Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 14983 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke.DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER, BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Deans' stroke musings
Changing stroke rehab and research worldwide now.Time is Brain!Just think of all thetrillions and trillions of neuronsthateach daybecause there areeffective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group. My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html
Tuesday, August 9, 2016
What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis
I bet the biggest barrier is your doctors and therapists not even suggesting getting to 100% recovery. Probably subtle and not so subtle ways of limiting this so this failure to recover doesn't look so bad. Walking is the goal instead of running, skipping or hopping. 100 feet instead of two miles. Walking in the pool instead of swimming. I had a goal of reading a newspaper, my replacement OT changed that to reading a newspaper flat on the table with dycem. She could mark that as complete in one session but did absolutely fucking nothing about solving reading a newspaper with two hands held in front of you. That would have been incredibly difficult, stopping the spasticity of my arm muscles pulling downward, stopping the spasticity of my fingers and getting my fingers to extend to be able to release and grab a new page. She did that because of the nonexistent stroke protocols to address these many upper limb problems I had and still have. Goal setting is incredibly simple: 100% recovery for all stroke survivors, you don't have to ask a single damned question. http://cre.sagepub.com/content/30/9/921.full
Objective: To identify the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries.
Data sources: AMED, Proquest, CINAHL and MEDLINE.
Review methods: Two
reviewers independently screened, extracted data and assessed study
quality using the Mixed Methods Appraisal Tool and
undertook thematic content analysis for papers
examining the barriers and facilitators to goal-setting during
rehabilitation (any design). Last searches were
completed in May 2016.
qualitative papers were selected, involving 202 participants in total:
88 patients, 89 health care professionals and
25 relatives of participating patients. Main
barriers were: Differences in staff and patients perspectives of
patient-related barriers; staff-related
barriers, and organisational level barriers. Main facilitators were:
tailored goal-setting processes, strategies to
promote communication and understanding, and strategies to avoid
and unrealistic goals. In addition, patients’
and staff’s knowledge, experience, skill, and engagement with
be either a barrier (if these aspects were
absent) or a facilitator (if they were present).
Conclusion: The main
barriers and facilitators to goal-setting during stroke rehabilitation
have been identified. They suggest that current
methods of goal-setting during inpatient/early
stage stroke or neurological rehabilitation are not fit for purpose.
Goal setting is a key part of stroke rehabilitation and is recommended in National Clinical Guidelines.1⇓⇓⇓–5
It is said to enhance patient confidence and motivation, engagement in,
and satisfaction with rehabilitation, whilst improving
task performance, team communication and team work
and, possibly improving recovery, goal achievement and self-care.6,7 This evidence has been summarised in two systematic reviews.6,7 Rosewilliam et al.6 reviewed the effects of patient-centred goal-setting during stroke rehabilitation up to 2010, while Sugavanam et al.7
assessed the effects and experience of using goal-setting in stroke
rehabilitation up to 2011. Both found that low methodological
quality and heterogeneity of the selected studies
meant that no firm conclusions regarding the effects of goal-setting
be drawn. Furthermore, both noted that adoption of
patient-centred goal-setting was limited and faced multiple challenges,
not least discrepancies between patients’ and
staff’s perceptions and experience.
This is supported by work on staff’s perspectives of goal-setting.8⇓⇓⇓–12 Patient-centeredness is a central tenet of goal-setting. That is, patients should be actively involved in the process with
clinicians who understand and respect their needs.13
However, the use of patient-centred goal setting appears to be a
challenge. Both patients and clinicians often report difficulty
with this approach, particularly during in-patient
Limited patient participation, professional skill and conflicting
priorities are considered contributory factors to the difficulty
using patient-centred goal-setting.11 Several different methods of goal setting during stroke rehabilitation have been proposed2,6,7,17⇓⇓⇓–21 but no method of choice has emerged.6,7,22,23
Thus as an initial stage to developing a
goal-setting model which addresses the barriers to uptake during
rehabilitation, we undertook a mixed methods
systematic review of contemporaneous evidence to specifically identify
and facilitators to goal-setting during stroke
rehabilitation using the ENTREQ guidelines for meta-synthesis.24