Deans' stroke musings: Delivering intensive rehabilitation in stroke: Factors influencing implementation

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, September 9, 2018

Delivering intensive rehabilitation in stroke: Factors influencing implementation

You mean you don't understand that only those with a small stroke will be able to do high intensity exercise. Please learn about cause and effect.
My therapists were worried all the time that I not exert myself at all. If they had tested my cardiovascular fitness they would have found out I had an athletes cardio and could have been pushed much harder.

Delivering intensive rehabilitation in stroke: Factors influencing implementation

Physical Therapy , Volume 98(4) , Pgs. 243-250.

NARIC Accession Number: J79076. What's this?
ISSN: 0031-9023.
Author(s): Connell, Louise A.; Klassen, Tara K.; Janssen, Jessie; Thetford, Clare; Eng, Janice.
Publication Year: 2018.
Number of Pages: 8.
Abstract: Study investigated factors influencing implementation of higher-intensity activity in stroke rehabilitation settings. Semi-structured interviews were conducted with 15 rehabilitation therapists from 4 sites across 2 Canadian provinces who had experience in delivering a higher-intensity intervention as part of the Determining Optimal post-Stroke Exercise (DOSE) study. DOSE is a multisite, randomized clinical trial in progress that assesses the feasibility of implementing intensive, task-specific physical therapy during inpatient rehabilitation. Interview transcripts were coded and analyzed using implementation frameworks. Generally, therapists had positive experiences regarding high-intensity interventions. However, therapists felt they would adapt the protocol to accommodate their beliefs about ensuring movement quality.(But read Peter Levines post on this, quality is overrated.) The requirement for all patients to have a graded exercise test and the use of sensors (e.g., heart rate monitors) gave therapists confidence to push patients harder than they normally would. Paradoxically, a system that enables routine graded exercise testing and the availability of staff and equipment contribute challenges for implementation in everyday practice. This study demonstrated that even therapists involved in delivering a high-intensity intervention as part of a trial wanted to adapt it for clinical practice. Therefore, it is imperative that researchers are explicit regarding key intervention components and what can be adapted to help ensure implementation fidelity. Changes in therapists’ beliefs and system-level changes (staffing and resources) are likely necessary to facilitate higher-intensity rehabilitation in practice.
Descriptor Terms: EXERCISE, PHYSICAL THERAPY, PROGRAM EVALUATION, REHABILITATION, SERVICE DELIVERY, STROKE.

Can this document be ordered through NARIC's document delivery service*?: Not available from NARIC.

Citation: Connell, Louise A., Klassen, Tara K., Janssen, Jessie, Thetford, Clare, Eng, Janice. (2018). Delivering intensive rehabilitation in stroke: Factors influencing implementation. Physical Therapy , 98(4), Pgs. 243-250. Retrieved 9/8/2018, from REHABDATA database.