Date Presented 03/28/20
Current evidence on robot-assisted therapy for improved use of a paretic upper extremity during everyday activities is limited. This study used semistructured interviews to investigate participants’ experiences with a novel cognitive-strategy-based protocol for individuals who had a stroke in order to gain a better understanding of how motor skills trained through robot-assisted therapy transferred to paretic upper-extremity use during daily occupational tasks.
Primary Author and Speaker: Madison Costa
Additional Authors and Speakers: Susan Fasoli
PURPOSE: Current evidence on the effects of robot-assisted therapy (RAT) to improve transfer of learned motor skills and functional use of the paretic upper extremity during everyday activities is limited. The Active Learning Program for Stroke (ALPS) is the first program to combine instruction in cognitive strategies and a task-oriented training home program with RAT for individuals with moderate upper extremity impairments. This study explored participants’ experiences with the ALPS program in order to: (1) Examine how components of the ALPS program impacted use of the paretic upper extremity during daily activities, and (2) Identify factors that contributed to home program adherence during intervention.
DESIGN: This study utilized qualitative methods, specifically semi-structured interviews with open-ended questions and thematic analysis to gather and interpret participant responses. A total of nine of the ten participants who were previously enrolled in an ALPS pilot study were included.
METHODS: Semi-structured interviews with open-ended questions were conducted individually with each participant. All interviews were audio-recorded and transcribed verbatim. Data was independently coded by both authors, responses were categorized, preliminary themes were extracted, and final themes were refined and evaluated for both internal homogeneity and external heterogeneity.
RESULTS: The data and thematic analysis identified two themes related to the study’s first objective: impact of strategies on performance (e.g. “Having a process to go through, to think through, and a sequence of steps to follow made it more logical”) and enhanced activity engagement with the paretic upper extremity (e.g. “I think without the program I would not have done most of these things [activities]”). The five themes of the study’s second objective (re: factors impacting home program adherence) included: task difficulty, time availability, energy level, motivation, and meaningfulness. All participants reported that they viewed the ALPS program as a beneficial experience that enhanced use of their paretic upper extremity during everyday tasks.
CONCLUSIONS: Participants reported that the ALPS program assisted with use of their paretic upper extremity for everyday activities by providing a step-wise problem-solving approach, chance to explore new specific strategies, and an opportunity to engage in activities that they would not have tried to do with their stroke-affected upper extremity. In addition, the data revealed that home program adherence was based on several personal (motivation, energy level), task (meaningfulness, task difficulty), and environmental (time availability) factors that were mentioned across participant interviews.
IMPACT STATEMENT: This study demonstrates that cognitive strategy-based home programs such as ALPS have the potential to enhance the functional outcomes of robot-assisted therapy interventions by facilitating active problem-solving and use of the paretic upper extremity post stroke. In addition given the current lack of literature on occupational therapy home program adherence, this study highlights several factors that therapists should consider when designing client-centered home programs.
References
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Radomski, M.V. (2011). More than good intentions: Advancing adherence to therapy recommendations. American Journal of Occupational Therapy, 65, 471-477. doi:10.5014/ajot.2011.000885
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Veerbeek, J.M., Langbroek-Amersfoort, A.C., Wegen, E.H., Meskers, C.G., & Kwakkel, G. (2017). Effects of robot-assisted therapy for the upper limb after stroke: A systematic review and meta-analysis. Neurorehabilitation and Neural Repair, 31(2), 107-121. doi: 10.1177/1545968316666957.
