Increasing the hours per week of therapy given to adults recovering from brain injury in hospital can accelerate the rate of recovery of personal independence and result in their being discharged from hospital sooner. Increased rehabilitation therapy after brain injury is associated with enhanced functional recovery and shorter hospital stay if provided in the context of an integrated service that can provide ongoing community support. There is no evidence of any ceiling effect of therapeutic intensity beyond which no further response is observed.

This study aimed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal-setting in children with cerebral palsy (CP). Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System (GMFCS), aged between 3 and 12 years. A 2 × 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts, and to compare the use of generalized aims set by the child's physiotherapist with the use of specific, measurable goals negotiated by the child's physiotherapist with each child, carer, and teacher. Following the six-month treatment period there was a further six-month period of observation. Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure (GMFM) and the Gross Motor Performance Measure (GMPM) at three-month intervals. There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim-directed and goal-directed therapy in either function or performance. Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period. This advantage declined over the subsequent six months during which therapy had reverted to its usual amount. Differences in goal-setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance.In our previous studies (Bower andMcLellan 1992, 1994b) we identified two elements that were widely believed by health care professionals and parents to be of particular importance in determining the rate of motor progress in children with cerebral palsy (CP). Both of these elements would be supported by basic principles of learning theory. One element was the intensity of physiotherapy treatment, i.e. the number of therapy sessions within a set time period. The other was the identification of precise objectives that were adopted and understood by the child and considered helpful by parents and carers.Physiotherapists often identify a set of general aims in relation to the treatment of their patients, such as improvement of trunk balance or gait pattern. While such aims reflect the general direction of changes in the patient's performance they do not define the achievement with any measurable precision. Such general aims can be contrasted with specific measurable goals of therapy collaboratively agreed upon by the child, parents, teacher, and therapist. Setting a treatment goal involves identifying and formulating standards of motor activity which are in advance of the child's current capacity or which retard deterioration (Bower and McLellan 1994a). Goals need to be formulated in such a way that there is no doubt as to the extent to which they have been achieved when performance is reviewed. Other studiesMcLaughlin...

This study aimed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal-setting in children with cerebral palsy (CP). Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System (GMFCS), aged between 3 and 12 years. A 2 x 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts, and to compare the use of generalized aims set by the child's physiotherapist with the use of specific, measurable goals negotiated by the child's physiotherapist with each child, carer, and teacher. Following the six-month treatment period there was a further six-month period of observation. Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure (GMFM) and the Gross Motor Performance Measure (GMPM) at three-month intervals. There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim-directed and goal-directed therapy in either function or performance. Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period. This advantage declined over the subsequent six months during which therapy had reverted to its usual amount. Differences in goal-setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance.

Purpose: To explore change in activity levels post-stroke. Methods: We measured activity levels using the activPALä in hospital and at 1, 2 and 3 years' post-stroke onset. Results: Of the 74 participants (mean age 76 (SD 11), 39 men), 61 were assessed in hospital: 94% of time was spent in sitting/lying, 4% standing and 2% walking. Activity levels improved over time (complete cases n ¼ 15); time spent sitting/lying decreased (p ¼ 0.001); time spent standing, walking and number of steps increased (p ¼ 0.001, p ¼ 0.028 and p ¼ 0.03, respectively). At year 3, 18% of time was spent in standing and 9% walking. Time spent upright correlated significantly with Barthel (r ¼ 0.69 on admission, r ¼ 0.68 on discharge, both p50.01) and functional ambulation category scores (r ¼ 0.55 on admission, 0.63 on discharge, both p50.05); correlations remained significant at all assessment points. Depression (in hospital), left hemisphere infarction (Years 1-2), visual neglect (Year 2), poor mobility and balance (Years 1-3) correlated with poorer activity levels. Conclusion: People with stroke were inactive for the majority of time. Time spent upright improved significantly by 1 year post-stroke; improvements slowed down thereafter. Poor activity levels correlated with physical and psychological measures. Larger studies are indicated to identify predictors of activity levels.ä Implications for Rehabilitation Activity levels (measured using activPALä activity monitor), increased significantly by 1 year post-stroke but improvements slowed down at 2 and 3 years. People with stroke were inactive for the majority of their day in hospital and in the community. Poor activity levels correlated with physical and psychological measures. Larger studies are indicated to identify the most important predictors of activity levels.