Co-developing a danced version of the Graded Repetitive Arm Supplementary Program (GRASP): a participatory design study with clinicians and people with stroke

Self-directed exercise programs empower people with stroke to engage in recovery through daily practice but often present challenges in maintaining long-term adherence. Dance can make rehabilitation exercises more engaging, and help reduce the perception of efforts, due to its inherently enjoyable nature and the use of music. This project aims to co-develop a danced version of the Graded Repetitive Arm Supplementary Program (GRASP) delivered using short video capsules to enhance upper limb motor recovery. Using a participatory research approach, co-development meetings were conducted with researchers and occupational therapists to adapt and refine the GRASP-dance. We beta-tested the GRASP-dance with two people with stroke to refine the program. Feedback from participants and co-development meeting summaries were analyzed using inductive thematic analysis. Two main themes were derived from the co-development meetings: 1) Considerations for the transposition of the GRASP into a danced version, and 2) Challenges and solutions for the development of the GRASP-dance. We adapted the GRASP into a danced version, incorporating the fundamental elements of the GRASP and key considerations at the person, the environment and the dance level. The final program includes 47 video capsules across three difficulty levels along with a weekly virtual group meeting. This work emphasized the need to tailor self-directed exercise, to include a motivating artistic element, and to address key barriers to maximize stroke rehabilitation.