NeuroRehabilitation - Volume 39, issue 4

Authors: Danzl, Megan | Etter, Nicole

Article Type: Editorial

DOI: 10.3233/NRE-161377

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 463-464, 2016

Authors: Miller, Kenneth L.

Article Type: Research Article

Abstract: BACKGROUND: Patient Activation and Health confidence are constructs to assess patient engagement and are utilized to encourage patient engagement. A health care provider may increase patient engagement further by utilizing behavior change theories and models such as the Trans-Theoretical Model of Change (TTM), Self-Determination Theory (SDT) and Motivational Interviewing (MI) to realize effective and lasting health behavior change by placing accountability increasingly on the patient/caregiver to choose to make changes in their health behavior on their terms. Reducing or eliminating harmful behaviors such as smoking and/or beginning or increasing beneficial health behaviors such as diet modification or performance of …an exercise program, patients realize improved outcomes and better health. PURPOSE: The purpose of this article is to define health confidence as a measurement tool for patient engagement, use the TTM as a measure of the patient’s readiness to change, use TTM, SDT and MI as interventional approaches to effect patient change of behavior encouraged by physical therapists and incorporate the ICF as a means of identifying barriers and facilitators and incorporate the bio-psychosocial model for patient-centered care to improve health behavior, health and patient outcomes. CONCLUSION: Patient-centered care requires involvement of the patient and/or their caregiver at the center of the plan. Use of the International Classification of Functioning, Disability and Health (ICF) to identify facilitators and barriers unique to the patient/caregiver offers another opportunity to successfully engage the patient by incorporating the patient’s bio-psychosocial support system into care delivery and for sustainability. The ICF is a taxonomy and classification system that prompts clinicians to identify environmental factors (facilitators and barriers) that will influence the patient’s ability to perform during therapy session and to sustain the interventions and employ suggestions outside of formal therapy sessions. Using the facilitators to encourage sustainable change and removing barriers, patients are more likely to realize positive health behavior change and in turn demonstrate improved outcomes and health as a result of physical therapy intervention. Show more

Keywords: Patient activation, patient engagement, outcomes, patient-centered, health confidence

DOI: 10.3233/NRE-161378

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 465-470, 2016

Authors: Jones, Fiona | Pöstges, Heide | Brimicombe, Lucinda

Article Type: Research Article

Abstract: BACKGROUND: Programmes providing self-management support for patients and families are gaining attention and have shown promising outcomes with regards to reducing long-term unmet needs post stroke. However, notions of what good self-management support looks like can differ depending on professional opinion, individual preferences, skills and experiences of patients and their families as well as on how care and rehabilitation is organised in a particular healthcare setting. This resonates with the perspective of patient-centred care, according to which the meaning of good care is not universal, but rather jointly shaped between healthcare professionals and patients in everyday interactions. While self-management …support is continuously co-produced in care and rehabilitation practices, most self-management programmes are typically provided as an ‘add-on’ to existing statutory care. OBJECTIVE: This paper aims to deepen the understanding of how self-management support can be made an integral part of everyday care and rehabilitation using Bridges methodology. METHODS: The authors provide a self-reflective account on ‘Bridges’ an integrated approach to self-management support, which is used by healthcare professionals within acute and community stroke rehabilitation across the UK, and in some parts of New Zealand and Australia. RESULTS: Bridges is based on self-efficacy principles, but has a central aim of professionals sharing decision-making and expertise with patients and families in every healthcare interaction. Methodologically, the co-production of a Bridges support package with local healthcare professionals and patients is critical. The authors present the values articulated by the support package and how it engages professionals, patients and Bridges training facilitators in a continuous process of adjusting and re-adjusting situated self-management support practices. CONCLUSIONS: Our reflections reveal the need to consider development and implementation of self-management support as one and the same on-going process, if we are to facilitate successful engagement and interest from healthcare professionals as well as their patients and families. Show more

Keywords: Self-management, co-production, stroke, long-term conditions

DOI: 10.3233/NRE-161379

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 471-480, 2016

Authors: Bland, Marghuretta D. | Birkenmeier, Rebecca L. | Barco, Peggy | Lenard, Emily | Lang, Catherine E. | Lenze, Eric J.

Article Type: Research Article

Abstract: BACKGROUND: Patient engagement in medical rehabilitation can be greatly influenced by their provider during therapy sessions. We developed Enhanced Medical Rehabilitation (EMR), a set of provider skills grounded in theories of behavior change. EMR utilizes 18 motivational techniques focused on providing frequent feedback to patients on their effort and progress and linking these to patient goals. OBJECTIVE: To examine the effectiveness of a clinical training protocol for clinicians to do EMR, as measured by clinician adherence. METHODS: A physical therapist, physical therapist assistant, occupational therapist, and certified occupational therapist assistant were trained in EMR. Training …consisted of five formal training sessions and individual and group coaching. Adherence to EMR techniques was measured during two phases: Pre-Training and Maintenance, with an a priori target of 90% adherence by clinicians to each EMR technique. RESULTS: With training and coaching, clinician adherence per therapeutic activity significantly improved in 13 out of 18 items (p  < 0.05). The target of 90% adherence was not achieved for many items. CONCLUSIONS: Our training and coaching program successfully trained clinicians to promote patient engagement during therapeutic service delivery, although not typically to 90% or greater adherence. Ongoing coaching efforts were necessary to increase adherence. Show more

Keywords: Therapeutic engagement, skilled nursing facility, rehabilitation

DOI: 10.3233/NRE-161380

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 481-498, 2016

Authors: Caron, Jessica

Article Type: Research Article

Abstract: BACKGROUND: Communicative interactions, despite the mode (e.g., face-to-face, online) rely on the communication skills of each individual participating. Some individuals have significant speech and language impairments and require the use of augmentative and alternative communication (AAC) (i.e., signs, speech generating devices) to maximize their communication participation across a variety of on and offline contexts. Use of social media has brought about changes to communication environments, contributing new contexts for engagement. OBJECTIVES: To provide a framework for considering application of engagement theory for interventions around social media use by individuals who use AAC. METHODS: The author …has applied examples from qualitative social media and AAC research to a framework of engagement. No formal data collection was used. RESULTS: Social media use has become a conventional form of communication. Yet recognition of the value of social media (and other electronic modalities) for individuals who use AAC has not been fully translated into practice. The examples used illustrated how the proposed framework can assist in clinical practice and future research directions. CONCLUSION: Engagement, including the proposed framework for considerations of social media engagement activities, can provide a systematic way to approach social media use for individuals who use AAC. Show more

Keywords: Social media, augmentative and alternative communication, engagement, assistive technology

DOI: 10.3233/NRE-161381

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 499-506, 2016

Authors: Signal, Nada | McPherson, Kathryn | Lewis, Gwyn | Kayes, Nicola | Saywell, Nicola | Mudge, Suzie | Taylor, Denise

Article Type: Research Article

Abstract: BACKGROUND: Intensity refers to the amount of effort or rate of work undertaken during exercise. People receiving rehabilitation after stroke frequently do not reach the moderate to high intensity exercise recommended to maximise gains. OBJECTIVE: To explore the factors that influence the acceptability of, and engagement with, a high intensity group-based exercise programme for people with stroke. METHODS: This qualitative descriptive study included 14 people with stroke who had completed a 12-week, high intensity group-based exercise rehabilitation programme. Semi-structured interviews were used to explore the acceptability of high intensity exercise and the barriers and facilitators …to engagement. Interviews were recorded, transcribed and analysed using qualitative content analysis. RESULTS: The participants found high intensity exercise rehabilitation acceptable despite describing the exercise intensity as hard and reporting post-exercise fatigue. Participants accepted the fatigue as a normal response to exercise, and it did not appear to negatively influence engagement. The ease with which an individual engaged in high intensity exercise rehabilitation appeared to be mediated by inter-related factors, including: seeing progress, sourcing motivation, working hard, the people involved and the fit with the person and their life. Participants directly related the intensity of their effort to the gains that they made. CONCLUSIONS: In this study, people with stroke viewed training at higher intensities as a facilitator, not a barrier, to engagement in exercise rehabilitation. The findings may challenge assumptions about the influence of exercise intensity on engagement. Show more

Keywords: Stroke, qualitative, intensity, rehabilitation, exercise, engagement

DOI: 10.3233/NRE-161382

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 507-517, 2016

Authors: Travlos, Vivienne | Bulsara, Caroline | Patman, Shane | Downs, Jenny

Article Type: Research Article

Abstract: BACKGROUND: Youth with Neuromuscular Disorders (NMD) who are wheelchair users can now survive well into adulthood if their multisystem comorbidities are prudently managed. Uptake of health behaviors may optimize their health outcomes. OBJECTIVE: To explore youths’ perceptions of health, health behaviors and healthcare engagement. METHODS: This qualitative study purposefully recruited 11 youth with NMD from a concurrent, population-based study for variability of age, gender, type of NMD and their ratings of motivation and engagement. Interview data were analyzed and synthesized by thematic content. RESULTS: Participants perceived healthcare engagement as being given tools (knowledge …and responsibility) and using them to maintain their finely balanced health. Nested in adequate social, emotional and physical support, they took responsibility for creatively integrating health behaviors they felt were informed by credible knowledge, gained primarily through personal experience. CONCLUSION: Cognizant of their compromised health, youth with NMD in this study were motivated to maintain their physical health. Limited NMD condition specific knowledge challenged youths’ uptake of health behaviors. They valued a learning partnership with their healthcare professionals. By embracing the youth’s experience based knowledge and through facilitating supportive relationships, healthcare professionals co-construct youth’s healthcare engagement that may optimize health behaviors and outcomes. Show more

Keywords: Adolescents/youth/young people, neuromuscular disorders, healthcare engagement, perceptions/experiences, health education

DOI: 10.3233/NRE-161383

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 519-534, 2016

Authors: Fritz, Nora E. | Roy, Snehashis | Keller, Jennifer | Prince, Jerry | Calabresi, Peter A. | Zackowski, Kathleen M.

Article Type: Research Article

Abstract: BACKGROUND: Multiple sclerosis (MS) is characterized by physical and mental impairments that often result in pain and reduced quality of life. OBJECTIVE: To understand the relationship of pain, quality of life, and cognition to structural measures of brain volume. METHODS: Behavioral measures were assessed in a single session using standardized questionnaires and rating scales. Brain volume measures were assessed with structural magnetic resonance imaging (MRI). RESULTS: Twenty-nine individuals with relapsing-remitting MS and 29 age-matched controls participated in this study. Pain, quality of life, and cognition were significantly interrelated. Higher fluid attenuation inversion recovery …weighted lesion volume was significantly associated with increased reports of pain (p  = 0.01), lower physical quality of life (p  < 0.0001), and lower cognitive performance (p  = 0.001) in our cohort. CONCLUSIONS: Assessment of pain and quality of life along with structural MRI highlights the importance of understanding structure-function relationships in MS and suggests that therapists should not only evaluate individuals for cognition and quality of life, but should consider rehabilitation goals that target these areas. Show more

Keywords: Multiple Sclerosis, quality of life, pain, cognition, MRI, brain volume, lesion volume

DOI: 10.3233/NRE-161384

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 535-544, 2016

Article Type: Correction

DOI: 10.3233/NRE-161385

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 545-545, 2016

Article Type: Other

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 547-551, 2016

Article Type: Other

Citation: NeuroRehabilitation, vol. 39, no. 4, pp. 553-555, 2016