Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Current evidence on robot-assisted therapy to improve use of the paretic upper extremity during everyday activities is limited. Semistructured interviews and thematic analysis investigated 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 during robot-assisted therapy transferred to paretic upper extremity use during daily occupations.
Primary Author and Speaker: Madison R. Costa
Contributing Authors: Susan E. 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 occupations is limited. The Active Learning Program for Stroke (ALPS) is a novel program that combines 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 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 the 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 second objective (re: factors impacting home program adherence) included: task difficulty, time availability, energy level, motivation, and meaningfulness of participant-chosen activities.
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 otherwise 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 of chosen activities, task difficulty), and environmental (time availability) factors that were mentioned across patient interviews.
IMPACT STATEMENT: This study suggests that cognitive strategy-based home programs such as ALPS may enhance the functional outcomes of robot-assisted therapy interventions by facilitating active problem-solving and functional use of the paretic arm 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
Fasoli, S.E. & Adans-Dester, C.A. (2019). A paradigm shift: Rehabilitation robotics, cognitive skills training and function after stroke. Frontiers in Neurology, 10(1088). https://doi.org/10.3389/fneur.2019.01088
Proffitt R. (2016). Home exercise programs for adults with neurological injuries: A Survey. The American Journal of Occupational Therapy: Official publication of the American Occupational Therapy Association, 70(3), 7003290020. https://doi.org/10.5014/ajot.2016.019729
Radomski, M.V. (2011). More than good intentions: Advancing adherence to therapy recommendations. American Journal of Occupational Therapy, 65, 471-477. https://doi.org/10.5014/ajot.2011.000885
Saldana, J. (2000). Coding manual for qualitative researchers. Los Angeles, CA: Sage Publications.
