The yin and yang of safety and risk: a content analysis and critical narrative synthesis exploring the conceptualisation of risk in the stroke rehabilitation literature

My risk taking started my first day release from the hospital; went to watch a whitewater slalom race with a quarter mile rough path to get to the banks. Nurses found out about it and I got a stern visit from one of my doctors highly recommending against it. I totally ignored her since she obviously knew nothing about my risk taking. I was damn good at OC1 and OC2 slaloms and wasn't going to miss it.

The trophies are from the Buttercup series of whitewater slalom races(6 races in Wisconsin and Minnesota).

Left is 1rst place OC1(Open Canoe 1 person) 2004

Middle is 2nd place OC1(Open Canoe 1 person) 2003

Right is 3rd place OC1(Open Canoe 1 person) 2005, stroke was in May 2006

Missing are the two first place finishes in OC2(Open Canoe 2 person) in consecutive years with different paddling partners, they have the trophies.

One of my main reasons for my excellent balance is this: Don't follow me, I'm not medically trained, is your doctor?

bar stool rehab (3 posts to January 2014)

 The yin and yang of safety and risk: a content analysis and critical narrative synthesis exploring the conceptualisation of risk in the stroke rehabilitation literature

Sharon Jackson

,

Sara Demain

,

Francine O’Malley

 &

Dorit Kunkel

Received 04 Oct 2024, Accepted 11 Jul 2025, Published online: 25 Jul 2025

• Cite this article
 
• https://doi.org/10.1080/13698575.2025.2535973
 
• CrossMark

(open in a new window)

Abstract

Many people feel unprepared for life following discharge from stroke services. Rehabilitation occurs within a harm-reduction framework, but evidence suggests risk-taking is crucial for recovery. The aims of this review study were to explore how risk is conceptualised in the stroke rehabilitation literature and to develop a critical narrative synthesis of articles exploring and challenging dominant conceptualisations of risk, in the context of post-stroke identity and engagement in valued activities. We undertook a literature search (including Embase, PubMed, CINHAL and PsycINFO), including qualitative, quantitative and mixed-methods studies in post-stroke adults > 18 years. Phase 1 involved a content analysis, with 1420 articles screened and 246 included. Most (n = 233) were described by the theme ‘Safety first’, divided into sub-themes: i) Physical safety; ii) Societal and organisational protection; and iii) Cognitive, affective and communication risks. Remaining articles were described by Theme 2: ‘Taking risks as necessary and subjective’. Critical narrative synthesis in Phase 2 included fifteen articles, demonstrating the imposition of ‘rules’ for safety, despite risk-taking being important. The predominant narrative prioritised safety and harm-reduction during stroke rehabilitation, overlooking unintended consequences for post-stroke identity and engagement in valued activities. The voice of people post-stroke was largely absent(So, not listening to the experts in the field.) in decision-making around risk prioritisation and management, which often failed to acknowledge the inherent uncertainties and sociocultural factors influencing beliefs and behaviours in relation to risk. Further qualitative research is needed to understand the experiences of people post-stroke and to inform service co-design and shared decision-making in relation to risk in stroke rehabilitation.

Bar stool failures

 As part of my music therapy, I go to live jazz music at bars. If your doctor doesn't have you doing the same you don't have a competent doctor. Getting up on the bar stool isn't too bad, I'm tall enough to easily push one butt cheek onto the stool. But getting the left foot onto the foot ring is nigh impossible due to spasticity preventing the hamstring from engaging. So almost invariably I have to reach down with my right hand and pull the leg onto the ring. So far I haven't fallen off the stool doing  those contortions. But once on the stool the next problem rears its' ugly head, my left knee wanders outward due to spasticity which is a problem if the next door neighbor is not someone I want attention from. If it is someone I'd like attention from and she puts her hand on my leg, I can't respond in kind, my left arm and hand have zero control. I might be able to slap her on the butt in the process but that's not cool.

WHAT STROKE MEDICAL PROFESSIONAL HAS A GUARANTEED SOLUTION FOR THAT?

• music (94 posts back to March 2011)

• music therapy (53 posts back to October 2014)

• musical training (13 posts back to June 2014)

 

Can Brain Imaging Detect Risk Takers?

I think I have recovered relatively well because I am willing to take risks on the exercise I do and the situations I put myself into. With no challenges you will likely not recover very well. Magic Johnson did not become a great basketball player by practicing layups, he practiced the hard stuff precisely because it was hard. You are going to have to push your therapists to actively give you therapy that is very difficult. My best example of risk taking is considering and using a chainsaw for therapy, a lesser one is walking in the dark with no flashlight or walking on ice or bar stool rehab.
Your doctor should be telling you that stroke rehab will be the hardest thing you ever will have done.
http://brainblogger.com/2014/10/18/can-brain-imaging-detect-risk-takers/

Bar stool stroke rehab

Its important to do your rehab wherever you are. Getting my feet onto the crossbars on my stool usually doesn't work with just the left leg alone. My hamstrings are not strong enough to pull the leg underneath me, so I have to use my right leg to help. Then once there I can work on dorsiflexion and foot pointing while engaging in conversation and drinking. In order to get your million repetitions you have to take every chance you can to practice. And with no back on most bar stools you have to engage your core muscles to stay erect.  Walking after a few drinks really challenges your balance. Something your doctor should be prescribing if they were any good.  Have fun, I am.