balance and tolerance, intact cognitive function that will enable him or her to focus, patient’s vision must enable him to see and follow instructional material with minimal difficulty, and no significant limb contractures.

Exclusion criteria (p8):
Participant with uncontrolled comorbidities that make them more vulnerable to recurrent stroke or COVID-19, poor cognitive functioning, aphasia, behavioral problems (unable to focus), poor visual acuity, or poor auditory capacity, with impaired sensation, sensory-perceptual, and proprioception of the upper extremity, with incoordination and hand tremors, with open or fresh wound of the affected limb, pressure sore of the sacrum or other parts of the body that will produce difficulty in positioning the patient with the guitar, and with significant soft tissue contractures (ROM less than 50% of functional range).

Control group will be those doing the conventional occupational therapy.

Intervention group will be those doing the guitar lessons.

Patient recruitment will be based on the inclusion-exclusion criteria stated above. Qualified patients with impaired hand function due to cerebrovascular disease with will be invited to participate in the study. Each participant will be randomly grouped (minimum of 17 participants each) using systematic random sampling into the control group or the interventional group. Randomization (non-blind) will be done. Regardless of the grouping, each participant will be pre-evaluated to assess muscle tone, range of motion of joints, pinch and grip strength, and hand function of the paretic extremity to gain baseline data. Each participant assigned to a study group will undergo 8 sessions of therapy (conventional occupational therapy for the control group and guitar lessons for the intervention group). After 8-sessions, post-treatment evaluation will be done. Patient will then have to answer a short satisfaction survey form.