Use of Wrist-Hand-Finger Orthotics in the Rehabilitation of Patients with Upper Extremity Hemiparesis Post-Stroke: A Clinical versus Patient Perspective

 The patient perspective is you are COMPLETE FUCKING FAILURES BECAUSE YOU KNOW NOTHING EXACT ABOUT RECOVERY!

Use of Wrist-Hand-Finger Orthotics in the Rehabilitation of Patients with Upper Extremity Hemiparesis Post-Stroke: A Clinical versus Patient Perspective

Author

Amberly NewquistFollow

Date of Award

Spring 5-3-2025

Document Type

Non Thesis

Degree Name

Master of Science in Orthotics and Prosthetics

Department

Kinesiology

First Advisor

Amy Funke

Abstract

Upper extremity hemiparesis post-stroke is a complex condition with varying orthotic treatment options depending on the specific occupational therapist the patient sees. There is no current evidence based practice for prescribing a Wrist-Hand-Finger Orthotic (WHFO) for patients with upper extremity hemiparesis, leading to irregular care between providers and unsatisfactory outcomes for some patients.(Since only 10% fully recover, that means you have a humungous failure rate of 90%! Fireable in any business situation All outpatient occupational therapy clinics in the Minneapolis-St Paul area servicing adults with upper extremity complications post-stroke will be identified, all occupational therapists and their qualifying patients will be invited to participate in this study. A comprehensive analysis of the factors influencing the prescribing patterns, rationale, and evaluation methods of occupational therapists who provide WHFO’s for their patients will be examined in this study. These preferences and evaluation methods will be cross-examined against the patient-reported needs(The only goal in stroke is 100% recovery! Don't you dare try using the tyranny of low expectations to lower that!) and evaluation methods of the WHFO they have been provided. Discrepancies will be identified through analysis of common response themes and analyzed using Spearman's rank order correlation and content analysis to determine statistical significance. Occupational therapists are anticipated to be found to have a preference for static WHFO options to prevent contractures and are anticipated to be less likely to prescribe dynamic WHFO’s due to a lack of evidence based research for such devices. Patients are anticipated to be found to have a preference for low-profile devices which have the ability to aid them in their day-to-day activities rather than simply prevent contractures. Further research is needed to evaluate evidence based practices given currently available technologies for this population.

Recommended Citation

Newquist, A. (2025). Use of Wrist-Hand-Finger Orthotics in the Rehabilitation of Patients with Upper Extremity Hemiparesis Post-Stroke: A Clinical versus Patient Perspective (Thesis, Concordia University, St. Paul). Retrieved from https://digitalcommons.csp.edu/kinesiology_masters_science/141

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An Exploration of Patient Perspectives on Factors Affecting Participation in Stroke Rehabilitation

This is so damned simple. Patient engagement is less than optimal because you fucking idiots have NO PROTOCOLS LEADING TO 100% RECOVERY.  Talk to some intelligent patients sometime, I'm available.

An Exploration of Patient Perspectives on Factors Affecting Participation in Stroke Rehabilitation

Authors: Last, Nicole
Advisor: Harris, Jocelyn
 Department: Rehabilitation Science
Keywords: stroke rehabilitation;participation;facilitator;barrier;qualitative;interpretive description
Publication Date: 2019

Abstract: 

Though patient participation is recognized as an important element of rehabilitation, few studies have used a qualitative lens to specifically examine factors influencing patient-participation in stroke rehabilitation. Thus, the purpose of this work was to explore factors perceived by service users to influence their participation in hospital-based stroke rehabilitation activities and to use this information to generate knowledge relevant for the clinical context of stroke rehabilitation. The following research gaps provided rationale for this work: 1) no published studies from the patients’ perspective on influencers of participating in hospital-based stroke rehabilitation programs, and 2) limited studies about influences on participation in hospital-based stroke rehabilitation. The first manuscript (chapter two) was designed to specifically address these gaps while the second manuscript (chapter three) was developed to highlight important findings surrounding rehabilitation intensity from chapter two. This thesis has discussed a number of patient-perceived barriers and facilitators to participating in stroke rehabilitation, which the final chapter conceptualizes into a framework of personalized rehabilitation representing a patient-centred approach to providing rehabilitation that encourages patient participation. Together, this thesis contributes knowledge about: 1) patient perspectives on factors affecting participation in stroke rehabilitation, 2) promoting patient participation, 3) shortcomings in closing the evidence-to-practice gap with respect to therapy intensity during inpatient stroke rehabilitation, and 4) insights into an exploratory framework of personalized rehabilitation developed from service users’ perspectives of stroke rehabilitation. In addition, this work emphasizes a call to action for the delivery of user-centered stroke care, specifically in regard to rehabilitation intensity during inpatient stroke rehabilitation. The implications of this work are directed at stroke rehabilitation providers as well as policy makers and stroke health system planners in order to develop appropriate and effective services and strategies for optimal recovery and successful implementation of best practice recommendations.URI: http://hdl.handle.net/11375/25303Appears in Collections:Open Access Dissertations and Theses

If Only Health Care Would Focus On This One Thing

The patient perspective for stroke survivors would be 100% recovery. If doctors would do that they would:
1. Solve the neuronal cascade of death of these 5 causes.
2. Create a hyperacute protocol likely with these 31 possibilities in the first week
3. Solve all the problems in stroke
4. Know exactly how neuroplasticity works and make it 100% repeatable for chronic survivors.
5.  Know exactly how neurogenesis works and make it 100% repeatable for chronic survivors.
http://blogs.wsj.com/experts/2016/02/16/if-only-health-care-would-focus-on-this-one-thing/ 
In health care, our keystone habit should be taking the patient’s perspective. If we could develop the habit of always seeing health care from the perspective of the patient, we would have one guiding principle – not four – for the tough decisions and trade-offs that need to be made as we reform health care. How long should patients have to wait to make an appointment? It is worth investing in email communication systems with patients? If the response is governed by balancing patient experience, quality measurements, costs considerations and worker satisfaction, the answer gets complicated. If instead we habitually ask, “What do I want when I’m a patient?” the answer is clear.

More at link. 

Innovative Stroke Patient Management System Reduces Hospital Stay by Over 25 Percent

They never say whether the one usable statistic they should be using from this is that patients have an objectively better recovery. I'd be willing to bet a lot of money that this is just a faster way to push patients out of the hospital. Not better results, more pressure on the caregivers to accept the patients supposedly because they were involved in the care/rehabilitation decisions.  When you have the whole medical staff arrayed against you you are going to cave.

YOU are going to have to demand results and stand up to the pressure.

Big f*cking whoopee.

Article on it here:

Innovative Stroke Patient Management System Reduces Hospital Stay by Over 25 Percent

Press release here:

Innovative stroke patient management system cuts hospital bed usage by more than 25 percent

Contact: Amanda Bates amanda@curvecommunications.com
604-684-3170 Heart and Stroke Foundation of Canada @TheHSF 

'Win-win' program in Kelowna, BC, provides better care to patients and hospital savings of up to $800,000

An innovative patient management system at the acute stroke unit of Kelowna (BC) General Hospital has reduced the number of stroke patient bed days by more than 25 per cent, according to a study of the system presented at the annual Canadian Stroke Congress in Vancouver.
In total, it is estimated the new system is saving the 380-bed hospital more than 1,000 bed days per year. This represents annual savings of up to $800,000, all achieved without the need for any new investment in devices, treatments or personnel.
"It's a win-win situation," says Dr. John B. Falconer, director of the transient ischemic attack (TIA) and stroke clinic at the hospital, and author of the study. "Patients are better and more efficiently treated, the hospital saves resources and the morale of the whole unit is much better."
The program is called Proprietary Physician, or Pro-MD. It involves assuring that one of the hospital's five neurologists is always designated as primarily responsible for best bed usage and patient flow on the acute stroke unit.
"The ward becomes "that doctor's" ward; they have a propriety interest in it functioning well," says Dr. Falconer. Each doctor's assignment as Pro-MD could last several weeks or a month.
A crucial component of the program is that beyond the normal care to the patients by their own neurologist and other caregivers, the Pro-MD makes twice-weekly rounds of all patients with the full care team. This includes the ward head nurse, physiotherapist, occupational therapist, social worker, transition nurse, pharmacist, rehabilitation ward head nurse and – very importantly according to Dr. Falconer – the patient's family.
"This brings everyone who needs to have input into decisions about a patient's care together to agree on the action needed," says Dr. Falconer. "This is very advantageous compared to formerly having to compare written notes from one another and wait for input from others."
The meetings take only 30-45 minutes to discuss the usual half-dozen patients, but result in everyone agreeing on the course of care, including the family. This is crucial, particularly when discussing the timing and terms of a patient's discharge from hospital.
A further benefit, added Dr. Falconer, has been a huge boost in staff morale on the ward. "We're now the primo ward of the hospital, with staff enjoying the team-based collaboration," he says.
The program is actually very simple but has proven very effective. "It could perhaps be used in other areas of the hospital, but it's particularly relevant to stroke care because of the many players involved and the crucial role the patient and family play in rehabilitation."

Do all docs need to be hit by a car to understand the patient perspective?

I doubt any of our doctors understand the survivors perspective even with thousands upon thousands of survivors writing their experiences on the web.
Do all docs need to be hit by a car to understand the patient perspective?

Think you understand the patient experience? Read this doc’s scary story of an ER trip

Read more: http://medcitynews.com/2014/06/four-frightening-lessons-doctors-stay-er/#ixzz34cO9RGZG