Issn Print: 0885-9701

Publication Date: 2001/08/01


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Computer-Assisted Exercise Systems in Traumatic Brain Injury: Cases and Commentary

Susan McGhee Pierce; Nathaniel H. Mayer; John Whyte

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Excerpt

SAVING COST BY reducing therapist treatment time during service delivery is highly valued in an era of managed care. Because computer technology in the workplace has generally become more prevalent, it seemed to us that computer-assisted exercises might reduce therapist treatment time. We, therefore, implemented a movement retraining program for patients with neurologic disability using the Rehabilitation Workstation, a modified personal computer that provides computer-assisted exercises. 1
Earlier reports indicated that the Workstation was “user-friendly” for patients. 1–3 The Workstation could be customized to fit patient need, it delivered motor tasks that had functional relevance, it provided meaningful feedback to motivate performance, it had potential for home-based therapy, 4 and it was affordable because its components were low in cost. 5 Little was said about whether the Workstation was “user-friendly” for therapists who used it to train patients. Accordingly, this article will describe our experience with the Workstation from a therapist perspective to convey information about the practical demands made by “information age” systems on therapists who may be expected to use such systems simply as a matter of course.
SM, a physical therapist, kept detailed records on the use of the Rehabilitation Workstation in two patients with traumatic brain injury (TBI) who had an upper motoneuron syndrome (UMNS) with arm dysfunction. The Workstation was selected because it had favorably provided computer-assisted practice exercises for persons with neurologic disability. 1 The literature on normal motor learning argues for the benefits of intense and repetitive practice 6,7 with knowledge of results. 8 A review of literature on patients with UMNS suggests that many are capable of learning new motor tasks and that they may also benefit from intense practice. 9–14 These patient studies also indicate that blocked practice and context make a difference in strength and length of motor learning retention as they do in normal individuals. 15,16 Such studies in patients with UMNS support the importance of repetitive practice with knowledge of results under conditions of blocked practice. A training system such as the Rehabilitation Workstation, able to deliver many exercise trials in small blocks with feedback and with potential to save therapist time, might confer important service delivery advantages in the rehabilitation clinic.

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