Next up on Monday morning was Catherine Lang with Dosing and Timing for Plasticity and Participation: Adult Stroke.
Catherine brought our attention back to the basic FITT principle of prescribing exercise: Frequency, Intensity, Timing, Type. How you fill in those blanks depend on the goal you’re trying to achieve. If you need more info on the specifics with the FITT principle , click here. In therapy, dosage is the same as frequency. The research is saying that having more sessions in a day gets people better faster, but not necessarily better in the long run with regards to arm function. However, more may be better for mobility training. Intensity would be the repetitions. And of course we’ve always worked under the assumption that more is better…. but this isn’t necessarily true. More reps may get people a little better, but it may not be significantly better. However, at this point we’re not exactly sure where that repetition threshold is. We desperately need more research in this area. We’ve discussed timing as important in SCI due to the inflammation in the microenvironment after the injury. There is some similar inflammation going on after stroke too. But how that plays into the timing of intervention, there’s not much information. The big gains we often see early on may be just the natural resolution of the decreasing inflammation and not have a thing to do with the type of treatment provided. Michele didn’t mention it, but I do know that using constraint induced movement therapy (CIMT) in the acute recovery phase is detrimental to long term outcomes. And type we know is important in terms of saliency: if the treatment isn’t directly relatable to something functional or a goal the patient has in mind, it’s not going to work nearly so well.
The last take away Michele had was that the research is saying that improvements at the body functions and structure level do not necessarily translate into improvements in the activity or participation levels of the WHO ICF. Which is why I think it is important to train functionally as much as possible, so that you’ll have a direct translation into those areas.
In the open discussion after, someone mentioned an interesting point, we are truly conducting research all the time as each of our patients is a research subject in our own practices. During the eval you collect data. Then you assess what’s causing the data. The plan of care is your hypothesis. Then there’s the intervention which is the treatment. Then as we compile experience we also compile “research” to back up our clinical decisions. Cool, huh? Later on we’ll discuss how to make those individual research subjects into real, submittable research report. Stay tuned!