Adjusting to Life after Stroke: A Theoretical Model Based on Survivor Experience (original) (raw)

Experiences of Occupational Therapists in Stroke Rehabilitation: Dilemmas of Some Occupational Therapists in Inpatient Stroke Rehabilitation

Scandinavian Journal of Occupational Therapy, 2002

The aim of this study was to explore and gain an understanding of occupational therapists' experiences of therapy with patients in inpatient stroke rehabilitation, through the identi cation of their deliberations for practice. Two focus-group interviews were conducted. The deliberations for action were triggered by using a written case sample. The analysis of the study involved a perspective of meaning interpretation of the statements of the occupational therapists. The meaning structure that arose was that occupational therapists experience dilemmas when they are considering the courses of action open to them. Three dilemmas were named: ''focusing on adaptation while the patient is focused on recovery'', ''being client centred and protective simultaneously'' and ''setting meaningful goals in an institutional context''. The results of the study are discussed in relation to theoretical concepts in occupational therapy: a two-body practice, client centredness and meaningful goal setting in a realistic context. Further research regarding the use of meaningful occupation in stroke rehabilitation is recommended.

The process of adjustment over time following stroke: A longitudinal qualitative study

Neuropsychological rehabilitation, 2018

Understanding how people adjust following stroke is essential to optimise recovery and ensure services are responsive to people's needs. This study aimed to explore people's experiences over the first three years post-stroke and identify what helped or hindered recovery. As part of a longitudinal, qualitative descriptive study, 55 people and 27 significant others purposefully selected from a population-based stroke incidence study were interviewed 6, 12, 24 and 36 months post-stroke. Interviews were audio taped and transcribed verbatim. Participants described an ongoing process of shock, disruption, and fear, making sense of what happened, needing to fit in with what's offered, finding what works for them and evolving a new normal, whilst managing the ups and downs of life. This process needed to be re-negotiated over time, as people experienced changes in their recovery, comorbidities and/or wider circumstances. The adjustment process continued over the three years post...

Investigating recovery from stroke: a qualitative study

Journal of Clinical Nursing, 2000

· A recent randomized controlled trial evaluated the effects of specialist nurses providing information, advice and support to caregivers and patients at home during the ®rst year after a stroke. · Reported here are the results of a complementary study which used qualitative methods to examine the experience of patients and caregivers during the year of recovery after a stroke.

Integrating consequences of stroke into everyday life – Experiences from a long-term perspective

Scandinavian Journal of Occupational Therapy, 2020

Background: Occupational engagement encompasses both objective and subjective aspects of occupation. Long-term follow-up studies indicate that stroke can have a negative impact on the ability to perform IADL. Less is known about the subjective experiences of occupational engagement and how engagement may evolve after stroke. Objective: To explore stroke survivors' experiences of occupational engagement and how engagement changed over time and across contexts. Material and methods: Repeat, semi-structured interviews 15-18 years post-stroke, analysed using thematic analysis. Eight out of nine participants were classified as having had a mild stroke at onset. Results: The analysis resulted in five themes that together formed the main theme 'It takes timeintegrating consequences of stroke into everyday life by engaging in occupation, using internal resources and adapting to context'. This illustrated how occupational outcome was the result of a continuous process in which occupational engagement was a way of gradually integrating consequences of stroke into everyday life. Conclusion and significance: Occupational engagement plays an important part in the process of moving on with life and can serve as both goal and means of achieving desired outcomes after stroke. Interventions that focus on enabling opportunities for occupational engagement in valued occupations and support the use of abilities and internal resources can reduce the impact of stroke in everyday life.

Recovery after stroke: A qualitative perspective

Journal of Quality In Clinical Practice, 2001

The purpose of this study was to determine the impact of stroke on survivors of the condition and to identify their physical and psychosocial needs in rural and regional settings. Data were collected via focus group interviews with stroke survivors, carers and key informants. Data were managed using NUD*IST and analysed using a content analysis method identifying major themes related to the impact of living in the community after having a stroke. It was found that stroke survivors suffered severe physical and emotional effects. The findings also identified the vulnerability of this group and a lack of organised, on-going psychosocial and rehabilitative support.

Changing Face of Stroke: Implications for Occupational Therapy Practice

American Journal of Occupational Therapy, 2009

Stroke is one of the most life-altering syndromes affecting the world population. Rehabilitation for people experiencing stroke is focused almost exclusively on self-care activities and being able to return home and has little to no focus on work rehabilitation or community reintegration. The Cognitive Rehabilitation Research Group (CRRG) at the Washington University School of Medicine in St. Louis was formed with the vision of improving everyday life for people after stroke by translating knowledge from neuroscience into treatment programs for productive living. Descriptive analysis of the intake assessment from the CRRG Clinical Core (N = 7,740) revealed three important findings: The age at stroke is decreasing, most strokes are neurologically mild to moderate in nature, and discharge placement decisions are being made largely on the basis of measures of impairment. The changes in the stroke population require occupational therapy to expand rehabilitation beyond the acute management of stroke to address full participation in work, family, and community life.

Ntsiea MV, Van Aswegen H, Lord S, Olorunju S 2012 Physiotherapists’ and occupational therapists’ perceived barriers and enablers of return to work for survivors after stroke. Occupational health Southern Africa 18 (1): 26 – 31

According to the Health Professions Council of South Africa the scope of physiotherapy practice rehabilitation includes: "getting the patient to maximum potential in both work and sport, including adaptation to permanent disabilities" and community care includes "offering services at day hospitals, rehabilitation centres, schools, industries and other organisations." This indicates that physiotherapists and occupational therapists need to think of actual and potential barriers which may prevent a person from returning to work. The plight of people with disabilities with regards to RTW is also acknowledged within the South African Employment Equity Act 9 in which a former Minister of Labour in the foreword stated that "employees who become disabled are often dismissed for poor performance or incapacity or they resign unnecessarily. They are often encouraged or forced to apply for disability benefi ts and they tend to retire earlier than other employees do, although if their needs are reasonably accommodated, they can continue as productive employees." Recent research carried out internationally using ABSTRACT Stroke impacts on a survivors' ability to return to work. Successful return to work after stroke can enhance both recovery and life satisfaction by improving self esteem and social identity. This study was undertaken to establish therapists' perceived barriers and enablers of return to work of survivors after stroke. A cross sectional study in stroke rehabilitation facilities within Gauteng province in South Africa was conducted. The questionnaire was returned by 36 (68%) of these facilities. The most commonly perceived barriers were the severity of the stroke survivors' physical impairments (n = 13) (36%) and their employment status (n = 11) (31%) at the time of having a stroke. The commonly perceived enablers were willingness of the employer to reasonably accommodate the stroke survivor at work (n = 12) (33%), family support (n = 8) (22%) and increased length of hospital stay to allow for intensive rehabilitation (n = 7) (19%). Stigma in the workplace was the only variable which had a statistically signifi cant relationship with the type of clinical facility therapists worked at (p = 0.02).

How do people who have had a stroke experience the transition from inpatient rehabilitation to home?: A qualitative study

Australian Occupational Therapy Journal, 2019

Introduction: Occupational Therapy can be essentially described as enabling social inclusion through occupational participation. How does this best happen though? The answer is through working in deeply collaborative, power and knowledge sharing partnerships with individuals, families, communities and populations of people across contextual boundaries. Objectives: In this three-part lecture, consideration with be given to, first, ways of working with communities of interest in Co-Design, Knowledge Co-Production and as Co-Researchers and how the philosophical underpinnings of the profession are consistent with such approaches. The second part of the lecture will examine epistemic and hegemonic "blindspots" (Fricker, 2007) of the profession which can act as a barrier to such person centred interactions, further reproducing dynamics of exclusion and marginalization of already vulnerable persons and communities (Gerlach, 2015). Finally, the lecture will consider the "next era" in occupational therapy in which, in response to entrenched situations of occupational injustice in Australia and globally, we may work with people in what has been termed "radical solidarity" (Medina, 2013) using de-colonizing (Gibson et al, 2015) and occupation centred approaches (Fisher & Bray Jones, 2017) such as the Participatory Occupational Justice Framework (POJF) (Whiteford & Townsend, 2011; Whiteford et al 2018) and the Capabilities, Opportunities, Resources and Environments Approach (CORE) (Pereira, 2017). Implications & conclusions: Adopting a critical and epistemically reflexive (Kinsella & Whiteford, 2009) position is essential in identifying current hegemonic practices in the profession which can be inadvertently disempowering to the very people we are mandated to serve. Addressing such "hegemonic blindspots" and ensuring inclusive, power sharing practices can be achieved through use of decolonizing and occupation centred approaches in all arenas of practice.

Being a stroke patient: a review of the literature

Journal of Advanced Nursing, 1997

Being a stroke patient: a review of the literature The purpose of this paper is to review the research literature on the patient's experience of stroke. Four qualitative studies on how patients experience stroke were identified. The findings of these studies show that the stroke patient often has clear goals for himself in relation to functional abilities, against which he measures all success and forward progress in his rehabilitation. Even though the stroke patient accepts a lower level of functional ability, he is not willing to accept the rehabilitation professionals' prediction of his ultimate functional level if it is lower than his own goal. Furthermore, stroke patients see recovery as a return to the existence they had lived before the stroke, which is diÂerent from the health care providers' view. To the health care provider, recovery is measured in terms of isolated and discrete return of movement, whereas in the eyes of the patients, recovery is a return to previously valued activities. Further, studies on psychosocial function after stroke were reviewed. Recent studies show that the psychological impact of the stroke experience is immense and that stroke patients experience stress on a variety of levels. Also, depression exists in a large portion of the stroke population. The impact of stroke also influences the patient's social existence, as studies have shown that stroke patients do manifest diminished social function. However, the reviewed studies are not without limitations. Further studies, with a qualitative design, are needed to throw light on the patient's experience of being ill with stroke, and the process of his recovery.

First-time stroke survivors and caregivers’ perceptions of being engaged in rehabilitation

Aim. To explore community-dwelling first-time stroke survivors and family caregivers' perceptions of being engaged in stroke rehabilitation. Background. Stroke is recognized as a worldwide common healthcare problem and the leading cause of adult disability. An holistic approach to rehabilitation can only be achieved by engaging stroke survivors and caregivers in all stages of recovery and by providing ongoing coordinated rehabilitation programmes.