Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2009 Oct;90(10):1692-8.
doi: 10.1016/j.apmr.2009.04.005.

Observation of amounts of movement practice provided during stroke rehabilitation

Catherine E Lang  1 , Jillian R Macdonald, Darcy S Reisman, Lara Boyd, Teresa Jacobson Kimberley, Sheila M Schindler-Ivens, T George Hornby, Sandy A Ross, Patricia L Scheets
Affiliations
Clinical Trial

Observation of amounts of movement practice provided during stroke rehabilitation

Catherine E Lang et al. Arch Phys Med Rehabil. 2009 Oct.

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.

PubMed Disclaimer

Comment in

  • Physical activity following stroke.
    McDonnell MN. McDonnell MN. Arch Phys Med Rehabil. 2010 Apr;91(4):665-6. doi: 10.1016/j.apmr.2009.12.007. Arch Phys Med Rehabil. 2010. PMID: 20382307 No abstract available.

References

    1. Kleim JA, Barbay S, Nudo RJ. Functional reorganization of the rat motor cortex following motor skill learning. J Neurophysiol. 1998;80:3321–3325. - PubMed
    1. Nudo RJ, Milliken GW, Jenkins WM, Merzenich MM. Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys. J Neurosci. 1996;16:785–807. - PMC - PubMed
    1. Nudo RJ, Wise BM, SiFuentes F, Milliken GW. Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science. 1996;272:1791–1794. - PubMed
    1. Fine MS, Thoroughman KA. Motor adaptation to single force pulses: Sensitive to direction but insensitive to within-movement pulse placement and magnitude. J Neurophysiol. 2006;96:710–720. - PubMed
    1. Boyd L, Winstein C. Explicit information interferes with implicit motor learning of both continuous and discrete movement tasks after stroke. J Neurol Phys Ther. 2006;30:46–57. discussion 58–49. - PubMed

Publication types