Bruce H Dobkin1. 1. Geffen School of Medicine at the University of California Los Angeles, Reed Neurologic Research Center, Los Angeles, California, USA.
Abstract
PURPOSE OF REVIEW: Rehabilitation trials and postacute 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. RECENT 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 telerehabilitation 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.
PURPOSE OF REVIEW: Rehabilitation trials and postacute 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. RECENT 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 telerehabilitation 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.
Authors: Pamela W Duncan; Katherine J Sullivan; Andrea L Behrman; Stanley P Azen; Samuel S Wu; Stephen E Nadeau; Bruce H Dobkin; Dorian K Rose; Julie K Tilson; Steven Cen; Sarah K Hayden Journal: N Engl J Med Date: 2011-05-26 Impact factor: 91.245
Authors: Stephen E Nadeau; Samuel S Wu; Bruce H Dobkin; Stanley P Azen; Dorian K Rose; Julie K Tilson; Steven Y Cen; Pamela W Duncan Journal: Neurorehabil Neural Repair Date: 2013-03-15 Impact factor: 3.919
Authors: Annemarie Koster; Paolo Caserotti; Kushang V Patel; Charles E Matthews; David Berrigan; Dane R Van Domelen; Robert J Brychta; Kong Y Chen; Tamara B Harris Journal: PLoS One Date: 2012-06-13 Impact factor: 3.240
Authors: Marilyn MacKay-Lyons; Sandra A Billinger; Janice J Eng; Alex Dromerick; Nicholas Giacomantonio; Charlene Hafer-Macko; Richard Macko; Emily Nguyen; Peter Prior; Neville Suskin; Ada Tang; Marianne Thornton; Karen Unsworth Journal: Phys Ther Date: 2020-01-23
Authors: Amanda McIntyre; Stephanie L Marrocco; Samantha A McRae; Lindsay Sleeth; Sander Hitzig; Susan Jaglal; Gary Linassi; Sarah Munce; Dalton L Wolfe Journal: Top Spinal Cord Inj Rehabil Date: 2020