Factors Affecting the Ability of the Stroke Survivor to Drive Their Own Recovery outside of Therapy during Inpatient Stroke Rehabilitation

Abstract

Aim. To explore factors affecting the ability of the stroke survivor to drive their own recovery outside of therapy during inpatient rehabilitation. Method. One-on-one, in-depth interviews with stroke survivors (n = 7) and their main carer (n = 6), along with two focus groups with clinical staff (n = 20). Data was thematically analysed according to group. Results. Stroke survivors perceived “dealing with loss,” whilst concurrently “building motivation and hope” for recovery affected their ability to drive their own recovery outside of therapy. In addition, they reported a “lack of opportunities” outside of therapy, with subsequent time described as “dead and wasted.” Main carers perceived stroke survivors felt “out of control … at everyone's mercy” and lacked knowledge of “what to do and why” outside of therapy. Clinical staff perceived the stroke survivor's ability to drive their own recovery was limited by the lack of “another place to go” and the “passive rehab culture and environment.” Discussion. To enable the stroke survivor to drive their own recovery outside of therapy, there is a need to increase opportunities for practice and promote active engagement. Suggested strategies include building the stroke survivor's motivation and knowledge, creating an enriched environment, and developing daily routines to provide structure outside of therapy time.

Participants’ experiences of music, mindful music, and audiobook listening interventions for people recovering from stroke

“…Lifting of mood is consistent with findings that music has been shown to activate brain reward centers, including the ventral striatum . Stroke survivors, carers, and clinical staff have highlighted that time outside of therapy may be underexploited or wasted . Stroke survivors engaging in physical rehabilitation have also reported feeling bored and highly value engagement in physical activity .…”

Hospital Differences in Motor Activity Early after Stroke: A Comparison of 11 Norwegian Stroke Units

“…Staff:patient ratio and mobilization policy might also influence activity levels. 11,12 There is evidence that environmental factors, like access to communal areas may help to increase activity levels in a rehabilitation setting. 13 Regardless of stroke unit model, it appears that patients spend most of their day alone.…”

Structure and feasibility of extra practice during stroke rehabilitation: A systematic scoping review

“…Carers of stroke survivors have highlighted the need for therapists to provide clear step‐by‐step instructions on how to complete practice outside of scheduled therapy (Eng et al ., ). In addition, carers have reported that insufficient time and too few training sessions are dedicated to carer training, such as how to use written and pictorial information and opportunities to demonstrate task performance to therapists (Bower, Gustafsson, Hoffman & Barker, ).…”

“…That finding is consistent with observational studies showing that stroke inpatients are more likely to practice when a therapist is present (Ada et al ., ; King et al ., ). Stroke survivors on rehabilitation units have described the time outside of therapy as ‘dead and wasted’ (Eng, Brauer, Kuys, Lord & Hayward, ), while carers suggest that this inactivity may be partly due to ‘not knowing what they could be doing themselves’ outside of structured therapy time (Eng et al .). Unsupervised practice activities identified in this review that can be taught to stroke inpatients include the GRASP protocol for upper limb practice (Harris et al ., ), and mental practice delivered using a tape recording (Page et al ., ).…”