Original articleObservation of Amounts of Movement Practice Provided During Stroke Rehabilitation
Section snippets
Observed Sessions
We recorded the number of repetitions of all movement activities during 312 PT and OT sessions from 7 sites around the United States and Canada (table 1). Sites were selected based on convenience and are not a random sample of rehabilitation sites in North America. Data were collected between May 1, 2007, and June 30, 2008. PT and OT sessions were observed because both disciplines address movement rehabilitation. Research assistants were trained to observe and collect data at each site. To
Results
Repetitions were counted during 312 observed PT and OT sessions at 7 sites (see table 1, top). The sites were inpatient and outpatient settings (see second column of table 1). None were skilled nursing facilities. Inpatient settings typically saw patients 5 days per week, 1 to 2 times a day, while outpatient settings typically saw patients 2 to 3 days per week, 1 time a day. Average session duration was 36±14 minutes (range=16–104min). Time was recorded from the point when therapeutic
Discussion
We investigated the amount of practice, in numbers of repetitions, currently occurring in stroke rehabilitation. In each category, there was considerable variability in the amount of practice (see table 4, last column). Practice of functional upper extremity movements occurred in only half of the sessions that addressed upper limb rehabilitation, and the average number of repetitions in those sessions was low. Practice of gait occurred much more often in sessions that addressed lower limb
Conclusions
In summary, we found that the amount of task-specific practice currently provided during stroke rehabilitation is small compared with animal models and human motor learning studies. Given that patients poststroke spend large portions of their day relatively inactive,17, 38 the dose of practice provided during therapy is of utmost importance. Our results open up the possibility that current doses of task-specific practice may not be adequate to drive the neural changes needed to optimally
Acknowledgments
We thank Sage Tarter, DPT, for her assistance with data management and Angie Gregozeski for her assistance at the Zablecki Veterans Administration facility. We appreciate the many observers who spent hours training and collecting data for this project, and the rehabilitation facilities, therapists, and patients who permitted us to observe them, including the veterans at the Veterans Administration facility.
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Cited by (0)
Pilot funding for development and distribution of training materials was provided by the Research Division of the Program in Physical Therapy at Washington University. Salary support for C.E.L. during this project was provided by National Institutes of Health (grant no. HD047669). Funding from the Vancouver Coastal Health Research Institute and Foundation, the Heart and Stroke Foundation of British Columbia, and the North Growth Foundation provided salary support for data collection at University of British Columbia.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.