Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke.

Patients with acquired neurological deficits may capitalize on cortical reorganization to recover functional skills that have been lost. Research in neuroplasticity proposes that a high number of repetitions may lead to cortical reorganization. The purposes of this study were to quantify the number and type of activities performed by patients with traumatic brain injury (TBI) and stroke in physical and occupational therapy sessions to determine whether (1) the number of repetitions approaches the numbers in neuroplasticity research, (2) there were differences based on patient diagnosis, and (3) patient or therapist characteristics affected the type or amount of activities performed. Forty-eight patient and forty provider subjects participated. One hundred seven therapy sessions were observed. Data from therapy sessions were counted and categorized. Neither patient group approached the total number of repetitions neuroplasticity research suggests may be required for neuroplastic change. Repetitions per session did not differ between groups. Subjects with TBI performed more repetitions per minute in three categories (total upper-limb repetitions, gait steps, and transfers) than subjects with stroke. Therapists with <1 year or >15 years of neurological therapy experience instructed patients in fewer functional repetitions per minute than did therapists with 5 to 15 years of experience.