Standardizing the intensity of upper limb treatment in rehabilitation medicine.
OBJECTIVE
To describe a treatment protocol for the upper limb that standardizes intensity of therapy input regardless of the severity of presentation.


METHODS
The protocol is described (Part 1) and feasibility and effect explored (Part 2).


METHODS
Participants (n = 11) had a single ischaemic stroke in the middle cerebral artery territory more than one year previously, and had residual weakness of the hand with some extension present at the wrist and the ability to grasp.


METHODS
Following two baseline assessments, participants attended therapy for 1 hour a day for 10 consecutive working days. Treatment consisted of a combination of strength and functional task training. Outcomes were measured immediately after training, at one month and three months.


METHODS
Intensity was measured with Borg Rating of Perceived Exertion. Secondary outcome measures included Action Research Arm Test (ARAT), nine-hole peg test, and Goal Attainment Scale.


RESULTS
Borg scores indicated that the level of intensity was appropriate and similar across all participants despite individual differences in the severity of their initial presentation (median (interquartile range) = 14 (13-15)). The mean ARAT score significantly increased by 6.8 points (chi(2)(3) = 15.618, P<0.001), and was maintained at three-month follow-up (z = - 2.384, P = 0.016). The nine-hole peg test also showed a main effect of time and 88% of goals set were achieved.


CONCLUSIONS
The physiotherapy protocol standardized intensity of treatment by grading exercise and task-related practice according to the person's residual ability, rather than simply standardizing treatment times. It was feasible and well tolerated in this group.
Wallace
A C
AC
UCL Institute of Neurology, Sobell Department, London, UK. a.wallace@ion.ucl.ac.uk
Talelli
P
P
Dileone
M
M
Oliver
R
R
Ward
N
N
Cloud
G
G
Greenwood
R
R
Di Lazzaro
V
V
Rothwell
J C
JC
Marsden
J F
JF
D000203:Activities of Daily Living; D000818:Animals; D006040:Goals; D018737:Hand Strength; D006801:Humans; D009043:Motor Activity / Q000502:physiology; D018908:Muscle Weakness / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000592:standards*; D010865:Pilot Projects; D011788:Quality of Life; D051381:Rats; D020127:Recovery of Function; D012046:Rehabilitation / Q000379:methods / Q000592:standards*; D000071939:Stroke Rehabilitation; D013647:Task Performance and Analysis; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*