Examining Guided and Directed Cues in Strategy Training and Usual Rehabilitation.

Therapist approach and feedback during rehabilitation may influence patient outcomes. It is unclear how much guided cueing, the approach used in strategy training, is present in usual rehabilitation care. We compared the frequency of guided and directed cueing in strategy training sessions with cueing in usual care occupational and physical therapy. We videotaped strategy training, occupational therapy, and physical therapy sessions among 20 patients admitted to inpatient rehabilitation after stroke. Using a standardized coding scheme, we coded and analyzed frequencies of therapists' cues (guided or directed). The proportion of guided cues was significantly higher in strategy training intervention (42%) compared with occupational therapy (4%) and physical therapy (3%). Preliminary research suggests that guided cueing may be more prevalent in strategy training than in usual care. Given that guided cueing provides more opportunity for patients to take an active role in their rehabilitation, guided cueing may lead to superior outcomes.