Observation of Amounts of Movement Practice Provided During Stroke Rehabilitation
Abstract
Lang CE, MacDonald JR, Reisman DS, Boyd L, Jacobson Kimberley T, Schindler-Ivens SM, Hornby TG, Ross SA, Scheets PL. Observation of amounts of movement practice provided during stroke rehabilitation.
Objective
To investigate how much movement practice occurred during stroke rehabilitation, and what factors might influence doses of practice provided.
Design
Observational survey of stroke therapy sessions.
Setting
Seven inpatient and outpatient rehabilitation sites.
Participants
We observed a convenience sample of 312 physical and occupational therapy sessions for people with stroke.
Interventions
Not applicable.
Main Outcome Measures
We recorded numbers of repetitions in specific movement categories and data on potential modifying factors (patient age, side affected, time since stroke, FIM item scores, years of therapist experience). Descriptive statistics were used to characterize amounts of practice. Correlation and regression analyses were used to determine whether potential factors were related to the amount of practice in the 2 important categories of upper extremity functional movements and gait steps.
Results
Practice of task-specific, functional upper extremity movements occurred in 51% of the sessions that addressed upper limb rehabilitation, and the average number of repetitions/session was 32 (95% confidence interval [CI]=20–44). Practice of gait occurred in 84% of sessions that addressed lower limb rehabilitation and the average number of gait steps/session was 357 (95% CI=296–418). None of the potential factors listed accounted for significant variance in the amount of practice in either of these 2 categories.
Conclusions
The amount of practice provided during poststroke rehabilitation is small compared with animal models. It is possible that current doses of task-specific practice during rehabilitation are not adequate to drive the neural reorganization needed to promote function poststroke optimally.
aProgram in Physical Therapy, Program in Occupational Therapy, and Department of Neurology, Washington University, St. Louis, MO
bDepartment of Physical Therapy, Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE
cPhysical Therapy and Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
dDepartment of Physical Medicine and Rehabilitation, Program in Physical Therapy, University of Minnesota, Minneapolis, MN
eDepartment of Physical Therapy, Marquette University, Milwaukee, WI
fDepartment of Physical Therapy, University of Illinois at Chicago, Chicago, IL
gPhysical Therapy Program, Maryville University, St. Louis, MO
hTherapy Services, Carle Foundation Hospital, Urbana, IL
Reprint requests to Catherine E. Lang, PT, PhD, Program in Physical Therapy, Washington University, 4444 Forest Park, Campus Box 8502, St Louis, MO 63108
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.
ABSTRACT