The GRASP Program for upper limb rehabilitation in post-stroke patients: from Albanian translation and cross-cultural adaptation to clinical practice

Autori

Hasa Suila (Catholic University “Our Lady of Good Counsel” Catholic Hospital “Our Lady of Good Counsel” Rehabilitation and Sports Medicine Center Faculty of Medicine and Surgery, Tirana, Albania)

Background and aims

Over 70% of individuals who experience a stroke develop upper limb impairments, significantly limiting their ability to perform everyday activities. Although evidence supports that increased intensity of upper limb rehabilitation improves motor recovery, traditional therapy models often demand substantial therapist involvement, posing challenges in resource-limited healthcare settings. This is particularly relevant in countries like Albania, where standardized rehabilitation protocols are lacking and healthcare resources are constrained.The Graded Repetitive Arm Supplementary Program (GRASP) offers a cost-effective, self-administered solution to address these limitations. Designed to enhance upper extremity function post-stroke, GRASP consists of structured, repetitive, and progressively challenging exercises performed by patients independently, with periodic supervision by therapists and support from family members. The program aims to promote motor recovery, prevent learned non-use of the affected limb, and facilitate reintegration into daily life. This study aims to evaluate the feasibility and potential impact of GRASP as a scalable rehabilitation strategy in under-resourced clinical environments.

Methods

To make GRASP accessible in Albania and other Albanian-speaking regions, a rigorous translation and cultural adaptation process was conducted. After obtaining official permission from the program’s authors, the original materials were translated into Albanian. The process included independent translation by the author, a physiotherapy and rehabilitation expert; verification via back-translation to ensure fidelity to the original; and review by a multidisciplinary panel comprising physiotherapists and Albanian language experts.

Results

The adapted materials are now available in Albanian for patients and clinicians and are hosted by the University of British Columbia (UBC), the original developers of GRASP, ensuring accessibility for all Albanian-speaking healthcare stakeholders. The availability of GRASP materials in Albanian facilitates access to evidence-based protocols. However, successful implementation depends on intersectoral coordination, continuous staff training, and family support. Key challenges include integrating GRASP into national healthcare policies and securing resources for standardized training. Systemic barriers, such as inconsistent follow-up systems, must be addressed to ensure scalability.

Conclusion

GRASP represents a practical, evidence-based solution to enhance rehabilitative care in Albania and other Albanian-speaking regions. All program materials are now translated, culturally adapted, and freely accessible in Albanian via the University of British Columbia’s repository. To ensure effective clinical application, close coordination among healthcare institutions, professionals, and the community is essential. This includes ongoing therapist training, systematic outcome monitoring, and program adaptation to individual patient needs. GRASP not only reduces disability burden and increases patient autonomy but also standardizes rehabilitative care across Albanian-speaking populations, offering a scalable model for low-resource settings globally.

REFERENCES

The original GRASP materials and manuals are available from the University of British Columbia (UBC) website:
https://www.grasp-rehab.com