Interaction with the Physical Environment in Everyday Occupation after Stroke: A Phenomenological Study of Persons with Visuospatial Agnosia

Recovery beyond functional restoration: a systematic review of qualitative studies of the embodied experiences of people who have survived a stroke

OBJECTIVE

To synthesise the qualitative evidence of embodied experiences of people who have survived a stroke, the experiences of making sense of oneself, others and the world in the poststroke bodies.DesignQualitative systematic review.

DATA SOURCES

Five electronic databases, PsycINFO, PubMed, MEDLINE, CINAHL Plus and Cochrane Library, were employed to search for qualitative studies published up to February 2022.

INCLUSION CRITERIA

Literature in English that employed qualitative methods to investigate the embodied experiences of people who have survived a stroke.

QUALITY APPRAISAL

Two reviewers independently appraised the quality of the included studies based on the tool developed by Salter et al in 2008. It consists of seven questions assessing the credibility and relevance of the studies. Discrepancies were resolved until a consensus was reached.

DATA EXTRACTION AND SYNTHESIS

Thematic synthesis was applied to synthesise the related findings from all the included studies. Two reviewers were involved in the process.

RESULTS

1482 records were identified. After the screening process, 34 studies were included in this review. Three analytical themes and their related descriptive themes emerged. Analytical themes included 'disconnection between oneself, others and the world,' 'the transitional period: exploring and negotiating,' and 'reconnecting with oneself, others and the world'.

CONCLUSION

The findings demonstrated that the embodied experiences of people who have survived a stroke progressed from feeling disconnected to reconnecting with themselves, others and the world. Stroke recovery should not only be limited to functional restoration. Approaching 're-embodiment', the realignment between oneself and one's body, is crucial in reintegrating with others and the world on the trajectory toward recovery.

PROSPERO REGISTRATION NUMBER

CRD42020183125.

Built environments for inpatient stroke rehabilitation services and care: a systematic literature review

OBJECTIVES

To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff.

DESIGN

A convergent segregated review design was used to conduct a systematic review.

DATA SOURCES

Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff.

DATA EXTRACTION AND SYNTHESIS

Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies.

RESULTS

Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being.

CONCLUSIONS

Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care.

PROSPERO REGISTRATION NUMBER

CRD42020158006.

Activities in Daily Living: The development of a new client-centred ADL intervention for persons with stroke

BACKGROUND

An intervention that contains several interacting components can be defined as a complex intervention. This intervention was developed in accordance with the Medical Research Council (MRC) guidance for complex interventions.

AIM

To describe the development, theoretical framework, and content of a client-centred activities in daily living intervention (CADL) for people with stroke.

MATERIAL AND METHODS

Different steps were used; identifying the evidence base, identifying/developing theory and the modelling process and outcomes in the development of the CADL. The remodelling of the process and content of the intervention that emerged are defined.

RESULTS

Findings from a series of qualitative studies of people with stroke demonstrated the need to develop an ADL intervention based on the clients' lived experiences. The theoretical framework is based on empirical research, theories about human occupation and client-centredness. The CADL is applying an occupational and phenomenological perspective in order to enable agency in daily activities and participation in everyday life among persons with stroke.

CONCLUSIONS AND SIGNIFICANCE

The article can be used as an example of how to present the development and theoretical framework of a new complex intervention in occupational therapy.

Home setting after stroke, facilitators and barriers: A systematic literature review

This paper seeks to improve the understanding of the interaction between patients with stroke and the physical environment in their home settings. Stroke care is increasingly performed in the patient's home. Therefore, a systematic review was conducted to identify the existing knowledge about facilitators and barriers in the physical environment of home settings for the stroke rehabilitation process. Based upon Arksey and O'Malley's framework, a Boolean search strategy was performed in the databases; CINAHL, Medline, Web of Science and Scopus. Fifteen articles were retained from the literature search conducted between August and November 2016, and two researchers independently assessed their quality based on the Swedish Council on Health Technology Assessment guidelines. The results suggest that despite the healthcare system's ongoing shift towards home-based rehabilitation, the role played by the physical environment of home settings is still considered a side finding. Moreover, the research appears to focus mainly on how this environment supports mobility and activities of daily living, whereas information regarding the psychosocial and emotional processes that mediate the interaction between stroke survivors and their home setting are missing. A lack of information was also found with regard to the influence of different geographic locations on the stroke rehabilitation process. Future investigations are therefore needed to advance the understanding of the role played by the physical environment of home settings in supporting stroke recovery.

Work remains meaningful despite time out of the workplace and chronic pain

PURPOSE

Although work has been found to be meaningful and a source of motivation to return to work in certain disabled populations, it was unclear if this was also true for people experiencing a long period of unemployment and job loss due to a musculoskeletal injury. Therefore, the aim of this phenomenological study was to explore the meaning of work for those with chronic work disability due to a musculoskeletal injury.

METHOD

The data from 27 interviews, conducted with 9 participants, was analyzed using the Empirical Phenomenological Psychological method.

RESULTS

Work remained central to the lives of the participants and aligned with previous valued work outcomes and goals regardless of the amount of time away from work. These findings point to the importance of recognizing the ongoing centrality of work for those with chronic work disability and the importance of tapping into work values and beliefs to provide workers with the motivation needed to get past physical and systemic barriers to return to work.

CONCLUSIONS

This study shows that a shift in focus back to meaning not only has benefits for people with chronic work disability, but for occupational therapists in their ability to make a unique and effective contribution to the field of work disability. Implications for rehabilitation The chronic work disabled population remains one of the most challenging to return to work. Reflection on the meaning of work provides motivation needed for clients to overcome barriers to work including chronic pain. Exploring meaning is not difficult or time consuming in vocational rehabilitation.

Phenomenological Research: An Exploration of Conceptual, Theoretical, and Practical Issues

Phenomenological research has become increasingly popular in occupational therapy in recent years. However, phenomenological inquiry is one of the most philosophically and theoretically complex research traditions, many aspects of which remain poorly understood. This article is intended for individuals either interested in or about to conduct phenomenological research. It examines the conceptual foundations of phenomenology, particularly Heideggerian phenomenology, including an exploration of the concept of Being. A case example of how these concepts can be developed within an occupationally focused research project is presented. The article concludes with reflections on the value of phenomenological research in understanding complex, situated phenomena of interest to occupational therapists.

The Lived Experience of Memory Impairment in Daily Occupation after Acquired Brain Injury

The objective of this study was to identify what characterized the lived experience of memory impairment in daily occupations during the first year after acquired brain injury. Four participants were interviewed on four occasions during the year after the brain injury. The data were collected and analyzed using the Empirical Phenomenological Psychological method. The findings revealed four main characteristics that described the individual's experiences during the year of rehabilitation: a chaotic life-world, struggling for coherent doing in new contexts, conscious strategies in new contexts, and achieving new habits. After the brain injury, the life-world changed from a taken-for-granted existence to a chaotic world that was difficult to understand. The routine performance of daily activities and the habit patterns had broken down, so it was mostly the familiar activities that were already integrated in the “habit-body” that enabled coherent doings in everyday life during the year. The findings contribute to an understanding of how to use familiar and meaningful occupations as a therapeutic medium in the rehabilitation of clients with memory impairment following acquired brain injury.

Experience and Meaning of Group Altruistic Activities among Long-Term Care Residents

Purpose:

A phenomenological investigation was conducted of the experiences of long-term care residents as they planned, participated and reflected on their engagement in an altruistic activity.

Procedures:

Eight residents planned and engaged in the creation of flower arrangements and greeting cards for local hospice patients. Data were collected via in-depth group and individual interviews, as well as field notes. The process of data analysis was guided by the empirical, phenomenological and psychological method.

Findings:

A grand theme of ‘connectedness’ emerged and was supported by four underlying subthemes: (a) creative and thoughtful activity, (b) sense of community, (c) facilitation of reminiscence and (d) reciprocity.

Conclusion:

Through engagement in an altruistic activity, the participants developed a sense of connection with their pasts, the others in the group, the recipients and the activity itself. The findings suggest that occupational therapy services should include altruistic activities to help to facilitate a greater sense of connection for their clients.

The Meaning of Occupational Gaps in Everyday Life in the First Year after Stroke

This longitudinal study identified how occupational gaps were characterized in people's lived experiences of performing everyday occupations during the first year after stroke. Four participants were interviewed four times during the year after stroke. The data were collected and analyzed using the Empirical, Phenomenological, Psychological method. Five main characteristics were identified: (1) encountering occupational gaps in formerly taken-for-granted activities, (2) striving to narrow gaps in desired occupations, (3) recognizing oneself in doing, (4) searching for a new sense of self through doing, and (5) creating strategies to enable doing. The findings show the importance of being able to preserve some sense of self in everyday doings after a life course disruption caused by stroke. Important implications for clinical practice include sensitivity to clients' experiences during this process, enablement of experiences in occupations promoting recognition, and support of clients in recapturing desired occupations.

The Occupational Experience of Stroke Survivors in a Community Setting

The objective of this study was to explore the long-term experience of community-dwelling stroke survivors and identify influences on occupational engagement after stroke. In-depth, semi-structured interviews were conducted with 12 participants and a grounded theory approach was used for data analysis. Six men and 6 women between 42 and 92 years of age participated in this study. Time post-stroke varied between 1, 3, and 5 years. The findings identified three key themes from the data. The core theme “I can't” described changes in occupational engagement. The core theme “I feel” identified feelings associated with managing struggles in life as a result of stroke. The core theme “But now” identified modulating factors in adjustment to the experience of stroke. A concerning finding for the health system was the extent of depressive symptomatology attributed to reduced occupational engagement. This calls for improved assessment and education regarding mood changes post-stroke and should be underpinned by interventions. The essential role of occupational therapists in this context is to provide support and education regarding mood changes and to promote participation after stroke.

Characteristics associated with falls in patients with dementia in a psychogeriatric ward

BACKGROUND AND AIMS

Few studies have reported fall-risk factors for persons with dementia, and no successful randomized fall prevention studies have been published. The aim of this study was to identify characteristics associated with falls in patients with dementia in a psychogeriatric ward.

METHODS

This prospective study comprised 204 patients with any diagnosis of dementia. It was carried out in a psychogeriatric ward specializing in the assessment and treatment of behavioral and psychological symptoms in patients with dementia (BPSD). Baseline patient data were collected from medical records, and covered physical, behavioral and cognitive areas. Falls were recorded during time spent in the ward and median follow-up time was 52.5 days.

RESULTS

Eighty-two patients fell a total of 251 times. Factors significantly and independently associated with an increased risk of falling were male sex (IRR 3.36, 95% CI 2.02-5.61), failed "copy design" activity (decreased visual perception) (IRR 2.37, 95% CI 1.24-4.52), and any walking difficulty on level ground (IRR 1.84, 95% CI 1.10-3.08). Statins were associated with a decreased risk of falling (IRR 0.29, 95% CI 0.10-0.86). Twenty-seven percent of the variation in falls was explained.

CONCLUSIONS

Male sex, decreased visual perception, and walking difficulties were all associated with an increased number of falls, and the model explained 1/4 of the variation in falls. Well-planned furnishing and use of color to achieve a plain, clearly defined environment, as well as training in walking ability, may decrease the risk of falling in people with dementia.

Are different affordances subserved by different neural pathways?

This paper questions whether affordances are allied exclusively to dorsal stream processing within the visual system, or whether in fact different affordances are subserved by functionally independent neural pathways. Using case study evidence from patients with various visual pathologies, I argue that affordances can be categorised into type based upon their respective neurological underpinning. Such categorisation has implications for the extent to which affordances are consciously perceived or non-consciously 'picked up' within the optic array, as well as whether they indicate merely potentials for action or provide necessary information in the actualisation of behaviour.