Injury classification influences type and quantity of PT interventions during inpatient SCI rehabilitation and is a strong predictor of outcomes at discharge and 1 year post-injury. The impact of PT treatment increases when patient groupings become more homogeneous and outcomes become specific to the groupings. Note: This is the second of nine articles in the SCIRehab series.

Thesis directed by Assistant Clinical Professor Cynthia Harrison-Felix.Balance deficits are one of the most commonly occurring and physically limiting sequlae that result from more severe traumatic brain injury (TBI). The purpose of this study was to evaluate the effectiveness and applicability of using a commercially available virtual reality (VR) system as a treatment of these deficits for patients receiving inpatient rehabilitation for a primary diagnosis of TBI by conducting analyses of data collected as part of a pilot randomized controlled trial. The aims of this thesis were: (1) to examine the relationships between treatment received (VR or Extra Standard of Care) and static and dynamic balance changes over time; (2) to assess the predictive validity of the VR game scores on static and dynamic balance; and (3) to investigate dose response relationships between study treatments and changes in static and dynamic balance.Results indicate that patients receiving either treatment demonstrated significant balance improvements over time; however, neither treatment condition was found to be significantly better than the other. Scores from the VR balance games were found to have some moderately strong associations with the standardized assessment of static balance, with less strong relationships between VR scores and standardized assessments of dynamic balance. The results did not suggest the existence of any relationship between the amount of treatment received and changes in standardized assessments of balance. These data provide an essential first step in the establishment of the use of iv commercially available VR systems as effective tools for treating balance deficits for patients with TBI.The form and content of this abstract are approved. I recommend its publication.

Background/objective: To describe the nature and distribution of activities during physical therapy (PT) delivered in inpatient spinal cord injury (SCI) rehabilitation and discuss predictors (patient and injury characteristics) of the amount of time spent in PT for specific treatment activities. Methods: Six hundred patients from six inpatient SCI centers were enrolled in the SCIRehab study. Physical therapists documented details, including time spent, of treatment provided during 37 306 PT sessions that occurred during inpatient SCI rehabilitation. Ordinary least squares regression models associated patient and injury characteristics with time spent in specific PT activities. Results: SCIRehab patients received a mean total of 55.3 hours of PT over the course of their rehabilitation stay. Significant differences among four neurologic groups were seen in the amount of time spent on most activities, including the most common PT activities of strengthening exercises, stretching, transfer training, wheelchair mobility training, and gait training. Most PT work (77%) was provided in individual therapy sessions; the remaining 23% was done in group settings. Patient and injury characteristics explained only some of the variations seen in time spent on wheelchair mobility, transfer and bed mobility training, and range of motion/ stretching. Conclusion: Analysis yielded both expected and unexpected trends in SCI rehabilitation. Significant variation was seen in time spent on PT activities within and among injury groups. Providing therapeutic strengthening treatments consumed the greatest proportion of PT time. About one-quarter of all PT services were provided in group settings. Details about services provided, including time spent, will serve as a starting point in detailing the optimal treatment delivery for maximal outcomes.

Background/Objective: Outcomes research is in need of a classification system of physical therapy (PT) interventions for acute traumatic spinal cord injury (SCI) rehabilitation in the United States. The objective of this study was to describe a taxonomy (system to categorize and classify interventions) to examine the effects of PT interventions on rehabilitation outcomes. Methods: The SCIRehab study uses the rigorous observational practice-based evidence methodology to examine current treatment processes without changing existing practice. PT clinicians and researchers from 6 centers developed a taxonomy to describe details of each PT session. Results: The PT taxonomy consists of 19 treatment activities (eg, bed mobility, transfers, wheelchair mobility, strengthening and stretching exercises) and supplementary information to describe the associated therapeutic interventions. Details that focus on patient assistance needs and family involvement are included as additional descriptors to help to describe and justify PT activity selection. Time spent on each activity is used as the measure of intensity. Conclusion: The detailed PT taxonomy documentation process, which offers efficiency in data collection, is being used for all PT sessions with 1,500 patients with acute traumatic SCI at the 6 participating centers. It might be the first attempt to document the many details of the PT rehabilitation process for patients with SCI in the United States.

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