Guided and Directed Cues: Developing a Standardized Coding Scheme for Clinical Practice

Abstract

Guided cues facilitate discovery of problems and strategies. Directed cues are instructional statements and commands. Both types of cues are used by therapists to promote learning; yet, little is known about the frequency and effects of these cues in clinical practice. We developed a standardized coding scheme for characterizing training cues. We recorded 27 sessions among 10 participants engaged in inpatient rehabilitation after stroke. Two raters coded type and number of cues on 33% of sessions. We resolved discrepancies between raters and refined the standardized coding scheme, achieving excellent inter-rater reliability (ICC = 0.950, guided cues; ICC = 0.995, directed cues). We applied the final coding scheme to all 27 sessions (10 participants). Average cues per minute ranged from 1 to 13. Guided cues were less frequent than directed cues. This study sets the stage for future, larger studies designed to examine the significance of the number and types of cues in usual practice.