Principles into practice: an observational study of physiotherapists use of motor learning principles in stroke rehabilitation
Principles into practice: an observational study of physiotherapists use of motor learning principles in stroke rehabilitation
Objective(s): to describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics.
Design: direct non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively.
Setting: 6 UK Stroke Units
Participants: 89 therapy sessions were observed, involving 55 clinicians and 57 patients.
Results: proportion of time spent active within each session ranged from 26 to 98% (mean 85, SD 19;). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1 - 8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset.
Conclusions: to optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke.
Coaching, Intensity, Motor Learning, Motor Performance, Rehabilitation, Stroke
20-30
Johnson, Louise
e3990718-f3f9-417e-a122-f4bdc09ea9fc
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Ewings, Sean
326656df-c0f0-44a1-b64f-8fe9578ca18a
Westcott, Ellie
fe078d5d-fa39-445f-86a7-37e33a154330
Gayton, Marianne
f8b3c638-c692-40cd-afb3-54fbac86fa4d
Demain, Sara
09b1124d-750a-4eb1-90c7-91f5f222fc31
March 2023
Johnson, Louise
e3990718-f3f9-417e-a122-f4bdc09ea9fc
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Ewings, Sean
326656df-c0f0-44a1-b64f-8fe9578ca18a
Westcott, Ellie
fe078d5d-fa39-445f-86a7-37e33a154330
Gayton, Marianne
f8b3c638-c692-40cd-afb3-54fbac86fa4d
Demain, Sara
09b1124d-750a-4eb1-90c7-91f5f222fc31
Johnson, Louise, Burridge, Jane, Ewings, Sean, Westcott, Ellie, Gayton, Marianne and Demain, Sara
(2023)
Principles into practice: an observational study of physiotherapists use of motor learning principles in stroke rehabilitation.
Physiotherapy, 118, .
(doi:10.1016/j.physio.2022.06.002).
Abstract
Objective(s): to describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics.
Design: direct non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively.
Setting: 6 UK Stroke Units
Participants: 89 therapy sessions were observed, involving 55 clinicians and 57 patients.
Results: proportion of time spent active within each session ranged from 26 to 98% (mean 85, SD 19;). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1 - 8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset.
Conclusions: to optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke.
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More information
Accepted/In Press date: 14 June 2022
e-pub ahead of print date: 20 June 2022
Published date: March 2023
Additional Information:
Funding Information:
This project is funded by the National Institutes of Health Research (NIHR) [ ICA-CL-2017–03-011 ]. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Publisher Copyright:
© 2022
Keywords:
Coaching, Intensity, Motor Learning, Motor Performance, Rehabilitation, Stroke
Identifiers
Local EPrints ID: 469108
URI: http://eprints.soton.ac.uk/id/eprint/469108
ISSN: 0031-9406
PURE UUID: bc1ee8a9-66de-45e6-ba2f-92b502ebc619
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Date deposited: 06 Sep 2022 18:49
Last modified: 17 Mar 2024 04:00
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Contributors
Author:
Ellie Westcott
Author:
Marianne Gayton
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