Self-reflection, rehabilitation and returning to fitness: an interpretative phenomenological analysis of stroke survivors’ experiences

I don't know what use this could be for. 

Self-reflection, rehabilitation and returning to fitness: an interpretative phenomenological analysis of stroke survivors’ experiences

Garwood, Jessica K. and Miller, Paul K. (2019) Self-reflection, rehabilitation and returning to fitness: an interpretative phenomenological analysis of stroke survivors’ experiences. In: BASES Student Conference 2019: Sport and Exercise Science - Transforming Lives, 17-18 April 2019, University of Dundee and Abertay University, UK. (Unpublished)

PDF - Accepted Version Available under License CC BY-NC Download (252kB) | Preview

Official URL: https://www.bases.org.uk/spage-events-student_conf...

Abstract

Each year, over 100,000 individuals suffer strokes in the United Kingdom alone, and it is estimated that by 2035, not only will there be a 59% increase in the number of first-time strokes amongst individuals of 45 years and over, but also that there will be a significant increase in the proportion of survivors thereby requiring effective rehabilitation (meaning protocols) (Sentinel Stroke National Audit Programme (SSNAP)). Contemporary research has indicated, however, that many of the rehabilitation schemes currently provided can be somewhat variable in approach, and often focus strongly upon regaining physiological function at the expense of assisting patients with the more psychological and social elements essential to their recovery. Indeed, stroke survivors have reported particular dissatisfaction with their rehabilitation in terms of a lack of help with stress-management and access to social support mechanisms. There is, thus, further research needed into the complex experiences of individuals who have undergone stroke rehabilitation in order to better understand their nuanced needs, and how these were met (or not met) by the services provided. Therefore, this study aimed to explore extended, semi-structured interviews, reflecting on personal experiences of stroke and subsequent rehabilitation, with the purpose of drawing conclusions to potentially form a basis for further research. The reported study used Interpretative Phenomenological Analysis (IPA) to explore interviews with n=4 individuals (2 males and 2 females) who have (a) experienced a stroke in the last five years, and have (b) now fully completed their formal rehabilitation programmes, i.e. are no longer under regular NHS care. These participants are, thus, in an ideal position to provide a full account of, and reflection upon, their journey through the rehabilitation process. All interviews were conducted and recorded via telephone, while all collected data were handled in strict accordance with the institutional ethical conditions set-out for the project, stored in line with General Data Protection regulation (GDPR), and analysed using the standard conventions of IPA. Although analysis remains in progress at this time, it is currently clear that, for the participants, the rehabilitative experience was influenced by the manner in which they conceptualized their pre-stroke identities. Perceived difficulties within the process were most notable where participants felt that they were not being identified as an individual. Given such observations, it is contended that the results and subsequent conclusions made could potentially influence further research into the structure and delivery of stroke rehabilitation.

Item Type:	Conference or Workshop Item (Poster)
Departments:	Sports and Physical Activity
Depositing User:	Paul Miller
Date Deposited:	28 Mar 2019 10:40
Last Modified:	29 Mar 2019 06:23
URI:	http://insight.cumbria.ac.uk/id/eprint/4588

Want to learn a new skill more effectively? Stop thinking about yourself!

Does this also apply to our stroke exercises? Do your protocols  need to change based on this?
http://digest.bps.org.uk/2015/02/want-to-learn-new-skill-more.html
The human mind can be its own worst enemy. When we want to do well in sports, we often intensify attentional focus on bodily movements that are best off left on automatic pilot. The result, even for elite athletes, can be a dire instance of choking. The muscles stiffen or shake. Fluid, expert movement is lost, and the learning of new skills is impaired.

A common assumption is that an internal focus is harmful to performance because it directs unhelpful conscious attention to bodily control. But what if the costs of self-focus are more general and profound than that? Perhaps merely thinking about ourselves in any way is harmful to performance and learning because to do so activates the "self-schema".

The self-schema is "more than a philosophical construct" argue Brad McKay and his colleagues in a new paper, it is in fact a "functional neural network located anatomically in cortical midline structures." Their theory is that anything that activates this network - be that over-focus on bodily movements, memories of past performance, or the scrutiny of an audience - will be detrimental to skilled performance and learning.

The researchers began by dividing 36 students (26 men) into two groups and asking them to throw 10 balls underarm at a bulls-eye style target. Throws nearer the target earned more points. Both groups performed equally well. Now one group spent a minute "thinking about their previous throwing experience including their strengths and weaknesses as a thrower"; the other group acted as controls and just waited out the time. Both groups then performed 10 more throws. The students who'd spent time thinking about themselves showed inferior performance compared with their earlier standard; the control group maintained their skill level.

"A simple manipulation designed to activate the self-schema ... was sufficient to degrade performance," the researchers said. 

Next, 37 more students were recruited (18 women) and split into two groups. They spent time practising using a bat to hit golf-ball-sized balls, travelling at 25mph, at a target. None of them had played organised baseball or softball in the last year.

Over two practice days, all the students completed a writing task in the various short breaks between hitting. Those in the self-reflective group wrote for one minute either about their experience at baseball; their personal attributes as an athlete; their emotional experiences related to baseball; or their strengths and weaknesses as a hitter (all the different topics were covered during the different breaks). The other group acted as controls - they spent the same breaks writing about objects in the laboratory where the training took place, either focusing on colours or shapes or the names of the objects.

A few days later, the students had a final go at the ball hitting challenge. Adjusting for initial performance differences, the control group significantly outperformed the self-reflective group. The control group also outperformed the self-reflective group when the task was changed slightly by speeding up the delivery of the balls.

McKay and his team said their results were surprising - as one of their participants remarked, you'd think spending time writing about one's past glory days at baseball would have provided a confidence boost, and maybe rekindled old movement patterns too. Instead, the researchers said their results showed how the "ostensibly innocuous activity of contemplating one's own experiences, emotions, strengths, weaknesses and attributes, might have activated a lurking neural self-network that interfered with the process of motor learning."

Critics may feel this study raises as many questions as it answers - with no measures of muscle tension, or mood, or a myriad other possible mediating factors, we're left in the dark about why writing about the self appeared to be detrimental to motor skill learning.

However, the researchers believe their study has broken new ground. Where previous research has shown instructions to focus on parts of the body can be harmful to performance, McKay and his team said their "experiments are the first to show that self-reflection alone is sufficient to interfere with motor skill activation and performance."

_________________________________

McKay, B., Wulf, G., Lewthwaite, R., & Nordin, A. (2015). The self: Your own worst enemy? A test of the self-invoking trigger hypothesis The Quarterly Journal of Experimental Psychology, 1-10 DOI: 10.1080/17470218.2014.997765

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.