Stroke, Motivation and Rehabilitation Technology

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Stroke, Motivation and Rehabilitation Technology

• Ruth Moore
• Sheffield Hallam University
• December 2008

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The Smart Consortium
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Stroke Incidence

• 1999 110,000 had first stroke
• 54,000 survived
• 900,000 people living in England have survived a
  stroke
• Approximately 450,000 dependant on others for
  assistance with everyday activities.
• National clinical guideline for diagnosis and
  initial management of acute stroke and transient
• ischaemic attack (TIA) 2008 Royal College of
  Physicians

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Motivation

• Motivation refers to the influences that govern
  the initiation, direction, intensity and
  persistence of behaviour (Evans 1989)
• "Motivation of the patient is the most important,
  yet the most difficult part of the work of the
  therapeutic professions..." (O'Gorman, 1975)
• Motivation occurs at the pre-contemplation,
  contemplation, stages of action (Prochaska
  DiClemente 1983)

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Motivation

• Rehabilitation therapists commonly believe that
  motivation affects rehabilitation outcome
  (Maclean et al 2000)
• Apathy and low motivation are reported by
  rehabilitation staff and family members as being
  one of the most debilitating symptom they deal
  with in rehabilitation (Oddy, Cattran Wood
  2008 Wongpakaran van Reekum 2007).

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The Theory of Planned Behaviour

• A persons intention is a central determinant of
  their behaviour

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The Theory of Planned Behaviour

• Intention
• Attitudes toward behaviour
• Subjective norms
• Perceived control

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The Theory of Planned Behaviour

• Intention
• Attitudes toward behaviour

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The Theory of Planned Behaviour

• Intention
• Attitudes toward behaviour
• Good - bad

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The Theory of Planned Behaviour

• Intention
• Attitudes toward behaviour
• Good - bad
• Harmful beneficial

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The Theory of Planned Behaviour

• Intention
• Attitudes toward behaviour
• Good - bad
• Harmful beneficial
• Pleasant - unpleasant

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The Theory of Planned Behaviour

• Intention
• Attitudes toward behaviour
• Subjective norms

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The Theory of Planned Behaviour

• Intention
• Attitudes toward behaviour
• Subjective norms
• Perceived control
• (Ajzen Madden 1986 Ajzen Fishbein 1980)

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Motivation and Stroke

• Are these theories relevant to a stroke
  population?

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Motivation and Stroke

• Are these theories relevant to a stroke
  population?
• Does rehabilitation technology satisfactorily
  combine these theories?

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Motivation and Stroke

• Are these theories relevant to a stroke
  population?
• Does rehabilitation technology satisfactorily
  combine these theories?
• Do users report a change in their motivation for
  rehabilitation using rehabilitation technology?

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Rehabilitation

• Functional rehabilitation is more engaging
• (Merians et al 2006 Loureiro et al 2003
  Amirabdollahian et al. 2007)

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Rehabilitation

• Functional rehabilitation is more engaging
• (Merians et al 2006 Loureiro et al 2003
  Amirabdollahian et al. 2007)
• Repetition of movement increases recovery
• (Gaggioloi et al. 2006 Liebermann et al 2006)

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Rehabilitation

• Functional rehabilitation is more engaging
• Merians et al 2006 Loureiro et al 2003
  Amirabdollahian et al. 2007
• Repetition of movement increases recovery
• Gaggioloi et al. 2006 Liebermann et al 2006
• Once discharged from inpatient care patients
  access to community physiotherapy is limited
• Enderby Wade 2001

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Rehabilitation Technology
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Rehabilitation Technology
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Rehabilitation Technology
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Rehabilitation Technology
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Rehabilitation Technology Motivation
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Rehabilitation Technology Motivation

• Rehabilitation planning (Holmqvist von Koch
  2001)

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Rehabilitation Technology Motivation

• Rehabilitation planning (Holmqvist von Koch
  2001)
• Stroke education (Aujoulat, dHoore Deccache
  2007)

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Rehabilitation Technology Motivation

• Rehabilitation planning (Holmqvist von Koch
  2001)
• Stroke education (Aujoulat, dHoore and Deccache
  2007)
• Engaging patient in process
• Goal setting decision making
• (Siegert 2004 Levack et al. 2006 McClain 2005)
  

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Rehabilitation Technology Motivation

• Rehabilitation planning (Holmqvist von Koch
  2001)
• Stroke education (Aujoulat, dHoore and Deccache
  2007)
• Engaging patient in process
• Goal setting decision making
• (Siegert 2004 Levack et al. 2006 McClain 2005)
• Frequency of participation
• (Gaggioloi et al. 2006 Liebermann et al 2006)

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Research Questions

• Would the introduction of rehabilitation
  technology effect the motivation, participation
  and engagement of stroke patients in
  rehabilitation?
• Does the actuality match the theory?

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Research Questions

• What do therapists think?

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Research Questions

• What do therapists think?
• What do therapy educators think?

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Research Questions

• What do therapists think
• What do therapy educators think
• What did patients and their carers think

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Methodology

• Demonstration Interview with therapists
• Demonstration Interview with therapy educators
• Patients use of equipment

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Further Research

• What would be the experience of patients 2 of 3
  yrs post-stroke?
• RCT
• Equipment
• Quantitative measure of motivation

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Questions from Research

• Prototype
• Carers involvement needed
• Qualitative vs quantitative data
• Problems participants may encounter
• What happens after the study?

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Thank you for your attention.

• Any further questions?

37
References

• AUJOULAT, I. DHOORE, W. DECCACHE, A. (2007).
  Patient empowerment in theory and practice
  Polysemy or cacophony? online. Patient
  education and counselling, 66 (1), 13-20. at
  http//www.sciencedirect.com/science/article/B6TBC
  -4M81C24-2/1/c485e616cadba631194a226cba6aeaa8.
• Ajzen, I. Fishbein, M. (1980) Understanding
  attitudes predicting social behaviour. New
  Jersy Prentice-Hall
• Ajzen, I. Madden, TJ. (1986) Prediction of goal
  directed behaviour Attitudes, intentions and
  perceived behavioural control. Journal of
  Experimental Social Psychology, 22, 453 474
• AMIRABDOLLAHIAN, F., et al. (2007). Multivariate
  analysis of the fugl-meyer outcome measures
  assessing the effectiveness of GENTLE/s robot
  mediated stroke therapy. Journal of
  NeuroEngineering and rehabilitation, 4 .
• Enderby, P. Wade DT. (2001) Community
  Rehabilitation in the United Kingdom. Clinical
  Rehabilitation 15 577 - 581

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References

• Evans, P. (1989) Motivation Emotion. Routledge,
  London
• HOLMQVIST, L. and VON KOCH, L. (2001).
  Environmental factors in stroke rehabilitation.
  British medical journal, 322 1502.
• GAGGIOLOI, A., et al. (2006). A strategy for
  computer assisted mental practice in stroke.
  Neurorehabilitation and neural repair, 20 505.
• LEVACK, W., et al. (2006). Is goal planning in
  rehabilitation effective? A systematic review.
  Clinical rehabilitation, 20 739.
• LIEBERMANN, D., BUCHMAN, A. S. and FRANKS, I. M.
  (2006). Enhancement of motor rehabilitation
  through the use of information technologies.
  Clinical biomechanics, 21 8.

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References

• Loureiro, R., Amirabdollahian, F., Topping, M.,
  Driessen, B. Harwin,W. (2003). Upper limb
  mediated stroke therapy - GENTLEs approach.
  Autonomous robots, 15 35.
• Maclean, N., Pound, P., Wolfe, C., Rudd,A.
  (2000). Qualitative analysis of stroke patients'
  motivation for rehabilitation. British medical
  journal, 321 1051.
• MCCLAIN, C. (2005). Collaborative goal setting.
  Topics in stroke rehabilitation, 12 (4), 56.
• Merians, A., Poizner, H., Boian, R., Burdea, G.
  Adamovich,S. (2006). Semsorimotor training in a
  virtual reality environment Does it improve
  functional recovery poststroke?
  Neurorehabilitation and neural repair, 20 (2),
  252.
• Oddy, M., Cattran, C., Wood,R. (2008). The
  development of a measure of motivational changes
  following acquired brain injury. Journal of
  clinical and experimental neurology, 1 (8).

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References

• Prochaska, JO., DiClemente, CC. (1983). Stages
  and processes of self-change of smoking Toward
  an integrative model of change. Journal of
  Consulting and Clinical Psychology, 51, 390-395.
• Royal College of Physicians (2008) National
  clinical guideline for diagnosis and initial
  management of acute stroke and transient
  ischaemic attack (TIA)
• SIEGERT, R., Taylor (2004). Theoretical aspects
  of goal setting and motivation in rehabilitation.
  Disability and rehabilitation, 26 (1), 1.
• Wongpakaran, N., van Reekum,R. (2007). Apathy
  Clinical issues. Directions in psychiatry, 27
  261.