This is one of three Sydney-based units within the Brain Injury Rehabilitation

Program of New South Wales and provides a multidisciplinary rehabilitation program for adults who have sustained predominantly traumatic brain injuries. Patients were invited to participate if they fulfilled the following eligibility criteria: aged between 15 and 65 years; sustained a very severe or extremely severe traumatic brain injury (ie, post-traumatic amnesia period > 1 week assessed using the Modified SP600125 purchase Oxford Post Traumatic Amnesia Scale (Pfaff and Tate 2004); emerged from posttraumatic amnesia; currently attending or eligible to attend the circuit class at least twice per week and it was anticipated that they would be attending the class for at least four weeks. Patients were excluded from participating

if their treating rehabilitation physician and the lead investigator clinically determined they had: a concurrent medical condition for which moderate to high intensity exercise was contraindicated; behaviour problems not suitable for a group environment; or insufficient English or language skills to understand DNA Synthesis inhibitor verbal instruction and feedback. Circuit class therapy was provided by physiotherapy staff of the brain injury rehabilitation unit, including physiotherapy undergraduate students, physiotherapy assistants, and qualified physiotherapists why ranging in experience from one year to > 15 years of clinical experience. The circuit class that we investigated has been running at the rehabilitation unit since 2000. Circuit class therapy is implemented for one hour, three times per week, and is attended by patients from inpatient, transitional living, and community-based programs. Patients rotate around a circuit of 10 exercise stations, spending four minutes at each station. After completing all stations they undertake abdominal exercises and a competitive six-minute walk as a group. The circuit class is set to music, with the song changing every four minutes

to signal when to move to the next exercise. There are no rest periods between exercises. The circuit class is supervised by two to four physiotherapy staff, depending on the number and individual needs of the patients attending. On average eight patients attend each class, but it has capacity for up to 14 patients. In order to make the class as inclusive as possible, each station has an option of four or five different exercises depending on each individual’s current level of functioning. For example Station 1 ranges from basic standing balance exercises of stepping up to touch a step and stepping in different directions from the standing position, up to more difficult tasks such as balancing while performing fast hip flexion or jogging on a mini-tramp.