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4.1.3 TASk-SPECIFIC AND REPETITIVE TASk TRAINING
Task-specific training refers to interventions designed to improve specific tasks: these interventions may or
may not be intensive in nature. Repetitive task training is often used to describe an intervention that is both
task-specific and intensive and repetitive in nature.
A systematic review identified moderate evidence from one RCT (n=45) to support fine motor control
retraining, including functional tasks, resulting in improved fine motor coordination. 50 The review also
included a small RCT (n=22) which showed that sit-to-stand retraining improved the functional ability of
this task but had no effect on exercise capacity.
A small RCT found that repetitive task training using an electromechanical gait training device was beneficial
for improving walking ability for people with TBI or stroke. 53
A systematic review identified five studies of mixed quality that investigated the effects of intensity of
rehabilitation for people with TBI and found that there were medium term benefits in terms of improvement
of functional skills for people receiving more intensive rehabilitation. 55
B Repetitive task-oriented activities are recommended for improving functional ability, such as sitto-stand
or fine motor control.
4.1.4 PHySICAL FITNESS TRAINING
Regular fitness training is a relatively recent addition to the therapies available for people with TBI. While
physical fitness training can be regarded as safe and acceptable, historically some therapists may have
avoided this form of intervention for fear of inducing unwanted negative effects relating to muscle tone and
spasticity. Three systematic reviews provide evidence for physical fitness training in TBI patients.
One systematic review identified six RCTs investigating fitness training mostly in patients with TBI meeting
their quality criteria. These studies included 303 patients but were clinically diverse with regard to the
interventions, time post injury and the outcome measures used. Only one study showed an improvement
in fitness. No meaningful improvements in any other motor parameter were noted. 56
Another systematic review of 14 studies included four exclusively in patients with TBI. Benefits in cardiovascular
fitness following fitness or aerobic training for people with moderate-severe TBI were noted. However, these
benefits did not translate to improved activity or participation levels. A reduction in depression was also
noted. 55
A third systematic review identified eight studies investigating the effects of aerobic training on aerobic
capacity post TBI and reported that all studies identified at least one positive outcome. 51 An RCT included
in this review (n=157) compared a 12 week exercise programme against a 12 week relaxation programme
and demonstrated a significant increase in work rate by the exercise group. This increase in work rate did
not translate to improved functional ability.
Benefits of fitness training have not shown specific effects on impairments of motor function or spasticity
but it has been suggested that regular fitness training, of a sufficient intensity will improve some of the
56, 57
common physical and psychosocial sequalae of TBI.
4.1.5 VIRTUAL REALITy TRAINING
4 • Physical rehabilitation and management
Virtual reality training is an emerging area in rehabilitation enhanced by the development and popularity
of commercially available, interactive computer gaming devices. As such, there is limited evidence relating
to this therapy.
A systematic review conducted mostly in stroke patients found that there was insufficient robust evidence
to support virtual reality interventions in acquired brain injury rehabilitation. 58
One study (n=20) included a small number of people with TBI and found that both conventional balance
retraining and balance retraining incorporating the use of a WiiTM Balance Board showed improvements over
time with no significant differences between the groups.
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