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Lang, C. E.1; MacDonald, J. R.1; Gnip, C.1
1Physical Therapy, Washington University, St. Louis, MO, Occupational Therapy, Washington University, St. Louis, MO, 3Neurology, Washington University, St. Louis, MO.
Purpose/Hypothesis: To induce neuroplastic changes in stroke models, animals often perform 200–400 daily repetitions of a single task. Similarly, healthy adults in motor learning studies often perform 100 – 500 repetitions of the task to be learned. Given the contemporary clinical belief that more practice is better, it is critical to determine how much task practice currently occurs during physical (PT) and occupational (OT) therapy. The purpose of this study therefore was to examine the number of repetitions of various activities occurring during PT and OT treatment sessions for people with hemiparesis post stroke. Number of Subjects: 36 PT and OT treatment sessions from an outpatient day treatment program were observed. Materials/Methods: During each observation, the types of activities and the number of repetitions of each activity were recorded. Activities were grouped into 5 main categories: upper extremity (UE) movements, lower (LE) extremity movements, gait, stairs, and transfers. The UE and LE movement categories were further divided into 3 subcategories: active, passive, and purposeful movements. Active movements were therapeutic exercises performed by the patients, with or without assist. Passive movements were any movements performed by the therapist (e.g. passive range of motion). Purposeful activities were activities such as buttoning a jacket, reaching for an object, or donning a shoe. Descriptive statistics were generated for each category and subcategory of activity. Results: Mean treatment time was 36 minutes/session. In sessions addressing the UE, average repetitions/session were 39 for active UE movements, 34 for passive UE movements, and 12 for purposeful movements. In sessions addressing the LE, average repetitions/session were 33 for active LE movement, 6 for passive LE movement, and 8 for purposeful LE movement. In those sessions addressing gait, the average number of steps taken was 292. In those sessions addressing transfers, the average repetitions/session was 11. For most categories, there was considerable variability in the number of repetitions observed. Conclusions: The numbers of repetitions observed during PT and OT treatment for people with hemiparesis post stroke are relatively small. The fact that the number of repetitions of UE purposeful movements was smaller than the number of repetitions for active and passive UE movements was surprising, given that it is task practice of purposeful movements that might be expected to most improve functional status. Clinical Relevance: Our data provide an initial reference point to compare the current amount of task practice during rehabilitation for people with hemiparesis to the amount of task practice in human motor learning or animal neuroplasticity studies. PTs and OTs can compare the amount of practice they provide during therapy sessions to these numbers and work to increase task practice both during and outside of therapy sessions.
© 2006 Neurology Section, APTA
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