title: Hemiparetic optimal practice and evaluation (H.O.P.E.) for the stroke survivor with very low hand function.
abstract: OBJECTIVE
  The purpose of this study is to describe an approach that may benefit persons with severe hemiparesis following stroke.
  
  
  METHODS
  The subjects were 3 stroke survivors who had experienced a stroke that left their dominant right extremity severely disabled (mean age 43 years, mean time since stroke 26.6 months, mean Fugl-Meyer UE motor score 14.3/66). A multiple baseline, preintervention-postintervention case series design was used. The intervention consisted of structured whole body, increased intensity, activity-dependent practice strategy, with 3 to 5 sessions lasting for more than 3 hours per day, for 1-5 weeks for an average of 170 hours of therapy over 2.5 years. Subjects completed therapies such as body weight-supported treadmill training, overground multidirectional gait training, balance retraining, upper extremity functional activity, and trunk and extremity mobility.
  
  
  RESULTS
  The subjects experienced decreased fall risk (mean Timed Up and Go [TUG] scores decreased from 14.9 s to 6.8 s) and improved community safety (mean speed of gait in 10 m improved from 18.3 s to 8.3 s) and decreased impairment level as measured by the Fugl-Meyer Assessment (FMA: mean UE motor score from 14.3/66 to 53/66). Finally, subjects demonstrated an increase in their hemiparetic UE functional ability (mean amount of tasks completed in the Wolf Motor Function Test [WMFT] from 3.6/15 tasks to 15/15 tasks) following the intervention.
  
  
  CONCLUSIONS
  The findings indicate that hemiparetic optimal practice and evaluation (H.O.P.E) rehabilitation led to a decrease in the level of impairment along with a corresponding increase in function of the severely hemiparetic arm. The outcomes are significant: few treatment approaches have demonstrated an increase in the function of the severely affected arm in this population.
authors.affiliation: Program in Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, Arizona, USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Carter
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006225:Hand / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011788:Quality of Life; D012720:Severity of Illness Index; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation