Brain Impairment

Articles

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

Kathryn S. Haywarda1, Ruth N. Barkera2a3, Amy H. Wisemana4 and Sandra G. Brauera1 c1

a1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia

a2 Discipline of Physiotherapy, School of Public Health Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia

a3 Community Rehab Northern Queensland, Townsville Mackay Medicare Local, Townsville, Australia

a4 Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia

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 limb;
  • stroke;
  • dose;
  • occupational therapy;
  • physiotherapy

Correspondence

c1 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: s.brauer@uq.edu.au