Effect of rubber ball gripping range-of-motion exercise on hand muscle strength in patients with non-hemorrhagic stroke
https://doi.org/10.52235/lp.v7i1.694
Keywords:
exercise theraphy, muscle strength, range of motion, stroke rehabilitationAbstract
Background: Stroke remains a major cause of disability worldwide, often resulting in impaired upper limb function and decreased hand muscle strength that limit independence in daily activities. Simple, structured rehabilitation strategies such as range-of-motion (ROM) exercises using a rubber ball may provide practical and cost-effective support for motor recovery, yet evidence regarding their specific impact on hand muscle strength in non-hemorrhagic stroke patients remains limited.
Objective: This study aimed to examine the effect of rubber ball gripping range-of-motion exercise on hand muscle strength in patients with non-hemorrhagic stroke.
Methods: This study employed a pre-experimental one-group pretest–posttest design conducted in the Stroke Center inpatient ward of RSUD Labuang Baji Makassar. A total of 21 patients with non-hemorrhagic stroke who experienced upper extremity weakness were recruited using consecutive sampling based on predefined inclusion criteria. Hand muscle strength was measured using the manual muscle testing scale before intervention and daily after implementation. The intervention consisted of rubber ball gripping ROM exercise performed twice daily for six consecutive days as part of evidence-based nursing practice. Data were analyzed using descriptive statistics and paired statistical testing with a significance level of α = 0.05.
Results: The mean hand muscle strength score increased from 3.10 ± 0.301 before intervention to 4.10 ± 0.301 after six days of exercise. Progressive improvement was observed beginning on the third day of intervention, with statistically significant differences between pre- and post-intervention measurements (p < 0.05). These findings indicate that repetitive ROM rubber ball gripping exercise contributed to clinically meaningful improvement in upper limb muscle strength among non-hemorrhagic stroke patients.
Conclusion: Rubber ball gripping range-of-motion exercise demonstrated significant effectiveness in improving hand muscle strength in patients with non-hemorrhagic stroke.
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Amoros-Aguilar, L., Rodriguez-Quiroga, E., Sanchez-Santolaya, S., & Coll-Andreu, M. (2021). Effects of combined interventions with aerobic physical exercise and cognitive training on cognitive function in stroke patients: A systematic review. Brain Sciences, 11(4), 473. https://doi.org/10.3390/brainsci11040473
Anjos, J. M., Neto, M. G., Dos Santos, F. S., Almeida, K. D. O., Bocchi, E. A., Lima Bitar, Y. D. S., et al. (2022). The impact of high-intensity interval training on functioning and health-related quality of life in post-stroke patients: A systematic review with meta-analysis. Clinical Rehabilitation, 36(6), 726–739. https://doi.org/10.1177/02692155221087082
Annisa, T. N., & Siahaan, J. (2025). Factors affecting the incidence of hypertension in the elderly: A literature review. Journal of Community Nursing and Primary Care, 1(2), 43-50. https://doi.org/10.63202/jcnpc.v1i2.38
Boyne, P., Billinger, S. A., Reisman, D. S., Awosika, O. O., Buckley, S., Burson, J., et al. (2022). Optimal intensity and duration of walking rehabilitation in patients with chronic stroke: A randomized clinical trial. JAMA Neurology. https://doi.org/10.1101/2022.08.01.22278246
Chasanah, N. F. U., Sutawardana, J. H., Rondhianto, R., & Mustakim, M. (2025). Application of FAST in patient with ischemic stroke and risk for ineffective cerebral perfusion: A nursing case study. Lentera Perawat, 6(4), 684–693. https://doi.org/10.52235/lp.v6i4.573
Chen, S., Lv, C., Wu, J., Zhou, C., Shui, X., & Wang, Y. (2021). Effectiveness of a home-based exercise program among patients with lower limb spasticity post-stroke: A randomized controlled trial. Asian Nursing Research, 15(1), 1–7.
Deijle, I. A., Hemmes, R., Boss, H. M., de Melker, E. C., van den Berg, B. T. J., Kwakkel, G., et al. (2022). Effect of an exercise intervention on global cognition after transient ischemic attack or minor stroke: The MoveIT randomized controlled trial. BMC Neurology, 22(1), 289. https://doi.org/10.1186/s12883-022-02805-z
Feigin, V. L., Stark, B. A., & Johnson, C. O. (2021). Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurology, 20(10), 795–820.
Frank, D., Gruenbaum, B. F., Zlotnik, A., Semyonov, M., Frenkel, A., & Boyko, M. (2022). Pathophysiology and current drug treatments for post-stroke depression: A review. International Journal of Molecular Sciences, 23(23).
Hsu, C. C., Fu, T. C., Huang, S. C., Chen, C. P. C., & Wang, J. S. (2021). Increased serum brain-derived neurotrophic factor with high-intensity interval training in stroke patients: A randomized controlled trial. Annals of Physical and Rehabilitation Medicine, 64(4), 101385. https://doi.org/10.1016/j.rehab.2020.03.010
Joyce Black, J. H. (2014). Keperawatan Medikal Bedah: manajemen klinis untuk hasil yang diharapkan (3-Vol Set). Elsevier (Singapore) Pte Ltd.
Koch, S., Tiozzo, E., Simonetto, M., Loewenstein, D., Wright, C. B., Dong, C., et al. (2020). Randomized trial of combined aerobic, resistance, and cognitive training to improve recovery from stroke: Feasibility and safety. Journal of the American Heart Association, 9(10), e015377. https://doi.org/10.1161/JAHA.119.015377
Lapointe, T., Houle, J., Sia, Y. T., Payette, M., & Trudeau, F. (2023). Addition of high-intensity interval training to a moderate intensity continuous training cardiovascular rehabilitation program after ischemic cerebrovascular disease: A randomized controlled trial. Frontiers in Neurology, 13, 963950. https://doi.org/10.3389/fneur.2022.963950
Li, X., Geng, D., Wang, S., & Sun, G. (2022). Aerobic exercises and cognitive function in post-stroke patients: A systematic review with meta-analysis. Medicine, 101(41), e31121. https://doi.org/10.1097/MD.0000000000031121
Liu, Q., Ni, W., Zhang, L., Zhao, M., Bai, X., Zhang, S., Ding, Y., Yin, H., & Chen, L. (2023). Comparative efficacy of various exercise interventions on depression in older adults with mild cognitive impairment: A systematic review and network meta-analysis. Ageing Research Reviews, 91, 102071.
Ma, Y., Luo, J., & Wang, X. Q. (2022). The effect and mechanism of exercise for post-stroke pain. Frontiers in Molecular Neuroscience, 15, 1074205. https://doi.org/10.3389/fnmol.2022.1074205
Mah, S. M., Goodwill, A. M., Seow, H. C., & Teo, W. P. (2023). Evidence of high-intensity exercise on lower limb functional outcomes and safety in acute and subacute stroke population: A systematic review. International Journal of Environmental Research and Public Health, 20(1), 153.
Mahmood, A., Deshmukh, A., Natarajan, M., Marsden, D., Vyslysel, G., Padickaparambil, S., et al. (2022). Development of strategies to support home-based exercise adherence after stroke: A Delphi consensus. BMJ Open, 12(1), e055946.
Naghavi, M., Abajobir, A. A., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S. F., Aboyans, V., Adetokunboh, O., Ärnlöv, J., Afshin, A., Agrawal, A., Kiadaliri, A. A., Ahmadi, A., Ahmed, M. B., Aichour, A. N., Aichour, I., Aichour, M. T. E., Aiyar, S., Al-Eyadhy, A., … Murray, C. J. L. (2017). Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1151–1210. https://doi.org/10.1016/S0140-6736(17)32152-9
Nascimento, L. R., Rocha, R. J., Boening, A., Ferreira, G. P., & Perovano, M. C. (2022). Home-based exercises are as effective as equivalent doses of centre-based exercises for improving walking speed and balance after stroke: A systematic review. Journal of Physiotherapy, 68(3), 174–181.
Noreen A, Lu J, Xu X, Jiang H, Hua Y, Shi X, Tang X, Bai Z, Liang Q, Tian Y, Han T, Lu Y, Ao L, Yang L. Comparing the effects of Swiss-ball training and virtual reality training on balance, mobility, and cortical activation in individuals with chronic stroke: study protocol for a multi-center randomized controlled trial. Trials. 2024 Oct 14;25(1):677. doi: 10.1186/s13063-024-08532-9. Erratum in: Trials. 2024 Oct 28;25(1):724. doi: 10.1186/s13063-024-08575-y.
Parikh RJ, Sutaria JM, Ahsan M, Nuhmani S, Alghadir AH, Khan M. Effects of myofascial release with tennis ball on spasticity and motor functions of upper limb in patients with chronic stroke: A randomized controlled trial. Medicine (Baltimore). 2022 Aug 5;101(31):e29926. doi: 10.1097/MD.0000000000029926.
Putri, A. U., Rosadi, E., & KK, I. F. J. (2025). Relationship between Knowledge Level and Medication Compliance in Hypertension Patients at Plaju Health Center, Palembang City. Indonesian Journal of Health Services, 2(2), 26-31. https://doi.org/10.63202/ijhs.v2i2.100
Resnayati, Y., Riasmini, N. M., & Carolina, D. (2025). Pelatihan Kader Kesehatan Sebagai Upaya Peningkatan Kemampuan Skrining Penderita Hipertensi. Bakti Nusantara Pengabdian Masyarakat Indonesia, 2(1), 7-13. https://doi.org/10.63202/bnpmi.v2i1.90
Saposnik G, Cohen LG, Mamdani M, Pooyania S, Ploughman M, Cheung D, Shaw J, Hall J, Nord P, Dukelow S, Nilanont Y, De Los Rios F, Olmos L, Levin M, Teasell R, Cohen A, Thorpe K, Laupacis A, Bayley M; Stroke Outcomes Research Canada. Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation (EVREST): a randomised, multicentre, single-blind, controlled trial. Lancet Neurol. 2016 Sep;15(10):1019-27. doi: 10.1016/S1474-4422(16)30121-1.
Saputra, A., Susanti, M., Pratiwi, S. H., KK, I. F. J., Kastina, K., & Regina, R. (2025). Nursing care using roy’s adaptation model–based mirror therapy for physical mobility impairment in stroke patients: A case study. Lentera Perawat, 6(4), 821–826. https://doi.org/10.52235/lp.v6i4.643
Sari Wijayanti, MI Ekatrina Wijayanti, & Thomas Aquino Erjinyuare Amigo. (2025). Relationship between Family Knowledge and Prevention of Recurrent Stroke Attacks at the Neurological Polyclinic. Lentera Perawat, 6(1), 10–15. https://doi.org/10.52235/lp.v6i1.407
Saunders, D. H., Sanderson, M., Hayes, S., Johnson, L., Kramer, S., Carter, D. D., et al. (2020). Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews, 2020(3). https://doi.org/10.1002/14651858.CD003316.pub7
Suwaryo PAW, Ristanto R, Waladani B, Siwi AS. Swiss ball exercise post-stroke with hemiparesis to improve mobility: a randomised controlled trial. Med J Malaysia. 2023 Jul;78(4):508-510
Yeh, T. T., Chang, K. C., Wu, C. Y., Chen, C. J., & Chuang, I. C. (2022). Clinical efficacy of aerobic exercise combined with computer-based cognitive training in stroke: A multicenter randomized controlled trial. Topics in Stroke Rehabilitation, 29(4), 255–264. https://doi.org/10.1080/10749357.2021.1922045
Zhao, N., Sun, W., Xiao, Z., Fan, C., Zeng, B., Xu, K., Liao, M., & Lu, W. (2022). Effects of Transcranial Direct Current Stimulation on Poststroke Dysphagia: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Archives of Physical Medicine and Rehabilitation, 103(7), 1436–1447. https://doi.org/10.1016/J.APMR.2022.03.004
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