Systematic Review on Graded Repetitive Arm Supplementary Program (GRASP Approach) on Functional Ability of Hand, Gross and Fine Motor Control of Upper Limb in Stroke

Purpose: Stroke frequently causes severe deficits in upper limb function, which makes it difficult for patients to carry out daily tasks. An organized home-based intervention called the Graded Repetitive Arm Supplementary Program (GRASP) was developed to help stroke patients regain function in their hands and arms. This systematic review assesses the data demonstrating beneficial effects of the GRASP approach on hand function, gross and fine motor control of the upper limb in individuals post-stroke. Methods: A systematic search was performed in databases including PubMed, Scopus, CINAHL, and Cochrane Library up to April 2025. We searched the data using Keywords such as “GRASP,” “Graded Repetitive Arm Supplementary Program,” “stroke rehabilitation,” “upper limb recovery,” “fine motor skills,” and “gross motor control.” Inclusion criteria were randomized controlled trials (RCTs), quasi-experimental studies, and cohort studies involving adult stroke survivors undergoing GRASP. Studies were excluded if they were non-English and focused on other forms of intervention. Quality assessment was performed using the PEDro scale and Cochrane risk-of-bias tool. Results: Out of 243 studies initially screened, 8 met the inclusion criteria. Most studies reported significant improvements in upper limb function, including enhanced hand dexterity, grip strength, and coordination following participation in GRASP programs. High adherence rates and participant satisfaction were consistently noted. Some studies indicated that benefits were maintained at follow-up, suggesting long-term efficacy. Common outcome measures included the Fugl-Meyer Assessment (FMA), Box and Block Test (BBT), and Action Research Arm Test (ARAT). Discussion: The findings suggest that GRASP is an effective adjunct to conventional stroke rehabilitation, particularly for enhancing hand function and motor control. The structured yet flexible nature of GRASP allows for scalability and adaptability to various patient needs. Limitations of the reviewed studies include small sample sizes, heterogeneity in intervention duration, and variability in outcome measures. Further research with standardized protocols and larger samples is warranted. Conclusion: The GRASP approach appears to be a promising intervention for improving functional ability of the hand, and gross and fine motor control in the upper limbs post-stroke. Incorporating GRASP into home-based rehabilitation could enhance recovery and reduce long-term disability. Continued research is essential to establish best practices for implementation and to optimize patient outcomes