scholarly journals Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation

2016 ◽  
Vol 96 (12) ◽  
pp. 1930-1937 ◽  
Author(s):  
Louise A. Connell ◽  
Naoimh E. McMahon ◽  
Sarah F. Tyson ◽  
Caroline L. Watkins ◽  
Janice J. Eng
Keyword(s):  
Knowledge Translation ◽  
Upper Limb ◽  
Stroke Rehabilitation ◽  
Case Series ◽  
Practice Change ◽  
Research Approach ◽  
Arm Exercise ◽  
Upper Limb Rehabilitation ◽  
Action Research Approach ◽  
Limb Exercise

Abstract Background and Purpose Current approaches to upper limb rehabilitation are not sufficient to drive neural reorganization and maximize recovery after stroke. To address this evidence-practice gap, a knowledge translation intervention using the Behaviour Change Wheel was developed. The intervention involves collaboratively working with stroke therapy teams to change their practice and increase therapy intensity by therapists prescribing supplementary self-directed arm exercise. The purposes of this case series are: (1) to provide an illustrative example of how a research-informed process changed clinical practice and (2) to report on staff members' and patients' perceptions of the utility of the developed intervention. Case Descriptions A participatory action research approach was used in 3 stroke rehabilitation units in the United Kingdom. The intervention aimed to change 4 therapist-level behaviors: (1) screening patients for suitability for supplementary self-directed arm exercise, (2) provision of exercises, (3) involving family and caregivers in assisting with exercises, and (4) monitoring and progressing exercises. Data on changes in practice were collected by therapy teams using a bespoke audit tool. Utility of the intervention was explored in qualitative interviews with patients and staff. Outcomes Components of the intervention were successfully embedded in 2 of the 3 stroke units. At these sites, almost all admitted patients were screened for suitability for supplementary self-directed exercise. Exercises were provided to 77%, 70%, and 88% of suitable patients across the 3 sites. Involving family and caregivers and monitoring and progressing exercises were not performed consistently. Conclusions This case series is an example of how a rigorous research-informed knowledge translation process resulted in practice change. Research is needed to demonstrate that these changes can translate into increased intensity of upper limb exercise and affect patient outcomes.

scholarly journals Evidence-based practice ‘on-the-go’: using ViaTherapy as a tool to enhance clinical decision making in upper limb rehabilitation after stroke, a quality improvement initiative

2019 ◽  
Vol 8 (3) ◽  
pp. e000592 ◽  
Author(s):  
Nicola J Hancock ◽  
Kathryn Collins ◽  
Charlie Dorer ◽  
Steven L Wolf ◽  
Mark Bayley ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Upper Limb ◽  
Stroke Rehabilitation ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Improvement Project ◽  
Upper Limb Rehabilitation ◽  
Community Rehabilitation ◽  
Limb Rehabilitation

Recovery of upper limb function after stroke is currently sub-optimal, despite good quality evidence showing that interventions enabling repetitive practice of task-specific activity are effective in improving function. Therapists need to access and engage with such evidence to optimise outcomes with people with stroke, but this is challenging in fast-paced stroke rehabilitation services. This quality improvement project aimed to investigate acceptability and service impact of a new, international tool for accessing evidence on upper limb rehabilitation after stroke—‘ViaTherapy’—in a team of community rehabilitation therapists. Semi-structured interviews were undertaken at baseline to determine confidence in, and barriers to, evidence-based practice (EBP) to support clinical decision making. Reported barriers included time, lack of access to evidence and a research-practice disconnect. The clinicians then integrated use of ‘ViaTherapy’ into their practice for 4 weeks. Follow-up interviews explored the accessibility of the tool in community rehabilitation practice, and its impact on clinician confidence, treatment planning and provision. Clinicians found the tool, used predominantly in mobile device app format, to be concise and simple to use, providing evidence ‘on-the-go’. Confidence in accessing and using EBP grew by 22% from baseline. Clinicans reported changes in intensity of delivery of interventions, as rapid access to recommended doses via the tool was available. Following this work, the participating health and social care service provider changed provision of therapists’ technology to enable use of apps. Barriers to use of EBP in stroke rehabilitation persist; the baseline situation here supported the need for more accessible means of integrating best evidence into clinical processes. This quality improvement project successfully integrated ViaTherapy into clinical practice, and found that the tool has potential to underpin positive changes in upper limb therapy service delivery after stroke, by increasing accessibility to, use of and confidence in EBP. Definitive evaluation is now indicated.

scholarly journals Stroke Rehabilitation

2021 ◽  
Author(s):  
◽  
Patrick Kauraka
Keyword(s):  
Upper Limb ◽  
Stroke Rehabilitation ◽  
Action Observation ◽  
Modern Technology ◽  
Patient Treatment ◽  
Upper Limb Rehabilitation ◽  
Advantages And Disadvantages ◽  
Visual Style ◽  
Game Designer ◽  
Limb Rehabilitation

<p>Upper limb rehabilitation after a stroke is vital when bringing a range of motion and strength back to a patient. Treatment for upper limb rehabilitation has come in many diverse methods over the years including the use of modern technology through the use of mirror visual feedback (MVF) and action observation therapy; this thesis digital applications for stroke rehabilitation and how varying visual styles can impact the patients experience in the upper limb rehabilitation process.  Within the gaming medium the visual style in a game is an aspect of immersion and appeal that is often neglected by the user. The visual style of a game often reflects the tone a game designer has intended to convey while also catering to the target audiences expectations, with realism potentially appealing to a more mature audience while brighter abstract visuals may appeal to a younger demographic. By utilising two different styles of imagery, both realistic and cartoon based visuals, the level of immersion was observed and the user’s reaction to each form of visuals was analysed. The aim of this thesis is to investigate both realistic and stylized visual styles of computer generated imagery, distinguish the advantages and disadvantages for both realism in comparison to cartoon and finally analyse its effectiveness to assist the rehabilitation of upper limb deficiencies. The application being used for this study was made in collaboration with Victoria University Masters student Nicholas Wellwood, providing me the opportunity to focus solely on producing diverse and engaging visual styles to work in unison with a fully developed framework.</p>

Serious Games Design Principles Using Virtual Reality to Gamify Upper Limb Stroke Rehabilitation

2022 ◽  
pp. 235-261
Author(s):  
Robert Herne ◽  
Mohd Fairuz Shiratuddin ◽  
Shri Rai ◽  
David Blacker
Keyword(s):  
Virtual Reality ◽  
Upper Limb ◽  
Game Design ◽  
Serious Games ◽  
Stroke Rehabilitation ◽  
Design Principles ◽  
Stroke Survivors ◽  
Upper Limb Rehabilitation ◽  
Post Stroke ◽  
Limb Rehabilitation

Stroke is a debilitating condition that impairs one's ability to live independently while also greatly decreasing one's quality of life. For these reasons, stroke rehabilitation is important. Engagement is a crucial part of rehabilitation, increasing a stroke survivor's recovery rate and the positive outcomes of their rehabilitation. For this reason, virtual reality (VR) has been widely used to gamify stroke rehabilitation to support engagement. Given that VR and the serious games that form its basis may not necessarily be engaging in themselves, ensuring that their design is engaging is important. This chapter discusses 39 principles that may be useful for engaging stroke survivors with VR-based rehabilitation post-stroke. This chapter then discusses a subset of the game design principles that are likely to engage stroke survivors with VR designed for upper limb rehabilitation post-stroke.

scholarly journals Factors influencing allied health professionals’ implementation of upper limb sensory rehabilitation for stroke survivors: a qualitative study to inform knowledge translation

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042879
Author(s):  
Liana S Cahill ◽  
Leeanne M Carey ◽  
Yvonne Mak-Yuen ◽  
Annie McCluskey ◽  
Cheryl Neilson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Qualitative Study ◽  
Knowledge Translation ◽  
Upper Limb ◽  
Occupational Therapists ◽  
Practice Change ◽  
Normalisation Process Theory ◽  
Evidence Based ◽  
Implementation Theory ◽  
Factors Influencing

ObjectivesSomatosensory loss is common after stroke with one-in-two individuals affected. Although clinical practice guidelines recommend providing somatosensory rehabilitation, this impairment often remains unassessed and untreated. To address the gap between guideline recommendations and clinical practice, this study sought to understand the factors influencing delivery of evidence-based upper limb sensory rehabilitation after stroke.DesignQualitative study involving focus groups and interviews. Data analysis used an inductive approach (thematic analysis) and deductive analysis using implementation theory (the Theoretical Domains Framework and Normalisation Process Theory).SettingEight healthcare organisations in metropolitan and regional areas of Victoria and New South Wales, Australia.ParticipantsEighty-seven rehabilitation therapists (79% occupational therapists and 21% physiotherapists) were purposively sampled and participated in a knowledge translation study with staggered recruitment from 2014 to 2018.ResultsThree types of factors influenced therapists’ delivery of upper limb somatosensory rehabilitation: individual (‘The uncertain, unskilled therapist’), patient (‘Patient understanding and priorities’) and organisational (‘System pressures and resources’). Deductive analysis using implementation theory identified key determinants of practice change, such as opportunities to consolidate new skills, the anticipated benefits of upskilling as a therapy team and the work anticipated by therapists to incorporate a new somatosensory rehabilitation approach.ConclusionsOccupational therapists and physiotherapists hold valuable insights towards practice change in somatosensory rehabilitation from the ‘frontline’. Therapists experience barriers to change including a lack of knowledge and skills, lack of resources and organisational pressures. Facilitators for change were identified, including social support and therapists’ perceived legitimacy in using new somatosensory rehabilitation approaches. Results will inform the design of a tailored implementation strategy to increase the use of evidence-based somatosensory rehabilitation in Australia.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12615000933550).

scholarly journals Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

2014 ◽  
Vol 95 (12) ◽  
pp. 2410-2419 ◽  
Author(s):  
Louise A. Connell ◽  
Naoimh E. McMahon ◽  
Lisa A. Simpson ◽  
Caroline L. Watkins ◽  
Janice J. Eng
Keyword(s):  
Upper Limb ◽  
Exploratory Study ◽  
Stroke Rehabilitation ◽  
Exercise Program ◽  
Limb Exercise
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