Calligraphy-based rehabilitation exercise for improving the upper limb function of stroke patients: protocol for an evaluator-blinded randomised controlled trial

Abstract

IntroductionA common complication of stroke is upper limb dysfunction. Chinese calligraphy handwriting (CCH) is an aesthetical exercise developed from the traditional way of writing in China and holds potential to become a rehabilitation method to improve upper limb functions in patients with stroke. This study aims to design a randomised controlled trial to assess the effect of a customised CCH-based exercise for poststroke rehabilitation of upper limb dysfunction.Methods and analysisA single-blinded randomised controlled trial will be conducted on 60 stroke patients. The patients will be randomly allocated into three groups: (1) conventional occupational therapy (COT) group, (2) COT+CCH group, (3) COT+Graded Repetitive Arm Supplementary Program (GRASP) group. For the COT group, patients will receive COT treatment of 1 hour/day. For the COT+CCH group, patients will receive 30 mins COT treatment and 30 mins CCH training. For the COT+GRASP group, patients will receive 30 mins COT treatment and 30 mins GRASP training. All the interventions will be performed 5 days per week for a total of 3 weeks. The upper limb functions will be assessed before and after the interventions using a series of rating scales.Ethics and disseminationThis study has been approved by the Research Ethics Committees of the Second Rehabilitation Hospital of Shanghai (study ID: 2020-32-01) and the Shanghai University of Sport (study ID: 102772021RT043). Results will be directly disseminated to the patients at the end of the study and to the public via publications in peer-reviewed journals and presentations in conferences.Trial registration numberChiCTR 2100043036; Chinese Clinical Trials Registry.

A scoping review of the use of creative activities in stroke rehabilitation

“…The flowchart of the literature selection process is shown in Figure 1. These studies originate from five countries: China, 10,17-25 UK, [26][27][28][29] Australia, 30 Canada, 31 and Turkey 32 ; comprising a total of 11 randomized controlled trials 10,[17][18][19][20][21][22][23][24]27,28 (including two feasibility studies 27,28 ), three nonrandomized controlled trials 26,31,32 (including 1 feasibility study 31 ), and three qualitative studies. 25,29,30 Two studies recruited post-stroke depression patients, 19,24 and one study recruited post-stroke anxiety patients.…”

“…Among the included studies, 11 categorized the interventions under the domain of Art Therapy, 18,19,[24][25][26][27][28][29][30][31][32] while six studies are categorized under Occupational Therapy. 10,17,[20][21][22][23] These creative activity interventions are also named "creative art-based activities," "group interactive art therapy," "visual arts", "handicraft activities," "handicraft training," or "manual training."…”

“…Implementation unit: In Art Therapy, nine studies reported units of implementation for creative activities, with 63.6% (n = 11) were group-based 19,[25][26][27][28][29][30] and 18.2% (n = 11) were individual-based. 18,31 In Occupational Therapy, only three studies reported the implementation unit, with 33.3% (n = 6) were group-based 10,23 and 16.7% (n = 6) were individualbased. 21 These diverse approaches are influenced by various factors, such as research objectives, participant needs, and research feasibility.…”

“…Activities and Materials: Six studies chose a single form of activity for intervention, 18,20,23,24,31,32 and 11 studies combined multiple forms and materials for intervention. 10,17,19,21,22,[25][26][27][28][29][30] The selection of activities and materials was based on the interests and abilities of the participants.…”

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

“…In a recent research proposal [22], we proposed a self-administered exercise involving traditional Chinese calligraphy. Chinese calligraphy is a visually guided practice of artistic writing, during which individuals use a "brush" pen to apply ink on a paper.…”