Vasanthan Rajagopalan1, Manikandan Natarajan2, Johnson Alex3, John M Solomon2. 1. Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India. Electronic address: rvasanthan1@gmail.com. 2. Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India; Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Acdemy of Higher Education, Manipal, India. 3. Department of Behavior Sciences, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia.
Abstract
OBJECTIVE: To explore the personal and environmental contextual factors that influence use of affected arm for function among stroke survivors. METHODS: We conducted a qualitative phenomenological study using an interpretivist paradigm among 23 stroke survivors in their late sub-acute and chronic stages and their relatives living in the rural regions of India using maximum variation sampling. Semi-structured interviews were conducted to identify personal and environmental contextual factors relevant to arm use. Their current level of arm use, motor and functional ability were evaluated using Motor Activity Log, AbilHand and Lawton Instrumental Activities of Daily Living scales and the scores were categorized in order to describe and compare the participant's characteristics before analyzing each interview. Differences among the contextual factors of participants with high and low levels of functional arm use and exercise using paretic limb were analyzed using qualitative content analysis. RESULTS: Study participants followed active exercises or passive interventions to improve their arm. Their immediate social environment influenced these decisions. Lack of awareness on how to self-engage or scale down their physical environment to match their abilities demoted active functional task performance. Ability to perceive small gains in arm function helped them sustain their efforts. CONCLUSION: Context influences arm use. Addressing contextual determinants influencing arm use such as facilitating understanding about the need for active functional task engagement; identifying and addressing factors moderating motivation to sustain functional task practice and enriching objects to match their movement abilities can increase arm use and promote upper limb recovery.
OBJECTIVE: To explore the personal and environmental contextual factors that influence use of affected arm for function among stroke survivors. METHODS: We conducted a qualitative phenomenological study using an interpretivist paradigm among 23 stroke survivors in their late sub-acute and chronic stages and their relatives living in the rural regions of India using maximum variation sampling. Semi-structured interviews were conducted to identify personal and environmental contextual factors relevant to arm use. Their current level of arm use, motor and functional ability were evaluated using Motor Activity Log, AbilHand and Lawton Instrumental Activities of Daily Living scales and the scores were categorized in order to describe and compare the participant's characteristics before analyzing each interview. Differences among the contextual factors of participants with high and low levels of functional arm use and exercise using paretic limb were analyzed using qualitative content analysis. RESULTS: Study participants followed active exercises or passive interventions to improve their arm. Their immediate social environment influenced these decisions. Lack of awareness on how to self-engage or scale down their physical environment to match their abilities demoted active functional task performance. Ability to perceive small gains in arm function helped them sustain their efforts. CONCLUSION: Context influences arm use. Addressing contextual determinants influencing arm use such as facilitating understanding about the need for active functional task engagement; identifying and addressing factors moderating motivation to sustain functional task practice and enriching objects to match their movement abilities can increase arm use and promote upper limb recovery.
Authors: Gert Kwakkel; Roland van Peppen; Robert C Wagenaar; Sharon Wood Dauphinee; Carol Richards; Ann Ashburn; Kimberly Miller; Nadina Lincoln; Cecily Partridge; Ian Wellwood; Peter Langhorne Journal: Stroke Date: 2004-10-07 Impact factor: 7.914
Authors: Heidi Janssen; Julie Bernhardt; Janice M Collier; Emily S Sena; Patrick McElduff; John Attia; Michael Pollack; David W Howells; Michael Nilsson; Mike B Calford; Neil J Spratt Journal: Neurorehabil Neural Repair Date: 2010-09-12 Impact factor: 3.919
Authors: Valery L Feigin; Mohammad H Forouzanfar; Rita Krishnamurthi; George A Mensah; Myles Connor; Derrick A Bennett; Andrew E Moran; Ralph L Sacco; Laurie Anderson; Thomas Truelsen; Martin O'Donnell; Narayanaswamy Venketasubramanian; Suzanne Barker-Collo; Carlene M M Lawes; Wenzhi Wang; Yukito Shinohara; Emma Witt; Majid Ezzati; Mohsen Naghavi; Christopher Murray Journal: Lancet Date: 2014-01-18 Impact factor: 79.321