Practice is critical when recovering from brain injury or stroke. The need for consistent practice during brain rehabilitation is why clinicians must convey to their cognitive and speech therapy clients why home practice between therapy sessions will benefit their recovery.

We all know the old adage “practice makes perfect”— and nowhere is this more true than for people recovering from stroke or brain injury. For them, repetition of science-based therapy tasks is key to the process of brain rehabilitation. It is critical in relearning skills lost when stroke or brain injury affects part of the brain.

Consistent repetition that re-establishes communication between the injured parts of the brain and the body is critical to help survivors move toward independence and to help improve their quality of life.

Unfortunately, the thought of doing additional practice (or “homework”) between therapy sessions, feels daunting to many people. To provide an extra boost of motivation, we’ve created this guide to help you remind your clients why extra practice is so important and how it will benefit their recovery.

Share The Goals of Home Practice With Your Patients

You typically assign your patients cognitive and speech therapy exercises to continue to practice at home as part of brain rehabilitation. If you are using Constant Therapy in your sessions, you’ll assign and track homework within the app. The goals of home practice are to:

• Reinforce and strengthen skills targeted in therapy sessions.
• Develop greater automaticity (the ability to do tasks quickly, accurately and effortlessly).
• Maintain proficiency of mastered abilities.
• Provide valuable tools for continued practice after discharge.

Research Proves That Patients Benefit From Extra Work

Provided are 5 ways consistent home practice benefits your clients:

1. Promote Neuroplasticity
   Neuroplasticity is the brain’s ability to “repair itself” by forming new synapses, or connections between neurons, especially in response to a brain injury. The nervous system compensates for injury by reorganizing the neurons that remain intact. To form new connections, those neurons must be stimulated through specialized, and consistent tasks—tasks you are working on with your clients as part of their brain rehabilitation program. The more practice, the more new connections are made, and the more recovery happens.
2. Facilitate faster improvement
   Published, peer-reviewed scientific research using Constant Therapy shows that the more patients practice, the more improvement they make. These same patients, who practiced an average of 4 hours per week, made significantly more recovery progress than those who didn’t practice as much.
3. Encourage the Generalization of New Skills and Strategies
   Help patients transfer a learned skill or task from the clinical setting to a more natural setting (e.g, their home or work) or activity (e.g., reading, running errands).
4. Enable Caregivers to Stay Connected With Their Loved One’s Recovery
   For some individuals, it can be valuable for family members or caregivers to stay connected with what the individual is working on in therapy sessions. Constant Therapy makes it easy for individuals to share progress with caregivers through progress reports.
5. Promote Learning and Application of Strategies Using Feedback From Mobile Apps Like Constant Therapy.
   One great benefit of technology is getting immediate feedback on responses. Patients know immediately if a response is correct or incorrect, which can build self-monitoring skills and application of cognitive, speech, or language strategies. The program does not automatically advance until the patient is ready, so they can learn from and correct errors. There are robust progress reports that keep the patient and family members motivated. Staying connected with the clinician can also add an extra layer of support to promote better home compliance.

In some situations practicing at home increases the overall therapy hours a patient gets, based on how many in-clinic sessions their individual insurance plan covers.

According to an ASHA National Outcomes Measurement System (NOMS) 2017 report, 85.6% of outpatients with stroke receive two or fewer sessions per week. Since data proves that intensity, frequency and consistency in therapy lead to better outcomes, doing homework between sessions each week may be the only way for some patients to reach the minimum therapy hours needed to improve the probability of strong recovery.

These Patients Practice On Average 4 Hours Per Week More

We’re often asked how often and for how many hours should home practice occur. A study published in Frontiers in Human Neuroscience found that Constant Therapy users practiced an average of 4 hours per week. Some users practice more hours per week (e.g., one individual uses Constant Therapy an average of 15 hours) and some practice less. Users often break their home practice into multiple sessions so that they are practicing a little each day.

As a clinician, you will prescribe the amount of home practice in between therapy visits that is right for you and your patients. There is currently no “right” answer. There are many factors that influence how much homework is appropriate—things like symptoms such as headaches, fatigue, sensitivity to light or sound, the patient’s schedule, what level of assistance is needed at home—can all influence the amount of recommended home practice.

Practice doesn’t always require sitting formally at a desk or table with a tablet. Practice can take place while relaxing in a favorite chair, sitting in the car, or waiting for an appointment in a waiting room. One benefit of Constant Therapy is that it is accessible anytime and anywhere, so individuals can use Constant Therapy when it works best for their schedule.

More Practice Leads To Better Outcomes

Current research has shown that more intense therapy for patients results in greater outcomes (Bhogal et al, 2003, Godecke et al 2013, Persad et.al, 2013). According to the ASHA National Outcomes Measurement System 2011 national report, more treatment time correlates to better outcomes. It was found that bringing a patient to a Level 7 in spoken language expression “requires 2.5 times the amount of treatment needed to progress to a level 5” (ASHA, 2017).

Research conducted at Constant Therapy also looked at the relationship between the rate of improvement in Constant Therapy exercises and how many days per week these individuals with stroke used Constant Therapy at home in the course of brain rehabilitation. Findings showed that those who used Constant Therapy 2-3 times per week showed higher rates of improvement than those who used the application 1 or fewer times per week, and those who used Constant Therapy 5 times per week performed significantly better than those who engaged 2-3 times per week.

Strategies to Motivate Your Clients

When patients and caregivers have a clear appreciation of the importance of a home program, as well as a positive attitude toward it, it can result in better home compliance and consistent practice in brain rehabilitation.

There are strategies you can use to motivate reluctant clients or push clients further. These include things like setting practice goals, encouraging clients to use a planner, making a “practice contract” with clients, and helping them set up a reward system.

To get them started, point clients to our blog post on how to make practice a daily habit, or this one on setting SMART goals, or this one on our favorite quotes to help get inspired and stay motivated.

Looking for other ideas to keep patients motivated? This blog has 10 tips to empower patients to stay motivated with home practice.

References:

• American Speech-Language-Hearing Association. (2017) National Outcomes Measurement System: Adults in Healthcare-Outpatient National Data Report 2011. Rockville, MD: National Center for Evidence-Based Practice in Communication Disorders.
• American Speech-Language-Hearing Association. (2017) National Outcomes Measurement System: Adults in Healthcare-SLP Treatment Outcomes in Outpatient Settings Fact Sheet 2011. Rockville, MD: National Center for Evidence-Based Practice in Communication Disorders.
• Bhogal SK, Teasell R, Speechley M (2003). Intensity of aphasia therapy, impact on recovery. Stroke, 34(4):987–993.
• Godecke, E., Rai, T., Ciccone, N., Armstrong, E., Granger, A., & Hankey, G. J. (2013). Amount of therapy matters in very early aphasia rehabilitation after stroke: a clinical prognostic model. Semin Speech Lang, 34(3), 129-141. doi:10.1055/s-0033-1358369.
• Persad, C., Wozniak, L., & Kostopoulos, E. (2013). Retrospective analysis of outcomes from two intensive comprehensive aphasia programs. Topics in Stroke Rehabilitation, 20(5), 388-397.