Article

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.

Langue : ANGLAIS