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Jocelyn Harris has helped devise a set of exercises for the arm and hand that patients can do without therapists - photo by Martin Dee
Jocelyn Harris has helped devise a set of exercises for the arm and hand that patients can do without therapists - photo by Martin Dee

UBC Reports | Vol. 55 | No. 5 | May 7, 2009

Homework is the best medicine

By Brian Kladko

Jocelyn Harris is the first to admit that the research she undertook for her doctorate is a “no brainer.” Yet it may very well usher in a new approach to helping victims of stroke recover faster.

Harris, who will be one of the first two UBC students to receive a PhD in Rehabilitation Science, drew from her own experience as an occupational therapist, helping patients regain their strength and dexterity after suffering strokes or injuries.

“I had way too many patients to see individually,” says Harris, a 39-year-old Vancouver resident. “I was really frustrated that I couldn’t give them enough time. I started to think about what we could do. That’s what inspired me to go back to school.”

The answer was staring her in the face during those 50-minute therapy sessions: the patient and their families. What if they could do “homework” between sessions, so the patients could build on the progress made with their therapists?

As commonsensical as the idea seems, it went against occupational therapy orthodoxy. Therapists fear that exercises done improperly could be harmful. Family members, already overwhelmed by events, may not want the additional burden of learning a set of tasks and rallying their loved ones to exert themselves.

“But I still think it was way under-utilized,” Harris says. At MSA Hospital in Abbotsford, where she worked mostly with stroke patients, “family members were often there, especially spouses. Often they would sit in my therapy sessions with the client. I just sort of thought, ‘What if we could actually get them more involved?’ ”

With Physical Therapy Professor Janice Eng, Harris devised the Graded Repetitive Arm Supplementary Program (GRASP), a set of exercises for the arm and hand that patients could do without therapists. With funding from the Heart and Stroke Foundation of BC and Yukon, they created a user-friendly book with detailed pictures and instructions describing the exercises.

Therapists at four sites in Vancouver, Kelowna and Victoria distributed the books to 53 stroke patients, thoroughly reviewed the material with them and their family members, and asked them to do the assignments outside of the sessions.

The results, to be published in the June issue of Stroke, showed GRASP patients notched a 30 per cent improvement in the use of their arms after four weeks, compared to a 15 per cent improvement in the control group, based on their ability to perform such tasks as putting toothpaste on a toothbrush or pouring water into a glass.

Harris also saw results on a more personal level. A wife who was helping her husband turned to Harris and remarked, “I didn’t really know what I was supposed to do to help him, and now I feel like I can be part of his recovery.”

All four sites are now implementing GRASP, incorporating it into group therapy and outpatient settings. Eng, her advisor, is developing a similar program for the leg.

“Jocelyn represented the ideal doctoral student, who critically questioned the current practices in rehabilitation, really pushed the boundaries of innovation, and set in motion change that would benefit the health of our patients,” says Eng, who is also a member of the Vancouver Coastal Health Research Institute.

In June, Harris heads to the Toronto Rehabilitation Institute for a two-year fellowship. It should come as no surprise that Harris, who believes homework can be the best medicine, wants to pursue a career in academia.

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Last reviewed 12-May-2009

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