Marsha Neville

Loss, Gain, and the Reframing of Perspectives in Long-Term Stroke Survivors: A Dynamic Experience of Quality of Life

Abstract Purpose: Little is known about stroke survivors’ subjective quality of life experience. The purpose of this study was to understand the lived experience of quality of life in 6 long-term stroke survivors. Method: Using a phenomenological design, we interviewed participants (who were 21 months to 11 years post stroke) twice and gave them journals to write in between interviews. Data were evaluated using thematic analysis. Results: The main theme, “It makes me feel like a human again,” integrates 2 subthemes – activity loss: “That’s what I miss” and awakening: “Reality comes to your world.” The main theme describes quality of life as a constantly changing experience, and the subthemes elaborate on the process of change. Conclusion: Themes described quality of life as a dynamic experience that changed as activities of value were lost or gained and as participants experienced changes in their perspectives, beliefs, values, and behaviors. The discussion examines these themes through the lens of the Model of Human Occupation and the Shifting Perspectives Model of Chronic Illness. Clinical implications of the results are also discussed.

Task Oriented Training and Evaluation at Home

Principles of experience-dependent plasticity, motor learning theory, and the theory of Occupational Adaptation coalesce into a translational model for practice in neurorehabilitation. The objective of this study was to explore the effectiveness of a Task Oriented Training and Evaluation at Home (TOTE Home) program completed by people with subacute stroke, and whether effects persisted 1 month after this training. A single-subject design included a maximum of 30, 1hour sessions of training conducted in participants’ homes. Repeated target measures of accelerometry and level of confidence were used to assess movement and confidence in weaker arm use through baseline, intervention, and follow-up phases of TOTE Home. Four participants completed TOTE Home and each demonstrated improvement in movement and confidence in function. The degree of improvement varied between participants, but a detectable change was evident in outcome measures. TOTE Home, using client-centered, salient tasks not only improved motor function but also facilitated an adaptive response demonstrated in continued improvement beyond the intervention.

How Patient Educators Teach Students: “Giving a Face to a Story”

Patient Educators are persons with specific pathologies that have participated in an education program in which they learn how to instruct students on physical examinations. The aim of this study was to explore the impact of graduate student experiences with Patient Educators during coursework on occupational therapy clinical internships. A phenomenological design was used to explore the lived experiences of students through a qualitative interview. As participants described their experiences with the Patient Educators, three primary themes emerged: (a) self-awareness, (b) confidence, and (c) empathy. The quotes from the transcriptions were organized into four sequential plot categories: (a) Before the Interaction, (b) During the Interaction, (c) Immediate Change, and (d) Impact on Clinical Internship. The results reveal a narrative of the learning process experienced by students from before the Patient Educators lab through clinical internships. These results suggest that incorporating Patient Educators in the classroom could be a critical component in preparing students for clinical internship and future clinical practice.

Client Perceptions of Task-Oriented Training at Home: “I Forgot I Was Sick”:

Task-oriented training is a contemporary intervention based on behavioral neuroscience and recent models of motor learning. It can logically be guided by the theory of occupational adaptation. This report presents the perceptions of four participants who underwent task-oriented training at home (TOTE Home) for upper extremity hemiparesis following a stroke. Guided by principles of motor learning and the theory of occupational adaptation, a directed content analysis was used with field notes recorded during the TOTE Home. Three themes emerged: salience of the activity within context, desire for mastery by creating the just right challenge, and adapted self-perception of abilities. While motor learning principles informed the method of task practice and feedback, it was the person’s desire to perform meaningful, relevant activities that drove the adaptive process. This study provided insight in the perceptions and experiences of participants undergoing TOTE Home.

In-home contextual reality: a qualitative analysis using the Multiple Errands Test Home Version (MET-Home)

ABSTRACT Adults with stroke frequently experience executive dysfunction. Despite the range of assessments that examine the effects of executive dysfunction on daily tasks, there remains a paucity of literature that examines the influence of the environment on performance in the community. The MET-Home is an ecologically valid assessment for examining post-stroke executive dysfunction in the home environment. This qualitative study explores the relationship between the environment and MET-Home performance among home-dwelling adults with stroke and matched controls. Using a descriptive qualitative approach, we analysed video, interview, and observation notes from a MET-Home validation study. An overarching theme of interplay between everyday task performance and the home environment produced further themes: naturalistically emerging supports and barriers and environment as strategy. Within naturalistically emerging supports and barriers, five contextual sub-themes were discovered: physical environment, social environment, temporal context, virtual context, and personal context. Within environment as strategy, we identified four sub-themes: reducing distractions, using everyday technologies, planning in context, and seeking social support. These findings extend the conceptualisation of how we evaluate executive dysfunction in the context of the community to also consider the inherent influence of the environment.