Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-24T13:44:55.695Z Has data issue: false hasContentIssue false
  • English
  • Français

Dose and Content of Training Provided to Stroke Survivors with Severe Upper Limb Disability Undertaking Inpatient Rehabilitation: An Observational Study

Published online by Cambridge University Press:  28 November 2013

Kathryn S. Hayward ,
Ruth N. Barker ,
Amy H. Wiseman  and
Sandra G. Brauer
Kathryn S. Hayward
Affiliation:
Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
Ruth N. Barker
Affiliation:
Discipline of Physiotherapy, School of Public Health Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia Community Rehab Northern Queensland, Townsville Mackay Medicare Local, Townsville, Australia
Amy H. Wiseman
Affiliation:
Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
Sandra G. Brauer*
Affiliation:
Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
*
Address for correspondence: Sandra G. Brauer, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane St Lucia, Queensland, Australia, 4072. E-mail: [email protected]
Get access

Abstract

Background: To retrain upper limb function after stroke, a high dose of activity-related therapy is recommended. However, observational studies indicate that the dose undertaken is minimal. While it is speculated that those with severe disability will perform less therapy, this remains to be explored.

Objective: Quantify the dose and content of upper limb therapy performed by stroke survivors with severe upper limb disability during routine inpatient rehabilitation.

Methods: Therapy provided by physiotherapists and occupational therapists to 32 stroke survivors receiving inpatient rehabilitation over 20 weekdays was recorded. Dose of individual and group therapy was analysed by discipline and severity of upper and lower limb disability. Dose and content of individual therapy was also analysed by functional domain.

Results: On average, 46 minutes of individual and 11 minutes of group upper limb therapy were provided per participant, per day. Occupational therapists provided a higher dose of both individual and group therapy compared to physiotherapists (p < 0.0005). Findings suggest that greater residual upper and lower limb movement can lead to provision of a higher dose of activity-related therapy. Within individual therapy, a higher dose (29 versus 17 minutes, p < 0.002) and greater number (1218 versus 549) of impairment- than activity-related interventions were administered.

Conclusions: The dose of activity-related upper limb therapy provided to stroke survivors with severe disability was limited. There is a need to identify interventions and models of service delivery that can increase the intensity and appropriateness of therapy that stroke survivors with severe disability undertake during inpatient rehabilitation.

Keywords

upper limbstrokedoseoccupational therapyphysiotherapy
Type
Articles
Information
Brain Impairment , Volume 14 , Issue 3 , December 2013 , pp. 392 - 405
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ada, L., Canning, C.G., Carr, J.H., Kilbreath, S.L., & Shepherd, R.B. (1994). Task specific training of reaching and manipulation. In Bennett, K.M. & Castiello, U. (Eds.), Insights into the reach to grasp movement (pp. 239–264). Amsterdam: Elsevier.Google Scholar
Ada, L., Mackey, F., Heard, R., & Adams, R.J. (1999). Stroke rehabilitation: Does the therapy area provide a physical challenge? Australian Journal of Physiotherapy, 45, 33–38.Google ScholarPubMed
Bagley, P., Hudson, M., Green, J., Forster, A., & Young, J. (2009). Do physiotherapy staff record treatment time accurately? An observational study. Clinical Rehabilitation, 23, 841–845.CrossRefGoogle ScholarPubMed
Barker, R.N., & Brauer, S.G. (2005). Upper limb recovery after stroke: The stroke survivors’ perspective. Disability and Rehabilitation, 27, 1213–1223.CrossRefGoogle ScholarPubMed
Carr, J.H., & Shepherd, R.B. (2003). Stroke rehabilitation: Guidelines for exercise and training to optimize motor skills. London: Butterworth-Heinemann.Google Scholar
Chen, S.-Y., & Winstein, C.J. (2009). A systematic review of voluntary arm recovery in hemiparetic stroke. Clinical predictors for meaningful outcomes using the International Classification of Functioning, Disability and Health. Journal of Neurological Physical Therapy, 33, 2–13.CrossRefGoogle ScholarPubMed
Dean, C.M., & Mackey, F. (1992). Motor assessment scale scores as a measure of rehabilitation outcome following stroke. Australian Journal of Physiotherapy, 38, 31–35.CrossRefGoogle ScholarPubMed
Dean, C.M., Richards, C., & Malouin, F. (2000). Task-related circuit training improves performance of locomotor tasks in chronic stroke: A randomised controlled pilot trial. Archives of Physical Medicine & Rehabilitation, 81, 409–417.CrossRefGoogle Scholar
English, C., Hillier, S., Stiller, K., & Warden-Flood, A. (2007). Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: A controlled trial. Archives of Physical Medicine & Rehabilitation, 88, 955–963.CrossRefGoogle ScholarPubMed
Foley, N.C., McClure, A., Meyer, M., Salter, K., Bureau, Y., & Teasell, R.W. (2012). Inpatient rehabilitation following stroke: Amount of therapy received and associations with functional recovery. Disability and Rehabilitation, Early online, 34, 2132–2138.CrossRefGoogle ScholarPubMed
French, B., Thomas, L.H., Leathley, M.J., Sutton, C.J., McAdam, J., Forster, A., . . . Watkins, C.L. (2007). Repetitive task training for improving functional ability after stroke. Cochrane Database of Systematic Reviews, CD006073.CrossRefGoogle Scholar
Garraway, M. (1985). Stroke rehabilitation units: Concepts, evaluation and unresolved issues. Stroke, 16, 178–181.CrossRefGoogle ScholarPubMed
Hayward, K.S., Barker, R.N., & Brauer, S.G. (2010a). Advances in neuromuscular electrical stimulation for the upper limb post stroke. Physical Therapy Reviews, 15, 309–319.CrossRefGoogle Scholar
Hayward, K.S., Barker, R.N., & Brauer, S.G. (2010b). Interventions to promote upper limb recovery in stroke survivors with severe paresis: A systematic review. Disability and Rehabilitation, 32, 1973–1986.CrossRefGoogle ScholarPubMed
Hendricks, H.T., van Limbeek, J., Geurts, A.C., & Zwarts, M.J. (2002). Motor recovery after stroke: A systematic review of the literature. Archives of Physical Medicine and Rehabilitation, 83, 1629–1637.CrossRefGoogle ScholarPubMed
Kaur, G., English, C., & Hillier, S. (2012). How physically active are people with stroke in physiotherapy sessions aimed at improving motor function? A systematic review. Stroke Research and Treatment, 820673.CrossRefGoogle Scholar
Kleim, J.A. (2012). Behavioural signals driving plasticity. Neural plasticity. Scottsdale, Arizona: TANAS Publishing.Google Scholar
Kleim, J.A., Barbay, S., & Nudo, R.J. (1998). Functional reorganization of the rat motor cortex following motor skill learning. Journal of Neurophysiology, 80, 3321–3325.CrossRefGoogle ScholarPubMed
Kleim, J.A., Hogg, T.M., VandenBerg, P.M., Cooper, N.R., Bruneau, R., & Remple, M. (2004). Cortical synaptogenesis and motor map reorganization occur during late, but not early, phase of motor skill learning. Journal of Neuroscience, 24, 628–633.CrossRefGoogle Scholar
Kleim, J.A., & Jones, T.A. (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Journal of Speech, Language and Hearing Research, 51, S225–S239.CrossRefGoogle ScholarPubMed
Kuys, S.S., Brauer, S.G., & Ada, L. (2006). Routine physiotherapy does not induce a cardiorespiratory training effect post-stroke, regardless of walking ability. Physiotherapy Research International, 11, 219–227.CrossRefGoogle Scholar
Kwakkel, G., & Kollen, B.J. (2007). Predicting improvement in the upper paretic limb after stroke: A longitudinal prospective study. Restorative Neurology and Neuroscience, 25, 453–460.Google ScholarPubMed
Kwakkel, G., Kollen, B.J., Van der Grond, J., & Prevo, A.J. (2003). Probability of regaining dexterity in the flaccid upper limb. The impact of severity of paresis and time since onset in acute stroke. Stroke, 34, 2181–2186.CrossRefGoogle ScholarPubMed
Kwakkel, G., van Peppen, R.P.S., Wagenaar, R.C., Wood Dauphinee, S., Richards, C., Ashburn, A., . . . Langhorne, P. (2004). Effects of augmented exercise therapy time after stroke: A meta-analysis. Stroke, 35, 2529–2536.CrossRefGoogle ScholarPubMed
Lang, C.E., Macdonald, J.R., Reisman, D.S., Boyd, L., Jacobson Kimberley, T., Schindler-Ivens, S. M., . . . Scheets, P.L. (2009). Observation of amounts of movement practice provided during stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 90, 1692–1698.CrossRefGoogle ScholarPubMed
Lindsay, M.P., Gubitz, G., Bayley, M., Davies-Schinkel, C., Singh, S., & Phillips, S. (2010). Canadian best practice recommendations for stroke care (Update 2010). On behalf of the Canadian Stroke Strategy Best Practice and Standards Writing Group. Ottawa, Ontario, Canada: Canadian Stroke Network.Google Scholar
Magill, R.A. (2007). Motor learning and control: Concepts and applications (8th ed.). Sydney: McGraw Hill.Google Scholar
Nakayama, H., Jorgensen, H.S., Rasschou, H.O., & Olsen, T.S. (1994). Recovery of upper extremity function in stroke patients: The Copenhagen Stroke Study. Archives of Physical Medicine and Rehabilitation, 75, 394–398.CrossRefGoogle Scholar
National Stroke Foundation. (2010). Clinical guidelines for stroke management. Melbourne, Australia: National Stroke Foundation.Google Scholar
Olsen, T.S. (1989). Improvement of function and motor impairment after stroke. Journal of Neurological Rehabilitation, 3, 187–192.Google Scholar
Parker, V.M., Wade, D.T., & Langton Hewer, R. (1986). Loss of arm function after stroke: Measurement, frequency and recovery. International Rehabilitation Medicine, 8, 69–73.CrossRefGoogle ScholarPubMed
Peppen, R.P.S., Kwakkel, G., Harmeling-van der Wel, B.C., Kollen, B.J., Hobbelen, J.S.M., & Buurke, J.H. (2004). KNGF Clinical Practice Guidelines for physical therapy in patients with stroke: Review of the evidence. Dutch Journal of Physical Therapy, 114 (Suppl. 5).Google Scholar
Plautz, E.J., Milliken, G.W., & Nudo, R.J. (2000). Effects of repetitive motor training on movement representations in adult squirrel monkeys: role of use versus learning. Neurobiology of Learning and Memory, 74, 27–55.CrossRefGoogle ScholarPubMed
Royal College of Physicians of London, Intercollegiate Stroke Working Party. (2008). National clinical guidelines for stroke. London: Royal College of Physicians.Google Scholar
Royal Dutch Society for Physical Therapists. (2008). Stroke: Review of the evidence: Clinical practice guideline for physical therapy in patients with stroke. Amsterdam: Royal Dutch Society for Physical Therapists.Google Scholar
Sunderland, A., Bradley, L., Tinson, D., & Hewer, R. L. (1989). Arm function after stroke: An evaluation of grip strength as a measure of recovery and a prognostic indicator. Journal of Neurology, Neurosurgery and Psychiatry, 52, 1267–1272.CrossRefGoogle Scholar
Taub, E., Crago, J.E., Burgio, L.D., Groomes, T.E., Cook, E.W., DeLuca, S.C., & Miller, N.E. (1994). An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping. Experimental Analysis of Behaviour, 61, 281–293.CrossRefGoogle ScholarPubMed
Winstein, C.J., Rose, D.K., Tan, S.M., Lewthwaite, R., Chui, H.C., & Azen, S.P. (2004). A randomised controlled trial of the comparison of upper-extremity rehabilitation strategies in acute stroke: A pilot of immediate and long term outcomes. Archives of Physical Medicine and Rehabilitation, 85, 620–628.CrossRefGoogle ScholarPubMed
Wolf, S.L., Newton, H., Maddy, D., Blanton, S., Zhang, Q., Winstein, C.J., . . . Light, K. (2007). The Excite Trial: Relationship of intensity of constraint induced movement therapy to improvement in the Wolf motor function test. Restorative Neurology and Neuroscience, 25, 549–562.Google ScholarPubMed
Wolf, S.L., Winstein, C.J., Miller, J.P., Taub, E., Uswatte, G., Morris, D., . . . EXCITE Investigators. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: The EXCITE randomised clinical trial. Journal of the American Medical Association, 296, 2095–2104.CrossRefGoogle Scholar
World Federation of Occupational Therapists. (2010). Statement on occupational therapy. Retrieved from: http://www.wfot.org/Portals/0/PDF/STATEMENT%20ON%20OCCUPATIONAL%20THERAPY%20300811.pdfGoogle Scholar
World Health Organisation. (2001). ICF, International classification of functioning, disability and health (short ed.). Geneva: World Health Organisation.Google Scholar