scholarly journals Limited Use Only. How Can the Design of an Everyday Object Evoke an Initiation of Use in Chronic Stroke Survivors

2021 ◽  
Author(s):  
◽  
Mailin Lemke
Keyword(s):  
Behaviour Change ◽  
Physical Restraint ◽  
Stroke Survivor ◽  
Chronic Stroke ◽  
Daily Activities ◽  
Stroke Survivors ◽  
Design Strategies ◽  
Everyday Objects ◽  
Everyday Object

<p>Stroke causes significant damage to the brain and affects 15 million people annually worldwide. Symptoms commonly affect one or both limbs on one side of the body, limiting ability to perform daily activities. The preferential use of the less affected limb for performing everyday activities in the form of compensatory movement is a common phenomenon after a stroke and can lead to a “learned nonuse” of the affected arm and hand. This learned behaviour can be overcome by applying a physical restraint on the less affected arm to initiate use of the affected one. Stroke interventions that use physical restraint are criticised for being labour intensive and expensive and having a limited focus on the home environment of the stroke survivor. This study aimed to design everyday objects that restrain movement to initiate the use of the affected arm and hand. It was undertaken from a pragmatist theoretical perspective, using a human-centred design approach to develop an understanding of the users’ needs and create design solutions that addressed the observed problem. A qualitative multimethod approach helped understanding of how the restraining effect needs to be delivered to initiate use of the affected arm, and which everyday objects are key in daily activities post-stroke. The research through design methodology was employed for developing expansive and serial design prototypes to test how the restraint could be incorporated into a design prototype. The prototypes were evaluated with health professionals and chronic stroke survivors to validate the intended initiation of use. Findings of this study indicate that the development of learned nonuse is multifactorial and occurs over time. The current use of restraint in clinical practice focuses on reminding the survivor to use the affected arm and hand rather than physically restraining its use. It was emphasised by the therapists that a behaviour change is a crucial element in overcoming learned nonuse in the long-term. The evaluation of the design prototypes indicated that the design of the object needs to take into consideration the conceptual model the user has of the object and the interaction needs to be feasible to perform for the stroke survivor. Five different design strategies were developed to restrain movement and elicit an initiation of use. The restraining effect that is evoked by the design strategies can vary between the different users. Additionally, the object needs to provide sufficient feedforward to initiate the use of the affected arm and hand, increase self-efficacy beliefs, provide a repetitive and increasingly challenging movement, provide feedback and sensory input to secure engagement in the process. A behaviour change is an essential element to overcome the learned nonuse in the long-term. A behaviour contract was, therefore, incorporated in the form of the design components to facilitate such a change. At this stage it is unclear which strategy offers the greatest potential to evoke an initiation of use and if the behaviour contract contributes to overcoming the learned nonuse. Further studies are needed to increase the restraining effect and usability of the design prototypes and validate the long-term impact.</p>

scholarly journals Limited Use Only. How Can the Design of an Everyday Object Evoke an Initiation of Use in Chronic Stroke Survivors

2021 ◽  
Author(s):  
◽  
Mailin Lemke
Keyword(s):  
Behaviour Change ◽  
Physical Restraint ◽  
Stroke Survivor ◽  
Chronic Stroke ◽  
Daily Activities ◽  
Stroke Survivors ◽  
Design Strategies ◽  
Everyday Objects ◽  
Everyday Object

<p>Stroke causes significant damage to the brain and affects 15 million people annually worldwide. Symptoms commonly affect one or both limbs on one side of the body, limiting ability to perform daily activities. The preferential use of the less affected limb for performing everyday activities in the form of compensatory movement is a common phenomenon after a stroke and can lead to a “learned nonuse” of the affected arm and hand. This learned behaviour can be overcome by applying a physical restraint on the less affected arm to initiate use of the affected one. Stroke interventions that use physical restraint are criticised for being labour intensive and expensive and having a limited focus on the home environment of the stroke survivor. This study aimed to design everyday objects that restrain movement to initiate the use of the affected arm and hand. It was undertaken from a pragmatist theoretical perspective, using a human-centred design approach to develop an understanding of the users’ needs and create design solutions that addressed the observed problem. A qualitative multimethod approach helped understanding of how the restraining effect needs to be delivered to initiate use of the affected arm, and which everyday objects are key in daily activities post-stroke. The research through design methodology was employed for developing expansive and serial design prototypes to test how the restraint could be incorporated into a design prototype. The prototypes were evaluated with health professionals and chronic stroke survivors to validate the intended initiation of use. Findings of this study indicate that the development of learned nonuse is multifactorial and occurs over time. The current use of restraint in clinical practice focuses on reminding the survivor to use the affected arm and hand rather than physically restraining its use. It was emphasised by the therapists that a behaviour change is a crucial element in overcoming learned nonuse in the long-term. The evaluation of the design prototypes indicated that the design of the object needs to take into consideration the conceptual model the user has of the object and the interaction needs to be feasible to perform for the stroke survivor. Five different design strategies were developed to restrain movement and elicit an initiation of use. The restraining effect that is evoked by the design strategies can vary between the different users. Additionally, the object needs to provide sufficient feedforward to initiate the use of the affected arm and hand, increase self-efficacy beliefs, provide a repetitive and increasingly challenging movement, provide feedback and sensory input to secure engagement in the process. A behaviour change is an essential element to overcome the learned nonuse in the long-term. A behaviour contract was, therefore, incorporated in the form of the design components to facilitate such a change. At this stage it is unclear which strategy offers the greatest potential to evoke an initiation of use and if the behaviour contract contributes to overcoming the learned nonuse. Further studies are needed to increase the restraining effect and usability of the design prototypes and validate the long-term impact.</p>

Relationship between Age and Activities of Daily Living using Modified Shah Barthel Index on Stroke Patient in Chronic Phase

2020 ◽  
Vol 70 (6) ◽  
pp. 115-120
Author(s):  
Malika Sabrina Yunifananda ◽  
Widjajalaksmi Kusumaningsih
Keyword(s):  
Barthel Index ◽  
Chronic Phase ◽  
Chronic Stroke ◽  
Daily Activities ◽  
Bivariate Analysis ◽  
Age Group ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Cross Sectional Design

Background: Stroke is the chief cause of long-term disability in the world. Predominantly, the disease is known as a degenerative disease on geriatrics age group, yet several studies have proven that incidence on productive ages are also increasing.  Objective: The study aimed to know whether there are any difference in Modified Shah Barthel Index (MSBI) score in different age group, geriatric and productive age group and to know independence score in daily activities based on age. Method: The study utilized the cross-sectional design and analytical observational method. Twenty five samples of chronic stroke patients was recruited and grouped into two groups productive and geriatric age group. MSBI score was calculated and compared between two groups.   Result: Bivariate analysis proves that there is a significant association between MSBI score and age of stroke patients on chronic phase (p=0.017). Discussion.  There is a significant association between age and MSBI score on stroke patients in chronic phase. Conclusion: There was a significance difference between productive and geriatric age with daily activities using MSBI in chronic stroke patients. The productive age group has a higher Modified Shah Barthel Index score than the geriatric age group.

scholarly journals Stroke Survivor and Caregiver Perspectives on Post-Stroke Visual Concerns and Long-Term Consequences

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Theresa M. Smith ◽  
Monique R. Pappadis ◽  
Shilpa Krishnan ◽  
Timothy A. Reistetter
Keyword(s):  
Quality Of Life ◽  
Community Support ◽  
Stroke Survivor ◽  
The United States ◽  
Stroke Survivors ◽  
Care Providers ◽  
Post Stroke ◽  
Vision Care

Approximately 800,000 people in the United States have a stroke annually. Up to two thirds of stroke survivors have some visual problems, which result in disability and can affect survivors’ overall rehabilitation outcomes. Although some post-stroke visual impairments can be corrected and respond well to intervention, ocular signs can be subtle and may not be recognized or reported by the stroke survivor but rather by a vigilant caregiver. The purpose of this study was to explore the post-stroke visual concerns and consequences expressed by stroke survivors and caregivers. This study employed a qualitative design using semistructured interviews conducted with a convenience sample of stroke survivors and caregivers recruited from either a community support group or skilled nursing and long-term care facilities. Interviews were recorded and transcribed verbatim. Comparative content analysis was used to identify vision-related themes by two independent coders. All research team members completed quality checking of coding. Twenty participants (11 stroke survivors and 9 caregivers) expressed visual concerns or consequences following stroke: (1) eye movement problems, (2) perceptual issues, and (3) consequences of vision problems or issues, which affected their daily life/quality of life. Stroke survivors and caregivers reported receiving vision care from (1) eye doctors, (2) occupational therapists, and (3) other healthcare professionals. All vision care providers need to be observant of potential post-stroke visual concerns. Stroke survivors should have a thorough vision evaluation to optimize their independence in everyday activities and quality of life.

scholarly journals Self-Reported and Objective Sleep Measures in Stroke Survivors With Incomplete Motor Recovery at the Chronic Stage

2021 ◽  
pp. 154596832110298
Author(s):  
Melanie K. Fleming ◽  
Tom Smejka ◽  
David Henderson Slater ◽  
Evangeline Grace Chiu ◽  
Nele Demeyere ◽  
...  
Keyword(s):  
Sleep Onset ◽  
Motor Impairment ◽  
Depression Scale ◽  
Chronic Stroke ◽  
Sleep Diary ◽  
Poor Sleep ◽  
Stroke Survivors ◽  
Healthy Controls ◽  
Cross Sectional

Background. Stroke survivors commonly complain of difficulty sleeping. Poor sleep is associated with reduced quality of life and more understanding of long-term consequences of stroke on sleep is needed. Objective. The primary aims were to (1) compare sleep measures between chronic stroke survivors and healthy controls and (2) test for a relationship between motor impairment, time since stroke and sleep. Secondary aims were to explore mood and inactivity as potential correlates of sleep and test the correlation between self-reported and objective sleep measures. Methods. Cross-sectional sleep measures were obtained for 69 chronic stroke survivors (mean 65 months post-stroke, 63 years old, 24 female) and 63 healthy controls (mean 61 years old, 27 female). Self-reported sleep was assessed with the sleep condition indicator (SCI) and sleep diary ratings, objective sleep with 7-nights actigraphy and mood with the Hospital Anxiety and Depression Scale. Upper extremity motor impairment was assessed with the Fugl-Meyer assessment. Results. Stroke survivors had significantly poorer SCI score ( P < .001) and higher wake after sleep onset ( P = .005) than controls. Neither motor impairment, nor time since stroke, explained significant variance in sleep measures for the stroke group. For all participants together, greater depression was associated with poorer SCI score ( R2adj = .197, P < .001) and higher age with more fragmented sleep ( R2adj = .108, P < .001). There were weak correlations between nightly sleep ratings and actigraphy sleep measures ( r s = .15–.24). Conclusions. Sleep disturbance is present long-term after stroke. Depressive symptoms may present a modifiable factor which should be investigated alongside techniques to improve sleep in this population.

scholarly journals Long-Term Use of a Static Hand-Wrist Orthosis in Chronic Stroke Patients: A Pilot Study

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Aukje Andringa ◽  
Ingrid van de Port ◽  
Jan-Willem Meijer
Keyword(s):  
Pilot Study ◽  
Upper Limb ◽  
Chronic Stroke ◽  
Descriptive Statistics ◽  
Daily Activities ◽  
Stroke Patients ◽  
Telephone Interviews ◽  
Appropriate Treatment ◽  
One Year

Background. Long-term splinting, using static orthoses to prevent contractures, is widely accepted in stroke patients with paresis of the upper limb. A number of stroke patients complain about increased pain and spasticity, which leads to the nonuse of the orthosis and a risk of developing a clenched fist.Objectives. Evaluating long-term use of static hand-wrist orthoses and experienced comfort in chronic stroke patients.Methods. Eleven stroke patients who were advised to use a static orthosis for at least one year ago were included. Semistructured telephone interviews were conducted to explore the long-term use and experienced comfort with the orthosis. Data were analyzed using descriptive statistics.Results. After at least one year, seven patients still wore the orthosis for the prescribed hours per day. Two patients were unable to wear the orthosis 8 hours per day, due to poor comfort. Two patients stopped using the orthosis because of an increase in spasticity or pain.Conclusions. These pilot data suggest that a number of stroke patients cannot tolerate a static orthosis over a long-term period because of discomfort. Without appropriate treatment opportunities, these patients will remain at risk of developing a clenched fist and will experience problems with daily activities and hygiene maintenance.

scholarly journals Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers

2020 ◽  
Author(s):  
Jennifer Hall ◽  
Sarah Morton ◽  
Claire F Fitzsimons ◽  
Jessica Faye Hall ◽  
Rekesh Corepal ◽  
...  
Keyword(s):  
Sedentary Behaviour ◽  
Behaviour Change ◽  
Intervention Development ◽  
Stroke Survivor ◽  
Stroke Survivors ◽  
Structured Interviews ◽  
Stroke Service ◽  
Service Staff ◽  
Framework Approach ◽  
The Impact

Abstract Background: Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour.Methods: Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 hours) were analysed thematically and interview data (n=31 stroke survivors, n=12 caregivers) were analysed using the Framework approach.Findings: Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers’ influence on, and role in influencing stroke survivors’ sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers’ inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. Conclusions: Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke.

The Perceived Marital Intimacy of Spouses Directly Influences the Rehabilitation Motivation of Hospitalized Stroke Survivors

2020 ◽  
pp. 105477382092457
Author(s):  
Kil Je Moon ◽  
Misook L. Chung ◽  
Seon Young Hwang
Keyword(s):  
Depressive Symptoms ◽  
Stroke Survivor ◽  
R Package ◽  
Stroke Survivors ◽  
Reciprocal Effects ◽  
Cross Sectional ◽  
Marital Intimacy ◽  
Path Analyses ◽  
Rehabilitation Hospitals

Spousal support is likely to influence the rehabilitation motivation of stroke survivors who require long-term rehabilitation. This study was conducted to examine the reciprocal effects of the depressive symptoms and marital intimacy of stroke survivors and their spouses, and identify the factors that influence the rehabilitation motivation of stroke survivors. For this cross-sectional descriptive study, 72 stroke survivor-spouse couples were recruited from four rehabilitation hospitals in South Korea in 2017. The collected data were analyzed using path analyses with SPSS 20.0 and the R package. There were significant differences in the actor effects of stroke survivors’ and spouses’ depressive symptoms on the marital intimacy of the survivors and their spouses. The perceived marital intimacy of spouses was significantly associated with the rehabilitation motivation of stroke survivors. In order to enhance their rehabilitation motivation, it is necessary to periodically assess the depressive symptoms and perceived marital intimacy of their spouses.

Sleep disordered breathing in chronic stroke survivors. A study of the long term follow-up of the SCOPES cohort using home based polysomnography

2005 ◽  
Vol 12 (6) ◽  
pp. 632-637 ◽  
Author(s):  
Dominique A Cadilhac ◽  
Rachel D Thorpe ◽  
Dora C Pearce ◽  
Maree Barnes ◽  
Peter D Rochford ◽  
...  
Keyword(s):  
Sleep Disordered Breathing ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Home Based ◽  
Long Term Follow Up ◽  
Disordered Breathing

scholarly journals Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers

2019 ◽  
Author(s):  
Jennifer Hall ◽  
Sarah Morton ◽  
Claire F Fitzsimons ◽  
Jessica Faye Hall ◽  
Rekesh Corepal ◽  
...  
Keyword(s):  
Sedentary Behaviour ◽  
Behaviour Change ◽  
Intervention Development ◽  
Stroke Survivor ◽  
Stroke Survivors ◽  
Structured Interviews ◽  
Stroke Service ◽  
Service Staff ◽  
Framework Approach ◽  
The Impact

Abstract Background: Stroke survivors are highly sedentary. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour. Methods: Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 hours) were analysed thematically and interview data (n=31 stroke survivors, n=12 caregivers) were analysed using the Framework approach. Findings: Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers’ influence on, and role in influencing stroke survivors’ sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers’ inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. Conclusions: Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach [1] to develop strategies to reduce sedentary behaviour after stroke.

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