Can art rehabilitation therapy aid in stroke recovery?
That’s exactly what one pilot study at Providence Care Hospital is looking into.
According to Canadian Stroke Best Practices, stroke is the leading cause of adult disability, with more than 405,000 Canadians living with the effects of one.
Of those, more than 40 percent have a moderate to severe disability that requires more intense rehabilitation.
Researchers with Providence Care’s Department of Physical Medicine and Rehabilitation, as well as Queen’s University’s School of Rehabilitation Therapy and Centre for Neuroscience Studies, are trying to determine if an intensive art rehabilitation therapy program, in addition to regular therapies, can benefit stroke patients.
“We continue to look for additional ways to engage our patients in stimulating activities that can contribute to their functional recovery and quality of life,” said Dr. Benjamin Ritsma, Clinical Director of Stroke Rehabilitation at Providence Care Hospital and Assistant Professor, Department of Physical Medicine and Rehabilitation, at Queen’s University.
“We felt this art therapy program and related research aligned well with this goal. It offers the potential for additional sessions outside of regular therapeutic activities and provides tasks that focus on different elements of functional and neurologic recovery.”
Research assistant Marta Scythes, medical illustrator and college teacher for close to 40 years, came up with the concept.
“In leisure study programs I would get the occasional person who had Parkinson’s disease, an acquired brain injury, or a stroke and I started to recognize that people were coming to art classes for self-rehabilitation,” explained Scythes.
Focusing on training arms, hands and fingers of stroke patients, Scythes created a program that aims to enhance motor function, sensory perception and cognition.
“This program is not meant to replace regular therapies, it’s meant to enhance them,” said Scythes.
Here’s how it works.
Stroke patients admitted to Providence Care Hospital are asked if they would like to participate in the art rehabilitation study, on top of their individualized therapeutic programs.
It starts with clinical and KINARM assessments.
KINARM stands for Kinesiological Instrument for Normal and Altered Reaching Movements.
“The robotic exoskeleton device and its software are used to assess upper limb movements,” explained Ritsma.
“The KINARM also gives us information about a patient’s sensory, motor and cognitive function.”
Following their first KINARM assessment, the stroke patient meets with Scythes for one-on-one, private art lessons for approximately two to six weeks, depending on their length of stay at the hospital.
Each session lasts about an hour and features a video, worksheets and freehand drawing exercises.
“The video explains what they’ll be drawing that lesson and demonstrates the task with both hands,” explained Scythes.
“Then using the worksheets and a coloured marker, the patient traces the task. Once that is done, I get them to draw it free hand, with or without a reference. It’s their choice.”
Each session has a specific task.
Patients start by drawing very basic geometric shapes such as lines, circles, squares and triangles.
They then work their way up to sketching recognizable objects like tables, chairs or trees, using the geometric shapes they learned to draw from previous sessions.
Participants must also complete the exercises with both hands.
“Most times for things like writing or signing a cheque stroke patients would use the hand that works,” said Scythes.
“But this program encourages them to use their affected side even if they have no function. In that case I would support their arm and hold their grasp.”
That’s exactly what Scythes did for Aaron Wilson.
The 46-year-old had a stroke on the right side of his brain during Easter weekend.
“It was quite bad,” said Wilson.
“I burst an artery and it just bled through my brain.”
The stroke initially paralyzed Wilson, a research technician with the University of Toronto, on his left side.
He began his rehabilitation journey with Providence Care Hospital in early May, and agreed to take part in the art rehabilitation study.
“I wasn’t sure, but I thought I’d give it shot because I am in research and it’s important to encourage other people’s research,” said Wilson.
“With Aaron there really was no movement on his affected side, so I would support his elbow and hand while drawing,” explained Scythes.
It took Wilson 11 sessions to complete the program – with both hands.
“I came in with an open mind and I didn’t know what to expect, but I’ve done some nice stuff and I think it’s a great idea,” said Wilson.
“It gives people with stroke, instead of just lying in bed, to show you’re artistic. It allows you to express yourself.”
Once patients complete the program, they have follow up clinical and KINARM assessments and are asked to complete a feedback survey.
“A key message we’ve heard back from patients is they really enjoyed participating in this program and felt it assisted in their recovery,” said Ritsma.
“In several instances, patients were quite surprised by their level of enjoyment and have continued art-related pursuits after leaving the hospital, despite not having any experience with art prior to their stroke.”
“It motivated them to do something meaningful between their regular therapies,” added Scythes.
“And it was something they could practice on their own.”
Wilson’s artistic journey hasn’t stopped.
In fact, he’s moved on from drawing to picking up a paintbrush.
“I enjoy the painting,” smiled Wilson.
“It’s nice to produce something that looks good.”
The 46-year-old is just one of a handful of stroke patients to complete the program during the pilot study.
“I think it’s novel and it would be so great if we could get it out to more people, and implement this program across the country,” said Scythes.
And that’s what she’s working on.
Data collected from this pilot study will help evaluate the feasibility of hosting larger scale studies in the future.
Scythes is also producing instructional videos and a manual for healthcare professionals, and working with volunteers at Providence Care Hospital to train them to administer the program.
The hope is to one day see the art rehabilitation therapy program at hospitals and other healthcare centres across the region, country and beyond.
The Art Rehabilitation Therapy Program pilot study was funded by the University Hospitals Kingston Foundation (UHKF), Providence Care and the Centre for Neurosciences Studies (Dr. Stephen Scott) at Queen’s University.
For more information about the program please contact:
Marta, Congratulations! I am so thrilled that your research has an incredible impact on the stroke rehab patients.
Way to go!