Exploring the use of free time in an inpatient stroke rehabilitation setting

From some of my earlier posts:
Only 13 % of a stroke unit patient’s day is typically spent in activities related to functional outcome,(precisely what action observation should be used for to fill that time).

Patients should have no downtime except to sleep and with that they should be trained in lucid dreaming. There is no place for slackers in stroke recovery. Eating should be therapy, using your affected side. The foods you eat should be proven as stroke prevention. If you aren't working the hardest you have ever worked in your life you aren't going to recover to the best of your ability. Nothing your doctor or therapist does will magically make your recovery occur. ALL the work is for you to accomplish. 

And you are going to work even harder because your doctor completely failed at stopping the 5 causes of the neuronal cascade of death in the first week thus killing off millions to billions of neurons!

 Exploring the use of free time in an inpatient stroke rehabilitation setting

Abstract:

Background.

 Stroke patients within an inpatient rehabilitation setting often find themselves with considerable unstructured periods prior, between and after scheduled therapy sessions. These periods could provide the opportunity to engage and participate in activities and occupations that provide meaning, as well as promote physical and mental well-being.

Purpose.

The aim of this study was to explore how stroke patients spend their free time in an inpatient setting and the perspectives of occupational therapists and nurses regarding how the patients spend or could spend their free time in a neurorehabilitation ward. Method. The study consisted of a small-scale qualitative design using one set of interview questions with four stroke patients, and another set for two occupational therapists and two nurses working within a neurorehabilitation ward. Following ethical approval, participants were recruited through purposive sampling via an intermediary. An observation tool was devised and used by the researcher who collected her observations and reflections. Thematic analysis was used to analyse the coded data collected from the interviews and a summary of the main points emerging from the observation sheet used by the researcher was compiled.

Results.

Two main themes were developed for each of the two participant group interviews – namely, the barriers and facilitators to engaging and participating in activities during free time in the ward, and the barriers to organising activities on the ward. The main findings gathered from these interviews and the researcher’s observation show that a number of barriers, including environmental restrictions, limited resources and time availability from staff are present within the ward that limit stroke patients from engaging and participating in meaningful occupations and activities.

Implications.

This study aims to shed light on the significance of occupational engagement and participation in promoting both physical and mental well-being among individuals undergoing inpatient rehabilitation. Furthermore, it seeks to contribute to the enhancement of recovery by potentially informing the development of tailored activities and improving accessibility within hospital environments to facilitate greater engagement and participation in meaningful occupations for stroke patients during the rehabilitation phase of their hospital stay.

Authors:	Agius, Julia (2024)
Keywords:	Cerebrovascular disease -- Patients -- Rehabilitation -- Malta Hospital patients -- Rehabilitation -- Malta Hospital patients -- Recreation -- Malta Nurses -- Malta Nurses -- Attitudes Occupational therapists -- Malta Occupational therapists -- Attitudes
Issue Date:	2024
Citation:	Agius, J. (2024). Exploring the use of free time in an inpatient stroke rehabilitation setting (Bachelor's dissertation).
Description:	B.Sc. (Hons)(Melit.)
URI:	https://www.um.edu.mt/library/oar/handle/123456789/128710
Appears in Collections:	Dissertations - FacHSc - 2024 Dissertations - FacHScOT - 2024

Fast path to stroke recovery at Cleveland Clinic Rehabilitation Hospital in Avon

The intensity of 3 hours of therapy a day is still appallingly low when you consider that patients have plenty of time to do therapy.
From some of my earlier posts:
Only 13 % of a stroke unit patient’s day is typically spent in activities related to functional outcome.

Patients should have no downtime except to sleep and with that they should be trained in lucid dreaming. There is no place for slackers in stroke recovery. Eating should be therapy, using your affected side. The foods you eat should be proven as stroke prevention. If you aren't working the hardest you have ever worked in your life you aren't going to recover to the best of your ability. Nothing your doctor or therapist does will magically make your recovery occur. ALL the work is for you to accomplish.

Fast path to stroke recovery at Cleveland Clinic Rehabilitation Hospital in Avon

 

Study: Telehealth-based Programs for Stroke Therapy Accelerates Recovery

Somehow our stroke departments need to figure out how to get massive amounts of rehab done while still in the hospital. From some of my earlier posts:
Only 13 % of a stroke unit patient’s day is typically spent in activities related to functional outcome.

Physiotherapists systematically overestimate the amount of time stroke survivors spend engaged in active therapy rehabilitation: an observational study

 

http://hitconsultant.net/2016/05/11/study-telehealth-based-programs-stroke-therapy-accelerates-recovery/ 

Stroke survivors engaged in telehealth-based stroke therapy programs received 5 times more therapy than patients receiving in­-clinic therapy alone, according to an internal study conducted by Constant Therapy, which provides a science­-based, customized brain rehabilitation software program. After analyzing more than 20 million therapy exercises completed by users on its mobile platform, the company found that stroke patients experience greater improvement in both cognitive and speech accuracy and processing speed during their recovery using telehealth-based programs.
Because therapy is available for use on an iPad, Android or Kindle tablet device, rehabilitation exercises that are assigned and practiced during an in-clinic session can be continued at home. As the person continues to practice, a speech and language pathologist — or the technology itself — can advance an individual through a series of more challenging exercises to help improve memory, attention and speaking.
Other key findings from Constant Therapy’s study, which analyzed more than 100 million data points, include:

– Accuracy in language and cognitive exercises improved 15% in individuals with severe impairments by completing 100 exercises, and 40% for those completing 500 or more of the same exercises.
– Processing speed in language and cognitive exercises improved more than 20% with 100 items completed, and over 80% after completing more than 500 exercises
That same data, now available at scale, enables speech-­language pathologists and other healthcare clinicians to understand and predict what brain therapy exercises will be most effective for individual stroke patients. The company’s NeuroPerformance EngineTM, an advanced analytics engine, analyzes patient performance and automatically personalizes therapy based on their specific performance and needs.

“Combining big data and mobile technology allows us to collect more and better data throughout the rehabilitation process than was ever possible before,” said Keith Cooper, CEO of Constant Therapy. “The more data we collect, the better our algorithms become and the more we can recommend and deliver precision medicine. It’s really the dream of personalized healthcare.”

“FIND Technology”: investigating the feasibility, efficacy and safety of controller-free interactive digital rehabilitation technology in an inpatient stroke population: study protocol for a randomized controlled trial

You will have to have your doctor follow this to see what the conclusions are.

“FIND Technology”: investigating the feasibility, efficacy and safety of controller-free interactive digital rehabilitation technology in an inpatient stroke population: study protocol for a randomized controlled trial

• M. L. BirdEmail author,
• J. Cannell,
• M. L. Callisaya,
• E. Moles,
• A. Rathjen,
• K. Lane,
• A. Tyson and
• S. Smith

Trials201617:203

DOI: 10.1186/s13063-016-1318-0

©  Bird et al. 2016

Received: 3 February 2016

Accepted: 15 March 2016

Published: 16 April 2016

Open Peer Review reports

Abstract

Background

Stroke results in significant disability, which can be reduced by physical rehabilitation.(Notice no mention of doctor interventions to reduce disability) High levels of repetition and activity are required in rehabilitation, but patients are typically sedentary. Using clinically relevant and fun computer games may be one way to achieve increased activity in rehabilitation.

Methods/design

A single-blind randomized controlled trial will be conducted to evaluate the feasibility, efficacy and safety of novel stroke-specific rehabilitation software. This software uses controller-free client interaction and inertial motion sensors. Elements of feasibility include recruitment into the trial, ongoing participation (adherence and dropout), perceived benefit, enjoyment and ease of use of the games. Efficacy will be determined by measuring activity and using upper-limb tasks as well as measures of balance and mobility. The hypothesis that the intervention group will have increased levels of physical activity within rehabilitation and improved physical outcomes compared with the control group will be tested.

Discussion

Results from this study will provide a basis for discussion of feasibility of this interactive video technological solution in an inpatient situation. Differences in activity levels between groups will be the primary measure of efficacy. It will also provide data on measures of upper-limb function, balance and mobility.

Trial registration

ACTRN12614000427​673. Prospectively registered 17 April 2014.

Background

In the US alone, one person per minute has a stroke, and although death rates have declined over the last decade, the burden of disease remains high [13]. Physical rehabilitation has the potential to positively impact functional outcomes and improve this burden; however, this requires a high dose of therapy. A significant factor limiting rehabilitation outcomes is low levels of patient activity [10]. Observational studies in different countries have found that patients after stroke in rehabilitation are surprisingly inactive for the vast majority of the waking day. For example, only 13 % of a stroke unit patient’s day is typically spent in activities related to functional outcome,(precisely what action observation should be used for to fill that time) such as active therapy or walking practice [2]. Many rehabilitation activities, aimed at stimulating neuroplasticity, are by their very nature repetitive and tend to be tedious [19]. One method by which engagement with rehabilitation programs and levels of activity could be improved involves the use of fun and engaging video games.

Physiotherapists systematically overestimate the amount of time stroke survivors spend engaged in active therapy rehabilitation: an observational study

This correlates to one of Peter Levines' posts.
http://www.sciencedirect.com/science/article/pii/S1836955313701462

Questions

How accurately do physiotherapists estimate how long stroke survivors spend in physiotherapy sessions and the amount of time stroke survivors are engaged in physical activity during physiotherapy sessions? Does the mode of therapy (individual sessions or group circuit classes) affect the accuracy of therapists’ estimates?

Design

Observational study embedded within a randomised trial.

Participants

People who participated in the CIRCIT trial after having a stroke.

Intervention

47 therapy sessions scheduled and supervised by physiotherapists (n = 8) and physiotherapy assistants (n = 4) for trial participants were video-recorded.

Outcome measures

Therapists’ estimations of therapy time were compared to the video-recorded times.

Results

The agreement between therapist-estimated and video-recorded data for total therapy time and active time was excellent, with intraclass correlation coefficients (ICC) of 0.90 (95% CI 0.83 to 0.95) and 0.83 (95% CI 0.73 to 0.93) respectively. Agreement between therapist-estimated and video-recorded data for inactive time was good (ICC score 0.62, 95% CI 0.40 to 0.77). The mean (SD) difference between therapist-estimated and video-recorded total therapy time, active time, and inactive time for all sessions was 7.7 (10.5), 14.1 (10.3) and –6.9 (9.5) minutes respectively. Bland-Altman analyses revealed a systematic bias of overestimation of total therapy time and total active time, and underestimation of inactive time by therapists. Compared to individual therapy sessions, therapists estimated total circuit class therapy duration more accurately, but estimated active time within circuit classes less accurately.

Conclusion

Therapists are inaccurate in their estimation of the amount of time stroke survivors are active during therapy sessions. When accurate therapy data are required, use of objective measures is recommended.