2011 Annual Conference

Hale, Jennifer

Clinicians and researchers alike recognize the gap in translating scientific evidence to physical therapy (PT) practice, as well as the potential impact of this evidence on clinical outcomes. In recovery following brain injury (BI), current evidence indicates a need for high intensity, task-specific, repetitive practice to maximize motor recovery. These principles are well supported in the literature, but often not applied within the clinical setting. Circuit training (CT) is a novel intervention which utilizes a series of workstations to encourage greater intensity and repetition of motor tasks. CT is a cost effective intervention for promoting motor recovery in acute rehabilitation and outpatient settings. The goals of this research were to: 1.) demonstrate how a body of research can be synthesized and effectively translated to clinical practice 2.) assess the effectiveness of CT in promoting motor recovery in persons with acquired BI participating in an outpatient community re-entry program.

10 individuals with acquired brain injury

Individuals with acquired BI participated in 60 minutes of CT group therapy twice weekly, in addition to standard therapy (those who participated less than twice weekly were excluded). An average of 4 group participants rotated through a series of workstations, including gait, transfers, balance, obstacle negotiation, and lower extremity strengthening (specific to walking function). A PT was present to continually challenge and progress the participants as appropriate. Walking performance and balance were assessed pre and post intervention with the 6 minute walk test (6MWT), 10 meter walk test (10MWT), and Functional Gait Assessment (FGA). The average time duration of CT varied based on individual performance, with a range of 4-10 weeks (mean=6.6 weeks).

The well founded principles from neuroscience research of high intensity, task-specific, repetitive practice were successfully integrated into an outpatient clinical practice. Following group CT, all participants demonstrated improvements in walking performance. The mean change on the 6MWT and 10 MWT from pre to post intervention was 484 feet and 0.5 m/s, respectively. Functional balance was assessed in five participants and all demonstrated improvements, with a mean change of 6.4 points from pre to post intervention.

The implementation of a CT group within an outpatient community re-entry program is feasible and appears to contribute to improved walking performance and balance, with the mean change in walking performance and balance exceeding the minimal detectable change (MDC) across all measures. Further research with a larger sample and control group is essential.

CT is an evidence-based, cost effective intervention that was relatively easy to implement and warrants consideration across a variety of practice settings for persons recovering from BI.