Experiences of Occupational Therapists in Stroke Rehabilitation: Dilemmas of Some Occupational Therapists in Inpatient Stroke Rehabilitation

Abstract

Daniëls R, Winding K, Borell L. Experiences of occupational therapists in stroke rehabilitation: dilemmas of some occupational therapists in inpatient stroke rehabilitation. Scand J Occup Ther 2002; 9: 167 -175.The aim of this study was to explore and gain an understanding of occupational therapists' experiences of therapy with patients in inpatient stroke rehabilitation, through the identi cation of their deliberations for practice. Two focus-group interviews were conducted. The deliberations for action were triggered by using a written case sample. The analysis of the study involved a perspective of meaning interpretation of the statements of the occupational therapists. The meaning structure that arose was that occupational therapists experience dilemmas when they are considering the courses of action open to them. Three dilemmas were named: ''focusing on adaptation while the patient is focused on recovery'', ''being client centred and protective simultaneously'' and ''setting meaningful goals in an institutional context''. The results of the study are discussed in relation to theoretical concepts in occupational therapy: a two-body practice, client centredness and meaningful goal setting in a realistic context. Further research regarding the use of meaningful occupation in stroke rehabilitation is recommended.

Task‐specific training: evidence for and translation to clinical practice

“…Again, much of this may not be new to readers, but may provide evidence to support practices already applied. However, there is some evidence that the inpatient setting particularly can raise competing agendas for therapists (Daniëls et al, 2002), and these strategies may serve to refocus the efforts of therapists in their prescription of neuromotor interventions.…”

Understanding and supporting occupational therapists clinical decision-making for the management of upper limb post stoke sensory impairment

“…This is consistent with the dilemma noted in a study involving two focus groups with 13 occupational therapists experienced in stroke rehabilitation (Daniels, Winding, & Borell, 2002). While these therapists found it difficult to balance remedial and compensatory approaches there remain arguments for both to be offered during rehabilitation when appropriate.…”

“…This divergence between the stroke survivors' goals and the therapists' focus has been described previously in a qualitative study with occupational therapists working in stroke rehabilitation (Daniels, Winding, & Borell, 2002). Daniels et al proposed that one way of addressing this difference might be to take an occupation-based approach to therapy as it could provide an alternative focus potentially sitting between remedial and compensatory approaches.…”

“…The aetiology of post-stroke fatigue is multifactorial and often unclear and while fatigue due to mental effort has not been frequently identified in the literature (McGeough, Pollock, Smith, Dennis, Sharpe, Lewis, at al., 2010;Daniels, Winding, & Borell, 2002), fatigue specifically related to compensating for ULPSSI has not been previously mentioned. This study identified a potential role that additional mental effort plays in adding to the overall post-stroke fatigue burden.…”

“…While these therapists found it difficult to balance remedial and compensatory approaches there remain arguments for both to be offered during rehabilitation when appropriate. Daniels, Winding and Borell (2002) suggest that using an occupation-based approach to rehabilitation may ease the distinction between remedial and compensatory approaches in the rehabilitation. Safety and the ability to use compensatory approaches to participate in activities and enable positive experiences are important.…”