Behavioral self-management strategies for practice and exercise should be included in neurologic rehabilitation trials and care

Abstract

Purpose Rehabilitation trials and post-acute care to lessen impairments and disability after stroke, spinal cord injury, and traumatic brain injury almost never include training to promote long-term self-management of skills practice, strengthening and fitness. Without behavioral training to develop self-efficacy, clinical trials and home-based therapy may fail to show robust results. Findings Behavioral theories about self-management and self-efficacy for physical activity have been successfully incorporated into interventions for chronic diseases, but rarely for neurologic rehabilitation. The elements of behavioral training include education about the effects of practice and exercise that are relevant to the person, goal setting, identification of possible barriers, problem solving, feedback about performance, tailored instruction, decision making, and ongoing personal or social support. Mobile health and tele-rehabilitation technologies offer new ways to remotely enable such training by monitoring activity from wearable wireless sensors and instrumented exercise devices to allow real-world feedback, goal setting, and instruction. Summary Motivation, sense of responsibility and confidence to practice and exercise in the home can be trained to increase adherence to skills practice and exercise both during and after formal rehabilitation. To optimize motor learning and improve long-term outcomes, self-management training should be an explicit component of rehabilitation care and clinical trials.

Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study

“…29 increases as self-management progresses successfully. 30 CSE plays a significant role in both moderating and mediating effects on the well-being of caregivers. Studies have demonstrated that CSE has moderating effects on physical and psychological health as well as the coping ability of caregivers.…”

“…Caregiving self‐efficacy refers to caregivers' beliefs that they can perform confidently and are capable of responding to the demands of caregiving and is considered a key determinant of emotional and behavioural response to stressors . It has been found that CSE increases as self‐management progresses successfully . CSE plays a significant role in both moderating and mediating effects on the well‐being of caregivers.…”

A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training

“…28 Self-management training to develop self-efficacy for the practice of skills and exercise appears to be necessary and should be considered as a routine strategy in clinical trials and early post stroke care. 29,30 …”

The Evolution of Personalized Behavioral Intervention Technology

“…4 With the continuous, objective measurements of change during real-world activity that are provided by devices, therapists gain potentially powerful behavioral intervention technologies that, for the first time, enable personalized, remotely managed rehabilitation during clinical trials and post-inpatient care. 5 …”

“…5 With remote technology-supported trials, the therapist has a tool to teach self-efficacy for training. Telerehabilitation interactions based on monitoring devices can reinforce the person’s understanding of the health benefits of greater physical activity; identify possible personal and environmental barriers to activity and practice; teach problem solving; use behavioral intervention techniques such as goal setting, feedback about performance drawn from sensor data, tailored instruction, and reassessment of goals no less than once a week; and provide ongoing personal social support.…”