Since you're not even measuring patient recovery you really need to consider a different line of work. Nothing here directly leads to survivor recovery.
Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation
Introduction
Creating practice conditions that will optimise motor learning is an important consideration for stroke rehabilitation professionals [1]. Factors that are understood to have an effect on the performance and learning of motor skills include: intensity; task specificity; the frequency and focus of instructions, feedback and cues; autonomy; and motivation. Whilst much of the research in this field considers the independent contribution of these factors, there is growing evidence highlighting a cumulative effect when certain practice variables are applied together [2], [3].
It is widely accepted that intensity of practice has a direct influence on recovery, a concept well supported by the evidence base [4], [5], [6], [7], [8]. However, intensity is unlikely to be the only influencing factor – what is practiced, how it is practiced, and the broader practice conditions also contribute. For example, stroke rehabilitation is most effective when there is sufficient physical challenge [6], and when training is task specific [9].
In the context of motor learning, the term “coaching” refers to the process of instructing, motivating and guiding someone (the patient), to facilitate improved performance. As part of this process, the coach (the therapist) will use “coaching language” – instructions, feedback and/or short cues, that aim to influence the way a person moves [10], and subsequently their ability to learn a movement. The connection between coaching language and motor skill learning is well evidenced in the field of sport [10]; numerous studies have demonstrated the impact that coaching language has on performance and learning [11], [12]. Within stroke rehabilitation, a number of small studies have demonstrated performance benefits relating to specific coaching techniques, such as an external focus of attention [13], [14], [15], [16], reduced quantity feedback [17], [18], and action-observation [19], [20], [21].
Observational studies have highlighted that therapist’s may not optimally apply specific motor learning principles during stroke rehabilitation. Studies investigating intensity of practice report that around a third of time in therapy sessions is spent resting [22], [23], and that number of task repetitions is relatively low [24]. Furthermore, therapists typically use frequent instructions and favour an internal focus of attention [25], [26], and that feedback that is non-specific [27]. Studies that examine the use of principles relating to practice design or autonomy support in stroke rehabilitation are limited.
The purpose of this current study is twofold. Firstly, we report how motor learning principles are applied during standard physiotherapy care, with a focus on post stroke lower limb rehabilitation. This is part of a programme of work is investigating the use of implicit motor learning principles in stroke rehabilitation. We are therefore predominantly interested in how therapists use coaching strategies, such as instructions and feedback. Our findings will be used as a comparator in a pilot trial, the protocol for which is described elsewhere [28]. Secondly, we describe the context in which different learning principles are applied, in relation to patient and/or task characteristics. Findings are discussed in relation to current literature in this field, in order to better understand how and where practice could change, in order to optimise learning and recovery.
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