In the current climate of increasing expectations to maximize patient outcomes with reduced amount of rehabilitation services, physical therapists continue to explore the best ways to improve function in our patients. New research findings challenge our current beliefs and treatment strategies. Brief strolls through the vendor area of the conferences we attend reveal an overwhelming number of alternative or complementary treatment strategies or tools that might facilitate recovery of the patients we treat. With the vast amount of information, it is often difficult to sort through the noise to decipher what factors can truly benefit our patient population.

Could there be factors that influence patient outcomes that we don't always think about? Could there be strategies outside of our direct clinical practice that we perceive as somewhat basic that have complex interactions with the interventions we provide?

The study by Al-Sharam and Siengsukon1 in this issue addresses a potentially simple factor, that is: sleep, which rehabilitation specialists often overlook. Previously published, carefully controlled laboratory studies have indicated that sleep enhances learning of various experimental tasks, such as learning a sequence of finger movements in a serial reaction time task (see details in the article). Building on this previous work, Al-Sharam and Siengsukon1 investigated how sleep affects the ability to learn a complex locomotor task in healthy middle-aged and older adults. This is the kind of motor activity that we often practice with our patient populations, with the hope of facilitating learning and improving outcomes. In this study, people who slept in the time between task practice and testing performed better in the retention test than people who did not sleep. This was true for the middle-aged and the older patient groups, the same age of most people referred to neurological physical therapists. These results suggest that helping our patients get an adequate amount of sleep could improve their ability to learn in our therapy sessions and might eventually achieve better outcomes.

Further research is clearly needed on this topic, as the authors readily acknowledge. But now within our current clinical practice, we can certainly consider how patterns of sleep and wakefulness might bolster or degrade functional performance and motor skill retention. We can ask our patients whether they are sleeping and/or sleeping well. In the inpatient rehabilitation setting, we can assess how our facility (eg, nightly interruptions) may be enabling or disrupting sleep. In the outpatient setting, we can encourage patients and caregivers to consider modifications that promote a healthy sleep schedule.

Within the context of our interventions, there may be factors we can manipulate to assist with healthy sleeping. For example, previous data suggest that the amount, intensity, and/or specificity of task practice are important determinants of motor outcomes.2 Provision of lots of intense practice might bring about higher fatigue levels but might actually facilitate healthier sleeping habits. Alternatively, too great an intensity might result in increased pain that negatively affects sleep. How pain, anxiety, depression, and any medications used for these conditions might influence a person's sleep behaviors are important considerations as well.

While our fundamental goal as therapists is to structure interventions to maximize functional outcomes, we may have the capability to alter motor performance in a potentially effective manner through mechanisms that we may rarely think about. Consideration of sleep and other daily processes that we take for granted may have the potential to impact the outcomes of physical therapy interventions - they matter quite a bit.

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