Strategies for increasing the intensity of upper limb task-specific practice after acquired brain impairment: A secondary analysis from a randomised controlled trial

Abstract

Introduction: Patients with acquired brain impairments require intensive, task-specific training to maximise upper limb recovery.Current evidence suggests, however, that they rarely achieve this. The purpose of this study was to describe the amount of practice that can be achieved by patients with acquired brain impairment during intensive upper limb treatment within a public hospital, and to examine the strategies used by therapists to maximise practice. Method: A secondary analysis was conducted using data from a previously published randomised trial. The training received by 20 people with acquired brain impairment over the 6-week trial period was recorded. The strategies used by therapists to maximise practice were also noted. Results: Over the 6-week period, 45 hours of upper limb training was provided. The median (interquartile range) amount of actual practice achieved by patients was 59 (54-63) minutes per day, with a median (interquartile range) of 186 (50-330) repetitions of active movement. Patients' practice was maximised through the use of task-specific feedback, practice books, counters, environmental cues and stopwatches. In addition, therapists provided coaching as well as ensuring tasks were goal-oriented, measurable and patient-driven. Conclusion: Described strategies enabled patients with acquired brain impairment to practise upper limb tasks at intensities greater than currently reported in the literature.