Relational interaction in occupational therapy: Conversation analysis of positive feedback

Rehabilitation with brain-computer interface and upper limb motor function in ischemic stroke: A randomized controlled trial

BACKGROUND

Upper limb motor dysfunction is a major problem in the rehabilitation of patients with stroke. Brain-computer interface (BCI) is a kind of communication system that converts the "ideas" in the brain into instructions and has been used in stroke rehabilitation. This study aimed to investigate the efficacy and safety of BCI in rehabilitation training on upper limb motor function among patients with ischemic stroke.

METHODS

This was an investigator-initiated, multicenter, randomized, open-label, blank-controlled clinical trial with blinded outcome assessment conducted at 17 centers in China. Patients were assigned in a 1:1 ratio to the BCI group or the control group based on traditional rehabilitation training. The primary efficacy outcome is the difference in improvement of the Fugl-Meyer Assessment upper extremity (FMA-UE) score between two groups at month 1 after randomization. The safety outcomes were any adverse events within 3 months.

FINDINGS

A total of 296 patients with ischemic stroke were enrolled and randomly allocated to the BCI group (n = 150) and the control group (n = 146). The primary efficacy outcomes of FMA-UE score change from baseline to 1 month were 13.17 (95% confidence interval [CI], 11.56-14.79) in the BCI group and 9.83 (95% CI, 8.19-11.47) in the control group (mean difference between groups was 3.35; 95% CI, 1.05-5.65; p = 0.0045). Adverse events occurred in 33 patients (22.00%) in the BCI group and in 31 patients (21.23%) in the control group.

CONCLUSIONS

BCI rehabilitation training can further improve upper limb motor function based on traditional rehabilitation training in patients with ischemic stroke. This study was registered at ClinicalTrials.gov: NCT04387474.

FUNDING

This work was supported by the National Key R&D Program of China (2018YFC1312903), the National Key Research and Development Program of China (2022YFC3600600), the Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University (CCMU2022ZKYXZ009), the Beijing Natural Science Foundation Haidian original innovation joint fund (L222123), the Fund for Young Talents of Beijing Medical Management Center (QML20230505), and the high-level public health talents (xuekegugan-02-47).

Procedural Detailing: A Patient's Practice for Normalizing Routine Behaviors

In palliative care in the UK, occupational and/or physiotherapists consult with patients to assess how they are managing their activities for daily living in light of their life-limiting condition(s), and to identify any activities that might benefit from therapeutic intervention. In this paper we use conversation analysis to describe a patient's practice in these consultations, which we call "procedural detailing," whereby they produce a step-by-step description of how they do some everyday activity, such that it is depicted as adequate, stable, and unproblematic. Based on a collection of 15 cases identified in video recordings of consultations in a large English hospice, we demonstrate how patients use this practice to normalize their routine conduct and thereby reject or rule out an actual or anticipated therapeutic recommendation. Our analysis suggests that such descriptions let patients participate in shared decision-making by revealing their preference for routines that preserve their level of independence and dignity.

Occupational and Physical Therapists' Use of Intrapersonal and Interpersonal Emotion Regulation Strategies During Patient Interactions: A Qualitative Study

IMPORTANCE

Occupational and physical therapists' use of intrapersonal and interpersonal emotion regulation strategies may play an important role in building therapeutic relationships, but little is known about how they use these strategies during patient interactions.

OBJECTIVE

To understand how therapists use intrapersonal and interpersonal emotion regulation strategies during their patient interactions.

DESIGN

This qualitative study consisted of two stages of data collection. In Stage 1, therapists were interviewed regarding how they use emotion regulation strategies in their therapeutic relationships. In Stage 2, patient-therapist dyads were observed during treatment sessions and then interviewed at the end of the therapeutic relationship.

SETTING

Inpatient and outpatient rehabilitation hospitals and clinics in the United Kingdom.

PARTICIPANTS

In Stage 1, 13 occupational therapists and 9 physical therapists participated; in Stage 2, 14 patient-therapist dyads participated.

OUTCOME AND MEASURES

A semistructured interview guide was used to ask therapists how they use emotion regulation strategies during patient interactions.

RESULTS

Therapists used a wide range of interpersonal and intrapersonal emotion regulation strategies that can be categorized in prominent emotion regulation strategy taxonomies. They used these strategies both proactively, in anticipation of emotional events, and reactively, in response to emotional events. Their use helped them to build and maintain the therapeutic relationship and to protect themselves, feel better, and get their jobs done.

CONCLUSIONS AND RELEVANCE

The ability to regulate one's own and others' emotions is an essential part of therapists' work. In this study, therapists used a wide range of emotion regulation strategies to benefit themselves and their patients. What This Article Adds: This is the first study to identify the specific intrapersonal and interpersonal emotion regulation strategies used by occupational and physical therapists during patient-therapist interactions. This study makes an important contribution to understanding therapists' use of proactive and reactive emotion regulation strategies to build and maintain therapeutic relationships.

Patients' and professionals' perspectives on the consideration of patients' convenient therapy periods as part of personalised rehabilitation: a focus group study with patients and therapists from inpatient neurological rehabilitation

BACKGROUND

Research on the optimal period for administering health services, especially rehabilitation interventions, is scarce. The aims of this study were to explore the construct of patients' convenient therapy periods and to identify indicators based on the perspectives of patients and different health professionals from inpatient neurological rehabilitation clinics.

METHODS

This study was part of a larger project on patients' convenient therapy periods following a mixed methods approach. In the current study a grounded theory approach was employed based on the use of focus group interviews. Focus group interviews were conducted in three different inpatient neurological rehabilitation clinics. Patients and therapists from inpatient neurological rehabilitation clinics who were able to speak and to participate in conversations were included.

RESULTS

A total of 41 persons, including 23 patients and 18 therapists, such as music and occupational therapists, participated in a total of six focus group interviews. The analysis of the focus group interviews resulted in the identification of a total of 1261 codes, which could be summarised in fifteen categories. However, these categories could be divided into five indicators and ten impact factors of convenient therapy periods. Identified indicators were verbal and non-verbal communication, mental functions, physiological needs, recreational needs, and therapy initiation.

CONCLUSIONS

The results provide initial evidence that convenient therapy periods are clinically relevant for patients and therapists. Different states of patients' ability to effectively participate in a rehabilitation intervention exist. A systematic consideration of patients' convenient therapy periods could contribute to a personalised and more efficient delivery of intervention in neurological rehabilitation. To our knowledge, this study is one of the first attempts to research convenient therapy periods.

Unidimensional analysis of the nursing diagnoses of situational low self-esteem and chronic low self-esteem

PURPOSE

To analyze the unidimensionality of the nursing diagnoses low situational self-esteem and low chronic self-esteem proposed by NANDA-I.

DESING AND METHODS

Diagnostic accuracy study carried out with 180 patients with depressed mood in a psychiatric hospital in northeastern Brazil.

FINDINGS

The analysis of the latent class considered the hypothesis of low self-esteem as a unique construct and included the indicators: Excessive seeking of reassurance, repeatedly unsuccessfulness in life events, rejection of positive feedback, insomnia, solitude, and nonassertive behavior.

PRACTICE IMPLICATIONS

The recognition of low self-esteem as a unique diagnostic construct allows nurses to be more assertive in the provision of care.

Meaning-making in occupational therapy interventions: a scoping review

Abstract Introduction Meaning-making is an experience-centred process. It is an essential element for understanding the impact of occupational therapy interventions focused on fostering processes of becoming, one of the four integrated dimensions of meaningful occupation (along with doing, being, and belonging). Objective This paper aims to explore further some of the aspects that are essential for meaning-making in occupational therapy interventions. Method A scoping review guided by Arksey and O’Malley’s methodological framework was conducted. In the initial search, 528 articles were retrieved from three databases; 16 met the criteria for inclusion: articles in English, peer-reviewed, published between January 2008 and December 2017, that addressed some type of occupational therapy intervention, with data related to the meanings of the participants of the studies. Results The articles address a multiplicity of populations, services, and fields of practice, in qualitative studies, with methodologies that prioritise reflection on the lived experience. Thematic analysis highlights the interconnection between being, doing, and belonging to foster meaning-making; implications of professional actions; and meaning-making triggered by reflective processes. Conclusion Meaning-making demands reflection on the lived experience, and is influenced by human and physical environments. Both conditions/limitations and new skills/abilities enhance processes of meaning-making. Implications for future research are considered.

Brain Functional Networks Study of Subacute Stroke Patients With Upper Limb Dysfunction After Comprehensive Rehabilitation Including BCI Training

Brain computer interface (BCI)-based training is promising for the treatment of stroke patients with upper limb (UL) paralysis. However, most stroke patients receive comprehensive treatment that not only includes BCI, but also routine training. The purpose of this study was to investigate the topological alterations in brain functional networks following comprehensive treatment, including BCI training, in the subacute stage of stroke. Twenty-five hospitalized subacute stroke patients with moderate to severe UL paralysis were assigned to one of two groups: 4-week comprehensive treatment, including routine and BCI training (BCI group, BG, n = 14) and 4-week routine training without BCI support (control group, CG, n = 11). Functional UL assessments were performed before and after training, including, Fugl-Meyer Assessment-UL (FMA-UL), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT). Neuroimaging assessment of functional connectivity (FC) in the BG was performed by resting state functional magnetic resonance imaging. After training, as compared with baseline, all clinical assessments (FMA-UL, ARAT, and WMFT) improved significantly (p < 0.05) in both groups. Meanwhile, better functional improvements were observed in FMA-UL (p < 0.05), ARAT (p < 0.05), and WMFT (p < 0.05) in the BG. Meanwhile, FC of the BG increased across the whole brain, including the temporal, parietal, and occipital lobes and subcortical regions. More importantly, increased inter-hemispheric FC between the somatosensory association cortex and putamen was strongly positively associated with UL motor function after training. Our findings demonstrate that comprehensive rehabilitation, including BCI training, can enhance UL motor function better than routine training for subacute stroke patients. The reorganization of brain functional networks topology in subacute stroke patients allows for increased coordination between the multi-sensory and motor-related cortex and the extrapyramidal system. Future long-term, longitudinal, controlled neuroimaging studies are needed to assess the effectiveness of BCI training as an approach to promote brain plasticity during the subacute stage of stroke.