Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke.

Patients with acquired neurological deficits may capitalize on cortical reorganization to recover functional skills that have been lost. Research in neuroplasticity proposes that a high number of repetitions may lead to cortical reorganization. The purposes of this study were to quantify the number and type of activities performed by patients with traumatic brain injury (TBI) and stroke in physical and occupational therapy sessions to determine whether (1) the number of repetitions approaches the numbers in neuroplasticity research, (2) there were differences based on patient diagnosis, and (3) patient or therapist characteristics affected the type or amount of activities performed. Forty-eight patient and forty provider subjects participated. One hundred seven therapy sessions were observed. Data from therapy sessions were counted and categorized. Neither patient group approached the total number of repetitions neuroplasticity research suggests may be required for neuroplastic change. Repetitions per session did not differ between groups. Subjects with TBI performed more repetitions per minute in three categories (total upper-limb repetitions, gait steps, and transfers) than subjects with stroke. Therapists with <1 year or >15 years of neurological therapy experience instructed patients in fewer functional repetitions per minute than did therapists with 5 to 15 years of experience.

[1]  J. Ghajar.  Traumatic brain injury , 2000, The Lancet.

[2]  L. Ada,et al.  Routine physiotherapy does not induce a cardiorespiratory training effect post-stroke, regardless of walking ability. , 2006, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[3]  V. Edgerton,et al.  Locomotor ability in spinal rats is dependent on the amount of activity imposed on the hindlimbs during treadmill training. , 2007, Journal of neurotrauma.

[4]  J. Kleim,et al.  Functional reorganization of the rat motor cortex following motor skill learning. , 1998, Journal of neurophysiology.

[5]  C. Granger,et al.  The functional independence measure: a new tool for rehabilitation. , 1987, Advances in clinical rehabilitation.

[6]  S. Wolf,et al.  Repetitive Task Practice: A Critical Review of Constraint-Induced Movement Therapy in Stroke , 2002, The neurologist.

[7]  Catherine E Lang,et al.  Counting Repetitions: An Observational Study of Outpatient Therapy for People with Hemiparesis Post-Stroke , 2007, Journal of neurologic physical therapy : JNPT.

[8]  Pamela W. Duncan,et al.  Textbook of Neural Repair and Rehabilitation: Functional plasticity in CNS system , 2006 .

[9]  R. Nudo,et al.  Effects of Repetitive Motor Training on Movement Representations in Adult Squirrel Monkeys: Role of Use versus Learning , 2000, Neurobiology of Learning and Memory.

[10]  J. Langlois,et al.  Incidence of Traumatic Brain Injury in the United States, 2003 , 2006, The Journal of head trauma rehabilitation.

[11]  Scott M Lewis,et al.  Comparison of Finger Tracking Versus Simple Movement Training via Telerehabilitation to Alter Hand Function and Cortical Reorganization After Stroke , 2007, Neurorehabilitation and neural repair.

[12]  K. Mauritz,et al.  Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand , 1995, Journal of the Neurological Sciences.

[13]  Catherine E. Lang,et al.  Translating Animal Doses of Task-Specific Training to People With Chronic Stroke in 1-Hour Therapy Sessions: A Proof-of-Concept Study , 2010, Neurorehabilitation and neural repair.

[14]  K. Uğurbil,et al.  Analysis of fMRI and finger tracking training in subjects with chronic stroke. , 2002, Brain : a journal of neurology.

[15]  Janet H Carr,et al.  A randomized controlled trial of the effects of intensive sit-to-stand training after recent traumatic brain injury on sit-to-stand performance , 2003, Clinical rehabilitation.

[16]  C. English,et al.  Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial. , 2007, Archives of physical medicine and rehabilitation.

[17]  J. Liepert,et al.  Motor cortex plasticity during constraint-induced movement therapy in stroke patients , 1998, Neuroscience Letters.

[18]  R. Nudo.  Adaptive plasticity in motor cortex: implications for rehabilitation after brain injury. , 2003, Journal of rehabilitation medicine.

[19]  S. Rossignol,et al.  Early locomotor training with clonidine in spinal cats. , 1998, Journal of neurophysiology.

[20]  M. Hallett,et al.  Rapid plasticity of human cortical movement representation induced by practice. , 1998, Journal of neurophysiology.

[21]  J. Liepert,et al.  Training‐induced changes of motor cortex representations in stroke patients , 2000, Acta neurologica Scandinavica.

[22]  V R Edgerton,et al.  Locomotor capacity attributable to step training versus spontaneous recovery after spinalization in adult cats. , 1998, Journal of neurophysiology.

[23]  R. Nudo,et al.  Neural Substrates for the Effects of Rehabilitative Training on Motor Recovery After Ischemic Infarct , 1996, Science.

[24]  R. Nudo,et al.  Descending pathways to the spinal cord: A comparative study of 22 mammals , 1988, The Journal of comparative neurology.

[25]  H. Krebs,et al.  Effects of Robot-Assisted Therapy on Upper Limb Recovery After Stroke: A Systematic Review , 2008, Neurorehabilitation and neural repair.

[26]  Y. Hsieh,et al.  Potential Predictors of Motor and Functional Outcomes After Distributed Constraint-Induced Therapy for Patients With Stroke , 2009, Neurorehabilitation and neural repair.

[27]  G. Kwakkel,et al.  The impact of physical therapy on functional outcomes after stroke: what's the evidence? , 2004, Clinical rehabilitation.

[28]  G. Grant,et al.  Mild traumatic brain injury in U.S. soldiers returning from Iraq. , 2008, The New England journal of medicine.

[29]  P. Nathan,et al.  The rubrospinal and central tegmental tracts in man. , 1982, Brain : a journal of neurology.

[30]  C. English,et al.  How much physical activity do people recovering from stroke do during physiotherapy sessions , 2009 .

[31]  D. Reisman,et al.  Observation of amounts of movement practice provided during stroke rehabilitation. , 2009, Archives of physical medicine and rehabilitation.

[32]  J. Carey,et al.  Electrical stimulation driving functional improvements and cortical changes in subjects with stroke , 2004, Experimental Brain Research.

[33]  M. Merzenich,et al.  Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys , 1996, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[34]  Staci McKay,et al.  Constraint-induced movement therapy for recovery of upper-limb function following traumatic brain injury. , 2005, Journal of rehabilitation research and development.

[35]  J. P. Miller,et al.  Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. , 2006, JAMA.