Movement repetitions in physical and occupational therapy during spinal cord injury rehabilitation

Abstract

Study DesignLongitudinal observational study.ObjectiveTo quantify the amount of upper and lower extremity movement repetitions (i.e., voluntary movements as part of a functional task or specific motion) occurring during inpatient spinal cord injury (SCI) physical (PT) and occupational therapy (OT), and examine changes over the inpatient rehabilitation stay.SettingTwo stand-alone inpatient SCI rehabilitation centres.MethodsParticipants103 patients were recruited through consecutive admissions to SCI rehabilitation.InterventionsTrained assistants observed therapy sessions and obtained clinical outcome measures in the second week following admission and in the second to last week prior to discharge.Main Outcome MeasuresPT and OT time, upper and lower extremity repetitions, and changes in these outcomes over the rehabilitation stay.ResultsWe observed 561 PT and 347 OT sessions. Therapeutic time comprised two-thirds of total therapy time. Summed over PT and OT, median upper extremity repetitions in patients with paraplegia were 7 repetitions and in patients with tetraplegia, 42 repetitions. Lower extremity repetitions and steps primarily occurred in ambulatory patients and amounted to 218 and 115, respectively (summed over PT and OT sessions at discharge). Wilcoxon signed rank tests revealed that most repetition variables did not change significantly over the inpatient rehabilitation stay. In contrast, clinical outcomes for the arm and leg improved over this time period.ConclusionsRepetitions of upper and lower extremity movement are markedly low during PT and OT sessions. Despite improvements in clinical outcomes, there was no significant increase in movement repetitions over the inpatient rehabilitation stay.

Traumatic brain injury rehabilitation in Riyadh, Saudi Arabia: Time to rehabilitation admission, length of stay and functional outcome

“…By itself, LOS is an inadequate way to compare rehabilitation effectiveness, since a longer LOS may reflect inefficiency as much as it indicates increased therapeutic time and a shorter LOS may reflect increased efficiency/intensity or be indicative of cuts in health care provision, as seen in recent decades in the USA [40]. Accounting for the intensity of therapy, at least in terms of time [41] and ideally in terms of therapy content [42], would allow for a true comparison of rehabilitation interventions between countries.…”

Getting the Best Out of Advanced Rehabilitation Technology for the Lower Limbs: Minding Motor Learning Principles

“…The average number of steps taken was 357 (between 200 and 300 m) per training session. Zbogar et al [24] conducted a similar analysis but observed 561 physical therapy sessions with individuals with SCI. They counted an average of 51 steps, and these steps occurred primarily in patients who were already able to walk.…”

Priming for Improved Hand Strength in Persons with Chronic Tetraplegia: A Comparison of Priming-Augmented Functional Task Practice, Priming Alone, and Conventional Exercise Training

“…Second, we did not attempt to quantify the training dose in terms of repetitions of the task in the FPT + PNSS or CET groups; such a measure may have been valuable for understanding differences in outcomes across subjects. However, undoubtedly, the number of repetitions was substantially higher than has been reported for inpatient rehabilitation wherein the median number of UE task repetitions for patients with tetraplegia is 42, and with 0 repetitions of hand-related activities (5). A third limitation of this study is that we assessed measures of CSE in a subset of participants.…”

“…Not surprisingly, this group frequently cites recovery of arm and hand function as the single most important priority in terms of functional restoration (2–4). Yet inpatient therapy for persons with tetraplegia has little if any focus on restoration of hand function (5), despite the fact that in persons with tetraplegia hand muscle force generation is highly correlated with success or failure in the ability to perform common functional tasks (6). …”