Given the contemporary clinical belief that more practice is better, it is important to determine how much practice currently occurs during physical therapy (PT) and occupational therapy (OT). The purpose of this study was to examine the number of repetitions of various activities during PT and OT outpatient treatment sessions for people with hemiparesis post-stroke. We observed 36 treatment sessions and recorded the types of activities and the number of repetitions of each activity that were done. Observations were categorized and descriptive statistics were generated for each category and subcategory. Our results showed that treatment time averaged 36 minutes per session. In sessions addressing the upper extremity, the average number of repetitions per session were 39 for active-exercise movements, 34 for passive-exercise movements, and 12 for purposeful movements. In sessions addressing the lower extremity, the average number of repetitions per session were 33 for active-exercise movements, six for passive-exercise movements, and eight for purposeful movements. In sessions addressing gait, the average number of steps taken was 292. In sessions addressing transfers, the average number of repetitions per session was 11. For most categories, there was considerable variability in the number of repetitions observed. We conclude that the numbers of repetitions observed during PT and OT for people with hemiparesis post-stroke are relatively small, except for gait steps. The fact that the number of repetitions of upper extremity purposeful movements was smaller than the number of repetitions of upper extremity active- and passive-exercise movements was surprising. This finding is inconsistent with current teaching that practice of purposeful movements is an integral part of improving functional status.

Purpose/Hypothesis: The purposes of this study were to compare gait and balance performance of a patient with chronic lower extremity spasticity and other motor deficits secondary to stroke prior to botulinum toxin, following botulinum toxin, and with combined botulinum toxin and body weight supported treadmill training (BWSTT), and to determine if those outcomes were maintained across time. Number of Subjects: A single-subject design (A/B1/B2/Delayed Post-Test) was used. Materials/Methods: Four weeks following lower extremity botulinum toxin injections (B1), intense BWSTT three sessions per week for eight weeks was added to the intervention (B2). The dependent variables, measured weekly, included: Berg balance scale, timed-up-and-go, 10-meter walk test and 6-minute walk test. The stroke impact scale (SIS) was measured one time during A and the Delayed Post-Test. Results: Each dependent variable showed significant improvement from A to B1, and performance remained improved through B2 phase and at the time of the Delayed Post-Test. Clinically significant differences were found in the mobility and handicap dimensions of the SIS. Conclusions: For this participant, BWSTT did not enhance outcomes beyond those observed with botulinum toxin injections alone. Improvements that were made during intervention were maintained at the Delayed Post-Test. Clinical Relevance: Previous literature has indicated limited functional carryover following botulinum toxin injections to reduce spasticity. The participant in this study enhanced functional outcomes following botulinum toxin injections only and was able to maintain those improvements during and after intense task-specific gait training.Purpose/Hypothesis: The two studies reported here evaluate the effectiveness of electrical stimulation in the management of long standing stroke impairments in a home-based exercise program. The two targeted impairments are chronic shoulder subluxation and wrist/finger contractures. Both studies compared exercise through implanted microstimulators (BIONs) with a standard surface stimulation program. Number of Subjects: Fourteen individuals with chronic shoulder subluxation due to stroke and 16 persons with wrist or finger contractures following stroke have participated in a 6 week stimulation program, either using surface electrodes or implanted microstimulators (BIONs). The average time from the stroke was 35 months. Materials/Methods: Following consent, subjects were randomized into either surface or implant stimulation groups. Following instruction regarding the appropriate equipment, subjects exercised daily at home for two or three 30 minute stimulation sessions. The exercise program continued for 6 weeks. Assessments of passive wrist and finger range of motion, or shoulder subluxation through xray, were done before and after the exercise programs. After 6 weeks of follow-up, individuals with implants were provided support for continued use. Individuals who had been compliant with surface stimulation were offered the continued use of the s...