A Calligraphy Exercise for Improving Upper Limb Functions in Subacute Stroke Patients: A Pilot Randomized Control Study

Abstract

Background: Self-administered rehabilitation exercises can improve upper limb (UL) function in stroke patients, but their effects depend on successful integration of fundamental principles of neurorehabilitation. This study aimed to validate the effect of a modified calligraphy exercise for improving UL function in subacute stroke patients. Methods: 30 subacute stroke patients were randomized into experimental and control groups. Patients in the experimental group received three-week calligraphy interventions. Patients in the control group received education protocol. Fugl-Meyer Assessment for UL (FMA-UL), Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, and Modified Barthel Index (MBI) assessment were performed before and after the interventions.Results: Both groups got significantly higher FMA-UL scores after the interventions (P < 0.001), but no significant improvement was found in the DASH assessment in the experimental (P = 0.336) or the control group (P = 0.024). For the MBI assessment, significant improvements after the interventions were found in the experimental (P = 0.001) and the control groups (P < 0.001). It was also found that patients in the experimental group had significantly better performance in the post-intervention FMA-UL assessment than patients in the control group (P = 0.001). However, patients in the experimental group did not get significantly higher scores in the post-intervention MBI assessment than patients in the control group (P = 0.243).Conclusions: The outcomes indicated that the modified calligraphy exercise improved the motor impairments in the patients’ UL, suggesting its potential as a self-administered exercise for facilitating UL function recovery in subacute stroke patients.Trial RegistrationThis study was registered at Chinese Clinical Trial Registry on Feb. 4, 2021, and was assigned of a trial registration number: ChiCTR2100043036.